Choice of cancer treatment is influenced by several factors, including the specific characteristics of your cancer; your overall condition; and whether the goal of treatment is to cure your cancer, keep your cancer from spreading, or to relieve the symptoms caused by cancer. Depending on these factors.

You may receive one or more of the following : –

1)  Surgery
2)  Chemotherapy
3)  Radiation therapy
4)  Hormonal therapy
5)  Targeted therapy
6)  Biological therapy

One or more treatment modalities may be used to provide you with the most effective treatment. Increasingly, it is common to use several treatment modalities together (concurrently) or in sequence with the goal of preventing recurrence. This is referred to as multi-modality treatment of the cancer.

Surgery

Surgery is used to diagnose cancer, determine its stage, and to treat cancer. One common type of surgery that may be used to help with diagnosing cancer is a biopsy. A biopsy involves taking a tissue sample from the suspected cancer for examination by a specialist in a laboratory. A biopsy is often performed in the physician’s office or in an outpatient surgery center. A positive biopsy indicates the presence of cancer; a negative biopsy may indicate that no cancer is present in the sample.

When surgery is used for treatment, the cancer and some tissue adjacent to the cancer are typically removed. In addition to providing local treatment of the cancer, information gained during surgery is useful in predicting the likelihood of cancer recurrence and whether other treatment modalities will be necessary.

Chemotherapy

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.

More than half of all people diagnosed with cancer receive chemotherapy. For millions of people who have cancers that respond well to chemotherapy, this approach helps treat their cancer effectively, enabling them to enjoy full, productive lives. Furthermore, many side effects once associated with chemotherapy are now easily prevented or controlled, allowing many people to work, travel, and participate in many of their other normal activities while receiving chemotherapy.

Radiation Therapy

Radiation therapy, or radiotherapy, uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment used to eliminate or eradicate visible tumors. Radiation therapy is not typically useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer. Radiation may be used to cure or control cancer, or to ease some of the symptoms caused by cancer. Sometimes radiation is used with other types of cancer treatment, such as chemotherapy and surgery, and sometimes it is used alone.

Hormonal Therapy

Hormones are naturally occurring substances in the body that stimulate the growth of hormone sensitive tissues, such as the breast or prostate gland. When cancer arises in breast or prostate tissue, its growth and spread may be caused by the body’s own hormones. Therefore, drugs that block hormone production or change the way hormones work, and/or removal of organs that secrete hormones, such as the ovaries or testicles, are ways of fighting cancer. Hormone therapy, similar to chemotherapy, is a systemic treatment in that it may affect cancer cells throughout the body.

Targeted Therapy

A targeted therapy is one that is designed to treat only the cancer cells and minimize damage to normal, healthy cells. Cancer treatments that “target” cancer cells may offer the advantage of reduced treatment-related side effects and improved outcomes. Conventional cancer treatments, such as chemotherapy and radiation therapy, cannot distinguish between cancer cells and healthy cells. Consequently, healthy cells are commonly damaged in the process of treating the cancer, which results in side effects. Chemotherapy damages rapidly dividing cells, a hallmark trait of cancer cells.

In the process, healthy cells that are also rapidly dividing, such as blood cells and the cells lining the mouth and GI tract are also damaged. Radiation therapy kills some healthy cells that are in the path of the radiation or near the cancer being treated. Newer radiation therapy techniques can reduce, but not eliminate this damage. Treatment-related damage to healthy cells leads to complications of treatment, or side effects. These side effects may be severe, reducing a patient’s quality of life, compromising their ability to receive their full, prescribed treatment, and sometimes, limiting their chance for an optimal outcome from treatment.

Biological Therapy

Biological therapy is referred to by many terms, including immunologic therapy, immunotherapy, or biotherapy. Biological therapy is a type of treatment that uses the body’s immune system to facilitate the killing of cancer cells. Types of biological therapy include interferon, interleukin, monoclonal antibodies, colony stimulating factors (cytokines), and vaccines.

Personalized Cancer Care

There is no longer a “one-size-fits-all” approach to cancer treatment. Even among patients with the same type of cancer, the behavior of the cancer and its response to treatment can vary widely. By exploring the reasons for this variation, researchers have begun to pave the way for more personalized cancer treatment. It is becoming increasingly clear that specific characteristics of cancer cells and cancer patients can have a profound impact on prognosis and treatment outcome. Although factoring these characteristics into treatment decisions makes cancer care more complex, it also offers the promise of improved outcomes. The idea of matching a particular treatment to a particular patient is not a new one.

It has long been recognized, for example, that hormonal therapy for breast cancer is most likely to be effective when the breast cancer contains receptors for estrogen and/or progesterone. Testing for these receptors is part of the standard clinical work-up of breast cancer. What is new, however, is the pace at which researchers are identifying new tumor markers, new tests, and new and more targeted drugs that individualize cancer treatment. Tests now exist that can assess the likelihood of cancer recurrence, the likelihood of response to particular drugs, and the presence of specific cancer targets that can be attacked by new anti-cancer drugs that directly target individual cancer cells.

Cancer Types

1)Bladder Cancer
2)Anal Cancer
3)Adrenocortical  Cancer
4)Colorectal Cancer
5)Breast Cancer
6)Cervical Cancer
7)Colon Cancer
8)Esophageal Cancer
9)Endometrial Cancer
10)Head and Neck Cancer
11)Hodgkin’s Lymphoma
12)Leukemia
13)Liver Cancer
14)Lung Cancer
15)Melanoma
16)Mesothelioma
17)Aids-Related Lymphoma
18)Bile Duct Cancer
19)Ovarian Cancer
20)Pancreatic Cancer
21)Prostate Cancer
22)Sarcoma
23)Testicular Cancer
24)Gallbladder Cancer
25)Stomach Cancer
26)Kidney Cancer
27)Laryngeal Cancer
28)Nasopharyngeal Cancer
29)Oropharyngeal  cancer

Bladder Cancer

What is Bladder Cancer?

 

Bladder cancer typically begins in the lining of your bladder,the balloon-shaped organ in your pelvic area that stores urine. Some bladder cancer remains confined to the lining, while others cases may invade other areas.

Most bladder cancers are transitional cell carcinomas (cancer that begins in cells that normally make up the inner lining of the bladder). Other types include squamous cell carcinoma (cancer that begins in thin, flat cells) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids). The cells that form squamous cell carcinoma and adenocarcinoma develop in the inner lining of the bladder as a result of chronic irritation and inflammation.

 

Bladder Cancer Risk factors

1)Smoking : – Smoking appears to be the single greatest risk factor for bladder cancer.
2)Industrial chemicals : – Repeated exposure to chemicals.
3)Age : – The chance of getting bladder cancer increases as you grow older.
4)Race : – Whites are twice as likely to develop bladder cancer as blacks and Hispanics / Asians.
5)Sex : – Men are about four times as likely to get bladder cancer as women are.
6)Chemotherapy and radiation therapy : – Treatment with the anti-cancer drugs cyclophosphamide (Cytoxan) and ifosfamide (Ifex) increases your risk of bladder cancer.
7)Chronic bladder inflammation : – Chronic or repeated urinary infections or inflammations (cystitis), such as may happen with long-term use of a urinary catheter.
8)Personal or family history : – Having bladder cancer once makes it more likely you’ll get it again.
9)Exposure to arsenic : – Drinking water containing high levels of arsenic increases risk of with bladder cancer.
10)Bladder birth defect : – Rare birth defects of the bladder may lead to an unusual form of bladder cancer called adenocarcinoma.

Symptoms of Bladder Cancer

1. Blood in the urine (urine looks bright red or rusty).

1. Pain or burning when urinating.

1. Passing urine often.

1. Feeling the need to urinate but no urine comes out.

1. Difficulty in passing urine.

 

Diagnosis of Bladder Cancer

To diagnose bladder cancer, the doctor will take a medical history, do a physical examination and request a urine test. He or she may order an x-ray test and perform a cystoscopy (described below) and if needed, a biopsy for bladder cancer. A urine sample is taken and then examined under a microscope for cancerous cells (for bladder cancer).

An x-ray procedure, called an Intravenous pyelogram (IVP), is used to detect any abnormalities or growths in the bladder. For the IVP x-ray, a special dye containing iodine is given to the patient through a needle inserted in the vein. The dye goes in the bladder, making the bladder easier to see on the x-rays.

A Cystoscopy is a procedure using a thin, lighted tube called a cystoscope that is inserted into the bladder through the urethra. If the doctor sees any abnormal areas or growths, he or she will remove some of that tissue (biopsy) for further examination under a microscope.

Treatment of Bladder Cancer in India

There are four main types of treatment for bladder cancer: surgery, radiation therapy, chemotherapy and biological therapy. The type and staging of the cancer, age, and overall health, determine which treatment method(s) will be used.

Surgery

There are three (3) main types of surgeries for bladder cancer : –

Transurethral resection (TUR) is an operation that uses a cystoscope inserted into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer or to burn the tumor away with high-energy electricity.

Cystectomy is an operation to remove the bladder. There are two types of cystectomy – segmental (partial), and radical (complete). Segmental cystectomy is an operation to take out part of the bladder where the cancer is located. Radical cystectomy is the removal of the bladder and nearby organs. In women, this operation includes removing the uterus, fallopian tubes, ovaries and part of the vagina. In men, the prostate and seminal vesicles are removed.

Urinary diversion is an operation to make way for urine to pass out of the body so that it does not go through the bladder.

Anal Cancer

What is Anal Cancer ? 

The incidence of anal cancer is higher among women compared to men. This is usually a disease of the older population, and 80 percent of all anal cancers occur in people over the age of 60. 

The anus is where stool leaves your body. It is made up of your outer layers of skin and the end of your large intestine. Anal cancer is a disease in which cancer cells form in the tissues of the anus. 

 

 

Anal Cancer Risk Factors

1)Smoking cigarettes
2)Infection of HPV virus
3)Receiving anal intercourse
4)Abnormal openings in or around the anus (fistulas)
5)Having multiple sexual partners
6)Being over 50 years of age
7)Anal swelling, redness or soreness that occurs frequently

Symptoms of Anal Cancer

The commonest symptoms of anal cancer are bleeding, pain and a feeling of fullness. Most often these symptoms of anal cancer are attributed some other problems like hemorrhoids or anal fissures with a subsequent result of delay in the diagnosis.

Possible signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.

1)Bleeding from the anus or rectum.
2)Pain or pressure in the area around the anus.
3)Itching or discharge from the anus.
4)A lump near the anus.
5)A change in bowel habits.

How is anal cancer diagnosed ?

Anal cancer is found as a mass on rectal examination, or endoscopic examination. An incision biopsy will usually lead to the diagnosis of anal cancer. A CT scan may be ordered to evaluate for pelvic nodes. If the inguinal nodes are enlarged this should be evaluated for metastatic disease.

The following tests and procedures may be used for anal cancer : –

1)  Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
2)  Digital rectal examination (DRE): An exam of the anus and rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.
3)  Anoscopy: An exam of the anus and lower rectum using a short, lighted tube called an anoscope.
4)  Proctoscopy: An exam of the rectum using a short, lighted tube called a proctoscope.
5)  Endo-anal or endorectal ultrasound: A procedure in which an ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
6)  Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If an abnormal area is seen during the anoscopy, a biopsy may be done at that time.

Treatment of anal cancer

The 3 main methods of treatment for anal cancer are surgery, radiation therapy, and chemotherapy. Often the best approach combines 2 or more of these strategies. In the past, surgery was the only treatment for anal cancer, but doctors have found that most anal cancers can be successfully treated with radiation and chemotherapy combined and without the need for surgery. This treatment approach, called chemo radiotherapy, is now the most widely used approach for anal cancer.

Surgery for Anal Cancer

Surgery may be done if the anal cancer is detected at an early stage, but this is not the preferred mode of therapy. Currently surgery for anal cancer is indicated only in those patients who have failed to combination of chemotherapy and radiation therapy.

Radiation therapy alone for Anal Cancer

This mode of treatment was used in Europe for early anal cancer lesions, but is associated with higher complication rates compared to combination of chemotherapy and radiation therapy, which is the preferred treatment in anal cancer.

Combined chemo-radiation for Anal Cancer

This is the preferred mode of treatment for most patients with anal cancer. About 80 to 90 percent of patients usually experience complete remission (complete disappearance of tumor) with this mode of treatment and most of these patients are cured of anal cancer. Most commonly used chemotherapy combination is 5-FU plus mitomycin. The anal cancer can continue to regress for 3 to 4 months following chemo-radiation. Those patients who do not experience a complete remission following chemo-radiation should undergo surgical treatment.

Adrenocortical Cancer

 

What is Adrenocortical Carcinoma?

 

There are two adrenal glands, one above each kidney in the back of the upper abdomen. Each adrenal gland is composed of two layers : –

1)The adrenal cortex, or outer layer of the adrenal gland, which produces a variety of steroid hormones.
2)The adrenal medulla, or inner layer of the adrenal gland, which produces the hormones epinephrine and norepinephrine.

Cancer of the adrenal cortex, also called adrenocortical carcinoma, is discussed below. (Cancer of the adrenal medulla, also called pheochromocytoma, is discussed separately.) 

The cells in the adrenal cortex make important hormones that help the body function properly. When cells in the adrenal cortex become cancerous, they may make too much of one or more hormones, which can cause symptoms such as high blood pressure, weakening of the bones, or diabetes. Cancers that make hormones are called functioning tumors. However, many cancers of the adrenal cortex do not make extra hormones and are called nonfunctioning tumors. 

A person with the following symptoms should see a doctor: pain in the abdomen, loss of weight without dieting, and weakness. If there is a functioning tumor, there may be symptoms or signs caused by too many hormones, such as high blood pressure, weakening of the bones, or diabetes. 

If a patient has symptoms of cancer of the adrenal cortex, the doctor will order blood and urine tests to see whether the amounts of hormones in the body are normal. A doctor may also order a computed tomography scan, a special x-ray that uses a computer to make a picture of the inside of the abdomen. Other special x-rays may also be taken to determine what kind of tumor is present. 

The chance of recovery (prognosis) from cancer of the adrenal cortex depends on how far the cancer has spread (the stage of the disease) and on whether a doctor is able to surgically remove all of the cancer.

Stages

Once cancer of the adrenal cortex has been diagnosed, more testing will be done to see how far the cancer has spread-a process called staging. 

Treatment options vary depending on the stage of the disease. The following stages are used for cancer of the adrenal cortex: 
Stage I : –The cancer is less than 5 centimeters (less than 2 inches) wide and has not spread into tissues around the adrenal gland. During this stage, the primary treatment will probably be surgery to remove the cancer.

 

Stage II : – The cancer is more than 5 centimeters (less than 2 inches) wide and has not spread into tissues around the adrenal gland. During this stage, the primary treatment will probably be surgery to remove the cancer, although clinical trials are now under way to test new treatments for this stage of the disease.

Stage III : –The cancer has spread into tissues around the adrenal gland or has spread to the lymph nodes around the adrenal gland. Lymph nodes are part of the lymphatic system and are small, bean-shaped organs that make and store infection-fighting cells.

During this stage, treatments may be one of the following : –

1)Surgery to remove the cancer. Lymph nodes in the area may also be removed (lymph node dissection).
2)A clinical trial involving radiation therapy.

A clinical trial involving chemotherapy if the size of the tumor can be measured with x-rays and/or if the tumor is making hormones.

Stage IV : –The cancer has spread to tissues or organs in the area and to lymph nodes around the adrenal cortex, or the cancer has spread to other parts of the body. During this stage, treatments may be one of the following : –

1. A clinical trial involving chemotherapy.

1. Radiation therapy to bones where the cancer has spread.

1. Surgery to remove the cancer in places where it has spread.

 

Recurrent : – The cancer has come back (recurred) after it has been treated. It may come back in the adrenal cortex or in another part of the body. Treatment during this stage depends on many factors, including where the cancer came back and what treatment has already been received. In some cases, surgery can be effective in decreasing the symptoms of the disease by removing some of the tumor. Also, clinical trials are currently testing new treatments for this stage of the disease.

Treatment Options

 

There are three primary treatment options for patients with cancer of the adrenal cortex : –

Surgery
Chemotherapy
Radiation therapy

Surgery : –
Surgery is local therapy to remove the tumor. Tissues around the tumor and nearby lymph nodes may also be removed during the operation. When treating cancer of the adrenal cortex, a doctor may take out the adrenal gland in an operation called an adrenalectomy. Tissues around the adrenal glands that contain cancer may also be removed. Lymph nodes in the area may be removed as well (lymph node dissection).

 

Chemotherapy : –
Chemotherapy is treatment with drugs that kill cancer cells. Most anticancer drugs are injected into a vein or muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles; a treatment period is followed by a recovery period, then another treatment period, and so on.

Radiation Therapy (also called radiotherapy) : –
Radiation therapy is treatment with high-energy rays that damage cancer cells and stop them from growing and dividing. It is a local therapy that only affects cancer cells in the treated area. Radiation may come from a machine (external radiation) or from an implant placed directly into or near a tumor (internal radiation). External radiation is typically the method used for cancer of the adrenal cortex. Besides treatment for the cancer itself, a patient with cancer of the adrenal cortex may also receive therapy to prevent or treat symptoms caused by the extra hormones that are made by the cancer.

Treatment Side Effects

Side effects can occur with cancer treatments because the treatment often damages healthy cells along with the cancer cells. The type and extent of these side effects vary depending on the particular treatment involved, its duration, and its dose:

Surgery : – The side effects of surgery depend on the location of the tumor and the type of operation, among other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can usually be controlled with medicine. The recovery period after an operation varies from patient to patient.

Chemotherapy : – Chemotherapy drugs generally target rapidly dividing cancer cells. However, other cells that also divide rapidly include blood cells, cells that line the digestive tract, and cells in hair follicles. Unfortunately, these healthy cells may also be affected by the chemotherapy drugs, resulting in side effects such as infections, tiredness, temporary hair loss, and mouth sores. Not all chemotherapy patients develop all of these symptoms, and they usually go away during the recovery period or after treatment stops. Medicines and other treatments are available to control or minimize many of these symptoms.

One of the most important side effects of many chemotherapy drugs is lowering of the blood counts. Because chemotherapy can reduce the function of the bone marrow, where most blood cells are produced, it can cause:

1)anemia (you may have less energy).
2)low platelets (you may bruise or bleed easily).
3)low antibodies (you may be more susceptible to infections).

Radiation Therapy : – The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

During cancer treatment, patients may lose their appetite and find it hard to eat well. In addition, the common side effects of treatment (nausea, vomiting, and mouth sores) can make it difficult to eat. To some patients, foods taste different. Others may not feel like eating when they are uncomfortable or tired.

Eating well means getting enough calories and protein to help prevent weight loss and regain strength. Patients who eat well during cancer treatment often feel better and have more energy. In addition, they may be better able to handle the side effects of treatment.

Colorectal Cancer

What Is Colorectal Cancer (Colon and Rectal Cancer)?

Colorectal cancer is a term used to refer to cancer that starts in the colon or rectum. Colon and rectal cancers begin in the digestive system, also called the GI (gastrointestinal) system. This is where food is processed to create energy and rid the body of solid waste matter (stool).

After food is chewed and swallowed, it travels down to the stomach. There it is partly broken down and sent to the small intestine. The word “small” refers to the width of the small intestine. The small intestine is really the longest part of the digestive system. It is about 20 feet long.

The small intestine continues breaking down the food and absorbs most of the nutrients. The small intestine joins the large intestine (also called the large bowel or colon), a muscular tube about five feet long. The first part of the colon absorbs water and nutrients from the food and also serves as a storage place for waste matter. The waste matter moves from the colon into the rectum, the last 6 inches of the digestive system. From there the waste passes out of the body through the opening called the anus.

The colon has 4 sections, as shown in the picture above. Cancer can start in any of the 4 sections or in the rectum. The wall of each of these sections (and rectum) has several layers of tissues. Cancer starts in the inner layer and can grow through some or all of the other layers. Knowing a little about these layers is helpful because the stage (extent of spread) of a cancer depends to a great degree on which of these layers it affects.

Cancer that starts in the different areas may cause different symptoms. But colon cancer and rectal cancer, together known as colorectal cancer, have many features in common. They will be discussed together in this document except for the section about treatment. There they will each be discussed separately.

In most cases, colorectal cancers develop slowly over a period of several years. We now know that most of these cancers begin as a polyp–a growth of tissue that starts in the lining and grows into the center of the colon or rectum. A type of polyp known as an adenoma can become cancerous. Removing the polyp early may prevent it from becoming cancer.

Over 95% of colon and rectal cancers are adenocarcinomas. These are cancers of the cells that line the inside of the colon and rectum. There are some other, more rare, types of tumors of the colon and rectum, but the facts given here refer only to adenocarcinomas.

Causes of colorectal cancer

 

There is no single cause of colorectal cancer, but some factors appear to increase the risk of developing it : –

1)age – particularly after 50.
2)having polyps (small growths on the inner wall of the colon and rectum).
3)family history of colorectal cancer – especially if the relative (parent, sibling, child) developed colorectal cancer before the age of 45.
4)having familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNCC).
5)inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
6)high-fat diet.
7)alcohol consumption.
8)smoking.
9)physical inactivity.
10)obesity.
11)ethnic background – people of Ashkenazi (Eastern European Jewish) descent.
12)Researchers are also looking at how diet affects the risk of developing colorectal cancer. A diet high in vegetables and fruit is known to lower risk. A diet high in fiber and low in animal fats also seems to decrease risk, but more research is necessary to be sure.
13)Some people develop colorectal cancer without any of these risk factors.

Symptoms of Colorectal Cancer (Colon and Rectal Cancer)

 

The following are the most common symptoms of colorectal cancer. However, each person may experience symptoms differently : –

1. A change in bowel habits-such as diarrhea, constipation, or narrowing of the stool-that lasts for more than a few days.

1. Bright red or very dark blood in the stool.

1. Discomfort in the stomach area, such as frequent gas pain, cramps, and feelings of being full or bloated.

1. Constant weakness and fatigue.

1. Jaundice – yellowing of the skin and eyes.

1. Weight loss for no known reason.

 

The diagnosis of Colorectal Cancer (Colon and Rectal Cancer)

The first step in the diagnosis of colorectal cancer may be a “digital rectal exam.” In this test, which is often part of a routine physical exam, the doctor inserts a gloved finger into the rectum to feel for abnormal growths and may test your stool for occult blood. If colorectal cancer is suspected, you and your doctor have many tests to choose from to make sure the diagnosis is correct. Since there is a wide range of options, knowing the differences can help you make a smart decision.

Before these tests (except the fecal occult blood test), your colon must be completely empty. To clean out your bowels before the procedure, you may be instructed to have an enema or drink a large volume of a liquid laxative prescribed by your doctor. This preparation is very important in ensuring the accuracy of the test.

Fecal occult blood test : – In this simple, initial screening test for colorectal cancer, a stool sample is applied to a special card that turns color if any blood is detected.

Barium enema : – A narrow tube is inserted into the rectum to allow liquid barium (a white, chalky liquid) into the colon. A special x-ray is then taken, on which tumors or masses appear as dark shadows. The barium makes it easier to see the tumors. Before this test, you will be told to fast (not eat or drink) for several hours.

Flexible sigmoidoscopy : – A thin, lighted tube inserted into the rectum allows the doctor to look into the rectum and first section of the colon (where half of all polyps are found).

Colonoscopy : – The most accurate and thorough test for colorectal cancer (colon and rectal cancer). A long, thin, lighted tube inserted into the rectum allows the doctor to look into the entire colon, remove polyps, and take tissue for biopsy. Polyp removal will prevent cancer from developing. A mild sedative is usually given with this test.

Ultrasound : –
This noninvasive test uses images and sound waves to take a picture of the inside of the body. Unusual patterns in this image can indicate a mass or tumor. This test is used primarily to find cancer that has already spread to other organs.

Virtual colonoscopy (CT colonography) : – This test creates a 3-dimensional reconstruction of the colon to reveal any abnormal masses. Images are taken seconds after the colon is inflated with carbon dioxide through a small rectal tube. Virtual colonoscopy is a fairly new technology, so it is not yet clear how accurate it is.

Treatment options for Colorectal Cancer in India : – Treatment options for colorectal cancer depend on the stage of the tumor-that is, how far it has spread or how deeply it is affecting the intestinal wall and other tissues. Treatment is also determined by the patient’s age, medical history, overall health, and tolerance for specific medications and therapies.

Standard options for colorectal cancer treatment in India include : –

1. Partial colectomy for colorectal cancer in India (also called partial bowel resection)-The tumor and normal tissue on either side of the diseased area in the colon are removed. The surgeon then reconnects the healthy colon. Sometimes the physician may have to create a temporary colostomy, or an opening for solid waste from the bowel to a special bag a patient wears outside the body, until the healthy tissue has healed. At times, the colostomy is permanent.

1. Laparoscopic surgery or keyhole surgery for colorectal cancer in India -Small tube-like instruments and an extremely small camera are inserted into the abdomen through incisions made in the abdominal wall. The surgeon sees what the camera sees on a television-type screen and can cut out a large section of the bowel and adjacent tissue, called the mesentery.

1. Radiation therapy for colorectal cancerin India – High-energy radiation is used to kill cancer cells. Radiation may be used in conjunction with surgery as definitive therapy, or may be used to reduce, or palliate, the symptoms of colorectal cancer such as pain, bleeding, or blockage. Radiation therapy is usually delivered as external-beam radiation. Radiation comes from outside the patient’s body and is directed onto the cancer and surrounding tissues.

1. Chemotherapy for colorectal cancer in India -Drugs are given intravenously or orally to kill cancer cells. Chemotherapy is often given to decrease the chance of the tumor returning elsewhere in the body. Like radiation therapy, chemotherapy can ease disease symptoms and increase length of survival for patients with tumors that have spread.

 

Breast Cancer

 

What is Breast Cancer?

The term breast cancer refers to a malignant tumor that has developed from cells in the breast. The breast is composed of two main types of tissues: glandular tissues and stromal (supporting) tissues. Glandular tissues house the milk-producing glands (lobules) and the ducts (the milk passages) while stromal tissues include fatty and fibrous connective tissues of the breast. The breast is also made up of lymphatic tissue-immune system tissue that removes cellular fluids and waste.

There are several types of tumors that may develop within different areas of the breast. Most tumors are the result of benign (non-cancerous) changes within the breast. For example, fibrocystic change is a non-cancerous condition in which women develop cysts (accumulated packets of fluid), fibrosis (formation of scar-like connective tissue), lumpiness, areas of thickening, tenderness, or breast pain.

Breast Cancer Risk factors

A risk factor is anything that makes it more likely you’ll get a particular disease. Some risk factors, such as your age, sex and family history, can’t be changed, whereas others, including weight, smoking and a poor diet, are under your control.

Other factors that may make you more susceptible to breast cancer include : –

Age : –

1.  Your chances of developing breast cancer increase with age. Close to 80 percent of breast cancers occur in women older than age 50. In your 30s, you have a one in 233 chance of developing breast cancer. By age 85, your chance is one in eight.

A personal history of breast cancer : –

1.  If you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.

Family history : –

1.  If you have a mother, sister or daughter with breast or ovarian cancer or both, or a male relative with breast cancer, you have a greater chance of also developing breast cancer

Genetic predisposition : –

1.  Between 5 percent and 10 percent of breast cancers are inherited.

Radiation exposure : –

1.  If you received radiation treatments to your chest as a child or young adult, you’re more likely to develop breast cancer later in life. Your risk is greatest if you received radiation as an adolescent during breast development.

Excess weight : –

1.  The relationship between excess weight and breast cancer is complex. In general, weighing more than is healthy increases your risk, particularly if you gained the weight as an adolescent. But risk is even greater if you put the weight on after menopause. Your risk also is greater if you have more body fat in the upper part of your body.

Early onset of menstrual cycles : –

1.  If you got your period at a young age, especially before age 12, you may have a greater likelihood of developing breast cancer. Experts attribute this risk to the early exposure of the breast tissue to estrogen.

Late menopause : –

1.  If you enter menopause after age 55, you’re more likely to develop breast cancer. Experts attribute this to the prolonged exposure of the breast tissue to estrogen.

First pregnancy at older age : –

1.  If your first full-term pregnancy occurs after age 30, or you never become pregnant, you have a greater chance of developing breast cancer. Although it’s not entirely clear why, an early first pregnancy may protect breast tissue from developing genetic mutations that result from estrogen exposure.

Race : –

1.  White women are more likely to develop breast cancer than black

Hormone therapy : –

1.  Treating menopausal symptoms with the hormone combination of estrogen and progesterone for four or more years increases your risk of breast cancer.

Birth control pills : –

1.  Use of birth control pills is associated with an increased risk of breast cancer in premenopausal women. The risk seems to be greater for women who use birth control pills for four or more years before their first full-term pregnancy.

Smoking : –

1.  Evidence is mixed on the relationship between smoking and breast cancer risk. Some studies show no link between cigarette smoking and exposure to secondhand smoke and breast cancer.

Excessive use of alcohol : –

1.  Women who drink more than one alcoholic beverage a day have about a 20 percent greater risk of breast cancer than do women who don’t drink. To reduce your breast cancer risk, limit alcohol to no more than one drink daily.

 

Symptoms of Breast Cancer

Early breast cancer usually does not cause pain. In fact, when it first develops, breast cancer may cause no symptoms at all. But as the cancer grows, it can cause these changes:
1. a lump or thickening in the breast or armpit 2. a change in the size or shape of the breast 3. discharge from the nipple 4. A change in the color or texture of the skin of the breast or areola (such as dimpling, puckering, or scaliness).

Diagnosis of Breast Cancer

Treatment decisions depend on these findings. The first step in the work-up of breast disease is usually a physical exam by a doctor or nurse practitioner. Mammography and ultrasound may be important additions to the physical examination. On the basis of these evaluations, the decision may be made to confirm a clinical impression with a tissue biopsy.

Imaging for Breast Cancer : – Imaging is an important component used to diagnose breast cancer and to evaluate the stage and extent of disease in breast cancer patients

Screening Mammography : – A mammogram is a low-dose X-ray of the breast. This is the best test we have to screen women for breast cancer. A Screening Mammogram consists of two “pictures” of each breast. If an area on the mammogram looks suspicious or is not clear, additional mammograms with different views may be needed. Annual screening mammography is recommended for all women over 40 years old.

Diagnostic Mammography : –This is a mammogram used for problem-solving, rather than for screening. For instance, if a patient has a lump in her breast, a directed investigation of that area is performed. This is also done when a particular finding in the breast is being followed over time. A diagnostic mammogram is tailored to the patient’s case and is carefully monitored by a radiologist, who interprets the images and determines whether there is any need for further tests.

Ultrasonography : –Using high-frequency sound waves, ultrasonography can often show whether a lump is solid or filled with fluid. This exam may be used along with Diagnostic Mammography or MRI to answer questions about a specific area of the breast. Because it uses sound waves instead of X-Rays, ultrasound provides information that is different and often complementary to the mammogram.

Breast MRI : –Magnetic resonance imaging (MRI) can be used to look specifically at the breast. Each exam produces hundreds of images of the breast, cross-sectional in all three directions (side-to-side, top-to-bottom, front-to-back), which are then read by a radiologist. It is non-invasive and no radioactivity is involved. The technique is believed to have no health hazards in general.

Biopsy for Breast Cancer

One way to find out if a breast lump or abnormal tissue is cancer is by having a biopsy. During a biopsy, a surgeon, a pathologist or a radiologist removes a portion or all of the suspicious tissue. The suspicious tissue is examined under a microscope by a pathologist who checks for cancer cells and makes the diagnosis. The following are different types of biopsies as well as how you can best prepare yourself for each of them. The following are different types of biopsies. 

Fine Needle Aspiration (FNA) Biopsy : – FNA samples a woman’s lump using a thin small needle that leaves a mark no bigger than a needle stick from a blood test. FNA often allows us to diagnose a lump within two to three days 

Stereotactic Core Biopsy : – This procedure was developed as a less invasive way to obtain tissue samples for diagnosis. It involves removing tissue with a biopsy needle while your breast is compressed in a way similar to a mammogram. This biopsy requires less recovery time than surgery and causes no significant scarring 

Needle (Wire) Localization Biopsy : – This type of biopsy involves the use of a needle and wire to locate the abnormal tissue and surgery to remove it. Needle localization is performed when you have an abnormality on a mammogram that cannot be felt. It is an outpatient biopsy that is done in two steps on the same day.

Treatment of a Breast Cancer in India

Mastectomy in India
Mastectomy is the surgical removal of a breast. Surgery is presently the most common treatment for breast cancer. Following mastectomy, immediate or delayed breast reconstruction is possible in many instances.

Types of Mastectomy

There are several different types of surgical procedures used to treat breast cancer. Depending on the location or surgeon who performs the procedure, different terms may be used.

Surgical procedures for breast cancer include : –

1)Simple or total mastectomy: removal of the breast, with its skin and nipple, but no lymph nodes. In some cases, a separate sentinel node biopsy is performed to remove only the first one to three axillary (armpit) lymph nodes.
2)Modified radical mastectomy: removal of the entire breast, nipple/areolar region, and often the axillary lymph nodes. This is the most common form of mastectomy performed today.
3)Radical mastectomy: removal of the entire breast, nipple/areolar region, the pectoral (chest) major and minor muscles, and lymph nodes. This procedure is rarely performed today.
4)Quandrantectomy: removal of a quarter of the breast, including the skin and breast fascia (connective tissues). The surgeon may also perform a separate procedure to remove some or all of the axillary (armpit) lymph nodes, either an axillary node dissection or a sentinel node biopsy.
5)Partial or segmental mastectomy: removal of a portion of the breast tissue and a margin of normal breast tissue. This procedure usually involves removing less tissue than a quandrantectomy but more than a lumpectomy or wide excision.
6)Lumpectomy or wide excision: removal of the breast cancer tumor and a surrounding margin of normal breast tissue.
7)Excisional biopsy also the removal of the breast tumor and a surrounding margin of normal breast tissue. Sometimes further surgery is not needed if an excisional biopsy successfully removes the entire breast cancer tumor. This is most likely to occur if the breast tumor is very small. An excisional biopsy may be performed with “needle” or “wire” localization.

In the past, radical mastectomy was the frequently performed on women with breast cancer. However, experts have found that modified radical mastectomy is equally effective in most cases, and therefore, it has become the most common type procedure for removing the entire breast.

 

[ Radical Mastectomy ]

[ Modified Radical Mastectomy ]

 

[ Simple (total) Mastectomy ]

[ Partial Mastectomy ]

 

Axillary Node Dissection in India

Axillary node dissection, the surgical removal of the axillary (armpit) lymph nodes, is usually performed on patients with invasive cancers. A radical mastectomy, modified radical mastectomy, or lumpectomy operation often includes axillary node dissection (this involves a separate incision for lumpectomy patients). After surgery, the axillary lymph nodes are examined under a microscope to determine whether the cancer has spread past the breast and to evaluate treatment options.

The most common side effect of axillary node dissection is lymphedema: chronic swelling of the arm. Approximately 10% to 20% of patients typically experience lymphedema when axillary node dissection is combined with radiation therapy. Patients are encouraged to report any tightness or swelling of the arm to their physicians as soon as symptoms occur to prevent possible long-term suffering. Other side effects of axillary node dissection include temporary to permanent limitations of arm and shoulder movement and numbness in the upper-arm skin.

Side effects of axillary node dissection : –

1)  lymphedema (swelling of the arm).
2)  limitations of arm/shoulder movement.
3)  numbness of upper-arm skin.

Sentinel Lymph Node Biopsy in India

Sentinel lymph node biopsy is a new procedure that involves removing only one to three sentinel lymph nodes (the first nodes in the lymphatic chain). To perform sentinel node biopsy, a radioactive tracer and/or blue dye is injected into a region of a tumor. The dye is then carried to the sentinel node (the lymph node most likely to be cancerous if the disease has spread from its original origin). If the surgeon determines that the sentinel node contains cancer, more lymph nodes are removed and examined. Surgeons detect the sentinel lymph node by either spotting the blue dye or by measuring a node’s radioactivity with a Geiger counter. If the removed sentinel node is cancer-free, additional lymph node surgery may be avoided. Research continues to show that sentinel lymph node biopsy may safely eliminate the need to remove many lymph nodes and reduce the chances of lymphedema (chronic arm swelling). Currently, researchers are investigating whether sentinel lymph node biopsy should be performed routinely in the place of axillary node dissection.

Lumpectomy in India

Lumpectomy is the surgical removal of a cancerous lump (or tumor) in the breast, along with a small margin of the surrounding normal breast tissue. Lumpectomy may also be called wide excision biopsy, breast conserving therapy or quadrantectomy (this latter term is used when up to one fourth of the breast is removed). The procedure is often performed on women with small or localized breast cancers and can be an attractive surgical treatment option for breast cancer because it allows women to maintain most of their breast after surgery. Several studies have shown that women with small breast tumors have an equal chance of surviving breast cancer regardless of whether they have a lumpectomy, followed by a full course of radiation therapy, or mastectomy (complete breast removal, which generally does not require post-operative radiation treatment).

Chemotherapy in India

This section is intended to provide general information on chemotherapy for breast cancer patients and to discuss a variety of possible side effects of chemotherapy drugs. Because chemotherapy regimens are individually tailored, the types of drugs administered and their side effects will vary considerably. While this article discusses many of the side effects of chemotherapy in detail, it is important to note that the majority of the side effects associated with chemotherapy are temporary and only occur during or immediately after treatment. In the vast majority of cases, the benefits of treating cancer with chemotherapy far outweighs the risks or inconveniences of any side effects. Chemotherapy is only one possible treatment for breast cancer and may be used in addition to surgery or other treatments. Patients should discuss all aspects of chemotherapy and breast cancer treatment with their physician or cancer treatment team.

Radiation Therapy for the Treatment of Breast Cancer in India

Radiation therapy (or radiotherapy) uses high-energy rays to stop cancer cells from growing and dividing. Radiation therapy is often used to destroy any remaining breast cancer cells in the breast, chest wall, or axilla (underarm) area after surgery. Occasionally, radiation therapy is used before surgery to shrink the size of a tumor. A common treatment for early stage breast cancer is breast-conserving therapy. Breast-conserving therapy (BCT) is the surgical removal of a breast lump (lumpectomy) and a surrounding margin of normal breast tissue. BCT is typically followed by at least six to seven weeks of radiation therapy. Treatment with radiation usually begins one month after surgery, allowing the breast tissue adequate time to heal. Radiation therapy may occasionally be recommended for women to destroy remaining cancer cells after mastectomy (surgical removal of the affected breast) or to shrink tumors in patients with advanced breast cancer.

Cervical Cancer

 

What is Cervical Cancer ?

Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cases of cervical cancer.

When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years before it eventually converts some cells on the surface of the cervix into cancer cells. Half of cervical cancer cases occur in women between ages 35 and 55.

Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. Still, every year more than 11,000 women in the United States are diagnosed with invasive cervical cancer, and nearly 4,000 die of cervical cancer, according to the American Cancer Society. Around the world, cervical cancer is the third-leading cause of cancer death in women.

Symptoms of Cervical Cancer

You may not experience any cervical cancer symptoms – early cervical cancer generally produces no signs or symptoms.

As the cancer progresses, these cervical cancer symptoms and signs may appear : –

1)Vaginal bleeding after intercourse, between periods or after menopause
2)Watery, bloody vaginal discharge that may be heavy and have a foul odor
3)Pelvic pain or pain during intercourse

Causes of Cervical Cancer

 

 

In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don’t die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

Cervical cancer most commonly begins in the thin, flat cells that line the bottom of the cervix (squamous cells). Squamous cell carcinomas account for about 80 percent of cervical cancers. Cervical cancer can also occur in the glandular cells that line the upper portion of the cervix. Called adenocarcinomas, these cancers make up about 15 percent of cervical cancers. Sometimes both types of cells are involved in cervical cancer. Very rare cancers can occur in other cells in the cervix.

What causes squamous cells or glandular cells to become abnormal and develop into cancer isn’t clear. However, it’s certain that the sexually transmitted infection called human papillomavirus (HPV) plays a role. Evidence of HPV is found in nearly all cervical cancers. However, HPV is a very common virus and most women with HPV never develop cervical cancer. This means other risk factors, such as your genetic makeup, your environment or your lifestyle choices, also determine whether you’ll develop cervical cancer.

Risk factors of Causes of Cervical Cancer

 

These factors may increase your risk of cervical cancer : –

1)  Many sexual partners : – The greater your number of sexual partners – and the greater your partner’s number of sexual partners – the greater your chance of acquiring HPV.
2)  Early sexual activity : – Having sex before age 18 increases your risk of HPV. Immature cells seem to be more susceptible to the precancerous changes that HPV can cause.
3)  Other sexually transmitted diseases (STDs) : – If you have other STDs – such as chlamydia, gonorrhea, syphilis or HIV/AIDS – you have a greater chance of also having acquired HPV.
4)  A weak immune system : – Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer.
5)  Cigarette smoking : – The exact mechanism that links cigarette smoking to cervical cancer isn’t known, but tobacco use increases the risk of precancerous changes as well as cancer of the cervix. Smoking and HPV infection may work together to cause cervical cancer.

When to seek medical advice

If you experience any unusual signs and symptoms that worry you, make an appointment with your doctor. Talk to your doctor about when to begin screening for cervical cancer. The American College of Obstetricians and Gynecologists recommends that girls have their first visit with an obstetrician-gynecologist between ages 13 and 15 to discuss sexual activity and ways to prevent sexually transmitted infections, such as HPV.

Tests and diagnosis of Risk factors of Causes of Cervical Cancer

 

 

[ Pap test ]

 

[ Cervical cells ]

 

 

[ Cone biopsy ]

Screening : –

When cervical cancer is detected in its earliest stages, treatment is more likely to be successful. Regular screening for cervical cancer and precancerous changes in the cervix is recommended for all women. Most guidelines suggest beginning screening within three years of becoming sexually active, or no later than age 21.

Screening may include : –

1)  Pap test : – During a Pap test, your doctor brushes cells from your cervix – the narrow neck of the uterus – and sends the sample to a lab. The cells to examined for abnormalities. 

A Pap test can detect abnormal cells in the cervix. This is the precancerous stage, when the abnormal cells (dysplasia) exist only in the outer layer of the cervix and haven’t invaded deeper tissues. If untreated, the abnormal cells may convert to cancer cells, which may spread in various stages into the cervix, the upper vagina, the pelvic areas and to other parts of your body. Cancer or precancerous conditions that are caught at the pre-invasive stage are rarely life-threatening and typically require only outpatient treatment.
2)  HPV DNA test : – Your doctor also may use a lab test called the HPV DNA test to determine whether you are infected with any of the 13 types of HPV that are most likely to lead to cervical cancer. Like the Pap test, the HPV DNA test involves collecting cells from the cervix for lab testing. It can detect high-risk strains of HPV in cell DNA before changes to the cells of the cervix can be seen.
The HPV DNA test isn’t a substitute for regular Pap screening, and it’s not used to screen women younger than 30 with normal Pap results. Most HPV infections in women of this age group clear up on their own and aren’t associated with cervical cancer.

Diagnosis : –

If you experience signs and symptoms of cervical cancer or if a Pap test has revealed cancerous cells, you may undergo further tests to diagnose your cancer.

To make a diagnosis, your doctor may : –

1)  Examine your cervix : – During an exam called colposcopy, your doctor uses a special microscope (colposcope) to examine your cervix for abnormal cells. If your doctor identifies unusual areas, he or she may take a small sample of cells for analysis (biopsy).
2)  Take a sample of cervical cells : – During a biopsy procedure your doctor removes a sample of unusual cells from your cervix using special tools. During one type of biopsy – punch biopsy – your doctor uses a circular knife to remove a small circular section of the cervix. Other special types of biopsy may be used depending on the location and size of the unusual area of cells.
3)  Remove a cone-shaped area of cervical cells : – A cone biopsy (conization) – so called because it involves taking a cone-shaped sample of the cervix – allows your doctor to obtain deeper layers of cervical cells for laboratory testing. Your doctor may use a scalpel, laser or electrified wire loop to cut away the tissue.

Staging : –

If your doctor determines that you have cervical cancer, you’ll undergo further tests to determine whether your cancer has spread and to what extent – a process called staging. Your cancer’s stage is a key factor in deciding on your treatment.

Staging exams include : –

Imaging tests : – Tests such as X-rays, computerized tomography (CT) scans and magnetic resonance imaging (MRI) help your doctor determine whether your cancer has spread beyond your cervix.

Visual examination of your bladder and rectum : – Your doctor may use special scopes to see inside your bladder (cytoscopy) and rectum (proctoscopy).

Your doctor then assigns your cancer a stage – typically a Roman numeral.

Stages of cervical cancer include : –

Stage 0 : – Also called carcinoma in situ or noninvasive cancer, this early cancer is small and confined to the surface of the cervix.

Stage I : – Cancer is confined to the cervix.
Stage II : – Cancer at this stage includes the cervix and uterus, but hasn’t spread to the pelvic wall or the lower portion of the vagina.

Stage III : – Cancer at this stage has moved beyond the cervix and uterus to the pelvic wall or the lower portion of the vagina.
Stage IV : – At this stage, cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones.

Complications

Treatments for invasive cervical cancer often make it impossible to become pregnant in the future. For many women – especially younger women and those who have yet to begin a family – infertility is a distressing side effect of treatment. If you’re concerned about your ability to get pregnant in the future, discuss this with your doctor.

For a specific subgroup of women with early cervical cancer, fertility-sparing surgery may be a treatment option. A surgical procedure to remove your cervix and surrounding lymphatic tissue only (radical trachelectomy) may preserve your uterus. Early studies of radical trachelectomy suggest that cervical cancer can be cured using this technique, though it isn’t appropriate for every woman and there may be added risks to this surgery. Future pregnancies may be possible, but are considered high risk because removing the cervical tissue can lead to a higher incidence of miscarriage and premature birth.

Tell your doctor about your concerns about infertility before your treatment begins. In most cases, preserving fertility is more successful than trying to restore fertility after treatment.

Treatments of Cervical Cancer

Limited, noninvasive cancer

Treatment of cervical cancer that’s confined to the outside layer of the cervix typically requires treatment to remove the abnormal area of cells. For most women in this situation, no additional treatments are needed.

Procedures to remove noninvasive cancer include : –

1)  Cone biopsy (conization) : – During this surgery, the doctor uses a scalpel to remove a cone-shaped piece of cervical

tissue where the abnormality is found.

2)  Laser surgery : – This operation uses a narrow beam of intense light to kill cancerous and precancerous cells.
3)  Loop electrosurgical excision procedure (LEEP) : – This technique uses a wire loop to pass electrical current, which cuts like a surgeon’s knife, and remove cells from the mouth of the cervix.
4)  Cryosurgery : – This technique involves freezing and killing cancerous and precancerous cells.
5)  Hysterectomy : – This major surgery involves removal of the cancerous and precancerous areas, the cervix and the uterus. Hysterectomy is usually done only in certain selected cases of noninvasive cervical cancer.

Invasive cancers

Cervical cancer that invades deeper than the outside layer of cells on the cervix is referred to as invasive cancer and requires more extensive treatment. Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your own preferences about treatment.

Treatment options may include : –

1)  Surgery : – Surgery to remove the uterus (hysterectomy) is typically used to treat the early stages of cervical cancer. A simple hysterectomy involves the removal of the cancer, the cervix and the uterus. Simple hysterectomy is typically an option only when the cancer is very early stage – invasion is less than 3 millimeters (mm) into the cervix. A radical hysterectomy – removal of the cervix, uterus, part of the vagina and lymph nodes in the area – is the standard surgical treatment when there’s an invasion of greater than 3 mm into the cervix and no evidence of tumor on the walls of the pelvis.
Hysterectomy can cure early-stage cervical cancers and prevent cancer from coming back, but removing the uterus makes it impossible to become pregnant in the future. Expect about six weeks of recovery time. Temporary side effects of radical hysterectomy include pelvic pain and difficulty with bowel movements and urination.
2)  Radiation : – Radiation therapy uses high-powered energy to kill cancer cells. Radiation therapy can be given externally using external beam radiation or internally (brachytherapy) by placing devices filled with radioactive material near your cervix. Radiation therapy is as effective as surgery for early-stage cervical cancer. For women with more advanced cervical cancer, radiation is often the best treatment.

Both methods of radiation therapy can be combined. Radiation therapy can be used alone, with chemotherapy, before surgery to shrink a tumor or after surgery to kill any remaining cancer cells. Side effects of radiation to the pelvic area include upset stomach, nausea, diarrhea, bladder irritation and narrowing of your vagina, which can make intercourse difficult. Premenopausal women may stop menstruating as a result of radiation therapy and begin menopause.
3)  Chemotherapy : – Chemotherapy uses strong anti-cancer chemicals to kill cancer cells. Chemotherapy drugs, which can be used alone or in combination with each other, are usually injected into a vein and they travel throughout your body killing quickly growing cells, including cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. 

Higher doses of chemotherapy are used to control advanced cervical cancer that may not be curable. Side effects of chemotherapy depend on the drugs being administered, but generally include diarrhea, fatigue, nausea and hair loss. Certain chemotherapy drugs may cause infertility and early menopause in premenopausal women.

Colon Cancer

Definition

Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last 6 inches of the colon. Together, they’re often referred to as colorectal cancers. About 112,000 people are diagnosed with colon cancer annually, and about 41,000 new cases of rectal cancer are diagnosed each year, according to the American Cancer Society. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers.

Polyps may be small and produce few, if any, symptoms. Regular screening tests can help prevent colon cancer by identifying polyps before they become cancerous. If signs and symptoms of colon cancer do appear, they may include changes in bowel habits, blood in your stool, persistent cramping, gas or abdominal pain.

Symptoms

Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they’ll likely vary, depending on the cancer’s size and location in your large intestine.

Signs and symptoms of colon cancer include : –

1)  A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool for more than a couple of weeks
2)  Rectal bleeding or blood in your stool
3)  Persistent abdominal discomfort, such as cramps, gas or pain
4)  Abdominal pain with a bowel movement
5)  A feeling that your bowel doesn’t empty completely
6)  Weakness or fatigue
7)  Unexplained weight loss

Blood in your stool may be a sign of cancer, but it can also indicate other conditions. Bright red blood you notice on bathroom tissue more commonly comes from hemorrhoids or minor tears (fissures) in your anus, for example. In addition, certain foods, such as beets or red licorice, can turn your stools red.

Iron supplements and some anti-diarrheal medications may make stools black. Still, it’s best to have any sign of blood or change in your stools checked promptly by your doctor because it can be a sign of something more serious.

Causes

 

Colorectal cancer

 

Precancerous colon lesions

 

Small colon polyps

 

Large colon polyp

 

Colon cancer

 

In general, cancer occurs when healthy cells become altered. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes this growth gets out of control – cells continue dividing even when new cells aren’t needed. In the colon and rectum, this exaggerated growth may cause precancerous cells to form in the lining of your intestine.

Over a long period of time – spanning up to several years – some of these areas of abnormal cells may become cancerous. In later stages of the disease, colon cancer may penetrate the colon walls and spread (metastasize) to nearby lymph nodes or other organs. As with most cancers, the exact cause for colon cancer is unknown.

Precancerous growths in the colon

Precancerous cells can occur anywhere in your large intestine, the muscular tube that forms the last part of your gastrointestinal tract. The colon comprises the upper 4 to 5 feet of your large intestine, and the rectum makes up the lower 6 inches.

Precancerous growths most commonly occur as clumps of cells (polyps) that extend from the wall of the colon. Polyps can appear mushroom-shaped. Precancerous growths can also be flat or recessed into the wall of the colon (nonpolypoid lesions). Nonpolypoid lesions are more difficult to detect, but are less common.

Several types of colon polyps exist. Among the most common are : –

1)  Adenomas : – These polyps have the potential to become cancerous and are usually removed during screening tests such as flexible sigmoidoscopy or colonoscopy.
2)  Hyperplastic polyps : – These polyps are rarely, if ever, a risk factor for colorectal cancer.
3)  Inflammatory polyps : – These polyps may follow a bout of ulcerative colitis. Some inflammatory polyps may become cancerous, so having ulcerative colitis increases your overall risk of colon cancer.

Risk factors

 

Factors that may increase your risk of colon cancer include : –

1)Age : – About 90 percent of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently.
2)A personal history of colorectal cancer or polyps : – If you’ve already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future.
3)Inflammatory intestinal conditions : – Long-standing inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can increase your risk of colon cancer.
4)Inherited disorders that affect the colon : – Genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes cause only about 5 percent of all colon cancers. One genetic syndrome called familial adenomatous polyposis (FAP) is a rare disorder that causes you to develop thousands of polyps in the lining of your colon and rectum. 

People with untreated FAP have a greater than 90 percent chance of developing colon cancer by age 45. Another genetic syndrome, hereditary nonpolyposis colorectal cancer (HNPCC), also called Lynch syndrome, is more common than FAP. People with HNPCC have an increased risk of colon cancer and tend to develop colon cancer at an early age. Both FAP and HNPCC can be detected through genetic testing. Talk to your doctor about whether your family history suggests you have a risk of these conditions.
Family history of colon cancer and colon polyps : – You’re more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater. In some cases, this connection may not be hereditary or genetic. Instead, cancers within the same family may result from shared exposure to an environmental carcinogen or from diet or lifestyle factors.
Diet : – Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meats. 

People who eat a diet similar to that of Western countries, such as the United States and Europe, have a higher risk of developing colon cancer than do people who eat diets typically seen in developing countries. When people move from a developing country to a Western country and adapt to the Western diet, their risk of colon cancer increases. Although many studies have tried to identify what part of the Western diet may cause colon cancer, the answer remains unknown.

A sedentary lifestyle : – If you’re inactive, you’re more likely to develop colon cancer. This may be because when you’re inactive, waste stays in your colon longer. Getting regular physical activity may reduce your risk.
Diabetes : – People with diabetes and insulin resistance may have an increased risk of colon cancer.

Obesity : – People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
Smoking : – People who smoke cigarettes may have an increased risk of colon cancer. They may also have an increased chance of dying of colon cancer.

Alcohol : – Heavy use of alcohol may increase your odds of colon cancer.
Growth hormone disorder : – Acromegaly, an uncommon disorder that causes an excess of growth hormone in your body, may increase your risk of colon polyps and colon cancer.

Radiation therapy for cancer : – Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colon cancer.

When to seek medical advice

If you notice any symptoms of colon cancer, such as blood in your stool or a persistent change in bowel habits, see your doctor as soon as possible. Keep in mind that colorectal cancer can occur in younger as well as older people. If you’re at high risk, don’t wait until symptoms appear. See your doctor for regular screenings.

Talk to your doctor about when you should begin screening for colon cancer. Guidelines generally recommend colon cancer screenings begin at age 50. Your doctor may recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease.

Tests and diagnosis

 

Barium enema

 

Sigmoidoscopy

 

Colonoscopy

 

Stages of colon cancer

Screening

Most colon cancers develop from adenomatous polyps. Screening can detect polyps before they become cancerous. Screening may also detect colon cancer in its early stages when there is a good chance for cure.

You may be embarrassed by the screening procedures, worried about discomfort or afraid of the results. Discuss your screening options and your concerns with your doctor. Most procedures are only moderately uncomfortable, and working with a doctor you like and trust can help ease your embarrassment.

Common screening and diagnostic procedures include the following : –

1)Stool blood test : – The fecal occult (hidden) blood test checks a sample of your stool for blood. It can be performed in your doctor’s office, but you’re usually given a kit that explains how to take the sample at home. You return the sample to a lab or your doctor’s office to be checked. Not all cancers can be detected with a stool blood test, since not all cancers bleed and those that do often bleed intermittently. 

This can result in a negative test result, even though you may have cancer. If blood is detected in your stool, your doctor may order other screening tests to determine the source of the blood. Blood in your stool can be the result of hemorrhoids or an intestinal condition other than cancer. Certain foods also may alter test results, suggesting blood in the colon when there is none.
2)Stool DNA test : – This test involves analyzing several DNA markers, which come from cells that are shed by colon cancers or precancerous polyps into stool. To complete the stool DNA test, you typically receive a collection kit from your doctor, collect one bowel movement at home and then send the kit to a laboratory for analysis. 

Stool DNA testing is thought to be more accurate for detecting colon cancer than polyps, and it’s important to remember that this test can’t detect all the possible DNA mutations that may indicate a tumor. This test isn’t widely available yet, and it may not be covered by your insurance. For these reasons it’s not commonly used.
3)Flexible sigmoidoscopy : – In this test, your doctor uses a flexible, slender and lighted tube to examine your rectum and sigmoid – approximately the last 2 feet of your colon. The test usually takes just a few minutes. It can sometimes be uncomfortable, and there’s a slight risk of perforating the colon wall. 

If a polyp or colon cancer is found during this exam, your doctor will recommend colonoscopy to look at the entire colon and remove any polyps that are present for examination under a microscope. Because sigmoidoscopy only examines the lower third of the colon, polyps or cancer in the rest of the colon won’t be detected.
4)Barium enema : – This diagnostic test allows your doctor to evaluate your entire large intestine with an X-ray. Barium, a contrast dye, is placed into your bowel in an enema form. During a double-contrast barium enema, air is also added. The barium fills and coats the lining of the bowel, creating a clear silhouette of your rectum, colon and sometimes a small portion of your small intestine. 

There’s also a slight risk of perforating the colon wall, and the test has a significantly high rate of missing important lesions. A flexible sigmoidoscopy is often done in addition to the barium enema to aid in detecting small polyps that a barium enema X-ray may miss, especially in the lower bowel and rectum. Barium enema may miss small polyps or small cancers. If an abnormality is detected using barium enema, your doctor may recommend a colonoscopy.
5)Colonoscopy : – Colonoscopy is similar to flexible sigmoidoscopy, but the instrument used – a colonoscope, which is a long, flexible and slender tube attached to a video camera and monitor – allows your doctor to view your entire colon and rectum. If any polyps are found during the exam, your doctor may remove them immediately or take tissue samples (biopsies) for analysis. This is done through the colonoscope and is painless. 

You may receive a mild sedative to make you more comfortable. Preparation for the procedure involves drinking a large amount of fluid containing a laxative to clean out your colon – enemas are no longer necessary. Major risks of diagnostic colonoscopy include bleeding and perforation of the colon wall, but these are rare.
6)Virtual colonoscopy (CT colonography) : – Though not available at all medical centers, virtual colonoscopy may be one screening option. Virtual colonoscopy uses a computerized tomography (CT) machine to take images of your colon, rather than using a scope inserted in your rectum to see inside your colon. Virtual colonoscopy still requires that you undergo a bowel preparation to remove any stool. If any abnormalities are detected on virtual colonoscopy, you’ll still need to undergo conventional colonoscopy. Research into virtual colonoscopy is still ongoing.

Diagnosis

If your doctor suspects you may have colon cancer based on your signs and symptoms, he or she may recommend colonoscopy to look for colon cancer. Colonoscopy allows your doctor to look for polyps or unusual areas in your colon. Your doctor can also remove a sample of tissue from your colon to look for cancer cells. In some cases, barium enema or flexible sigmoidoscopy may be used to diagnose colon cancer.

Staging your cancer

Once you’ve been diagnosed with colon cancer, your doctor will then order tests to determine the extent, or stage, of your cancer. Staging helps determine what treatments are most appropriate for you. Staging tests may include imaging procedures such as abdominal CT scan or chest X-ray.

The stages of colon cancer are : –

1)  Stage 0 : – Your cancer is in the earliest stage. It hasn’t grown beyond the inner layer (mucosa) of your colon or rectum. This stage of cancer may also be called carcinoma in situation.
2)  Stage I : – Your cancer has grown through the mucosa but hasn’t spread beyond the colon wall or rectum.
3)  Stage II : – Your cancer has grown into or through the wall of the colon or rectum but hasn’t spread to nearby lymph nodes.
4)  Stage III : – Your cancer has invaded nearby lymph nodes but isn’t affecting other parts of your body yet.
5)  Stage IV : – Your cancer has spread to distant sites, such as other organs – for instance to your liver or lung, to the membrane lining the abdominal cavity, or to an ovary.
6)  Recurrent : – This means your cancer has come back after treatment. It may recur in your colon, rectum or other part of your body.

Treatments and drugs

The type of treatment your doctor recommends will depend largely on the stage of your cancer. The three primary treatment options are: surgery, chemotherapy and radiation.

Surgery (colectomy) is the main treatment for colorectal cancer. How much of your colon is removed and whether other therapies, such as radiation or chemotherapy, are an option for you depend on the location of your cancer, how far cancer has penetrated into the wall of your bowel, and whether it has spread to your lymph nodes or other parts of your body.

[ Colectomy ]

[ Colostomy ]

Surgical procedures

Your surgeon removes the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer to help ensure that no cancer is left behind. Nearby lymph nodes are usually also removed and tested for cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. But when that’s not possible, for instance if the cancer is at the outlet of your rectum, you may need to have a permanent or temporary colostomy. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of body waste into a special bag. Sometimes the colostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent.

Side effects of colon cancer surgery may include short-term pain and tenderness, and temporary constipation or diarrhea. If you have a colostomy, you may develop an irritation on the skin around the opening (stoma).

Surgery to prevent cancer

In cases of rare, inherited syndromes such as familial adenomatous polyposis, or inflammatory bowel disease such as ulcerative colitis, your doctor may recommend removal your entire colon and rectum in order to prevent cancer from occurring in the future. Then, in a procedure known as ileal pouch-anal anastomosis, your surgeon will likely construct a pouch from the end of your small intestine that attaches directly to your anus. This allows you to expel waste normally, although you may have several watery bowel movements a day.

 

Surgery for early-stage cancer

If your cancer is small, localized in a polyp and in a very early stage, your surgeon may be able to remove it completely during a colonoscopy. If the pathologist determines that the cancer in the polyp doesn’t involve the base – where the polyp is attached to the bowel wall – then there’s a good chance that the cancer has been completely eliminated.

Some larger polyps may be removed using laparoscopic surgery. In this procedure, your surgeon performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on a video monitor. He or she may also take samples from the lymph nodes that drain the area where the cancer is located. Studies have found that people undergoing this procedure need less pain medication and leave the hospital a day earlier on average. Also, people who have this procedure don’t have higher rates of recurrence than those who choose the open surgery.

Surgery for advanced cancer 

If your cancer is very advanced or your overall health very poor, an operation to relieve a blockage of your colon or other conditions in order to improve your symptoms may be the best option. This type of surgery is referred to as palliative surgery. The goal of palliative surgery isn’t to cure your cancer, but to relieve signs and symptoms, such as bleeding and pain.

In specific cases where the cancer has spread only to the liver and if your overall health is otherwise good, your doctor may recommend surgery to remove the cancerous lesion from your liver. Chemotherapy may be used before or after this type of surgery. This treatment may improve your prognosis.

 

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy can be used to destroy cancer cells after surgery, to control tumor growth or to relieve symptoms of colon cancer. Your doctor may recommend chemotherapy if your cancer has spread beyond the wall of the colon. In some cases, chemotherapy is used along with radiation therapy.

Possible side effects of chemotherapy include nausea and vomiting, mouth sores, fatigue, hair loss and diarrhea. Discuss the side effects and risks as well as the potential benefits with your doctor.

Radiation therapy

Radiation therapy uses powerful energy sources, such as X-rays, to kill any cancer cells that might remain after surgery, to shrink large tumors before an operation so that they can be removed more easily, or to relieve symptoms of colon cancer and rectal cancer.

Radiation therapy is rarely used in early stage colon cancer, but is a routine part of treating early stage rectal cancer, especially if the cancer has penetrated through the wall of the rectum or traveled to nearby lymph nodes. Radiation therapy, usually combined with chemotherapy, may be used after surgery to reduce the risk that the cancer may recur in the area of the rectum where it began.

Side effects of radiation therapy may include diarrhea, rectal bleeding, fatigue, loss of appetite and nausea.

Targeted drug therapy 

Three drugs that target specific defects that allow cancer cells to proliferate are available to people with advanced colon cancer. The drugs bevacizumab (Avastin), cetuximab (Erbitux) and panitumumab (Vectibix) can be given along with chemotherapy drugs or alone. Bevacizumab works to prevent tumors from developing new blood vessels, which can deliver the oxygen and nutrients cancers need to survive.

Cetuximab and panitumumab target a chemical signal that tells cells to divide and reproduce. Cetuximab was approved by the Food and Drug Administration in 2007 as a single-agent treatment for advanced colon cancer for which other treatments have failed. Panitumumab remains experimental.

Esophageal Cancer

What is Esophageal Cancer?

Esophageal cancer starts in the cells of the esophagus. The esophagus is a muscular tube that leads from the back of the mouth (pharynx) to the stomach. It sits between the spine and the lungs. The muscles of the esophagus move in rhythmic waves to push food and drink to the stomach. The point where the esophagus joins the stomach is called the gastro esophageal junction. The muscles at the junction prevent the contents of the stomach from flowing back up into the esophagus. 

Cancer of the esophagus may develop anywhere along the length of the esophagus. 

There are 2 main types: Squamous cell carcinoma, which starts in the squamous cells that line the esophagus and. Adenocarcinoma, which starts in the glandular cells of the lower third of the esophagus or in cells that have been damaged by acid backing up from the stomach. 

 

 

 

 

 

Causes & Risk Factors of Esophageal Cancer

1)Age – Esophageal cancer is more likely to occur as people get older, over age 60.
2)Sex – Cancer of the esophagus is more common in men than in women.
3)Tobcco / Alcohol Use – Chronic and/or heavy use of alcohol is another major risk factor.
4)Barrett’s Esophagus – Long-term irritation can increase the risk of esophageal cancer. Tissues at the bottom of the esophagus can become irritated if stomach acid frequently “backs up” into the esophagus — a problem called gastric reflux. Over time, cells in the irritated part of the esophagus may change and begin to resemble the cells that line the stomach. This condition, known as Barrett’s esophagus, is a premalignant condition that may develop into adenocarcinoma of the esophagus.
5)Medical History – Patients with family history of cancer.

Signs and Symptoms of Esophageal Cancer

Early esophageal cancer usually does not cause symptoms. However, as the cancer grows, symptoms may include: difficult or painful swallowing, severe weight loss, pain in the throat or back, behind the breastbone or between the shoulder blades, chronic cough, Vomiting and / or Coughing up blood.

DIAGNOSIS OF ESOPHAGEAL CANCER

Barium Swallow or Upper Gastrointestinal (GI) X-rays : –Esophageal cancers grow from the wall of the esophagus into the opening of the esophagus, creating a tumor or bump inside the esophagus. Barium in liquid form is used to coat the esophagus wall before the x-ray is taken, allowing the x-ray to show the esophagus clearly.

Upper Endoscopy for Esophageal Cancer : – Upper endoscopy is a procedure involving use of an endoscope, which is a flexible, very narrow tube with a video camera and light on the end. The patient is sedated to allow for this tube to pass through into the esophagus and stomach. The camera is connected to a television and doctor to sees abnormalities in the wall of the esophagus clearly. Endoscopy is important test for diagnosing esophageal cancer.

Endoscopic Ultrasound for Esophageal Cancer : – An endoscope with a small ultrasound probe attached to its end is used. The probe sends very sensitive sound waves that penetrate deep into tissues. The sound waves bounce off the normal tissues and the cancer are picked up by the probe and determine how deeply the tumor has invaded into the esophagus.

Bronchoscopy for Esophageal Cancer : – This procedure is similar to an upper endoscopy except in this instance the doctor looks into the trachea (windpipe) and bronchi (tubes leading from the trachea to the lung). The patient is sedated the procedure.

Positron Emission Tomography for Esophageal Cancer : – In this test, radioactive glucose (sugar) is injected into your vein. Because cancers use sugar much faster than normal tissues, the cancerous tissue takes up the radioactive material. A scanner can spot the radioactive deposits. It may be a useful test for staging the cancer.

Thoracoscopy and Laparoscopy for Esophageal Cancer : – These procedures allow the doctor to see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube. The surgeon can operate instruments through the tube and remove lymph node samples and biopsy organs to see whether they contain cancer cells. It is often important to decide whether a person is likely to benefit from surgery.

Biopsy for Esophageal Cancer : – During an endoscopy or other procedure, the doctor will remove a small piece of tissue. This tissue is then examined by a pathologist who examines the tissue to determine whether cancer cells are present and if so, their type. It usually takes a couple of days to get the results of a biopsy.

Other diagnostic procedures include a CT Scan and an MRI : –

 

Treatment Of Esophageal Cancer in India

Surgery to remove the cancer in India : – Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, parts of the esophagus and nearby lymph nodes are removed, and the remaining portion of the esophagus is reconnected to the stomach. In the other surgery, part of the esophagus, nearby lymph nodes, and the top of the stomach are removed. The remaining portion of the esophagus is reconnected to the stomach.

Laser treatment and stents to relieve symptoms : – Even if your esophageal cancer cannot be cured and if your cancer is blocking your oesophagus and making it difficult to swallow, Laser treatment may be used to clear any blockages. Or a tube called a stent is put in to allow food and drink to pass through. Chemotherapy for Esophageal Cancer in India

Radiotherapy for Esophageal Cancer in India: – Combined chemotherapy and radiotherapy for Esophageal Cancer in India If your cancer hasn’t spread, but is difficult to remove, your doctor may suggest you have combined chemotherapy and radiotherapy.This treatment is designed to try to get rid of your cancer fully. Your doctor may also suggest this approach if you cannot have surgery for some reason, but your cancer could potentially be removed. It is quite an intensive treatment and there are side effects. It has proved to be particularly successful for squamous cell cancers that are nearer to the top of the oesophagus. Read More .

Photodynamic Therapy (PDT) : – This treatment involves the use of low powered lasers combined with a light sensitive drug to destroy cancer cells. PDT is a relatively new treatment. There are two situations where your doctor may suggest it.1)As a treatment to try to prevent high grade Barrett’s oesophagus developing into cancer 2) To destroy part of a tumour and improve swallowing when advanced oesophageal cancer is making this difficult.

Head And Neck Cancer

What is Head and Neck Cancer ?

Head and neck cancer is the term given to a variety of malignant tumors that develop in the

1)Oral cavity (mouth) : – The oral cavity includes the lips, the front two-thirds of the tongue, the gingiva (gums), the buccal mucosa (lining inside the cheeks and lips), the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area behind the wisdom teeth.
2)pharynx (throat) : – The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus (the tube that goes to the stomach) and the trachea (the tube that goes to the lungs). The pharynx has three parts : –
3)Nasopharynx : – The nasopharynx, the upper part of the pharynx, is behind the nose.
4)Oropharynx : – The oropharynx is the middle part of the pharynx. The oropharynx includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils.
5)Hypopharynx : – The hypopharynx is the lower part of the pharynx.
6)Para nasal sinuses (small hollow spaces around the nose lined with cells that secrete mucus) : – the paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose. nasal cavity (airway just behind the nose)
7)larynx (“Adam’s apple” or voice box) : – The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.
8)Salivary glands (parotid, submanidular, sublingual glands) : – The salivary glands produce saliva, the fluid that keeps mucosal surfaces in the mouth and throat moist. There are many salivary glands; the major ones are in the floor of the mouth, and near the jawbone.

 

 

The types of Oral Cancer are : –

1)Oral Cancer.
2)Salivary Gland Cancer.
3)Laryngeal Cancer.
4)Hypopharyngeal Tumors.
5)Nasopharyngeal Cancer.
6)Hypopharyngeal Tumors.
7)Tumors of the Oropharynx.
8)Tumors of the Nasal Cavity and Paranasal Sinuses.

 

Causes of cancer of the head and neck

Cancers of the head and neck are more common in men than women. In some cases (for example, salivary gland cancers, sarcomas and lymphomas) the causes are unknown.

Squamous cell carcinomas are much more common in smokers and people who drink a lot of alcohol, particularly spirits, and even more common in people who do both.

Other risk factors include the following : –

1. Pipe smokers and people who hold cigarettes between their lips for long periods have a higher risk of cancers in the lip area.

1. People who have long periods of sun exposure in their daily life have an increased risk of cancer of the lip and the skin of the head and neck, especially the ear.

1. People who chew tobacco or betel nuts and those who use paan have a higher risk of cancers in the oral cavity.

1. A diet that contains very little fresh fruit and vegetables.

1. Breathing in certain chemicals and hardwood dusts (for example, in workplaces) increases the risk of cancers of the nose and sinuses.

1. There are a number of precancerous conditions that can affect the head and neck, such as leukoplakia and erythroplakia, which can increase the risk of a cancer developing.

 

Symptoms of Head and Neck Cancer

 

These are common symptoms of head and neck cancer in general.

1. an ulcer or sore area in the head or neck that does not heal within a few weeks

1. difficulty in swallowing, or pain when chewing or swallowing

1. trouble with breathing or speaking, such as persistent noisy breathing, slurred speech or a hoarse voice

1. a numb feeling in the mouth or on the lips

1. an unexplained loose tooth

1. a persistent blocked nose, or nose bleeds

1. a constant sore throat and earache affecting one side

1. ringing in the ear, or difficulty in hearing

1. a swelling or lump in the mouth or neck

1. pain in the face or upper jaw

1. in people who smoke or chew tobacco, pre-cancerous changes can occur in the lining of the mouth, or on the tongue. These can appear as persistent white patches (leukoplakia) or red patches (erythroplakia). They are usually painless but can sometimes be sore and may bleed.

 

How head and neck cancers are diagnosed ?

At the hospital, the specialist will ask you about your current symptoms as well as your medical history, and will want to know if you are taking any medicines. The doctor will then examine your mouth, throat and neck.

Nasendoscopy
Biopsy
Fine needle aspiration cytology (FNAC)
Microcytoscopy

Nasendoscopy for Head and Neck Cancer

In order to examine your throat and neck, the doctor may use a small mirror held at the back of your mouth. The doctor may also pass a nasendoscope (a very thin flexible tube with a light at the end) into your nose to get a better view of the back of the mouth and throat.

These tests can be uncomfortable for you, but will only last a few minutes. You may be given a local anaesthetic lozenge to suck, which numbs the mouth for a few minutes. Instead, the area may be sprayed with an anaesthetic spray, which numbs the back of your throat. If you do have a local anaesthetic in your throat, you shouldn’t eat or drink anything for about an hour afterwards, until your throat has lost the numb feeling. Otherwise there is a risk of things going into your windpipe when you swallow. You could also scald your mouth or throat with hot drinks.

Biopsy for Head and Neck Cancer

The doctor can only make a definite diagnosis by taking a sample of cells from the abnormal area to examine under a microscope. This procedure is called a biopsy.

Sometimes the biopsy can be taken in the clinic. The affected area is first numbed with some local anaesthetic. A small piece of the suspected cancer is then removed using a very fine needle or a special pair of tweezers (biopsy forceps). However, it is more likely that a biopsy will be taken whilst you are asleep under a general anaesthetic. This allows the specialist to examine the mouth and throat area closely and take biopsies from any other suspicious areas..

By looking at the sample of cells under the microscope, the doctors will be able to tell if cancer cells are present. They will also be able to find out the type of cancer; for example, whether it has begun in the cells lining the mouth and throat (squamous cells).

 

Fine needle aspiration cytology (FNAC) for Head and Neck Cancer

This is a quick, simple procedure that is done in the outpatient clinic. Using a fine needle and syringe, the doctor takes a sample of cells from a lump and sends it to the laboratory to see if any cancer cells are present. An FNAC may be quite uncomfortable and the area may be bruised for a week or so afterwards.

 

Microcytoscopy for Head and Neck Cancer

This is a new test that is still being evaluated in research. It is sometimes used for people with pre-cancerous conditions who need to have regular biopsies. Instead of having biopsies a small amount of blue dye is painted onto the abnormal area, which is then very closely looked at using a microscope. Microcytoscopy should not be painful although it may be a little uncomfortable.

 

Treatment used for head and neck cancer in India

 

There are three main types of treatment for head and neck cancer : –

1. Surgery

1. Radiotherapy

1. Chemotherapy

 

Two other treatments may sometimes be used : –

1. Photodynamic therapy (PDT)

1. Biological therapies

 

Sometimes the treatment of head and neck cancers will involve two or more treatments combined together.

Treating head and neck cancer with surgery in India

Surgery is an important part of the treatment of head and neck cancers and aims to remove the cancer completely. The part of your mouth or throat that the doctor may remove depends on where the tumour is. Very small cancers can often be treated with a simple surgical operation under local or general anaesthetic, or with laser surgery, with no need to stay in hospital overnight.

If the cancer is larger, surgery will often involve a hospital stay and an operation under general anaesthetic. Sometimes the amount of surgery may involve more than one part of your head and neck, and may mean that you will have scars on your face or neck. Some people may also need to have reconstructive surgery to the face

Sometimes laser surgery may be used to remove small tumours in the mouth and the pharynx. This may be combined with a light-sensitive drug (sometimes called a photosensitising agent) in treatment known as photodynamic therapy (PDT).

A type of surgery called micrographic surgery is being tested in research trials for cancers of the lip and oral cavity. The surgeon removes the cancer, and during the surgery the tissue that has been removed is examined under a microscope. This is to make sure that all the cancer cells are removed.

The surgeon may need to remove part of the mouth or throat lining and occasionally some facial skin. This can be replaced using a thick piece of skin taken from another part of the body – usually the forearm or chest. This is known as a skin flap.

If the cancer is affecting part of your jawbone, the affected bone may be removed with the tumour. In this case, you may need to have part of a bone taken from elsewhere in your body to replace the missing jawbone. This is known as a bone graft. Modern techniques enable you to move your jaw again straight after the operation.

Treating head and neck cancer with radiotherapy in India

Radiotherapy may be used alone, instead of surgery. It can also be used after an operation, to destroy small areas of cancer that could not be removed by the surgery. It may also be given in combination with chemotherapy, which is known as chemo-radiotherapy.

Radiotherapy can be given in one of two ways:

from outside the body as external beam radiotherapy (a beam of x-rays or electrons from a large machine called a linear accelerator)

by implanting radioactive material into the tumour and leaving it there for a few days. This is known as internal radiotherapy, interstitial radiotherapy or brachytherapy.

Treating head and neck cancer with chemotherapy in India

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. As the drugs circulate in the bloodstream, they can reach the cancer cells all over the body.

Chemotherapy may be used before or after surgery or radiotherapy to try to increase their effectiveness. Sometimes chemotherapy may be given at the same time as radiotherapy (a treatment known as chemo-radiotherapy), as they can be more effective if they are given together.

Chemotherapy may also be given to people whose cancer has spread to other parts of the body or whose cancer has come back after radiotherapy. It is used in this situation to try to shrink and control the cancer and relieve symptoms, to try to prolong a good quality of life.

 

Treating head and neck cancer with photodynamic therapy in India

PDT uses a combination of laser light of a specific wavelength and a light-sensitive drug to destroy cancer cells.

The light-sensitive drug (the photosensitising agent) is injected into a vein. It circulates in the bloodstream and is taken up by cells throughout the body. The drug is taken up more by cancer cells than healthy cells. It is not activated until it is exposed to laser light of a particular wavelength. When a laser is shone on to the cancer, the drug is triggered to interact with oxygen, which then destroys the cancer cells.

There is a delay of four days between injection and the activation of the drug using the laser light. The laser light used in PDT is focused through a fibre-optic tube, and is shone for only a few minutes. The doctor holds the fibre-optic tube very close to the cancer so that the correct amount of light is delivered and the PDT causes the minimum amount of damage to normal, healthy cells.

In early-stage cancer of the head and neck PDT may be used to try to cure the cancer and is usually given as part of research trials.

PDT can sometimes be used to shrink an advanced cancer to reduce symptoms, but it cannot cure an advanced cancer.

Lymphoma

WHAT IS LYMPHOMA?

Lymphoma is type of blood Cancer that occurs when lymphocytes white blood cells that help to protect the body from infection and disease begin behaving abnormally. Abnormal may divide faster than cells or they may live longer than they are supposed to.Lymphoma may develop in many parts of the body, including the lymph nodes, spleen, bone marrow, blood or other organ.

 

TYPES OF LYMPHOMA

There are two main types of Lymphoma. Hodgkin’s Lymphoma, or Hodgkin’s disease, all other types of Lymphoma are called non-Hodgkin’s Lymphomas.

Hodgkin’s disease and non-Hodgkin’s Lymphoma are both Cancers that start in lymphoid tissue (also called lymphatic tissue). The lymphatic system is important for filtering germs and Cancer cells as well as fluid from the extremities and internal organs. Other types of Cancer, lung or colon Cancers, for example, can develop in other organs and then spread to lymphoid tissue. But these Cancers that can spread to lymph nodes are not Lymphomas. Lymphomas start in the lymphoid tissue and can spread to other organs.

This lymphoid tissue is found in many places throughout the body, including lymph nodes, the thymus (found behind the chest bone and in front of the heart), the spleen (on the left side of the abdomen next to the stomach), the tonsils and adenoids, in the bone marrow, and scattered within other systems such as the digestive and respiratory systems.

 

What Causes Lymphoma?

Lymphoma is a form of Cancer that can affect the various sections of the lymphatic system however it is commonly the lymphocyte cells and the lymph glands that are the primary sites of Cancerous growth

The cause of most Lymphomas is not known. Most are probably caused by mutations in certain genes, called oncogenes, which then allow normal cells to divide out of control.

 

These factors may increase a person’s risk of getting Lymphoma : –

1. Exposure to chemicals such as certain solvents, pesticides, herbicides, and water contaminated with nitrate.

1. Taking drugs that suppress the immune system.

1. Having an autoimmune disease, such as lupus or rheumatoid arthritis.

1. Having stomach ulcers or gastritis caused by a kind of bacteria called H. pylori.

1. Having a weakened immune system. For example, people with AIDS are 50 to100 times more likely to develop Lymphoma than people who are not infected with the AIDS virus.

1. Various viral infections, for example the Epstein – Barr virus and the Hepatitis C virus. Many of the general population carry the Epstein-Barr virus however it is quite safe while it remains inactive.

 

DIAGNOSIS OF LYMPHOMAS

 

To identify which areas of the body are affected by Lymphoma, the following tests are also commonly used : –

1)Blood tests, including complete blood count (CBC).
2)Blood chemistry, including tests of liver and kidney function.
3)Bone marrow biopsy or aspiration.
4)Lumbar puncture (spinal tap) to check for Cancer spread to the central nervous system (brain and spinal cord).
5)Ultrasound.
6)Computed tomography (CT) of the chest and abdomen or sometimes X-rays.
7)Magnetic resonance imaging (MRI).
8)Bone scan or gallium scan (when a radioactive material is injected into the bloodstream to look for evidence of inflammation or bone tumors).
9)Gallium scan to look for tumor or inflammatory cells.
10)Positron emission tomography (PET) scan to look for abnormal cells.

What are the common symptoms of Lymphoma?

There are a number of common signs and symptoms that are associated with Lymphoma however it must be pointed out that these symptoms can also be caused by numerous, less severe conditions and so anyone suffering with any of the following symptoms should not self-diagnose Lymphoma.

The common symptoms include : –

1)  Swollen lymph glands – although these often develop in the neck, armpit and groin areas they can also develop in the chest and these lymph glands can not be felt externally. This means that they can be swollen for some time without causing any external swelling that can be felt with the fingers.
2)  Fever and night sweats – because Cancerous cells are present in the body the immune system launches an attack and this causes the body’s internal temperature to rise, which is felt as a fever.
3)  Unexplained weight loss – Lymphoma can affect any system within the body and occasionally it affects the digestive system which then fails to function at its best. This means that food is not absorbed properly and the body begins to lose weight.
4)  Tiredness and fatigue – again this can occur when the digestive system is affected and the impaired food absorption leaves the body with little energy. It also occurs because the body is constantly trying to fight the spread and development of Cancerous cells.

Treatment of Lymphoma in India

Treatment planning takes into account the type of Lymphoma, the stage of disease, whether it is likely to grow slowly or rapidly, and the general health and age of the patient.

 

Common treatment options for several types are as follows : –

Low Grade Lymphoma Treatment in India

Low-grade Lymphomas include small lymphocytic, follicular small cleaved, and follicular mixed cell. For low-grade Lymphomas, which usually grow very slowly and cause few symptoms, the doctor may wait until the disease shows signs of spreading before starting treatment.

Although low-grade Lymphomas grow slowly and respond readily to chemotherapy, they almost invariably return and are generally regarded as incurable. The long-term outcome has not been favorably affected by the use of intermediate chemotherapy. Single agent or combination chemotherapy or radiation therapy may be required when the disease progresses or begins to cause symptoms.

Intermediate and High Grade Lymphomas Treatment in India

Intermediate grade includes follicular large cell, diffuse small cleaved, diffuse mixed cell, and diffuse large cell. The chance of recovery and choice of treatment depend on the stage of the Cancer, age, and overall condition. Whatever the origin, the features that best predict the prognosis and guide decisions about therapy are the size, shape and pattern of the lymphocytes as seen microscopically.

Intermediate- and high-grade Lymphomas are curable. Treatment for intermediate- or high-grade Lymphomas usually involves chemotherapy, with or without radiation therapy. In addition, surgery may be needed to remove a large tumor.

Combination chemotherapy is almost always necessary for successful treatment. Chemotherapy alone, or abbreviated chemotherapy and radiation, cure 70 to 80 percent of patients with limited (Stages I and II) intermediate-grade Lymphoma. Advanced (Stages III and IV) disease can be eradicated in about 50 percent of patients.

 

Leukemia

 

WHAT IS LEUKEMIA?

The term leukemia actually describes a group of cancers involving an excess of white blood cells. In leukemia normal control mechanism starts to produce large number of abnormal white blood cells disrupting production of normal blood cells and affecting vital functions that these blood cells carry out.

Leukemia can be classified as either lymphoid or myeloid, denoting the type of white blood cells affected. It is also categorized as either acute or chronic reflecting the speed of progression.

Acute Leukemia

Acute Lymphoblastic (lymphoid) Leukemia (ALL) accounts for more than 80% of cases of and one of the few forms of cancer that is more common in children than adults.
Acute Myeloid Leukemia (AML) accounts adults for most of the remaining cases

Chronic Leukemia

Chronic leukemia which progress slowly are very rare in childhood
Chronic Myeloid Leukemia (CML) accounts for less than 3% of childhood leukemia
Chronic Lymphoblastic Leukemia is unheard of in children

 

Causes of Leukemia?

 

Leukemia is more common in men than women. The main causes are : –

1)Radiation exposure : – Exposure to very high levels of radiation increases acute leukemia risk.
2)Exposure to benzene : – Exposure to the chemical benzene at work over a long period of time increases your risk of developing acute leukemia.
3)Smoking : –Smoking cigarettes can increase your risk of developing acute myeloid leukemia.
4)Genetic reasons : – Certain inherited conditions can increase the risk of developing acute leukemia. Children with Down’s syndrome are more likely to get acute myeloid leukemia than other children.
5)Family history : –Having a first or second-degree relative diagnosed with a  title=”Blood Cancer”>blood cancer or lymphoma.
6)Past chemotherapy : –People who have had treatment with particular chemotherapy drugs in the past.
7)Blood disorders : –Bone marrow disorders called myelodysplastic syndrome, Fanconi’s anaemia & diseases where bone marrow makes too many blood cells (myeloproliferative disorders).
8)Viruses : –Virus called HTLV-1 (human T cell leukemia virus) causes a rare form of adult T cell leukemia.
9)Electromagnetic fields : –Power lines produce ‘low frequency electromagnetic radiation’ (EMR), as do electric wiring and electrical equipment.
10)Exposure to infection and childhood leukemia

Diagnosis of Leukemia

Any diagnosis relies on a good medical history (the story of how the illness developed), a physical examination and special tests guided by the history and examination. Blood tests are important in the diagnosis of leukemia. A sample of blood is examined under a microscope to see what the cells look like and to determine the number of mature cells and blasts.

Bone Marrow test for Leukemia

To check further for leukemia cells or to tell the type of Leukemia, a heamatologist, oncologist, or pathologist performs a bone marrow biopsy. The doctor withdraws the sample by inserting a needle into a large bone (usually the hip) and removing a small amount of liquid bone marrow. This procedure is called bone marrow aspiration. A bone marrow biopsy is performed with a larger needle, and a small piece of bone and bone marrow is removed. This is usually done under local anesthesia or with sedation.

The marrow is then examined under the microscope, if leukemia is found in the bone marrow sample; further tests are done on the marrow to determine the type of leukemia. The patient’s doctor also orders other tests to find out the extent of the disease. A spinal tap (also known as a lumbar puncture) checks for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord (the cerebrospinal fluid). Chest X-rays can reveal signs of disease in the chest.

 

Symptoms of Leukemia

When leukemia develops, the leukemia cells take over the bone marrow and prevent the normal formation of the different blood cells.

 

They affect the normal three cell lines and their functions : –

1)  Leukemia cells are abnormal cells that cannot do what normal blood cells do. They cannot help the body fight infections. For this reason, people with leukemia often get infections and have fevers.
2)  They crowd out the normal blood-forming cells. As a result there are not enough red blood cells to carry oxygen, so patients become tired and pale (called anemia), and there are not enough platelets to stop bleeding and bruising.

Some of the common symptoms of leukemia are : –

Fever, chills, sore throat and other flu-like symptoms , Weakness and fatigue, Frequent infections, Loss of appetite and/or weight, Swollen or tender lymph nodes, liver or spleen, Easy bleeding or bruising, Tiny red spots (called petechiae) under the skin, Swollen or bleeding gums, Sweating, especially at night, Bone or joint pain

 

Treatment of Leukemia in India

Treatment for leukemia is complex. It varies with the type of leukemia, and it is not the same for all patients. The treatment depends not only on the type of leukemia, but also on certain features of the leukemia cells, the extent of the disease, and whether the leukemia has been treated before. It also depends on the patient’s age, symptoms and general health.

Bone marrow transplantation in India is a way of allowing doctors to use very large doses of chemotherapy and radiotherapy to kill the cancerous cells. It is currently preferred in some centres to use peripheral blood stem cells from the donor. A second option is the Graft-versus-Leukemia effect, where the cells from the new marrow recognise the leukemia cells as cancerous and kill them.

A few days before the transplant, the patient’s marrow is destroyed with the treatment and a new bone marrow given back to the patient. The new healthy marrow is given in a bag through a drip, much like a blood transfusion. This new marrow finds its way through the blood back to the bones, and starts growing straight away. But it takes a few weeks before the new marrow is able to produce enough cells to fight off infections and prevent bleeding. During that time, the patient has to stay in hospital and be protected from and treated for any infections or signs of bleeding that may develop.

Chemotherapy is the use of drugs to kill cancer cells.

For patients who need repeated courses of intravenous chemotherapy, the doctors may suggest placing a semi-permanent catheter into a vein (sometimes known as a Hickman or J line). This is a thin plastic tube that goes under the skin on the chest into a vein in the neck or chest. Although it is painful immediately after it has been put in, the pain settles quickly and the patient can then have all injections, blood tests and blood transfusions through the catheter. This avoids having repeated injections and drips in the arms.

Radiotherapy (also called radiation therapy) uses high-energy rays like X-rays to stop cancer cells from growing and multiplying. This may be directed to a specific part of the body like the spleen, or to the whole body, usually as preparation for a bone marrow transplant.

Biological therapy (also called immunotherapy) involves treatment with substances that affect the immune system’s ability to destroy cancer cells. The two available types of biological therapy are Interferon, which stimulates the immune system to kill cancer cells, and monoclonal antibodies, which stick to cancer cells to draw the immune system’s attention to them. These are usually used in the chronic rather than the acute leukemia’s.

 

Liver Cancer

 

Liver Cancer

Primary liver cancer begins in the cells of the liver itself. Although many cancers are declining in the United States, new cases of primary liver cancer are increasing.

Cancers that commonly spread to the liver include colon, lung and breast cancers. These cancers aren’t called liver cancer. Instead, they are named after the organ in which the cancer began – such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver. These metastatic cancers are treated based on where the cancer began, rather than being treated as primary liver cancers.

Primary liver cancer is rarely discovered early and often doesn’t respond to current treatments – thus, the prognosis is often poor. Even when treatments fail to provide much improvement in the liver cancer itself, pain and other signs and symptoms caused by liver cancer can be aggressively treated to improve quality of life. But the most important news about primary liver cancer is that you can greatly reduce your risk by protecting yourself from hepatitis infection and cirrhosis, the leading causes of the disease.

Symptoms of Liver Cancer

Most people don’t have signs and symptoms in the early stages of liver cancer, which means the disease may not be detected until it’s quite advanced.

When symptoms do appear, they may include some or all of the following : –

1)Loss of appetite and weight
2)Abdominal pain, especially in the upper right part of your abdomen, that may extend into your back and shoulder
3)Nausea and vomiting
4)General weakness and fatigue
5)An enlarged liver
6)Abdominal swelling (ascites)
7)A yellow discoloration of your skin and the whites of your eyes (jaundice)

Causes of Liver Cancer

Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach. Your liver processes most of the nutrients absorbed from your small intestine and determines how much sugar (glucose), protein and fat enter your bloodstream. It also manufactures blood-clotting substances and certain proteins. Your liver performs a vital detoxifying function by removing drugs, alcohol and other harmful substances from your bloodstream.

Liver cancer occurs when liver cells begin to grow abnormally. It’s not completely understood why this happens, but researchers believe that cancer starts with damage to DNA – the material that contains the instructions for every chemical process in your body, including the rate of cellular growth. DNA damage causes changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor – a mass of malignant cells.

Primary liver cancer : –

Primary liver cancer is divided into several types based on the type of cells that become cancerous

 

Types include : –

1)  Hepatocellular carcinoma (HCC) : – This is the most common form of primary liver cancer in both children and adults. It starts in the hepatocytes, the main type of liver cell.
2)  Cholangiocarcinoma : – This type of cancer begins in the small tube-like bile ducts within the liver. This type of cancer is sometimes called bile duct cancer.
3)  Hepatoblastoma : – This rare type of liver cancer affects children younger than 4 years of age. Most children with hepatoblastoma can be successfully treated.
4)  Angiosarcoma or hemangiosarcoma : – These rare cancers begin in the blood vessels of the liver and grow very quickly.

Metastatic cancer : –

In the United States, most cancer found in the liver has spread there from another part of the body. Rather than being referred to as liver cancer, this type of cancer is usually named after the organ where it originated and is described as “metastatic.” For instance, cancer that has spread to the liver from the colon is referred to as metastatic colon cancer.

Metastatic cancers form when malignant cells detach from the primary cancer and travel through the body in the circulatory or lymphatic system. Cancers that begin in certain organs near the liver, such as the pancreas, can spread directly to the liver. Most metastatic cancers reach the liver through the bloodstream. Why the liver is so commonly affected by metastatic cancer isn’t clear. One reason may be the liver’s rich blood supply.

 

Risk factors of Liver Cancer

Primary liver cancer can affect people of all ages and races, but certain factors may increase your risk, including : –

Sex : – Men are more likely to develop liver cancer than are women, though it isn’t clear why.
Age : – In the United States and Europe, liver cancer diagnosis occurs on average at about age 60. People in Asia and Africa tend to be diagnosed with liver cancer at younger ages – between 20 and 50.

Chronic infection with HBV or HCV : – Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is by far the most important risk factor for liver cancer.
Cirrhosis : – This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.

Diabetes : – People with this blood sugar disorder have a greater risk of liver cancer than do people who don’t have diabetes. Having both diabetes and hepatitis C infection increases the risk even more.
Exposure to aflatoxins : – Consuming foods contaminated with fungi that produce aflatoxins greatly increases the risk of liver cancer. Crops such as corn, soybeans and peanuts can become contaminated with aflatoxins.

Excessive alcohol consumption : – Consuming more than a moderate amount of alcohol can lead to irreversible liver damage and increase your risk of liver cancer. Moderate consumption is defined as no more than two drinks a day for men and one drink for women. A drink is one 4- to 5-ounce glass of wine, 12 ounces of beer or a 1.5-ounce shot of 80-proof distilled spirits.
Smoking : – Smoking tobacco of any kind makes it more likely that you’ll develop liver cancer.

Bile duct disease : – A disease called primary sclerosing cholangitis can cause inflammation and scarring of the liver’s bile ducts. This increases your risk of bile duct cancer.

Tests and diagnosis of Liver Cancer

Screening : –

Screening for liver cancer hasn’t been definitively proved to reduce the risk of dying of liver cancer. For this reason, many medical groups don’t recommend liver cancer screening.

However, the American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk.

 

including people who have : –

1)Hepatitis B and one or more of the following: Are an Asian male older than 40, Asian female older than 50 or African and older than 20, have liver cirrhosis, or have a family history of liver cancer
2)Liver cirrhosis from alcohol use
3)Hepatitis C
4)An inherited form of hemochromatosis
5)Primary sclerosing cholangitis

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves blood tests and an ultrasound exam once or twice each year.

 

Diagnosis : –

If you experience any of the symptoms of liver cancer, your doctor will ask you about your medical history and perform a physical exam.

 

Tests and procedures used to diagnose liver cancer include : –

1)  Ultrasound (ultrasonography) : – This test uses sound waves to produce a picture of internal organs, including the liver. Ultrasound is painless and usually takes less than 30 minutes. While you lie on a bed or examining table, a wand-shaped device (transducer) is placed on your body. It emits sound waves that are reflected from your liver and transformed into a computer image. Ultrasound provides information about the shape, texture and makeup of tumors.
2)  Computerized tomography (CT) scan : – This test uses X-rays to produce cross-sectional images of your body. You may also have a variation of the test – known as a CT angiogram – in which contrast dye is injected into an artery in your liver. X-rays then track the dye as it flows through the blood vessels in your liver. A CT angiogram, which may take up to an hour to perform, can provide detailed information on the number and location of liver tumors, but a CT scan exposes you to more radiation than conventional X-rays do, and some people may experience an allergic reaction to the contrast dye.
3)  Magnetic resonance imaging (MRI) : – MRI creates images using a magnetic field and radio waves. Sometimes a contrast dye also may be used. The test can take from 15 minutes to an hour. Newer MRIs can show images of the ducts that transport bile from the liver to the upper part of the small intestine (duodenum) as well as of the arteries and veins within the liver.
4)  Liver biopsy : – In this procedure, a sample of tissue is removed from your liver and examined under a microscope. Liver biopsy is considered the only definitive way to diagnose liver cancer. Your doctor may use a thin needle or a lighted instrument (laparoscope) to obtain the sample. Biopsy carries a risk of bleeding, bruising and infection.
5)  Blood tests : – Doctors sometimes use a blood test that checks for the presence of alpha-fetoprotein (AFP) – a type of protein found in small amounts in adults – to detect liver cancer. But the test isn’t perfect. Not all malignant liver tumors produce AFP, and those that do may be advanced by the time protein levels become elevated. In addition, other types of cancer and even some noncancerous liver diseases can raise AFP levels.

Staging : –

Staging tests help determine the size and location of cancer and whether it has spread. Liver cancer may be staged in different ways. One method uses the Roman numerals I through IV, with higher numbers indicating cancers that are more advanced. A stage I tumor is small and confined to one lobe of the liver. By stage IV, several tumors may exist in different lobes, or malignant cells may have spread to other parts of the body.

 

Doctors may also use the following stages to describe primary liver cancer in adults : –

Localized resectable : – At this stage, the tumor is confined to one lobe of your liver and can be completely removed in an operation. The term “resectable” refers to a tumor that can be surgically removed.

Localized unresectable : -The cancer is found in only one part of your liver, but can’t be completely removed, either because the noncancerous portion of your liver isn’t healthy or because the cancer is located near your liver’s main arteries, veins and bile ducts.
Advanced : – This stage of cancer has spread throughout the liver or to other parts of your body, particularly the bones or lungs. You’re more likely to have advanced cancer if you also have cirrhosis or chronic hepatitis.

Recurrent : – This means the cancer has returned to your liver or to another part of your body after being treated.

Stages of primary cancer in children : –

Doctors use the following stages to describe childhood liver cancer : –

Stage I. At this stage, the cancer can be removed with surgery.
Stage II. Most stage II liver cancers can be removed with an operation, but microscopic amounts of cancer remain in the liver after surgery.
Stage III. At this stage, some of the cancer may be surgically removed, but some will remain in the lymph nodes or abdomen.
Stage IV. This stage of cancer has spread to other parts of the body.
Recurrent. This means the cancer has returned after it has been treated. It may recur in the liver or in another part of the body.

Treatments of Liver Cancer

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health, feelings and personal preferences. Discuss all of your options carefully with your treatment team.

The goal of any treatment is to eliminate the cancer completely. When that isn’t possible, the focus may be on preventing the tumor from growing or spreading. In some cases palliative care only is appropriate. Palliative care refers to treatment aimed not at removing or slowing the disease but at helping relieve symptoms and making you as comfortable as possible.

Treatments for primary liver cancer in adults : –

Treatments for adults with primary liver cancer include : –

1)Surgery : – The best treatment for localized resectable cancer is usually an operation known as surgical resection. In some cases, the area of the liver where the cancer is found can be completely removed. You aren’t a candidate for surgical removal of liver tumors if you have cirrhosis or only a small amount of healthy liver tissue. Even when resections are successful, there is a chance the cancer can recur elsewhere in the liver or in other areas within a few years.
2)Alcohol injection : -In this procedure, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die. Each treatment consists of one injection, although you may need a series of injections for the best results. Alcohol injection has been shown to improve survival in people with small hepatocellular tumors. It may also be used to help reduce symptoms in cases of metastatic liver cancer. The most common side effect is leaking of alcohol onto the liver or into the abdominal cavity.
3)Radiofrequency ablation : – In this procedure, electric current in the radiofrequency range is used to destroy malignant cells. Using an ultrasound or CT scan as a guide, your surgeon inserts several thin needles into small incisions in your abdomen. When the needles reach the tumor, they’re heated with an electric current, destroying the malignant cells. Radiofrequency ablation is an option for people with small, unresectable hepatocellular tumors and for some types of metastatic liver cancers. Although the procedure has a somewhat higher risk of serious complications than alcohol injection does, it appears to provide better outcomes.
4)Chemoembolization : – Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. Chemoembolization isn’t curative, but it can shrink tumors in a certain percentage of people, which may provide symptom relief and improve survival. During the procedure, the hepatic artery – the artery from which liver cancers derive their blood supply – is blocked, and chemotherapy drugs are injected between the blockage and the liver. The idea is that by targeting the tumor directly, doctors can use potent doses of drugs without creating as many side effects as occur with systemic chemotherapy. But the fact is that chemoembolization causes many of the same side effects as other forms of chemotherapy, including abdominal pain, nausea and vomiting. Chemoembolization is less likely to cause some side effects such as lowered blood cell counts or hair loss.
5)Cryoablation (cryosurgery or cryotherapy) : – This treatment uses extreme cold to destroy cancer cells. Cryoablation may be an option for people with inoperable primary and metastatic liver cancers. It may also be used in addition to surgery, chemotherapy or other standard treatments. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. Side effects include damage to the bile ducts and major blood vessels, leading to bleeding or infection.
6)Radiation therapy : – This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors. Radiation may come from a machine outside your body or from radiation-containing materials inserted into your liver. Radiation may be used on its own to treat localized unresectable cancer. Or you may have radiation therapy following surgical removal of a tumor to help destroy any remaining malignant cells. Radiation side effects may include fatigue, nausea and vomiting.
7)Chemotherapy : – This treatment uses powerful drugs to kill cancer cells. Chemotherapy may be systemic – meaning it travels throughout your body in your bloodstream – or regional. Systemic chemotherapy is generally not effective in treating liver cancer, but may be a treatment option in certain cases.
8)Liver transplantation : – In this surgical procedure, a diseased liver is removed and replaced with a healthy, donated organ. Liver transplantation may be an option for some people with small, early-stage liver tumors and for certain people with bile duct tumors. In other cases, especially when tumors are larger or blood vessels are involved, a transplant may not improve long-term outlook because the cancer may recur outside the new liver.

Treatments for primary liver cancer in children : –

Liver cancer in young people is rare. As a result, most children with the disease are treated at centers that specialize in childhood cancers. In general, the treatments available for children are the same as for adults, and the best approach depends on the stage and type of cancer as well as the child’s age and overall health.

Lung Cancer

 

WHAT IS LUNG CANCER?

Lung cancer starts in the cells of the lung .The lungs are in the chest on either side of the heart. The right lung has 3components or lobes and the left lung 2 lobes. Air is inhaled through the nose and throat and flows past the voice box (larynx) into the windpipe (Trachea).The windpipe divides into 2tubes the left and right bronchi which supply air to each lung within the lung the tubes get smaller and smaller (bronchioles)until they reach air sacs(alveoli) The alveoli’s job is too add oxygen to the blood and to take waste gases out. The waste gas is removed from the body as exhale

 

 

Types of lung cancer

There are two major types of lung cancer. Each type of lung cancer grows and spreads in different ways. Each type may be treated differently.

Non-small cell lung cancer : –This is the most common type of lung cancer. It usually spreads more slowly than some other lung cancers.

 

There are three major types of non-small cell lung cancer : –

1)Squamous cell carcinoma.
2)Adenocarcinoma.
3)Large cell carcinoma.

Small cell lung cancer : –This is a less common type of lung cancer and it spreads faster than non-small-cell lung cancer.

There are three major types of small cell lung cancer : –

1)  Small cell carcinoma.
2)  Mixed small cell/large cell.
3)  Combined small cell carcinoma.

RISKS OF LUNG CANCER

Tobacco Smoking : – By far the most prominent risk factor is tobacco smoking. More than 80% of lung cancers are thought to result from smoking. The longer a person has been smoking and the more packs per day smoked, the greater the risk. If a person stops smoking before a cancer develops, the damaged lung tissue starts to gradually return to normal. Even after ten years, the ex-smoker’s risk still does not equal the lower risk of a person who never smoked. However, an ex-smoker’s risk is about half the risk of people who continue to smoke.

Nonsmokers who breathe in the smoke of others (also called second hand smoke or environmental tobacco smoke) are also at increased risk for lung cancer. A nonsmoker who is married to a smoker has a 30% greater risk of developing lung cancer than the spouse of a nonsmoker.

Radon : – Radon is a gas found in the soil in many parts of the country. Radon can enter a building through cracks in the foundation or insulation, or through drains or walls. People who have a high exposure to radon at home, school and work are at higher risk of lung cancer

Asbestos : – Asbestos is found is many workplaces and homes. In the past, it has been used in oven, brake pads, insulation, and many other industrial products Death from lung cancer is about seven times more likely to occur among asbestos workers than among the general population. Exposure to asbestos fibers is an important risk factor for lung cancer.

Marijuana : – Marijuana cigarettes contain more tar than tobacco cigarettes. Also, they are inhaled very deeply and the smoke is held in the lungs for a long time. Medical reports suggest marijuana may cause cancers of the mouth and throat.

Recurring Inflammation : – Tuberculosis and some types of pneumonia often leave scarred areas on the lung. This scarring increases the risk of the person developing the adenocarcinoma type of lung cancer.

Talcum Powder : – While no increased risk of lung cancer has been found from the use of cosmetic talcum powder, some studies of talc miners and millers suggest a higher risk of lung cancer and other respiratory diseases from their exposure to industrial grade talc.

Personal and Family History : – People who have lung cancer have an increased risk of another lung cancer. Brothers, sisters and children of those who have had lung cancer may have a slightly higher risk of lung cancer themselves. However, it is difficult to say how much of this excess risk is due to inherited factors and how much is due to environmental tobacco smoke.

Other Mineral Exposures : – People with silicosis and berylliosis (lung diseases caused by breathing in certain minerals) also have an increased risk of lung cancer.

Vitamin A Deficiency or Excess : – People who do not get enough vitamin A are at increased risk of lung cancer. On the other hand, taking too much vitamin A may also increase lung cancer risk.

Air Pollution : – In some cities, air pollution may slightly increase the risk of lung cancer. This risk is far less than that caused by smoking.

 

Symptoms of Lung Cancer

Lung cancer often does not produce symptoms in the early stages. When symptoms do occur, they are a result of tumor growth, pressure and invasion on nearby structures and nerves, regional growths or metastasis.

 

If the cancer originated and grew in the bronchi and spread to nearby lymph nodes, the symptoms may include : –

1)coughing (when a tumor grew and blocked a passage).
2)coughing up blood.
3)chest pain.
4)shortness of breath.
5)pneumonia.
6)hoarseness (caused by pressure on a nerve).
7)difficulty in swallowing (caused by an obstruction of the esophagus).
8)swelling of the neck, face and upper extremities (caused by pressure on blood vessels).
9)fatigue.
10)loss of appetite.
11)loss of weight.

If the cancer originated and grew at the top of the lung, the symptoms may include : –

Pancoast’s syndrome (weakness and pain in the shoulder, arm and hand, caused by pressure on the nerves)

If the cancer has metastasized and traveled to other parts of the body, the symptoms may include : –

Metastasis to brain: headache, weakness, behavioral changes, speech problems and memory lapses.
Metastasis to other parts: pain, bone fractures, jaundice and blood clots.

Additionally, lung tumors also may alter the production of hormones (called Paraneoplastic syndrome) that regulate body functions, causing : –

1)  breast enlargement in males.
2)  bone and joint pain.
3)  Cushing’s syndrome (overproduction of corticosteroid hormones).
4)  Carcinoid syndrome (excess of serotonin hormone in the body).
5)  Hypercalcemia.

Diagnosis of Lung Cancer

If lung cancer is suspected, the person will have their medical history taken, a physical examination, and a variety of tests to confirm the diagnosis.

During the physical exam, the doctor will look for lymph node enlargement in the neck or in the region above the collarbones, liver enlargement, abnormal abdominal enlargement, and signs of a lung mass.

 

The tests may include the following : –

1. chest x-ray to look for growths

1. a sputum test (phlegm coughed up from the lung) to detect cancerous cells

1. Biopsy (the surgical removal of a small piece of tissue for microscopic examination). There are various methods to obtain a biopsy. One way is with a procedure called a bronchoscopy. A bronchoscopy involves inserting a flexible lighted tube (a bronchoscope) into the person’s mouth or nose and guiding it into the bronchi. Other instruments can then be passed through the bronchoscope to remove the sample. Another method is called a percutaneous needle biopsy, in which a needle is inserted through the skin into the lung. With the help of ultrasound or a CT scan, the doctor is able to guide the needle to the cancerous growth and remove a sample.

1. Pulmonary function test, called a spirometry. Using a machine called a spirometer, the doctor is able to record the rate at which a person exhales air from the lungs and the total volume exhaled, thus indicating a narrowing or obstruction in the airways.

 

Staging of Lung Cancer

Once the diagnosis of lung cancer is made, further staging studies are done to determine the spread of the disease and the appropriate treatment method. These studies include computed tomography (CT or CAT scan), a bone scan and a PET scan.

The CT/CAT scan is a series of x-rays taken as a scanner revolves around the body. A computer then receives the x-ray images and creates a cross-sectional picture of the area being examined.

A bone scan, also called a radionuclide or nuclear medicine scan, involves injecting a radioactive substance into the body. An instrument then scans the body to measure radiation levels. A PET scan is similar to a bone scan except it gives information on all the organs of the body. It is especially useful to determine if the lung cancer has spread outside of the lung. It is important to realize, though, it is not 100% accurate; for example areas of cancer that range 0.6 centimeters to one centimeter will often not be visible on PET scan.

Once the additional tests are done, the doctor will determine what stage the cancer is in and base treatment decisions on this information.

 

Treatment of Lung Cancer in India

 

Standard treatment for patients with lung cancer is of limited effectiveness in all but the most localized tumors. For this reason, patients are encouraged to consider participating in clinical trials (research studies) designed to evaluate new approaches to therapy.

Surgery, radiation therapy and chemotherapy (used alone or in various combinations) are the standard methods used to treat lung cancer. The choice of treatment depends on many factors, including the type of tumor, the extent of the disease when it is diagnosed, the age and general health of the patient and other variables. The first question to ask is whether the lung cancer is caught at an early enough stage to allow for surgery with curative intent.

Surgical procedures that may be employed include wedge or segmental resection (removal of a portion of the affected lungs), lobetomy (removal of the entire lobe of the lung) or pneumonectomy (removal of the entire right or left lung).

Radiation therapy is usually given by external beam, using machines located outside the body that deliver x-rays or electrons to the location of the tumor. The radiation dose is based on the size and location of the tumor.

Some patients first receive external therapy to a wide area that includes the primary tumor and surrounding tissue. After the initial treatments, a smaller area is treated and a final treatment area that may be quite small. Radiation here is referred to as a “boost.” Like surgery, radiation therapy is called local treatment, because it affects only the cells in the area being treated.

Chemotherapy (treatment with anticancer drugs) is a systemic treatment – the drugs enter the bloodstream and travel through the body, affecting cancer cells outside the lung area. Drugs given to treat lung cancer may be given by mouth or injection to a muscle or vein. Most chemotherapy is taken on an outpatient basis.

 

Malignant Melanoma

WHAT IS MALIGNANT MELANOMA (Skin Cancer)?

MELANOMA is a cancer of the pigment producing cells in the skin, known as melanocytes. Cancer is a condition in which one type of cell grows without limit in a disorganized fashion, disrupting and replacing normal tissues and their functions, much like weeds overgrowing a garden. Normal melanocytes reside in the outer layer of the skin and produce a brown pigment called melanin, which is responsible for skin color. MELANOMA occurs when melanocytes become cancerous, grow, and invade other tissues.

MELANOMA begins on the surface of the skin where it is easy to see and treat. If time given to grow, MELANOMA can grow down into the skin, ultimately reaching the blood and lymphatic vessels, and spread around the body (metastasize), causing life-threatening illness. It is curable when detected early, but can be fatal if allowed to progress and spread. The goal is to detect MELANOMA early when it is still on the surface of the skin.

 

CAUSES OF MELANOMA (Skin Cancer)

It is not certain how all cases of MELANOMA develop. However, it is clear that excessive sun exposure, especially severe blistering sunburns early in life, can promote MELANOMA development. There is evidence that ultraviolet radiation used in indoor tanning equipment may cause MELANOMA. The risk for developing MELANOMA may also be inherited. Anyone can get MELANOMA, but fair-skinned sun-sensitive people are at a higher risk. Since ultraviolet radiation from the sun is a major culprit, people who tan poorly, or burn easily are at the greatest risk.

 

The following factors help to identify those at risk for MELANOMA : –

1)Fair skin.
2)A history of sunburns.
3)More than 50 moles.
4)Atypical moles.
5)Close relative who have had MELANOMA.

Anyone can develop MELANOMA, but people with one or more of the risk factors are more likely to do so. Periodic skin examinations by a dermatologist can truly be life saving.

 

 

 

 

SIGNS AND SYMPTOMS OF MELANOMA (Skin Cancer)

MELANOMA can occur anywhere on the skin or the nails, even in places not directly exposed to the sun like the eyes, mucous membranes (mouth and genitals), or internal organs. It is most common on the backs of men and legs of women. MELANOMA is usually brown or black in color, but sometimes, though rare, may be red, skin-colored, or white. It can arise from a pre-existing mole, or appear on previously normal skin. MELANOMAs grow slowly; therefore, growing, changing, or irregular lesions should arouse suspicion.

When looking at a spot on the skin it is helpful to apply the ABCD rules : –

 

The ABCDs of MELANOMA (Skin Cancer)

 

 

Asymmetry : –Meaning one half is different than another. Draw an imaginary line through the middle of the lesion, either up and down or side to side. Are the two sides the same size and shape (symmetric)? MELANOMAs are usually asymmetric.

 

 

Border Irregularity : – The edge, or border, of MELANOMAs are usually ragged, notched, or blurred.

 

 

Color : –Benign moles can be any color, but a single mole will be only one color. MELANOMA often has a variety of hues and colors within the same lesion.

 

 

Diameter : –MELANOMAs continue to grow, while moles remain small. Is the lesion larger than a pencil eraser (6mm)?

OTHER SUSPICIOUS CHANGES IN A MOLE MAY INCLUDE : –

1. SCALINESS.

1. ITCHING.

1. CHANGES IN TEXTUR FOR INSTANCE BECOME HARD OR LUMPY.

1. SPREADING OF PIGMENT FROM THE MOLE INTO THE SURROUNDING SKIN.

1. OOZING OR BLEEDING.

 

 

DIAGNOSIS OF MELANOMA (Skin Cancer)

A skin biopsy is usually necessary to confirm a MELANOMA diagnosis. In this procedure, the mole is removed and checked under a microscope. A skin biopsy often requires a local aesthetics.

A complete physical and ophthalmological (eye) examination should be done. Diagnostic imaging techniques such as x-ray, computed tomography (CAT scan), magnetic resonance imaging (MRI), positron emission tomography (PET scan) and radio-isotopic bone or organ scan may be included.

 

TREATMENT OF MELANOMA (Skin Cancer) in India

The best treatment is early detection. A quick look from a dermatologist can confirm whether a lesion is suspicious for MELANOMA. If so, the next step is to perform a biopsy. This involves numbing the area and removing the entire lesion, or a portion, which can be examined under a microscope. This simple, quick procedure is performed in the dermatologist’s office. If a MELANOMA is detected, treatment is guided by how deep the MELANOMA penetrates the skin.

 

 

Treatment for MELANOMA begins with the surgical removal of the MELANOMA and some normal-looking skin around the growth. Removal of the normal-looking skin is known as taking margins, and is done to be sure no MELANOMA is left behind. Early MELANOMA limited to the outermost layer of the skin (the epidermis) is known as MELANOMA in situ (in place), and simple surgical removal produces virtually a 100 percent cure rate. If left untreated, the MELANOMA grows deeper in the skin and is more likely to produce a life-threatening situation.

Deeper MELANOMAs are more likely to reach a blood vessel or lymphatic channel and spread. When a MELANOMA spreads, it goes to the lymph nodes first. The lymph nodes are part of the lymphatic system, a series of vessels throughout the body that are responsible for cleaning the body’s tissue. Different lymph nodes serve different parts of the body. It may be possible to find the MELANOMA in the lymph node before it goes any further. A procedure called a sentinel lymph node biopsy is a way of identifying and testing the first lymph node into which the MELANOMA drains. The decision to perform a sentinel lymph node biopsy is based on how deep the MELANOMA is in the skin, and how likely it is to have spread.

An open lymph node biopsy may also be done. This is the surgical removal of the lymph nodes which are examined under a microscope.

 

Mesothelioma

 

Mesothelioma

Malignant mesothelioma is a rare cancer that occurs in the thin layer of tissue that covers the majority of your internal organs (mesothelium).

Doctors divide mesothelioma into different types based on what part of the mesothelium is affected, including : –

1)malignant mesothelioma, which affects the tissue that surrounds the lungs and is the most common form of mesothelioma.
2)Peritoneal mesothelioma, which occurs in the tissue in your abdomen.
3)Pericardial mesothelioma, which affects the tissue surrounding the heart.
4)Mesothelioma of the tunica vaginalis, which occurs in the lining around the testicles.

Symptoms of Mesothelioma

Signs and symptoms of mesothelioma vary depending on where the cancer occurs.

 

Pleural mesothelioma signs and symptoms may include : –

1)  Shortness of breath
2)  Painful breathing (pleurisy)
3)  Painful coughing
4)  Chest pain under the rib cage
5)  Unusual lumps of tissue under the skin on your chest
6)  Unexplained weight loss
7)  Dry (nonproductive) cough

Peritoneal mesothelioma signs and symptoms may include : –

1)  Abdominal pain
2)  Abdominal swelling
3)  A change in your bowel habits, such as more frequent diarrhea or constipation
4)  Lumps of tissue in the abdomen
5)  Unexplained weight loss

Other forms of mesothelioma

Signs and symptoms of pericardial mesothelioma and mesothelioma of the tunica vaginalis are unclear. These forms are so rare that not much information is available. Pericardial mesothelioma signs and symptoms may include difficulty breathing or chest pains. Mesothelioma of the tunica vaginalis may be first detected as a mass on a testicle.

When to see a doctor

See your doctor if you have signs and symptoms that may indicate mesothelioma. Signs and symptoms of mesothelioma aren’t specific to this disease and, due to the rarity of mesothelioma, are more likely to be related to other conditions. If any persistent signs and symptoms seem unusual or bothersome to you, ask your doctor to evaluate them.

 

Causes of Mesothelioma

In general, cancer begins when a series of genetic mutations occur within a cell, causing the cell to grow and multiply out of control, when healthy cells would normally die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

It isn’t clear what causes the initial genetic mutations that lead to mesothelioma, though researchers have identified factors that may increase the risk. It’s likely that cancers form because of an interaction between many factors, such as inherited conditions, your environment, your health conditions and your lifestyle choices.

Benign pleural mesothelioma 

A form of noncancerous (benign) tumor that can occur in the chest is sometimes called benign mesothelioma. However, this name is misleading. Benign mesothelioma doesn’t begin in the same cells where the cancerous forms of mesothelioma begin. And, in a minority of cases, benign mesothelioma can be very aggressive, despite the term “benign.” For this reason, some doctors now refer this tumor as solitary fibrous tumor.

Solitary fibrous tumor usually doesn’t cause signs and symptoms. Most cases are inadvertently discovered during tests and procedures for other conditions. It isn’t clear what causes solitary fibrous tumors, but they aren’t linked to asbestos exposure. Treatment for solitary fibrous tumor typically includes surgery.

Risk factors of Mesothelioma

Asbestos exposure: The primary risk factor for mesothelioma

Asbestos is a mineral that’s found naturally in the environment. Asbestos fibers are strong and resistant to heat, making them useful in a wide variety of applications, such as in insulation, cement, brakes, shingles, flooring and many other products. People who work around asbestos fibers are thought to have the greatest risk of mesothelioma.

When asbestos is broken up, such as during the mining process or when removing asbestos insulation, dust may be created. If the dust is inhaled or swallowed, the asbestos fibers may settle in the lungs or in the stomach, where they can cause irritation that may lead to mesothelioma, though how exactly this happens isn’t understood.

Mesothelioma risk is believed to be increased in people who are exposed to high levels of asbestos, in people who are exposed to asbestos over a long period of time and in people exposed to asbestos at a young age. It can take 30 to 40 years or more for mesothelioma to develop as a result of asbestos exposure.

Some people with years of asbestos exposure never develop mesothelioma. And yet, others with very brief exposure develop the disease. This indicates that other factors may be involved in determining whether someone gets mesothelioma or doesn’t. For instance, you could inherit a predisposition to cancer or some other condition could increase your risk.

 

Possible risk factors

 

Factors that may increase the risk of mesothelioma include : –

1)Personal history of asbestos exposure : – If you’ve been directly exposed to asbestos fibers at work or at home, your risk of mesothelioma is greatly increased.
2)Living with someone who works with asbestos : -People who are exposed to asbestos may carry the fibers home on their skin and clothing. These stray fibers can put others in the home at risk of mesothelioma. People who work with asbestos should shower and change clothes before leaving work.
3)Smoking : – Risk of mesothelioma is increased greatly in smokers who are exposed to asbestos.
4)SV40 : – Some research indicates a link between mesothelioma and simian virus 40 (SV40), a virus originally found in monkeys. Millions of people may have been exposed to SV40 when receiving polio vaccinations between 1955 and 1963, because the vaccine was developed using monkey cells. Once it was discovered that SV40 was linked to certain cancers, the virus was removed from the polio vaccine. Whether SV40 increases the risk of mesothelioma is a point of debate, and more research is needed.
5)Radiation : – Some research links mesothelioma to the radioactive substance thorium dioxide, which was used along with X-rays to diagnose various health conditions from the 1920s to the 1950s. Thorium dioxide was later found to cause cancer and is no longer used.
6)Family history : – A family history of mesothelioma may increase your risk of mesothelioma, but more research is needed to understand this theory.

Tests and diagnosis of Mesothelioma

If you have signs and symptoms that might indicate mesothelioma, your doctor will conduct a physical exam to check for any lumps or other unusual signs. Your doctor may order imaging scans, such as a chest X-ray or a computerized tomography (CT) scan of your chest or abdomen, to look for abnormalities.

It’s not uncommon for mesothelioma to be misdiagnosed initially because mesothelioma is rare, and its signs and symptoms aren’t specific. Your doctor will likely rule out other more common conditions before considering mesothelioma.

Biopsy

Biopsy, a procedure to remove a small portion of tissue for laboratory examination, is the only way to determine whether you have mesothelioma. Depending on what area of your body is affected, your doctor selects the right biopsy procedure for you

 

Options include : –

1)  Fine-needle aspiration : – The doctor removes fluid or a piece of tissue with a small needle inserted into your chest or abdomen.
2)  Thoracoscopy : -Thoracoscopy allows the surgeon to see inside your chest. In this procedure, the surgeon makes one or more small incisions between your ribs. A tube with a tiny video camera is then inserted into your chest cavity – a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Special surgical tools allow your surgeon to cut away tissue for testing.
3)  Laparoscopy : – Laparoscopy allows the surgeon to see inside your abdomen. Using one or more small incisions into your abdomen, the surgeon inserts a tiny camera and special surgical tools to obtain a small piece of tissue for examination.
4)  Thoracotomy : – Thoracotomy is surgery to open your chest between the ribs to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.
5)  Laparotomy : – Laparotomy is surgery to open your abdomen to allow a surgeon to check for signs of disease. He or she removes a sample of tissue for testing.

The tissue sample is analyzed under a microscope to see whether the abnormal tissue is mesothelioma and what types of cells are involved. The type of mesothelioma you have determines your treatment plan.

 

Staging

Once mesothelioma is diagnosed, your doctor orders other tests to determine the extent, or stage, of the cancer.

Imaging tests that may help determine the stage of your cancer include : –

1)  Chest X-ray
2)  CT scans of the chest and abdomen
3)  Magnetic resonance imaging (MRI)
4)  Positron emission tomography (PET)

Once the extent of pleural mesothelioma is determined, a stage is assigned. Formal stages aren’t available for other types of mesothelioma because these types are rare and aren’t well studied.

 

The stages of pleural mesothelioma are : –

I : – Stage I pleural mesothelioma is considered localized cancer, meaning it’s limited to one portion of the lining of the chest.

II : – Stage II mesothelioma may have spread beyond the lining of the chest to the diaphragm or to a lung.
III : -Stage III mesothelioma may have spread to other structures within the chest and may involve nearby lymph nodes.

IV : – Stage IV mesothelioma is an advanced cancer that has spread to distant areas (metastasized). Mesothelioma most commonly spreads (metastasizes) to the brain, lymph nodes in the chest and areas of the lung that are away from the tumor.

Treatments of Mesothelioma

What treatment you undergo for mesothelioma depends on your health and certain aspects of your cancer, such as its stage and location. Unfortunately, mesothelioma often is an aggressive disease and for most people a cure isn’t possible. Mesothelioma is usually diagnosed at an advanced stage – when it isn’t possible to remove the cancer through an operation. Instead, your doctor may work to control your cancer to make you more comfortable.

Discuss treatment goals with your doctor. Some people want to do everything they can to treat their cancer, even if that means enduring side effects for a small chance of an improvement. Others prefer treatments that make them comfortable so that they can live their remaining months as symptom-free as possible.

Surgery

Surgeons work to remove mesothelioma in instances where it is diagnosed at an early stage. Sometimes it isn’t possible to remove all of the cancer. In those cases, surgery may help to reduce the signs and symptoms caused by mesothelioma spreading in your body.

 

Surgical options may include : –

1)Surgery to decrease fluid buildup : – Pleural mesothelioma may cause fluid to build up in your chest, causing difficulty breathing. Surgeons insert a tube or catheter into your chest to drain the fluid. Surgeons may also inject medicine into your chest to prevent fluid from returning (pleurodesis).
2)Surgery to remove the tissue around the lung or abdomen : – Surgeons may remove the tissue lining the ribs and the lungs (pleurectomy) or the tissue lining the abdominal cavity (peritonectomy) in order to relieve signs and symptoms of mesothelioma.
3)Surgery to remove as much of the cancer as possible (debulking) : – If all of the cancer can’t be removed, surgeons may attempt to remove as much as possible.
4)Surgery to remove a lung and the surrounding tissue : – Removing the affected lung and the tissue that surrounds it may relieve signs and symptoms of pleural mesothelioma. This procedure also allows doctors to use higher doses of radiation against any remaining mesothelioma, since they won’t need to worry about protecting your lung from damaging radiation.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells. Systemic chemotherapy travels throughout the body and may shrink or slow the growth of a pleural mesothelioma that can’t be removed using surgery. Chemotherapy may also be used before surgery (neoadjuvant chemotherapy) to make an operation easier or after surgery (adjuvant chemotherapy) to reduce the chance that cancer will return.

Chemotherapy drugs may also be heated and administered directly into the abdominal cavity (intraperitoneal chemotherapy), in the case of peritoneal mesothelioma, or into the chest cavity (intrapleural chemotherapy), in the case of pleural mesothelioma. Using this strategy, chemotherapy drugs can reach the mesothelioma directly without injuring healthy cells in other parts of the body. This allows doctors to administer higher doses of chemotherapy drugs.

Intraperitoneal chemotherapy may also be used to reduce the signs and symptoms of peritoneal mesothelioma that can’t be removed through surgery.

Radiation therapy

Radiation therapy focuses high-energy beams to a specific spot or spots on your body. Radiation may reduce signs and symptoms in people with pleural mesothelioma. Doctors aim radiation at the entire chest to obtain the best result. However, many sensitive organs are in the chest, such as the heart, lungs, esophagus and spinal cord, so doctors must use low doses of radiation to spare these organs. Radiation therapy is sometimes used after biopsy or surgery to prevent mesothelioma from spreading to the surgical incision.

Radiation therapy is used occasionally in people with peritoneal mesothelioma to reduce signs and symptoms caused by the cancer.

Combination therapy

Surgery, chemotherapy and radiation therapy may be combined. This aggressive therapy can be grueling and may not be appropriate for everyone. Younger, healthier people and those with earlier stage mesothelioma may be more able to endure this treatment. Combination therapy has shown the most promise in treating mesothelioma. However, most people will eventually experience a recurrence of this cancer despite aggressive treatment. Combination therapy has been used in both pleural mesothelioma and peritoneal mesothelioma.

Treatment for other types of mesothelioma

Pericardial mesothelioma and mesothelioma of the tunica vaginalis are very rare and can be very aggressive. Early-stage cancer may be removed through surgery. Doctors have yet to determine the best way to treat later stage cancers, though. Your doctor may recommend other treatments to improve your quality of life.

 

Aids-Related Lymphoma

 

What is AIDS Related Lymphoma?

AIDS-related lymphoma is a disease in which malignant (cancer) cells form in the lymph system of patients who have acquired immunodeficiency syndrome (AIDS).

AIDS is caused by the human immunodeficiency virus (HIV), which attacks and weakens the body’s immune system. The immune system is then unable to fight infection and diseases that invade the body. People with HIV disease have an increased risk of developing infections, lymphoma, and other types of cancer. A person with HIV disease who develops certain types of infections or cancer is then diagnosed with AIDS. Sometimes, people are diagnosed with AIDS and AIDS-related lymphoma at the same time. For information about AIDS and its treatment, please see the AIDSinfo Web site.

Lymphomas are cancers that affect the white blood cells of the lymph system, part of the body’s immune system.

Lymph : –Colorless, watery fluid that travels through the lymph system and carries white blood cells called lymphocytes. Lymphocytes protect the body against infections and the growth of tumors.

Lymph vessels : – A network of thin tubes that collect lymph from different parts of the body and return it to the bloodstream.

Lymph nodes : –Small, bean-shaped structures that filter lymph and store white blood cells that help fight infection and disease. Lymph nodes are located along the network of lymph vessels found throughout the body. Clusters of lymph nodes are found in the underarm, pelvis, neck, abdomen, and groin.

Spleen : –An organ that makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. The spleen is on the left side of the abdomen near the stomach.

Thymus : –An organ in which lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.

Tonsils : –Two small masses of lymph tissue at the back of the throat. The tonsils make lymphocytes.

Bone marrow : –The soft, spongy tissue in the center of large bones. Bone marrow makes white blood cells, red blood cells, and platelets.

 

Types of Lymphoma

 

There are many different types of lymphoma.

Lymphomas are divided into two general types: Hodgkin lymphoma and non-Hodgkin lymphoma. Both Hodgkin lymphoma and non-Hodgkin lymphoma may occur in AIDS patients, but non-Hodgkin lymphoma is more common. When a person with AIDS has non-Hodgkin lymphoma, it is called an AIDS-related lymphoma.

Non-Hodgkin lymphomas are grouped by the way their cells look under a microscope. They may be indolent (slow-growing) or aggressive (fast-growing). AIDS-related lymphoma is usually aggressive.

 

There are three main types of AIDS-related lymphoma : –

1)Diffuse large B-cell lymphoma.
2)B-cell immunoblastic lymphoma.
3)Small non- cleaved cell lymphoma.

Possible signs of AIDS-related lymphoma include weight loss, fever, and night sweats.
These and other symptoms may be caused by AIDS-related lymphoma. Other conditions may cause the same symptoms.

 

A doctor should be consulted if any of the following problems occur : –

1)Weight loss or fever for no known reason.
2)Night sweats.
3)Painless, swollen lymph nodes in the neck, chest, underarm, or groin.
4)A feeling of fullness below the ribs.

Diagnosis of AIDS related Lymphoma

Tests that examine the body and lymph system are used to help detect (find) and diagnose AIDS-related lymphoma.

The following tests and procedures may be used : –

Physical exam and history : – An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Complete blood count (CBC) : –Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.

1)  The number of red blood cells, white blood cells, and platelets.
2)  The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
3)  The portion of the sample made up of red blood cells.

Lymph node biopsy : – The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

One of the following types of biopsies may be done : –

Excisional biopsy: The removal of an entire lymph node.
Incisional biopsy: The removal of part of a lymph node.
Core biopsy: The removal of tissue from a lymph node using a wide needle.
Fine-needle aspiration (FNA) biopsy: The removal of tissue from a lymph node using a thin needle.

Bone marrow aspiration and biopsy : – The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.

HIV test : – A test to measure the level of HIV antibodies in a sample of blood. Antibodies are made by the body when it is invaded by a foreign substance. A high level of HIV antibodies may mean the body has been infected with HIV.

Epstein-Barr virus (EBV) test : – A test to measure the level of EBV antibodies in a sample of blood, tissue, or cerebrospinal fluid (CSF). Antibodies are made by the body when it is invaded by a foreign substance. A high level of EBV antibodies may mean the body has been infected with EBV.

Chest x-ray : – An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Certain factors affect prognosis (chance of recovery) and treatment options.

 

The prognosis (chance of recovery) and treatment options depend on the following : –

1)The stage of the cancer.
2)The number of CD4 lymphocytes (a type of white blood cell) in the blood.
3)Whether the patient has ever had AIDS-related infections.
4)The patient’s ability to carry out regular daily activities.

After AIDS-related lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.

The process used to find out if cancer cells have spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment, but AIDS-related lymphoma is usually advanced when it is diagnosed.

 

The following tests and procedures may be used in the staging process : –

CT scan (CAT scan) : – A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

PET scan (positron emission tomography scan) : – A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

MRI (magnetic resonance imaging : – A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Bone marrow aspiration and biopsy : – The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.

Lumbar puncture : – A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.

Blood chemistry studies : – A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. The blood sample will be checked for the level of LDH (lactate dehydrogenase).

 

Stages of AIDS-related lymphoma

Stages of AIDS-related lymphoma may include E and S

 

AIDS-related lymphoma may be described as follows:

1)E: “E” stands for extranodal and means the cancer is found in an area or organ other than the lymph nodes or has spread to tissues beyond, but near, the major lymphatic areas.
1)S: “S” stands for spleen and means the cancer is found in the spleen.

The following stages are used for AIDS-related lymphoma : –

Stage I

Stage I AIDS-related lymphoma is divided into stage I and stage IE.

1)  Stage I : – Cancer is found in one lymph node group.
2)  Stage IE: – Cancer is found in an area or organ other than the lymph nodes.

Stage II

Stage II AIDS-related lymphoma is divided into stage II and stage IIE.

1)  Stage II : – Cancer is found in two or more lymph node groups on the same side of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
2)  Stage IIE : – Cancer is found in an area or organ other than the lymph nodes and in lymph nodes near that area or organ, and may have spread to other lymph node groups on the same side of the diaphragm.

Stage III

Stage III AIDS-related lymphoma is divided into stage III, stage IIIE, stage IIIS, and stage IIIS+E.

1)  Stage III : –Cancer is found in lymph node groups on both sides of the diaphragm (the thin muscle below the lungs that helps breathing and separates the chest from the abdomen).
2)  Stage IIIE : –Cancer is found in lymph node groups on both sides of the diaphragm and in an area or organ other than the lymph nodes.
3)  Stage IIIS : –Cancer is found in lymph node groups on both sides of the diaphragm and in the spleen.
4)  Stage IIIS+E : –Cancer is found in lymph node groups on both sides of the diaphragm, in an area or organ other than the lymph nodes, and in the spleen.

Stage IV

In stage IV AIDS-related lymphoma, the cancer either : –

1)  is found throughout one or more organs other than the lymph nodes and may be in lymph nodes near those organs.
2)  is found in one organ other than the lymph nodes and has spread to lymph nodes far away from that organ.

Patients who are infected with the Epstein-Barr virus or whose AIDS-related lymphoma affects the bone marrow have an increased risk of the cancer spreading to the central nervous system (CNS).

AIDS-related lymphoma Treatment

 

For treatment, AIDS-related lymphomas are grouped based on where they started in the body, as follows : –

Peripheral/systemic lymphoma
Lymphoma that starts in lymph nodes or other organs of the lymph system is called peripheral/systemic lymphoma. The lymphoma may spread throughout the body, including to the brain or bone marrow.

Primary CNS lymphoma
Primary CNS lymphoma starts in the central nervous system (brain and spinal cord). Lymphoma that starts somewhere else in the body and spreads to the central nervous system is not primary CNS lymphoma.

 

Treatment option overview

 

There are different types of treatment for patients with AIDS-related lymphoma.

Different types of treatment are available for patients with AIDS-related lymphoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Treatment of AIDS-related lymphoma combines treatment of the lymphoma with treatment for AIDS.

Patients with AIDS have weakened immune systems and treatment can cause further damage. For this reason, patients who have AIDS-related lymphoma are usually treated with lower doses of drugs than lymphoma patients who do not have AIDS.

Highly active antiretroviral therapy (HAART) is used to slow progression of HIV (which is a retrovirus). Treatment with HAART may allow some patients to safely receive anticancer drugs in standard or higher doses. Medicine to prevent and treat infections, which can be serious, is also used.

AIDS-related lymphoma usually grows faster than lymphoma that is not AIDS-related and it is more likely to spread to other parts of the body. In general, AIDS-related lymphoma is harder to treat.

 

Three types of standard treatment are used : –

Chemotherapy : – Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Intrathecal chemotherapy may be used in patients who are more likely to have lymphoma in the central nervous system (CNS).

Colony-stimulating factors are sometimes given together with chemotherapy. This helps lessen the side effects chemotherapy may have on the bone marrow.

Radiation therapy : – Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

High-dose chemotherapy with stem cell transplant : – High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

 

New types of treatment are being tested in clinical trials. These include the following : –

Monoclonal antibody therapy : – Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. These may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Information about ongoing clinical trials is available from the NCI Web site.

 

Treatment options for AIDS-Related Lymphoma

AIDS-Related Peripheral/Systemic Lymphoma

There is no standard treatment plan for AIDS-related peripheral/systemic lymphoma.
Treatment is adjusted for each patient and is usually one or more of the following:

1)Combination chemotherapy.
2)High-dose chemotherapy and stem cell transplant.
3)A clinical trial of monoclonal antibodies.
4)A clinical trial of different treatment combinations.

AIDS-Related Primary Central Nervous System Lymphoma

Treatment of AIDS-related primary central nervous system lymphoma is usually radiation therapy.

 

Bile Duct Cancer

 

Bile duct cancer

The bile ducts are the tubes connecting the liver and gall bladder to the small intestine (small bowel). Bile is a fluid made by the liver and stored in the gall bladder. Its main function is to break down fats during their digestion in the small bowel. In people who have had their gall bladder removed, bile flows directly into the small intestine. The bile ducts and gall bladder are known as the biliary system. 

 

[ Diagram showing the position of the bile duct ]

 

Cancer is classified according to the type of cell from which it starts. Cancer of the biliary system almost always starts in a type of tissue called glandular tissue and is then known as adenocarcinoma.

If the cancer starts in the part of the bile ducts contained within the liver it is known as intra-hepatic. If it starts in the area of the bile ducts outside the liver it is known as extra-hepatic. This information concentrates mainly on extra-hepatic bile duct cancers. Intra-hepatic bile duct cancers may be treated like primary liver cancer.

 

Causes and risk factors

The cause of most bile duct cancers is unknown. There are a number of risk factors that can increase your risk of developing bile duct cancer.

These are : –

1)  Inflammatory bowel disease People who have a chronic inflammatory bowel condition, known as ulcerative colitis, are at an increased risk of developing this type of cancer.
2)  Abnormal bile ducts People who are born with (congenital) abnormalities of the bile ducts, such as choledochal cysts, are more at risk of developing cholangiocarcinoma.
3)  Infection In Africa and Asia, infection with a parasite known as the liver fluke is thought to cause a large number of bile duct cancers.

Bile duct cancer, like other cancers, is not infectious and cannot be passed on to other people.

 

Signs and symptoms

If cancer develops in the bile ducts it may block the flow of bile from the liver to the intestine. This causes the bile to flow back into the blood and body tissues, and leads to the skin and whites of the eyes becoming yellow (known as jaundice). The urine also becomes a dark yellow colour and stools (bowel motions) are pale. The skin may become itchy. Mild discomfort in the abdomen, loss of appetite, high temperatures (fevers) and weight loss may also occur.

These symptoms can be caused by many things other than bile duct cancer, but any jaundice or any symptoms which get worse or last for a few weeks should always be checked by your doctor.

 

How it is diagnosed

Usually you begin by seeing your GP, who will examine you. They will refer you to a hospital specialist for any tests that may be necessary and for expert advice and treatment.

At the hospital the doctor will ask you about your general health and any previous medical problems. They will also examine you and take blood samples to check your general health and that your liver is working properly.

 

The following tests are commonly used to diagnose bile duct cancer : –

1)Ultrasound scan Sound waves are used to make up a picture of the bile ducts and surrounding organs. These scans are done in the hospital’s scanning department. You will be asked not to eat, and to drink clear fluids only (nothing fizzy or milky) for four to six hours before the scan. Once you are lying comfortably on your back, a gel is spread onto your abdomen. A small device, like a microphone, is then rubbed over the area. The sound waves are converted into a picture using a computer. The test is completely painless and takes 15-20 minutes.
2)CT (computerised tomography) scan A CT scan takes a series of x-rays which are fed into a computer to build up a detailed picture of your bile ducts and surrounding organs. On the day of the scan you will be asked not to eat or drink anything for at least four hours before your appointment. You will be given a special liquid to drink an hour before the test and again immediately before the scan. The liquid shows up on x-ray to ensure that a clear picture is obtained. 

Once you are comfortably positioned on your back on the couch, the scan can be taken. About half-way through the scan a special dye will be injected into the vein to show up the blood vessels. This may make you feel warm or ‘flushed’ for up to half an hour. The test itself is completely painless, but it will mean that you have to lie still for about 10-30 minutes. If you had little to drink before the scan, you may be advised to drink plenty afterwards to make up for this.
3)MRI (magnetic resonance imaging) scan This test is similar to a CT scan, but uses magnetism instead of x-rays to build up cross-sectional pictures of your body. During the test you will be asked to lie very still on a couch inside a large metal cylinder which is open at both ends. The whole test may take up to an hour. It can be slightly uncomfortable and some people feel a bit claustrophobic during the scan, which is also very noisy. You will be given earplugs or headphones to wear. A two-way intercom enables you to talk with the people controlling the scanner.
4)ERCP (endoscopic retrograde cholangiopancreatography) This is a procedure by which an x-ray picture of the pancreatic duct and of the bile duct can be taken. It may also be used to unblock the bile duct if necessary. You will be asked not to eat or drink anything for about six hours before the test so that the stomach and duodenum (first part of the small bowel) are empty. 

You will be given an injection to make you relax (a sedative) and a local anaesthetic spray will be used to numb your throat. The doctor will then pass a thin flexible tube known as an endoscope through your mouth into your stomach and into the duodenum just beyond it. Looking down the endoscope, the doctor can find the opening through which the bile duct and the duct of the pancreas drain into the duodenum. A dye which can be seen on x-ray can be injected into these ducts and the doctor will be able to see whether there is any abnormality or any blockage in the ducts. 

If there is a blockage it may be possible or the doctor to insert a small tube known as stent. You may have some discomfort during this procedure; if you do, it is important that you let your doctor know. You will be given antibiotics beforehand (to help prevent any infection) and will probably stay in hospital for one night afterwards.
5) PTC (percutaneous transhepatic cholangiography) This is another procedure by which your doctor can obtain an x-ray picture of the bile duct. You will be asked not to eat or drink anything for about six hours before the test and will be given a sedative as for the ECRP. 

An area on the right side of your abdomen will be numbed with a local anaesthetic (an injection) and a thin needle will be passed into the liver through the skin. A dye will be injected through the needle into the bile duct within the liver. X-rays will then be taken to see if there is any abnormality or blockage of the duct. 

You may feel some discomfort as the needle enters the liver. You will be given antibiotics before and after this procedure (to help prevent infection) and you will stay in hospital for at least one night afterwards.
6)Angiography As the bile duct is very close to the major blood vessels of the liver, a test called an angiogram may be done. The angiogram can check whether the blood vessels are affected by the tumour. 

A fine tube is inserted into an artery in your groin and a dye is injected through the tube. The dye circulates in the arteries to make them show up on x-ray. An angiogram is carried out in a room within the x-ray department. Sometimes an MRI scan can be used to show up the blood vessels of the liver and then an angiogram will not be necessary.
7)Biopsy The results of the previous tests may make your doctor strongly suspect a diagnosis of cancer of the bile duct, but the only way to be sure of the diagnosis is to take some cells or a small piece of tissue from the affected area of the bile duct to look at under a microscope. This is called a biopsy and may be carried out during an ECRP or PTC. A fine needle is passed into the tumour through the skin after the area has been numbed using a local anaesthetic injection. CT or ultrasound may be used at the same time, to make sure that the biopsy is taken from the right place.
8)Endoscopic ultrasound scan (EUS) This scan is similar to an ERCP but involves an ultrasound probe being passed down the endoscope to take an ultrasound scan of the pancreas and surrounding structures.

Laparotomy

If the doctor cannot make the diagnosis from the above tests, a procedure called a laparotomy may be done under a general anaesthetic. This involves making a cut (incision) into your abdomen so that the surgeon can examine the bile duct and the tissue around it for cancer. Sometimes this examination can be done through a tiny cut using a camera called a laparoscope – this procedure is known as keyhole surgery.

If a cancer is found, but looks as though it has not spread to surrounding tissues, the surgeon may be able to remove the cancer or relieve any blockage that it is causing.

 

Staging and grading

Staging : –

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment.

Cancer can spread in the body, either in the blood stream or through the lymphatic system. The lymphatic system is part of the body’s defence against infection and disease. The system is made up of a network of lymph glands (also known as lymph nodes) that are linked by fine ducts containing lymph fluid. Your doctors will usually look at the lymph nodes close to the biliary system in order to find the stage of your cancer.

1)Stage 1A : – The cancer is contained within the bile duct.
2)Stage 1B : – The cancer has spread through the wall of the bile duct but has not spread into nearby lymph nodes or other structures.
3)Stage 2A : – The cancer has spread into the liver, pancreas or gall bladder or to the nearby blood vessels, but not the lymph nodes.
4)Stage 2B : – The cancer has spread into nearby lymph nodes.
5)Stage 3 : – The cancer is affecting the main blood vessels that take blood to and from the liver, or it has spread into the small or large bowel, the stomach or the abdominal wall. Lymph nodes in the abdomen may also be affected.
6)Stage 4 : – The cancer has spread to distant parts of the body such as the lungs

If the cancer comes back after initial treatment, this is known as recurrent cancer.

Grading

Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly and are more likely to spread.

 

Treatment overview

The type of treatment that you are given will depend on a number of factors, including your general health, the position and size of the cancer in the bile duct and whether the cancer has spread beyond the bile duct.

Consent

Before you have any treatment, your doctor will give you full information about what it involves and explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.

Benefits and disadvantages of treatment

Treatment can be given for different reasons and the potential benefits will vary for each person. If you have been offered treatment that aims to cure your cancer, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the cancer for a period of time, it may be more difficult to decide whether or not to go ahead.

If you feel that you can’t make a decision about treatment when it is first explained to you, you can always ask for more time to decide.

You are free to choose not to have the treatment and the staff can explain what may happen if you don’t have it. You don’t have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

 

Surgery

Surgery may be used to remove the cancer if it has not spread beyond the bile duct. It is not always possible to carry out surgery, as the bile duct is in a difficult position and it may be impossible to remove the cancer completely. The decision about whether surgery is possible or not depends on the results of the tests described above. If surgery is recommended then you will be referred to a surgeon with a special interest in this rare cancer.

 

There are different operations depending upon how big the cancer is and whether it has begun to spread into nearby tissues : –

1)  Removal of the bile ducts If the cancer is small and contained within the ducts, then just the bile ducts containing the cancer are removed and the remaining ducts in the liver are joined to the small bowel, allowing the bile to flow again.
2)  Partial liver resection If the cancer has begun to spread into the liver, the affected part of the liver is removed, along with the bile ducts.
3)  Whipple’s If the cancer is larger and has spread into nearby structures, then the bile ducts, part of the stomach, part of the duodenum (small bowel), the pancreas, gall bladder and the surrounding lymph nodes are all removed.

After your operation you may stay in an intensive-care ward for the first couple of days. You will then be moved to a general ward until you recover. Most people need to be in hospital for up to two weeks after this type of operation.
4)  Bypass surgery Sometimes it isn’t possible to remove the tumour and other procedures may be performed to relieve the blockage (obstruction) and allow the bile to go into the intestine. The jaundice will then clear up. 

The surgical method of dealing with blockage of the bile duct involves joining the gall bladder (or the bile duct) to part of your small bowel. This bypasses the blocked part of the bile duct and allows the bile to flow from the liver into the intestine. This operation is called a cholecysto-jejunostomy or cholecysto-duodenostomy if the gall bladder is used. It is called a hepatico-jejunostomy if the bile duct is used. 

Another type of operation may be necessary if the duodenum is also blocked. This is called a gastrojejunostomy and involves connecting a piece of the small bowel (the jejunum) to the stomach to bypass the duodenum. This will stop the persistent vomiting (being sick) that can occasionally happen if the cancer blocks the duodenum.

Stent insertion

There are two ways in which it may be possible to relieve jaundice without a surgical operation. These use the ERCP or PTC procedures described below.

The ERCP method involves the insertion of a tube, called a stent into the blocked bile duct. The stent is about as thick as a ball-point pen refill and about 5-10cm long (two to four inches). The stent clears a passage through the bile duct to allow the bile to drain away. The preparation and procedure is the same as for ERCP described above. By looking at the x-ray image the doctor will be able to see the narrowing in the bile duct. The narrowing can be stretched using dilators (small inflatable balloons), and the stent can then be inserted through the endoscope to enable the bile to drain.

The tube usually needs to be replaced every three to four months to prevent it becoming blocked. If the tube does block, recurrent high temperatures and/or return of the jaundice will occur. It is important to tell your specialist about these symptoms as early as possible. Antibiotic treatment may be needed and your specialist may advise that the stent is exchanged for a new one. This procedure can be done relatively easily for most people.

During the PTC method, the procedure and the preparation you will need is as described in the section about PTC. A temporary wire is passed to the area of blockage and the stent is guided along the wire. Sometimes a drainage tube (catheter) is left in the bile duct. One end of the catheter is in the bile duct and the other lies outside the body connected to a bag, which collects the bile. This is to help with the insertion of the stent or, sometimes, to enable x-rays to be taken to check the position of the stent after it has been put in place. It is usually left in for a few days. Once the catheter is removed the hole heals over within two days. You will be given antibiotics before and after the procedure to help prevent any infection. It is likely that you will stay in hospital for a few days.

Sometimes, if the bile duct cannot be opened easily from the small intestine during ERCP, a combination of ERCP and PTC may be used.

 

Other treatments

Radiotherapy

Radiotherapy is occasionally used to treat bile duct cancer. Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells while doing as little harm as possible to normal cells. It may be given either externally from a radiotherapy machine, or internally by placing radioactive material close to the tumour.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the cancer cells. They work by disrupting the growth of cancer cells. Occasionally, chemotherapy may be given in combination with radiotherapy for cancers that cannot be removed surgically. Researchers are still looking into how effective chemotherapy is for the treatment of bile duct cancer.

Photodynamic therapy (PDT)

PDT uses a combination of laser light of a specific wavelength and a light-sensitive drug to destroy cancer cells. In bile duct cancer it is used to help relieve symptoms.

The light-sensitive drug (a photosensitising agent) is injected into a vein. It circulates in the bloodstream and enters cells throughout the body. The drug enters more cancer cells than healthy cells. It does not do anything until it is exposed to laser light of a particular wavelength. When a laser is shone on to the cancer, the drug becomes active and destroys the cancer cells.

 

Clinical trials

Research into treatments for bile duct cancer is ongoing and advances are being made. Cancer doctors use clinical trials to assess new treatments.

You may be asked to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it means to take part.

Ovarian Cancer

OVARIAN CANCER

Ovarian cancer is a disease produced by the rapid growth and division of cells within one or both ovaries-reproductive glands in which the ova, or eggs, and the female sex hormones are made. The ovaries contain cells that, under normal circumstances, reproduce to maintain tissue health. When growth control is lost and cells divide too much and too fast, a cellular mass or tumor is formed. If the tumor is confined to a few cell layers, for example, surface cells, and it does not invade surrounding tissues or organs, it is considered benign. If the tumor spreads to surrounding tissues or organs, it is considered malignant, or cancerous. When cancerous cells break away from the original tumor, travel through the blood or lymphatic vessels, and grow within other parts of the body, the process is known as metastasis.

Ovarian cancer is not a single disease. There are actually more than 30 types and subtypes of ovarian malignancies, each with its own histopathologic (diseased tissue) appearance and biologic behavior.

 

Causes of OVARIAN CANCER

The exact cause of ovarian cancer isn’t known. It’s more common in women who live in developed countries. Other factors that are thought to make ovarian cancer more likely include:

1)  a family history of ovarian cancer – women who have two or more close relatives (mother, sister or daughter) with ovarian cancer are more at risk.
2)  having a non-cancerous condition called endometriosis.
3)  starting your period early and having the menopause late.

More research is needed to find out whether the risk of ovarian cancer is increased by : –

1)  having fertility treatment.
2)  having hormone replacement therapy (HRT).
3)  being overweight or obese.

Studies have shown that ovarian cancer may be less common in women who : –

·  have used the contraceptive pill.
·  have had children.
·  have breastfed their children.
·  have had a hysterectomy.

 

Symptoms of Ovarian Cancer

Most women with early-stage cancer of the ovary don’t have any symptoms for a long time.

When symptoms occur they may include any of the following : –

1. loss of appetite.

1. vague indigestion, nausea, excess gas (wind) and a bloated, full feeling.

1. unexplained weight gain.

1. swelling in the abdomen – this may be due to a build up of fluid, known as ascites, which can cause shortness of breath.

1. pain in the lower abdomen.

1. changes in bowel or bladder habits, such as constipation, diarrhoea or needing to pass urine more often.

1. lower back pain.

1. pain during sex.

1. abnormal vaginal bleeding, although this is rare.

 

DIAGNOSIS OF OVARIAN CANCER

1. Pelvic exam (for Ovarian Cancer) includes feeling the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size. (A Pap test, a good test for cancer of the cervix, is often done along with the pelvic exam, but it is not a reliable way to find or diagnose ovarian cancer.)

1. Ultrasound refers to the use of high-frequency sound waves. These waves, which cannot be heard by humans, are aimed at the ovaries. The pattern of the echoes they produce creates a picture called a sonogram. Healthy tissues, fluid-filled cysts, and tumors look different on this picture.

1. CA-125 assay (for Ovarian Cancer) is a blood test used to measure the level of CA-125, a tumor marker that is often found in higher-than-normal amounts in the blood of women with ovarian cancer.

1. Lower GI series, or barium enema, is a series of x-rays of the colon and rectum. The pictures are taken after the patient is given an enema with a white, chalky solution containing barium. The barium outlines the colon and rectum on the x-ray, making tumors or other abnormal areas easier to see.

1. CT (or CAT) scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine.

1. Biopsy is the removal of tissue for examination under a microscope. A pathologist studies the tissue to make a diagnosis . To obtain the tissue, the surgeon performs a laparotomy (an operation to open the abdomen). If cancer is suspected, the surgeon performs an oophorectomy (removal of the entire ovary). This is important because, if cancer is present, removing just a sample of tissue by cutting through the outer layer of the ovary could allow cancer cells to escape and cause the disease to spread.

1. If the diagnosis is ovarian cancer, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Staging may involve surgery, x-rays and other imaging procedures, and lab tests. Knowing the stage of the disease helps the doctor plan treatment.

 

TREATMENT OF OVARIAN CANCER in India

Treatment

 

There are three main forms of treatment for ovarian cancer offered in India : –

1. Surgery to remove cancerous tissue.

1. Chemotherapy to destroy cancer cells using strong anti-cancer drugs.

1. Radiotherapy to destroy cancer cells by high-energy radiation exposure.

 

There are also many combinations of these treatment methods and it is usually worthwhile to get a second opinion about treatment before entering into a specific program. Treatment depends upon a number of factors (e.g., stage and grade of the disease, the histopathologic type, and the patient’s age and overall health).

Surgery for Ovarian Cancer in India

Surgery usually is required to treat ovarian cancer. Most patients undergo surgery in addition to another form of treatment (e.g., chemotherapy and/or radiotherapy). Surgery helps the physician to accurately stage the tumor, make a diagnosis, and perform debulking (removal of as much tumor mass as possible). Debulking surgery is especially important in ovarian cancer because aggressive removal of cancerous tissue is associated with improved survival. Patients with no residual tumor mass, or tumor masses that measure less than 1 cm, have the best opportunity for cure.

The surgeon usually performs a laparotomy (through an abdominal incision) or laparoscopy (using a tube containing a light and camera that is inserted into the pelvic cavity through a small incision). A sample of the tumor (called a frozen section) is examined immediately under a microscope to confirm ovarian cancer and rule out metastasis from another site. If the cancer is a metastasis from another organ, the surgeon searches for the primary tumor within the abdominal cavity.

Once ovarian cancer is confirmed, a total hysterectomy (removal of the uterus [womb], bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries on both sides), omentectomy (removal of the fatty tissue that covers the bowels), lymphadenectomy (removal of one or more lymph nodes) may be performed. Tissue removed during debulking is sent for histopathological examination.

 

Chemotherapy for Ovarian Cancer in India

Chemotherapy involves using drugs to destroy cancer cells. Many of these drugs destroy cancer cells by preventing them from growing and dividing rapidly. Unfortunately, many normal cells also divide rapidly and are damaged by chemotherapy.

Radiation for Ovarian Cancer in India

Radiotherapy may be used to kill cancer cells from a cyst that ruptures during surgical removal of an ovary, or it may be used to treat certain patients who appear cancer-free or who have only microscopic evidence of disease at second-look surgery. It is historically the treatment of choice for germ cell tumors known as dysgerminomas. However, recently it has been found that chemotherapy can cure a percentage of such patients.

 

Pancreatic Cancer

 

What is Pancreatic Cancer?

Pancreatic cancer is one of the most serious of cancers. It develops when cancerous cells form in the tissues of your pancreas – a large organ that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of carbohydrates.

Pancreatic cancer spreads rapidly and is seldom detected in its early stages, which is a major reason why it’s a leading cause of cancer death. Signs and symptoms may not appear until the disease is quite advanced. By that time, the cancer is likely to have spread to other parts of the body and surgical removal is no longer possible.

For years, little was known about pancreatic cancer. But researchers are beginning to understand the genetic basis of the disease – knowledge that may eventually lead to new and better treatments. Just as important, you may be able to reduce your risk of pancreatic cancer with some lifestyle changes.

 

 

What Causes Pancreatic Cancer?

We still do not know exactly what causes most cases of pancreatic cancer. Several risk factors have been linked to the disease. A risk factor is something that affects a person’s chance of getting a disease such as cancer. Some risk factors, such as smoking, can be controlled. Others, like a person’s age or race, can’t be changed. But keep in mind that having one or more risk factors does not mean that a person will get the disease.

 

 

 

Risk Factors for Pancreatic Cancer

Age : – The risk of this cancer goes up with age. Almost 90% of patients are older than 55. The average age at the time the cancer is found is 72. Gender : – Men have this cancer slightly more often than women.

Race : – African Americans are more likely to have this cancer than are whites.

Smoking The risk of getting cancer of the pancreas is 2 to 3 times higher among smokers. About 3 out of 10 cases of pancreatic cancer are thought to be caused by smoking.

Diet : – There may be a link between pancreatic cancer and high-fat diets that include a lot of red meat and pork, especially processed meat (such as sausage and bacon). Some studies have found that diets high in fruits and vegetables may help reduce the risk of pancreatic cancer. But not all studies have found such links, and the exact role of diet in pancreatic cancer is still under study.

Obesity and Lack of Exercise : – Very overweight people are more likely to develop pancreatic cancer, as are those who don’t get much exercise.

Diabetes : Pancreatic cancer is more common in people with this disease.

Chronic Pancreatitis : – This is a long-term inflammation of the pancreas. It is linked with a slightly higher risk of pancreatic cancer, but most people with this condition do not get pancreatic cancer.

Work Exposure : – Heavy exposure at work to certain substances (pesticides, dyes, and chemicals) may increase the risk of getting cancer of the pancreas.

Family History : – Cancer of the pancreas seems to run in some families. This may account for about 1 in 10 cases. Changes in DNA that increase the risk for certain other cancers also increase the risk of this cancer.

Stomach Problems : – Having too much stomach acid or having a bacteria called H. pylori in the stomach may increase the risk of pancreatic cancer.

 

Signs and Symptoms of Pancreatic Cancer

Pancreatic cancer often is called a “silent” disease because it typically doesn’t cause symptoms early on. The cancer may grow and spread for some time before symptoms develop, which may be so vague that they are initially ignored. For these reasons, pancreatic cancer is hard to detect early. In many cases, the cancer has spread outside the pancreas by the time it is found. When symptoms appear, their type and severity depend on the location and size of the tumor.

 

Common symptoms of Pancreatic Cancer may include : –

Jaundice : –

1. If the tumor blocks the bile duct so bile can’t flow into the intestines, jaundice may occur, causing the skin and whites of the eyes to turn yellow, the urine to become dark and the stool to turn clay-colored.

Pain : –

2. As the cancer grows and spreads, pain often develops in the upper abdomen and the back. The pain may increase after a person eats or lies down.

Weight Loss : –

Cancer of the pancreas can also cause unintentional weight loss. This is often due to an inadequate intake of calories because of nausea, vomiting and loss of appetite.

Digestive Problems : –

4. Digestive problems may occur if the cancer blocks the pancreatic juices from flowing into the intestines, which help the body break down dietary fats, proteins and carbohydrates. Stools may be different than usual and appear pale, bulky or greasy, float in the toilet, or be particularly foul-smelling.

 

Tests for Pancreatic Cancer

Unfortunately, there are no laboratory tests available for the early detection or diagnosis of pancreatic cancer. Diagnosis is usually made after the cancer has already spread, using imaging tests and biopsy.

 

Some diagnostic and imaging tests that may be used include : –

1)Computed tomography (CT) scan: useful for detecting pancreatic masses and checking for metastasized cancer.
2)Biopsy: used to confirm diagnosis of cancer, often in conjunction with CT scan
3)Endoscopic retrograde cholangiopancreatography (ERCP): a test that uses a flexible scope inserted through the nose, stomach, and into the pancreas and may be used to introduce a dye for X-rays or to place a stent (a metal or plastic tube that can help keep a duct open and functioning).
4)Transabdominal ultrasound.
5)Magnetic resonance cholangiopancreatography (MRCP): a type of magnetic resonance imaging (MRI) used to see the pancreas, its ducts, and the bile ducts more clearly, often used before or instead of ERCP.

TREATMENT FOR PANCREATIC CANCER in India

1)Surgery.
2)Radiation.
3)Chemotherapy treatment for pancreatic cancer.
4)Operations include the Whipple resection, distal pancreatectomy, total pancreatectomy and portal vein surgery.

Whipple Procedure

The Whipple procedure (pancreatoduodenectomy) is the most common operation performed for pancreatic cancer and may be used to treat other cancers such as small bowel cancer. Surgeons remove the head of the pancreas, most of the duodenum (a part of the small intestine), a portion of the bile duct and sometimes a portion of the stomach. After the pancreatoduodenectomy, the surgeon reconstructs the digestive tract. Patients leave the hospital in an average of 14 days.

 

Distal Pancreatectomy

This illustration depicts pancreatic tumor in the body of the pancreas.

After mobilization of the spleen and the body and tail of the pancreas, the pancreas is divided and the body, tail, tumor and spleen are removed.

This operation is performed to remove tumors of the body and tail of the pancreas. The tail of the pancreas can be removed with the main portion of the organ left intact. This procedure eliminates the need for surgical reconstruction.

 

Total Pancreatectomy

This procedure is performed infrequently today because lifelong adverse effects may result. In this surgery, surgeons remove the entire pancreas, bile duct, gallbladder, and spleen, and possibly portions of the small intestine, stomach and nearby lymph

Portal Vein Removal

Most physicians consider pancreatic cancer inoperable if the tumor is attached to the portal vein. We Care India partner hospital is one of few medical facilities in India that offers removal and reconstruction of the entire portal vein. The capability to perform this procedure permits a larger percentage of patients who have pancreatic cancer to have a potentially curative operation.

 

Prostate Cancer

 

WHAT IS PROSTATE CANCER?

Prostate cancer is the leading malignancy in men over the age of 50. It is due to the abnormal proliferation of prostatic tissue cells. It is often a slow-growing cancer and remains localized at first. Later, it may extend as it spreads to nearby tissues and organs and then metastasizes to other more distant organs (lymph nodes, bones, lungs, etc.) via the bloodstream and the lymphatic system. Preventing such a development by early screening is a major public health issue, all the more so because as life expectancy increases, so does the frequency of this cancer.

 

 

Prostate cancer occurs when abnormal cells, fuelled by male hormones such as testosterone, grow uncontrollably to form tumors.

 

Causes of Prostate Cancer

The cause of prostate cancer isn’t fully understood at present. But there are certain factors that make prostate cancer more likely, which are listed below.

1. The risk of prostate cancer increases steadily with age and it is rare in men under 50.

2. Your risk is higher if you have close relatives (a father, uncle or brother) who have had prostate cancer.

3. If several women in your family have had breast cancer (especially if they were diagnosed at less than 40 years of age) an inherited faulty gene may be present. The gene may also increase the risk of the men in that family getting prostate cancer.

4. If you are African-Caribbean or African-American you are at highest risk whereas if you are Asian, you are at lower risk.

5. A high fat diet may increase your risk.

 

Symptoms of Prostate Cancer

Prostate cancer often has no symptoms, particularly in the early stages.

Some men may never have any symptoms or problems from the disease. Some types of prostate cancer can be slow-growing and may not become a serious threat to your health. Whereas others are a faster-growing and aggressive form and can be more harmful.

You are more likely to get symptoms if and when your cancer grows in the prostate gland and narrows the urethra.

Symptoms then include : –

1. problems urinating such as difficulty in starting to pass urine, a weak, sometimes intermittent flow of urine, dribbling of urine before and after urinating, a frequent or urgent need to pass urine or a need to get up several times in the night to urinate.

2. a feeling that your bladder is not completely empty.

3. pain when you orgasm.

4. rarely, blood in the urine.

 

These symptoms are similar to those produced by a common non-cancerous disease where the prostate becomes enlarged (benign prostatic hyperplasia)

Enlarged prostate (BPH)

If prostate cancer spreads to other parts of your body, other symptoms can develop. The most common site for prostate cancer to spread to is one or more bones, especially the lower back, pelvis and hips. These bones can become painful and tender.

 

Diagnosis of Prostate Cancer

Your doctor will ask you about your symptoms and will examine you for Prostate Cancer. He or she may do some of the following tests or refer you to a hospital specialist (urologist) for them.

1. A digital rectal examination (DRE) is an examination of your prostate. Your doctor will insert a lubricated, gloved finger into your rectum and feel your prostate through the wall of your rectum. If there is prostate cancer it may feel harder than usual, or knobbly.

2. A PSA blood test will test the amount of prostate-specific antigen (PSA) in a sample of your blood. PSA is a chemical which is made by both normal and cancerous prostate cells. If you have an abnormally high level of PSA, prostate cancer is a possibility. However, a high PSA score does not always indicate cancer and can be caused by other prostate diseases.

3. In a prostate biopsy, your doctor will surgically remove a small piece of tissue using a needle. The sample will be sent to a laboratory for examination to find out if it is a tumour and how fast it is growing.

4. CT (computerized axial tomography), MRI (magnetic resonance imaging) and bone scans can help your doctor see how far the cancer has spread (if at all). A bone scan involves injecting a small amount of radioactive liquid into your vein. This can show if the cancer has spread to the bone.

 

Treatment of Prostate Cancer in India.

Your treatment for prostate cancer will depend on a number of factors such as your age and whether the cancer has spread and if so, how far. There are a number of treatments which are described below.

Active monitoring of Prostate Cancer : – Sometimes, particularly for slow-growing tumors, no treatment is the best course of action. This is often called active monitoring or watchful waiting. Your condition will be monitored closely with routine check-ups. You can start treatment at any time and will be advised to do so if tests show the cancer is growing.

Surgery of Prostate Cancer in India : – Surgery is a common treatment for prostate cancer. It is most suitable for otherwise healthy men (usually, those under 70) whose cancer has not spread beyond the prostate.

The most common technique is a radical prostatectomy. This is a major operation, which removes the whole of the prostate, seminal vesicles and nearby lymph nodes.

 

Radiotherapy for Prostate Cancer in India : – Newer techniques that are used for treating prostate cancer with radiotherapy include conformal radiotherapy (CRT) or high-resolution intensity modulated radiotherapy (IMRT). Conformal radiotherapy shapes the radiation beams to match the shape of the prostate. This reduces the radiation received by the healthy surrounding cells in nearby organs such as the bladder and rectum.

This lowers the side-effects and may allow higher doses to be given which could be more effective. IMRT allows the radiotherapist to vary the dose of radiotherapy given to the tumour and surrounding tissue.

Brachytherapy for Prostate Cancer in India : – Brachytherapy involves implanting radioactive seeds into, or next to, the tumour in your prostate. Radiation can be released slowly over time. The seeds lose their radioactivity over about a year. Brachytherapy is more effective if the tumour is small and you have early prostate cancer.

 

Hormone therapy for Prostate Cancer in India : – Hormone therapy blocks the action of male sex hormones that help cancer grow. This can slow the growth and spread of prostate tumors but will not kill the cancer cells.

New treatments for Prostate Cancer in India : – There are new treatments being developed such as cryotherapy. This is surgery to freeze the prostate with liquid gas and kill cancer cells.

High intensity focused ultrasound (HIFU) is a treatment given using a machine that gives off high frequency sound waves. Some cancer cells die when this is focused directly onto them.

New surgical developments include keyhole surgery (a laparoscopic prostatectomy) where the prostate is removed through smaller incisions.

Green Light Laser therapy is also offered for prostate treatment.

 

Sarcoma

 

WHAT IS SARCOMA Cancer ?

A sarcoma is basically a cancer that is of the connective or supportive tissue, which are basically a bone, cartilage, fat, muscle, blood vessels and soft tissue. This term is derived from the Greek word, which means ‘fleshy growth’. Sarcomas are also referred to Bone tumours but they belong to an entirely different category, due to their different experimental and infinitesimal distinctiveness and they are also treated another way. One of the most common childhoods bone cancers are known as Osteogenic sarcoma or osteosarcoma. In adults Soft tissue sarcomas are seen as being more common than would be usually found in children.

 

 

Types of soft tissue sarcoma

There are many types of soft tissue sarcoma, and they tend to grow and develop differently. The most common types are described below. Your doctor will be able to give you more details about which type of sarcoma you have. Each type of sarcoma is named after the type of cell from which it has grown, rather than the part of the body in which it started.

1. Fibrosarcomas.

1. Myxofibrosarcomas.

1. Desmoid tumours.

1. Liposarcomas.

1. Synovial sarcomas.

1. Rhabdomyosarcomas.

1. Leiomyosarcomas.

1. Malignant peripheral nerve sheath tumours (MPNST).

1. Angiosarcomas.

1. Gastrointestinal stromal tumours (GIST).

1. Kaposi’s sarcoma (KS).

1. Other sarcomas.

1. Ewing’s tumours.

1. Soft tissue sarcomas in children.

 

Fibrosarcoma : – Fibrosarcoma is a malignant tumor that arises from fibroblasts (cells that produce connective tissue). This is a type of sarcoma that is predominantly found in the area around bones or in soft tissue.

Myxofibrosarcomas : – This is a type of fibrous sarcoma and the most common type of sarcoma in older people. They were previously called malignant fibrous histiocytomas (MFH). It is not clear which type of cell they start from. Myxofibrosarcomas can affect any part of the body, but most commonly occur in the arms or legs

Desmoid tumors : – Desmoid tumors arise from connective tissue – the cells involved with the formation of muscle, fibrous and nerve tissue. Desmoid tumors, also called aggressive fibromatoses, are locally aggressive. This means that they can grow into and even destroy adjacent normal tissues, even bones. They do not, however, have the capacity to spread distantly (metastasize) throughout the body. Hence, most doctors consider desmoid tumors to be benign and not malignant.

Liposarcomas : – These sarcomas start in the body’s fat cells. They can grow anywhere in the body and most commonly affect middle-aged people. Some grow very slowly (taking many years to develop) and others more quickly.

Synovial sarcomas : – Synovial sarcomas usually start near to joints, such as the knee or elbow, but can occur in any part of the body. They usually appear as hard lumps and are more common in younger adults.

Rhabdomyosarcomas : – Rhabdomyosarcomas grow in the active muscles of the body that we can control. These muscles are known as skeletal muscle or striated muscle. Rhabdomyosarcomas occur mostly in the head, neck and pelvis, but can occur in the arms or legs.

 

There are three sub-types of rhabdomyosarcoma: embryonal, alveolar and pleomorphic.

Embryonal : – Embryonal rhabdomyosarcomas tend to occur more commonly in children, while alveolar rhabdomyosarcomas occur more in the limbs of teenagers and young adults. Pleomorphic rhabdomyosarcoma tends to occur in middle-aged people.

Leiomyosarcomas : – Leiomyosarcomas start from smooth muscle that is not under our conscious control. Smooth muscle is also called involuntary muscle and forms the walls of the womb, stomach, intestine and the blood vessels. Leiomyosarcoma is one of the more common types of sarcoma and can occur anywhere in the body.

Malignant peripheral nerve sheath tumours (MPNST) : – These sarcomas arise in the cells that cover nerve cells and can occur anywhere in the body. The cells around the nerve cells are called schwann cells. MPNST can also be called malignant schwannomas or neurofibrosarcomas. They most commonly occur in people who have a rare genetic disorder called neurofibromatosis (von Recklinghausen’s disease).

Angiosarcomas : – Angiosarcomas start from the cells that make up the walls of blood or lymph vessels. If they develop from blood vessels they are called haemangiosarcomas. If they start from the lymph vessels they are called lymphangiosarcomas. Angiosarcomas sometimes arise in a part of the body that has been treated with radiotherapy many years before.

Gastrointestinal stromal tumours (GIST) : – GISTs are sarcomas that develop from the connective tissues in the walls of the digestive system. The digestive system is often called the gastrointestinal (GI) tract. This type of tumour may also be called GI stromal sarcoma. They behave differently from other types of sarcoma and are treated very differently.

Kaposi’s sarcoma (KS) : – Although Kaposi’s sarcoma is a type of sarcoma, it differs from other sarcomas in the way it develops. It starts from cells in the skin. Coloured patches or lumps can develop in the skin, in the mouth, and in the lymph nodes or internal organs such as the lung, liver or spleen.

Kaposi’s sarcoma can affect people with a weakened immune system, including people with HIV and Aids. Other types can affect people of Jewish, Italian and West African origin. Kaposi’s sarcoma is treated differently to other types of soft tissue sarcoma.

Other sarcomas : –

 

There are other, much rarer, types of sarcoma. These include : –

1)alveolar soft part sarcoma.
2)dermatofibrosarcoma protuberans (DFSP).
3)desmoplastic small round cell tumours.
4)epithelioid sarcomas.
5)extraskeletal myxoid chondrosarcomas.
6)giant cell fibroblastoma (GCF).

RISKS FACTORS OF SARCOMA CANCER

Age : – Soft tissue sarcoma can be diagnosed at any age, but is more likely to develop in people over 30.

Radiation : – Radiotherapy given as a treatment for other cancers can sometimes cause a sarcoma to develop years after the original treatment. This is because the radiation can affect healthy tissue in the treated area. A radiation induced sarcoma will not usually develop for at least 10 years after the original treatment. This is quite rare.

Radiotherapy and surgery for breast cancer can cause lymphoedema. A very small number of women with lymphoedema of the arm have gone on to develop a form of sarcoma called lymphangiosarcoma. We must stress that this is very rare and can take many years to develop.

Family history : –
There are a few rare genetic conditions that can increase your risk of getting a sarcoma. These are

1)  Neurofibromatosis.
2)  Li-Fraumeni syndrome.
3)  Retinoblastoma.

It is very unlikely that any of these conditions run in your family and you do not know about it. Any genetic condition can crop up in a family that has not had it before. But this is extremely rare. It happens because the same genetic fault that causes the disease to run in families has occurred randomly in a developing baby.

Neurofibromatosis : – is a genetic disease that causes non cancerous (benign) tumours to form in the nerves under the skin and in other parts of the body. But the risk of getting a very rare sarcoma called a malignant peripheral nerve sheath tumour is increased. About 15% of people with neurofibromatosis will have one of these cancers.

 

Li Fraumeni syndrome : – is a genetic syndrome that causes many cancers to occur in the affected families. It is sometimes called family cancer syndrome. Families with Li Fraumeni syndrome are at a higher risk of breast cancer, brain tumours, leukaemias and other cancers. They are also at a higher risk of developing soft tissue sarcomas.

 

Retinoblastoma : – is a type of inherited eye cancer. It is nearly always diagnosed in childhood. Children who have had retinoblastoma also have an increased risk of developing a soft tissue sarcoma in the future. They also have an increased risk of getting a bone tumour (osteosarcoma).

 

Exposure to chemicals : –

Several chemicals are thought to be linked to sarcomas. These include

Vinyl chloride (a chemical used in making plastics. PVC is poly vinyl chloride).
Some types of herbicides (weedkillers)
Dioxins (a defoliant)

Injury : –
Sometimes people think that an injury has caused a cancer. There is no evidence that an injury of any kind can cause a sarcoma. Because of the swelling, an injury may lead to a cancer that was already there being diagnosed. Cancers take many years to develop. In most cases where people think an injury responsible, the injury has only happened recently and so is unlikely to be linked to the cancer.

 

Symptoms / Signs of Sarcoma Cancer

1. Bone pain is the most common problem causing the patient to see a doctor – although specific complaints vary.

1. Progressing pain and/or swelling and fever may occur.

1. Pain may be worse at night.

1. Pain may be relieved by rest / not putting weight on the affected limb.

1. Symptoms similar to those of injuries, bursitis, arthritis or benign bony tumors, so diagnosis is difficult.

 

Diagnosis of Sarcoma Cancer

The only reliable way to determine if a soft tissue tumor is benign or cancerous is through a surgical biopsy. During this procedure, your doctor makes an incision or uses a special needle to remove a sample of tumor tissue. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually determine the type of cancer and its grade. The grade of the tumor is determined by how abnormal the cells appear when examined under a microscope. The grade predicts the probable growth rate of the tumor and its tendency to spread. Low-grade sarcomas, although cancerous, are unlikely to metastasize or spread. High-grade sarcomas are more likely to spread to other parts of the body.

 

Treatment of Sarcoma Cancer in India

Treatment options for soft tissue sarcomas include surgery, radiation therapy, and chemotherapy. The specific treatment plan for your child will depend on the stage of the cancer, which is based on size and grade of the tumor and whether it has spread to other parts of the body.

Surgery for Sarcoma Cancer in India : –

1.  Surgery is the most common treatment for soft tissue sarcomas. Your doctor may remove the cancer and a safe margin of healthy tissue around it. Depending on the size and location of the sarcoma, it may be necessary to remove all or part of an arm or leg but amputation is rare. In most cases, radiation or chemotherapy is given before surgery to shrink the tumor or after surgery to kill remaining cancer cells.

Radiation Therapy for Sarcoma Cancer in India : –

2. Radiation therapy is treatment with high-dose X-rays, given before surgery to shrink tumors or after surgery to kill any cancer cells that may have been left behind.

Chemotherapy for Sarcoma Cancer in India : –

Chemotherapy is treatment with anti-cancer drugs. Chemotherapy may be used to shrink tumors and make the tumor more accessible for removal by surgery or radiation treatment, or sometimes both. If the cancer has spread to other areas of the body, treatment is more difficult. In some situations, intense therapy with drugs, radiation and surgery followed by bone marrow or peripheral stem cell transplant may be used. Some children may be eligible to participate in research projects, or clinical trials, to test new anti-cancer drugs. Patients with soft tissue sarcomas usually receive chemotherapy intravenously, meaning it’s injected into a blood vessel.

Testicular Cancer

 

Testicular Cancer

Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.

Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 34. The cause of testicular cancer is unknown.

Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify growths early, when the chance for successful treatment of testicular cancer is highest.

Symptoms of Testicular Cancer

Testicular cancer can result in a number of signs and symptoms.

 

These may include : –

1)A lump or enlargement in either testicle
2)A feeling of heaviness in the scrotum
3)A dull ache in the abdomen or groin
4)A sudden collection of fluid in the scrotum
5)Pain or discomfort in a testicle or the scrotum
6)Enlargement or tenderness of the breasts
7)Unexplained fatigue or a general feeling of not being well

Cancer usually affects only one testicle.

 

 

[ Male reproductive system ]

 

 

[ Testicular lumps ]

 

Risk factors of Testicular Cancer

 

Researchers don’t know what causes testicular cancer. Risk factors may include : –

1)  An undescended testicle (cryptorchidism). The testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who have a testicle that never descended are at greater risk of testicular cancer than are other men are. The risk remains, even if the testicle has been surgically relocated to the scrotum. Still, the majority of men who develop testicular cancer don’t have a history of undescended testicles.
2)  Abnormal testicle development. Conditions that cause testicles to develop abnormally, such as Klinefelter’s syndrome, may increase your risk of testicular cancer.
3)  Family history. If other family members have had testicular cancer, you may have an increased risk.
4)  Age. Testicular cancer affects teens and younger men, particularly those between ages 15 and 34. However, it can occur at any age.
5)  Race. Testicular cancer is more common in white men than in black men. The reason for racial differences in the incidence of testicular cancer is unknown.

Causes of Testicular Cancer

Nearly all testicular cancers begin in the germ cells – the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn’t known.

Tests and diagnosis of Testicular Cancer

Most men discover testicular cancer themselves, either unintentionally or while doing a testicular self-examination to check for lumps. In other cases, your doctor may detect a lump during a routine physical exam.

To determine whether a lump is testicular cancer, your doctor may recommend : –

1)Ultrasound. A testicular ultrasound test uses sound waves to create a picture of the scrotum. During an ultrasound you lie on your back with your legs spread. Your doctor then applies a clear gel to your scrotum. A hand-held probe is moved over your scrotum to make the ultrasound image. 

An ultrasound test can help your doctor determine the nature of any testicular lumps, such as if the lumps are solid or fluid filled. Ultrasound also tells your doctor whether lumps are inside or outside of the testicle. Your doctor uses this information to determine whether a lump is likely to be testicular cancer.
2)Blood tests. Your doctor may order tests to determine the levels of tumor markers in your blood. Tumor markers are substances that occur normally in your blood, but the levels of these substances may be elevated in certain situations, including testicular cancer. A high level of a tumor marker in your blood doesn’t mean you have cancer, but it may help your doctor in determining your diagnosis.
3)Surgery to remove a testicle (radical inguinal orchiectomy). If your doctor determines the lump on your testicle may be cancerous, he or she may recommend surgery to remove the testicle. Your testicle will be analyzed in a laboratory to determine if the lump is cancerous and, if so, what type of cancer. 

In general, a biopsy or removal of the lump alone isn’t used when testicular cancer is suspected. However, a biopsy may be an option in certain situations, for instance, if you have only one testicle.

Determining the type of cancer

Your doctor will have your extracted testicle analyzed to determine the type of the testicular cancer. The type of testicular cancer you have determines your treatment and your prognosis.

 

In general, there are two types of testicular cancer : –

Seminoma. Seminomas occur in all age groups, but if an older man develops testicular cancer it is more likely to be seminoma. Seminomas, in general, aren’t as aggressive as nonseminomas, and are particularly sensitive to radiation therapy.

Nonseminoma. Nonseminoma tumors tend to develop earlier in life and grow and spread rapidly. Several different types of nonseminomatous tumors exist, including choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumor. Nonseminomatous tumors are sensitive to radiation therapy, but not as sensitive as seminomas. Chemotherapy is often very effective for nonseminomas, even if the cancer has spread. 

Sometimes both types of cancer are present in a tumor. In that case, the cancer is treated as though it is nonseminoma.

Staging the cancer

Once your doctor confirms your diagnosis, the next step is to determine the extent (stage) of the cancer.

 

To determine whether cancer has spread outside of your testicle, you may undergo : –

Computerized tomography (CT) : – CT scans take a series of X-ray images of your abdomen. Your doctor uses CT scans to look for signs of cancer in your abdominal lymph nodes.

X-ray : – An X-ray of your chest may determine whether cancer has spread to your lungs.
Blood tests : – Blood tests to look for elevated tumor markers can help your doctor understand whether cancer likely remains in your body after your testicle is removed.

After these tests, your doctor assigns your testicular cancer a stage. The stage helps determine what treatments are best for you.

The stages of testicular cancer are : –

1)  Stage I : – Cancer is limited to the testis.
2)  Stage II : – Cancer has spread to the lymph nodes in the abdomen.
3)  Stage III : – Cancer has spread to other parts of the body. Testicular cancer most commonly spreads to the lungs, liver, bones and brain.

Treatments of Testicular Cancer

The options you have for treating your testicular cancer depend on several factors, including the type and stage of your cancer, your overall health and your own preferences

Treatment options may include : –

1)Surgery : – Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer. To remove your testicle, your surgeon makes an incision in your groin and extracts the entire testicle through the opening. A prosthetic, saline-filled testicle can be inserted if you choose. You’ll receive anesthesia during surgery. All surgical procedures carry a risk of pain, bleeding and infection. 

You may also have surgery to remove the lymph nodes in your groin (retroperitoneal lymph node dissection). Sometimes this is done at the same time as surgery to remove your testicle. In other cases it can be done later. Your lymph nodes are removed through a large incision in your abdomen. Your surgeon takes care to avoid severing nerves surrounding the lymph nodes, but in some cases severing the nerves may be unavoidable. Severed nerves can cause difficulty ejaculating, but won’t prevent you from having an erection. A newer technique called nerve-sparing surgery may be an option. 

In cases of early-stage testicular cancer, surgery may be the only treatment needed. Your doctor will give you a recommended schedule for follow-up appointments. At these appointments – typically every few months for the first few years and then less frequently after that – you’ll undergo blood tests, CT scans and other procedures to check for signs that your cancer has returned. If you have a more advanced testicular cancer or if you’re unable to adhere closely to the recommended follow-up schedule, your doctor may recommend other treatments after surgery. 

2)Radiation therapy : – Radiation therapy may be a treatment option if you have the seminoma type of testicular cancer. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you’re positioned on a table and a large machine moves around you, aiming the energy beams at precise points on your body. Side effects may include fatigue, as well as skin redness and irritation in your abdominal and groin areas. You may experience infertility as a result of radiation therapy. However, as the treated area heals you may regain your fertility. 

3)Chemotherapy : – Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout your body to kill cancer cells that may have migrated from the original tumor. Your doctor might recommend chemotherapy after surgery. Chemotherapy may be used before or after lymph node removal. Side effects of chemotherapy depend on the drugs being used. Ask your doctor what to expect. Common side effects include fatigue, nausea, hair loss, infertility and an increased risk of infection. 
4)Treatment for advanced or recurrent testicular cancer : –If your cancer hasn’t responded to other treatments or if your cancer has returned, you and your doctor may consider other treatments. You may consider enrolling in a clinical trial. These research studies give you a chance to try experimental treatments and procedures that are being developed for future use. Clinical trials aren’t guaranteed to bring a cure, and side effects of new medications may not be known. Ask your doctor about clinical trials that are open to people with testicular cancer, as well as the possible risks and benefits of experimental treatments. 

One treatment being studied for use in advanced testicular cancer is stem cell transplant. Before a stem cell transplant, you’re given drugs that coax your body’s bone marrow stem cells out of your bones and into your bloodstream. Then the stem cells are filtered from your blood and frozen for later use. You then undergo high doses of chemotherapy to kill any cancer cells in your body, which may also kill bone marrow cells. Your stored stem cells are thawed and put back into your body to replenish your bone marrow cells.

Gallbladder Cancer

 

Definition

Gallbladder cancer and bile duct cancer are rare cancers of the biliary tract. Your gallbladder stores and your bile duct transports bile, a fluid produced by your liver that’s essential to the digestive process.

Gallbladder cancer seldom produces symptoms in the early stages. In fact, early gallbladder cancer is often only discovered when the gallbladder is removed as a treatment for gallstones. Otherwise, gallbladder cancer is often quite advanced by the time it’s diagnosed.

When gallbladder cancer is caught early, removing your gallbladder or part of the bile duct may eliminate all the cancerous cells. In advanced cases, treatment won’t cure gallbladder cancer but can help relieve symptoms and improve your quality of life.

Symptoms

Gallbladder cancer rarely produces early signs and symptoms. When symptoms do appear, they often resemble those of other, more common, gallbladder problems such as gallstones or infection.

Gallbladder cancer symptoms include : –

1)Abdominal pain : – Many people with gallbladder cancer have some abdominal pain – usually in the upper right part of the abdomen.
2)Nausea and vomiting : – These symptoms can occur when a tumor blocks the common bile duct.
3)Yellowing of your skin and the whites of your eyes (jaundice) : – Jaundice results from high blood levels of bilirubin – the residue from the breakdown of red blood cells. Normally, bilirubin is metabolized in your liver and eliminated through the bile ducts. But a blocked bile duct can cause bilirubin to accumulate in your blood. The built-up pigments may turn your skin and the whites of your eyes yellow and your urine dark brown. Because bilirubin isn’t being eliminated through your bile, your stools also may turn pale yellow or white.
4)Unintended weight loss or loss of appetite : – Tumors can prevent the normal passage of food or interfere with its absorption by blocking the flow of pancreatic enzymes.

Signs and symptoms of bile duct cancer (cholangiocarcinoma) : –

1)Jaundice : – A yellowing of your skin and the whites of your eyes, along with tea- or coffee-colored urine and light-colored stools, are common initial signs of bile duct cancer.
2)Enlarged gallbladder : – A blocked bile duct can cause bile to accumulate in your gallbladder, making it larger than normal. Although your gallbladder is hidden behind other organs in your abdomen, your doctor can sometimes feel this enlargement during a physical exam or it may be detected on an ultrasound.
3)Intense itching (pruritis) : – When the flow of bile is obstructed by a tumor, bile salts may be deposited in your skin, leading to intense itching.

Causes

Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. Its main function is to store bile, a bitter, yellow-green fluid that’s produced in the liver cells. Bile is essential for the proper digestion of fats and is one of the main ways your body eliminates drugs, cholesterol and waste products of metabolism. It flows from your liver through a thin tube called the common hepatic duct and enters your gallbladder through another small tube (cystic duct).

When you eat, your gallbladder releases a highly concentrated form of bile into the common bile duct, a continuation of the hepatic and cystic ducts. The bile flows through this duct to the upper part of your small intestine (duodenum), where it begins to break down the fat in your food.

How gallbladder cancer begins : –

Healthy cells grow and divide in an orderly way – a process that’s controlled by DNA, the genetic material that contains the instructions for every chemical process in your body. When DNA is damaged, changes occur in these instructions. One result is that cells may begin to grow out of control and eventually form a malignant tumor – a mass of cancerous cells.

Although the exact cause of gallbladder and bile duct cancers isn’t clear, researchers believe that DNA in the cells of your biliary tract may be damaged by toxins that are routinely metabolized by your liver. These toxins are released into bile so that they can be eliminated from your body. But if bile empties more slowly than normal, it increases the amount of time your cells are exposed to cancer-causing substances (carcinogens).

Most gallbladder tumors develop in the cells that line the inner surface of the gallbladder. These tumors are most commonly adenocarcinomas – a term that describes the way the cancer cells look when viewed under a microscope.

Gallbladder adenocarcinoma is highly invasive and can quickly penetrate deep into the gallbladder wall, moving through layers of tissue from the inner surface to the outside of the gallbladder. Eventually the cancer may spread to nearby lymph nodes, obstruct the bile duct or invade other organs such as the liver. Cancer cells may also travel through the bloodstream to more remote parts of the body.

 

 

[ Gallbladder and bile duct ]

 

Bile duct cancer (cholangiocarcinoma) : –

Cancer can develop in any part of the bile duct that stretches from your liver to your small intestine. Many tumors occur in the hepatic duct just as it leaves the liver (perihilar tumors). Other tumors may develop in the bile duct near your small intestine (distal tumors) or inside the liver itself (intrahepatic tumors).

The majority of bile duct cancers are adenocarcinomas that originate in the mucous glands lining the inside of the ducts. By the time these cancers are diagnosed, they often have spread to other tissues and organs.

Risk factors

 

A number of factors may increase your risk of both gallbladder and bile duct tumors, including : –

1)Gallstones : – These solid deposits of cholesterol or calcium salts form in your gallbladder, they are the most common risk factor for gallbladder cancer. The stones may cause your gallbladder to release bile more slowly, which increases the amount of time cells are exposed to toxins. Although most people with gallbladder cancer also have gallstones, the vast majority of people with gallstones never develop gallbladder cancer.
2)Age : – The chances of developing gallbladder cancer increase as you get older. Most people diagnosed with gallbladder cancer are in their 70s. Bile duct cancer is most common in those over 65.
3)Your sex : – Women are at least twice as likely as men are to develop gallbladder cancer. They’re also more likely to have gallstones because the female hormone estrogen causes more cholesterol, the main component of most gallstones, to be excreted in bile. But, bile duct cancers are more likely to occur in men than they are in women.
4)Bile duct abnormalities : – The pancreatobiliary duct junction is the point where the common bile duct – which carries bile from your liver and gallbladder to your small intestine – joins the pancreatic duct carrying digestive juices from your pancreas. In some people, these two ducts connect in a way that allows pancreatic juices to back up into the bile duct and prevents bile from being quickly emptied into the small intestine. This may irritate the cells lining the gallbladder and bile ducts, increasing the risk of cancer.
5)Gallbladder polyps : – These are growths on the inner surface of your gallbladder. Most aren’t cancerous, but polyps can contain malignant cells.
6)Diet : – Eating food high in carbohydrates and low in fiber may increase your risk of gallbladder cancer.
7)Hazardous chemicals and toxic substances : – People exposed to certain industrial chemicals, especially azotoluene, have an increased risk of developing gallbladder cancer. Thorium dioxide (Thorotrast), a dye once used in X-rays, can cause both liver and bile duct cancers. Although Thorotrast hasn’t been used for decades, exposure to other toxic materials – including dioxin, nitrosamines and polychlorinated biphenyls (PCBs) – may increase your risk of bile duct cancer.
8)Obesity : – If you are very overweight (about 30 pounds more than your ideal weight), you’re at increased risk of gallbladder cancer. It’s estimated that as many as one in every four cases of gallbladder cancer is linked to excess weight.
9)Race : – American Indians, especially those living in the Southwest, are five times as likely to develop gallstones and gallbladder cancer as whites are. Hispanics also have higher rates of gallbladder cancer than whites do.
10)Primary sclerosing cholangitis (PSC) : – This autoimmune disorder causes your immune system to attack your bile ducts. PSC creates scar tissue that narrows the bile ducts and prevents bile from reaching your intestines. Over time, repeated injury to bile duct tissue can increase the likelihood of developing cancer.
11)Ulcerative colitis : – Another autoimmune disease, ulcerative colitis is characterized by severe bouts of bloody diarrhea with abdominal pain and cramping.
12)Congenital abnormalities of the bile ducts : – These include choledochal cysts, which is a dilation or stretching of the common bile duct, and Caroli’s disease – a dilation of the bile ducts within your liver (intrahepatic ducts). Over time bile that collects in these dilated spaces may seriously damage the duct lining.
13)Bile duct stones : – Gallstones sometimes escape the gallbladder and enter the cystic duct, the common bile duct or, occasionally, the duct leading to your pancreas. These migrating stones can cause serious complications, including an increased chance of developing bile duct cancer.
14)Parasitic infections : – These are primarily a concern in Asian countries. Parasitic infections generally occur when humans eat fish containing the cysts of certain flatworms. The worms migrate to the bile ducts, where they damage the duct lining.

When to seek medical advice : –

See your doctor right away if you develop any of the signs and symptoms of biliary tract problems, such as : –

1)Jaundice
2)Nausea and vomiting
3)Abdominal pain
4)Severe itching
5)Dark urine
6)Clay-colored stools

Although these symptoms often aren’t related to cancer, they may indicate other conditions that require medical care.

Tests and diagnosis

Many gallbladder cancers are discovered after a laboratory examination of a gallbladder that’s been removed for other reasons. Only about one-quarter of gallbladder cancers are diagnosed before the cancer is advanced.

Diagnosing gallbladder cancer earlier than this is difficult because the gallbladder is hidden behind the liver and is relatively inaccessible, because signs and symptoms don’t develop until late in the disease, and because when symptoms do appear, they can easily be mistaken for those of many other, more common conditions.

To help detect the existence and spread of gallbladder cancer, you’re likely to have one or more of the following : –

1)Blood tests : – Your doctor may order tests to check for elevated levels of bilirubin or the enzyme alkaline phosphatase, which is released by damaged bile duct cells. You might also have tests to measure certain substances (markers) in your blood that sometimes indicate the presence of a tumor. People with bile duct cancer tend to have high levels of the marker CA 19-9. But CA 19-9 levels can be elevated in people with other types of cancer as well as in people who are cancer-free. For that reason, this isn’t considered a definitive test.
2)Ultrasound : – This test uses high-energy sound waves to produce images of your internal organs, including your gallbladder. It has no side effects, isn’t invasive and generally takes less than 30 minutes. During the procedure, you lie on a bed or table, and a wand-shaped device (transducer) that emits high-frequency sound waves is placed on your body. The sound waves are reflected from your gallbladder back to the transducer and then translated into a moving image. 

Ultrasound is usually one of the first tests done in cases of jaundice and is especially good at providing information about the shape and texture of tumors as well as diagnosing the presence of gallstones and obstructed bile ducts. 

Endoscopic ultrasound (EUS) is a technique that can sometimes provide even better images. In this test, an ultrasound transducer is attached to the end of a flexible, lighted viewing tube (endoscope). The endoscope is passed down your throat into your stomach and duodenum, and from there into the common bile duct.
3)Computerized tomography (CT) scan : – This is essentially a highly detailed X-ray that allows your doctor to see your gallbladder in two-dimensional slices. Split-second computer processing creates these images while a series of thin X-ray beams passes through your body. In most cases, you’ll have a dye (contrast medium) injected into a vein before the test. By producing clearer images, the dye makes it easier to distinguish a tumor from normal tissue. A CT scan can also help determine if cancerous cells have spread to the common bile duct, lymph nodes or liver. 

Your greatest risk is a possible allergic reaction to the dye. CT scans also expose you to more radiation than do ordinary X-rays.
4)Magnetic resonance imaging (MRI) : – Instead of X-rays, this test uses a powerful magnetic field and radio waves to create images. Used in combination with cholangiography – a test in which a small amount of dye is used to highlight the biliary tract – it can help determine whether the flow of bile is blocked or a tumor has invaded your liver. During the test, you’re encased in a cylindrical tube that can seem confining. The machine also makes a loud thumping noise. In most cases you’ll be given headphones for the noise. If you’re claustrophobic, mild sedation may be an option for you.
5)Endoscopic retrograde cholangiopancreatography (ERCP) : – In this procedure, an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. Your intestinal tract is inflated with air so that your doctor can more easily see the openings of the bile and pancreatic ducts, and a dye is injected into the ducts through a catheter that’s passed through the endoscope. Finally, X-rays are taken of the ducts. 

In spite of pain medication, the procedure can be uncomfortable. Your throat also may be sore for a time after the procedure, and you may feel bloated from the air introduced into your intestine. Major complications are rare and include infection and bleeding. This test is most sensitive for detecting an obstruction of the bile ducts and its cause.
6)Laparoscopy : – A more invasive procedure than ERCP, laparoscopy also uses a small, lighted instrument (laparoscope) to view your gallbladder, liver and surrounding tissue. But in this case, the instrument is attached to a television camera and inserted through a small incision in your abdomen. During the procedure, your surgeon may take tissue samples to help confirm the diagnosis of cancer. Laparoscopy is often used to confirm how far cancer has spread. Risks include bleeding and infection and injury to your abdominal organs or blood vessels.
7)Biopsy : – In this procedure, a small sample of tissue is removed and examined for malignant cells under a microscope. It’s the only way to make a definitive diagnosis of cancer. 

Biopsies of the gallbladder and bile ducts can be obtained in several ways. Your doctor may take tissue samples during laparoscopy. Or you may have fine-needle aspiration (FNA), a procedure in which a very thin needle is inserted through your skin and into your gallbladder. An ultrasound or CT scan is often used to guide the needle’s placement. 

When the needle has reached the tumor, cells are withdrawn and sent to a lab for further study. Tissue samples can also be removed during or after gallbladder surgery. 

Bile duct cells and tiny fragments of duct tissue can be obtained through a procedure known as biliary brushing. As in ERCP, an endoscope is inserted into the bile duct where it empties into your small intestine. But instead of injecting dye and taking X-rays, your surgeon uses a small brush placed in the endoscope to scrape cells and bits of tissue from the lining of your bile duct.

Staging biliary tract cancers : –

Staging tests help determine the size and location of cancer and whether it has spread. This information helps determine the best treatment options.

Doctors stage biliary tract cancers in several ways. One method is as follows : –

1)  Resectable : – These cancers have not spread beyond the walls of the gallbladder or bile ducts and can be entirely removed in an operation. The term “resectable” refers to a cancer that can be removed.
2)  Unresectable : – At this stage, the cancer has spread to nearby lymph nodes or other organs such as the liver, pancreas,

stomach or intestines and can’t be completely removed.

3)  Recurrent : – This refers to cancer that returns after it has been treated. It may recur in the gallbladder or bile duct or in

some other part of the body.

 

Treatments and drugs

Gallbladder cancer treatment depends on the type and stage of cancer, as well as on your age, overall health, feelings and personal preferences. Especially when cancer is advanced, choosing a treatment plan is a major decision, and it’s important to take enough time to consider your choices.

You may also want to consider seeking a second opinion. This can provide additional information to help you feel more certain about the option you’re considering.

The goal of any treatment is to eliminate the cancer completely. When that isn’t possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best. Palliative care refers to treatment aimed not at removing or slowing the disease, but at helping relieve symptoms and making you as comfortable as possible.

Gallbladder cancer : –

Surgical removal (resection) of the gallbladder usually offers the best hope for people with gallbladder cancer. If the tumor is very small and hasn’t spread to the deeper layers of gallbladder tissue, your surgeon may perform a simple cholecystectomy, which removes only the gallbladder. Sometimes this may be done laparoscopically, using a camera and miniature instruments inserted through small incisions in your abdomen.

If the cancer is more advanced, your surgeon will likely perform what’s known as an extended cholecystectomy – an operation in which some liver tissue and nearby lymph nodes are removed along with your gallbladder.

Once the cancer has spread beyond the walls of your gallbladder, it can no longer be completely removed with an operation. In that case, your treatment team will discuss other options with you. These may include radiation – either external beam radiation (high-energy X-rays) or implanted radiation “seeds” – or chemotherapy, which is anti-cancer medication.

These additional treatments may be used alone or in combination. Some doctors believe that radiation together with chemotherapy after surgery is more effective than either alone.

Radiation and chemotherapy may also be used for palliative care to help make you more comfortable if your cancer is so advanced that treating the cancer is no longer an option. For example, either treatment may be used to help shrink a tumor that’s blocking a bile duct.

 

Bile duct cancer : –

Surgery usually offers the best chance for people with bile duct cancer.

But the type of operation you may have will vary, depending on the location of the cancer and how extensive it is : –

1)Perihilar tumors : – Tumors that develop where the hepatic duct leaves your liver (perihilar tumors) are usually treated by surgically removing a portion of the bile duct, the gallbladder and surrounding lymph nodes.
2)Distal tumors : – Treatment for these tumors, located in the bile duct near your small intestine, is often by what’s known as a Whipple resection. In this operation, your surgeon removes part of your pancreas, the common bile duct and your gallbladder, as well as a small portion of your intestine where the common bile duct and pancreatic duct enter the intestine together.
3)Tumors that can’t be removed : – When a tumor is too close to major blood vessels, your surgeon may suggest an operation to bypass some of your small intestine. This may help prevent further blockage of your bile duct and digestive tract and may also help relieve symptoms, but won’t cure the cancer. If a bypass isn’t an option, your surgeon may place metal or plastic tubes known as stents into the bile duct to keep it open. After surgery, your doctor may also recommend radiation or chemotherapy.

Clinical trials : –

Because standard treatments are rarely effective for advanced biliary tract cancers, you may want to consider participating in a clinical trial. This is a study that tests new therapies – typically new drugs, different approaches to surgery or radiation treatments, and novel methods such as gene therapy. If the therapy being tested proves to be safer or more effective than current treatments, it will become the new standard of care.

Treatments used in clinical trials haven’t yet been shown to be effective. They may have serious or unexpected side effects, and there’s no guarantee you’ll benefit from them. On the other hand, cancer clinical trials are closely monitored by the federal government to ensure they’re conducted as safely as possible. And they offer access to treatments that wouldn’t otherwise be available to you. New methods of chemotherapy and radiation are currently in clinical trials.

Stomach Cancer

 

Stomach Cancer

Stomach cancer is cancer that occurs in the stomach – the muscular sac located in the upper middle of your abdomen, just below your ribs. Your stomach is responsible for receiving and holding the food you eat and then helping to break down and digest it. Another term for stomach cancer is gastric cancer. These two terms most often refer to stomach cancer that begins in the mucus-producing cells on the inside lining of the stomach (adenocarcinoma). Adenocarcinoma is the most common type of stomach cancer.

Stomach cancer is uncommon in the United States, and the number of people diagnosed with the disease each year is declining. Stomach cancer is much more common in other areas of the world, particularly Japan.

Symptoms

Signs and symptoms of stomach cancer may include : –

1)  Fatigue
2)  Feeling bloated after eating
3)  Feeling full after eating little
4)  Heartburn
5)  Indigestion
6)  Nausea
7)  Stomach pain
8)  Vomiting
9)  Weight loss

When to see a doctor

If you have signs and symptoms that worry you, make an appointment with your doctor. Your doctor will likely investigate more common causes of these signs and symptoms first.

Causes

 

 

Doctors aren’t sure what causes stomach cancer. There is a strong correlation between a diet high in smoked, salted and pickled foods and stomach cancer. As the use of refrigeration for preserving foods has increased around the world, the rates of stomach cancer have declined.

In general, cancer begins when an error (mutation) occurs in a cell’s DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when normal cells would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancer cells can break off from the tumor to spread throughout the body.

 

Types of stomach cancer

The cells that form the tumor determine the type of stomach cancer. The type of cells in your stomach cancer helps determine your treatment options.

Types of stomach cancer include : –

1)Cancer that begins in the glandular cells (adenocarcinoma) : – The glandular cells that line the inside of the stomach secrete a protective layer of mucus to shield the lining of the stomach from the acidic digestive juices. Adenocarcinoma accounts for more than 90 percent of all stomach cancers.
2)Cancer that begins in immune system cells (lymphoma). The walls of the stomach contain a small number of immune system cells that can develop cancer. Lymphoma in the stomach is rare.
3)Cancer that begins in hormone-producing cells (carcinoid cancer). Hormone-producing cells can develop carcinoid cancer. Carcinoid cancer is rare.
4)Cancer that begins in nervous system tissues. A gastrointestinal stromal tumor (GIST) begins in specific nervous system cells found in your stomach. GIST is a very rare form of cancer.

Because the other types of stomach cancer are rare, when people use the term “stomach cancer” they generally are referring to adenocarcinoma.

Risk factors

 

A diet high in salty and smoked foods

 

Factors that increase your risk of stomach cancer include : –

1)  A diet low in fruits and vegetables
2)  Eating foods contaminated with aflatoxin fungus
3)  Family history of stomach cancer
4)  Infection with Helicobacter pylori
5)  Long-term stomach inflammation (chronic gastritis)
6)  Pernicious anemia
7)  Smoking
8)  Stomach polyps

Tests and diagnosis

 

Tests and procedures used to diagnose stomach cancer include : –

A tiny camera to see inside your stomach (upper endoscopy) : – A thin tube containing a tiny camera is passed down your throat and into your stomach. Your doctor can look for signs of cancer. If any suspicious areas are found, a piece of tissue can be collected for analysis (biopsy).

Imaging tests : – Imaging tests used to look for stomach cancer include computerized tomography (CT) and a special type
of X-ray sometimes called a barium swallow.

Determining the extent (stage) of stomach cancer

The stage of your stomach cancer helps your doctor decide which treatments may be best for you

 

Tests and procedures used to determine the stage of cancer include : –

Imaging tests : – Tests may include CT, positron emission tomography (PET) and X-ray.

Exploratory surgery : – Your doctor may recommend surgery to look for signs that your cancer has spread beyond your stomach within your abdomen. Exploratory surgery is usually done laproscopically. This means the surgeon makes several

small incisions in your abdomen and inserts a special camera that transmits images to a monitor in the operating room.

Other staging tests may be used, depending on your situation.

Stages of stomach cancer

 

The stages of adenocarcinoma stomach cancer include : –

1)Stage I : – At this stage, the tumor is limited to the layer of tissue that lines the inside of the stomach. Cancer cells may also have spread to nearby lymph nodes.
2)Stage II : – The cancer at this stage has spread deeper, growing into the muscle layer of the stomach wall. Cancer may also have spread to the lymph nodes.
3)Stage III : – At this stage, the cancer may have grown through all the layers of the stomach. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.
4)Stage IV : – This stage of cancer extends beyond the stomach, growing into nearby structures. Or it is a smaller cancer that has spread to distant areas of the body.

Treatments and drugs

Your treatment options for stomach cancer depend on the stage of your cancer, your overall health and your preferences.

Treatment for the adenocarcinoma type of stomach cancer may include : –

Surgery : –

The goal of surgery is to remove all of the stomach cancer and a margin of healthy tissue, when possible.

 

Options include : –

1)  Removing early-stage tumors from the stomach lining : – Very small cancers limited to the inside lining of the stomach may be removed using endoscopy. The endoscope is a lighted tube with a camera that’s passed down your throat into your stomach. The doctor uses special tools to remove the cancer and a margin of healthy tissue.
2)  Removing a portion of the stomach (subtotal gastrectomy) : – During subtotal gastrectomy, the surgeon removes only the portion of the stomach affected by cancer.
3)  Removing the entire stomach (total gastrectomy) : – Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system.
4)  Removing lymph nodes to look for cancer : – The surgeon examines and removes lymph nodes in your abdomen to

look for cancer cells.

5)  Surgery to relieve signs and symptoms : – Removing part of the stomach may relieve signs and symptoms of a growing tumor in people with advanced stomach cancer. In this case, surgery can’t cure stomach cancer, but it can make you more comfortable.

Surgery carries a risk of bleeding and infection. If all or part of your stomach is removed, you may experience digestive problems, such as diarrhea, vomiting and dumping syndrome, which occurs when the small intestine fills too quickly with undigested food.

 

 

Radiation therapy : –

Radiation therapy uses high-powered beams of energy to kill cancer cells. The energy beams come from a machine that

moves around you as you lie on a table.

Radiation therapy can be used before surgery (neoadjuvant radiation) to shrink a stomach tumor so it’s more easily removed. Radiation therapy can also be used after surgery (adjuvant radiation) to kill any cancer cells that might remain around your stomach. Radiation is often combined with chemotherapy. In cases of advanced cancer, radiation therapy may be used to relieve side effects caused by a large tumor.

Radiation therapy to your stomach can cause diarrhea, indigestion, nausea and vomiting.

Chemotherapy : –

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs travel throughout your body, killing cancer cells that may have spread beyond the stomach.

Chemotherapy can be given before surgery (neoadjuvant chemotherapy) to help shrink a tumor so it can be more easily removed. Chemotherapy is also used after surgery (adjuvant chemotherapy) to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy. Chemotherapy may be used alone in people with advanced stomach cancer to help relieve signs and symptoms.

Chemotherapy side effects depend on which drugs are used. The type of stomach cancer you have determines which chemotherapy drugs you’ll receive.

Clinical trials : –

Clinical trials are studies of new treatments and new ways of using existing treatments. Participating in a clinical trial may give you a chance to try the latest treatments. But clinical trials can’t guarantee a cure. In some cases, researchers might not be certain of a new treatment’s side effects.

Ask your doctor whether you may be eligible for a clinical trial. Together you can discuss the benefits and risks.

 

Kidney Cancer

 

Kidney Cancer

Your kidneys are two bean-shaped organs, each about the size of your fist. They’re located behind your abdominal organs, one on each side of your spine. Like other major organs in the body, the kidneys can sometimes develop cancer.

In adults, the most common type of kidney cancer is renal cell carcinoma, which begins in the cells that line the small tubes within your kidneys. Children are more likely to develop a kind of kidney cancer called Wilms’ tumor.

Many kidney cancers are detected during procedures for other diseases or conditions. Imaging techniques, such as computerized tomography (CT), are being used more often, which may help find more kidney cancers.

Symptoms : –

Kidney cancer rarely causes signs or symptoms in its early stages.

 

In the later stages, kidney cancer signs and symptoms may include : –

1)  Blood in your urine, which may appear pink, red or cola-colored
2)  Back pain just below the ribs that doesn’t go away
3)  Weight loss
4)  Fatigue
5)  Intermittent fever

Causes : –

Your kidneys are part of the urinary system, which removes waste and excess fluid and electrolytes from your blood, controls the production of red blood cells, and regulates your blood pressure. Inside each kidney are more than a million small filtering units called nephrons. As blood circulates through your kidneys, the nephrons filter out waste products as well as unneeded minerals and water. This liquid waste – urine – flows through two narrow tubes (ureters) into your bladder, where it’s stored until it’s eliminated from your body through another tube, the urethra.

Just what causes kidney cells to become cancerous isn’t clear. But researchers have identified certain factors that appear to increase the risk of kidney cancer.

Types of kidney cancer

 

The most common types of kidney cancer include : –

Renal cell carcinoma : – This type of kidney cancer usually begins in the cells that line the small tubes of each nephron. In most cases, renal cell tumors grow as a single mass, but you may have more than one tumor in a kidney or develop tumors in both kidneys.
Transitional cell carcinoma : – This type of kidney cancer develops in the tissue that forms the tubes that connect the kidneys to the bladder. Transitional cell carcinomas can also begin in the ureters themselves or in the bladder.

Wilms’ tumor : – Wilms’ tumor is a type of kidney cancer that occurs in young children.

 

[ Female urinary system ]

 

 

[ Male urinary system ]

 

Risk factors

Renal cell carcinoma risk factors : –

The majority of kidney cancers are renal cell carcinomas.

Risk factors for renal cell carcinoma include : –

Age : – Your risk of renal cell carcinoma increases as you age. Renal cell carcinoma occurs most commonly in people 60 and older.

Sex : – Men are more likely to develop renal cell carcinoma than women are.

Smoking : – Smokers have a greater risk of renal cell carcinoma than nonsmokers do. The risk increases the longer you smoke and decreases after you quit.
Obesity : – People who are obese have a higher risk of renal cell carcinoma than do people who are considered average weight.

High blood pressure (hypertension) : – High blood pressure increases your risk of renal cell carcinoma, but it isn’t clear why. Some research in animals has linked high blood pressure medications to an increased risk of kidney cancer, but studies in people have had conflicting results.
Chemicals in your workplace : – Workers who are exposed to certain chemicals on the job may have a higher risk of renal cell carcinoma. People who work with chemicals such as asbestos, cadmium and trichloroethylene may have an

increased risk of kidney cancer.

Treatment for kidney failure : – People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer. People who have a kidney transplant and receive immunosuppressant drugs also are more likely to develop kidney cancer.

Von Hippel-Lindau disease : – People with this inherited disorder are likely to develop several kinds of tumors, including, in some cases, renal cell carcinoma.
Hereditary papillary renal cell carcinoma : – Having this inherited condition makes it more likely you’ll develop one or more renal cell carcinomas.

Transitional cell carcinoma risk factors : –

Risk factors for transitional cell carcinoma include : –

Smoking : – Smoking increases your risk of transitional cell carcinomas.
Chemicals in your workplace : – Working with certain chemicals may increase your risk of transitional cell carcinoma.
A withdrawn medication : – Phenacetin, which was removed from the market in the United States in the early 1980s, has been linked to kidney cancer. Phenacetin was used in prescription and over-the-counter pain relievers.

Tests and diagnosis

A kidney cancer diagnosis typically begins with a complete medical history and a physical exam. Your doctor may also recommend blood and urine tests. If your doctor suspects a problem or if you’re at high risk of kidney cancer.

you may also have one or more of the following tests to check your kidneys for growths or tumors : –

Ultrasound. An ultrasound uses high-frequency sound waves to generate images of your internal organs, such as your kidneys and bladder, on a computer screen.

Computerized tomography (CT) or magnetic resonance imaging (MRI) scan : – CT scans use computers to create more-detailed images than those produced by conventional X-rays. MRI scans use magnetic fields and radio waves to generate cross-sectional pictures of your body.
Tissue sample (biopsy) : – In selected cases, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. During a biopsy, a surgeon uses ultrasound or CT images to guide a long, thin needle into your kidney to remove the cells. The cells are then examined under a microscope to determine whether they are cancer.

Biopsy procedures have risks, such as infection, bleeding and a very small chance that cancer could spread to the area where the needle is inserted. Because surgery is usually the first line treatment for kidney cancer, your doctor may forgo biopsy if

he or she believes your tumor is very likely to be cancerous. That way you avoid the additional risks of a biopsy. Kidney biopsy is typically reserved for cases that are most likely to be noncancerous or for people who can’t undergo an operation.

Additional tests for transitional cell cancer : –

Tests and procedures used to diagnose transitional cell kidney cancer may include : –

X-ray imaging of your urinary system (excretory urogram) : – X-rays of your urinary system may show signs of cancer. Your health care team will inject a dye into a vein in your arm. The dye is processed by your kidneys and your urinary system, and the dye makes it possible to see your urinary system on an X-ray.

Looking inside your bladder (cystoscopy) : – Your doctor may use a long, narrow tube called a cystoscope to see the inside of your bladder. The cystoscope, which carries a light source and a special lens, is inserted through your urethra into your bladder. A cystoscope can also be used to extract a small tissue sample (biopsy) from any suspicious areas.

Kidney cancer staging : –

Once your doctor diagnoses kidney cancer, the next step is to determine the extent, or stage, of the cancer. Staging tests for kidney cancer may include additional CT scans, a chest X-ray or other imaging scans your doctor feels are appropriate. Then your doctor assigns a number, called a stage, to your cancer

 

Kidney cancer stages include : –

I. Tumor is small and confined to the kidney
II. Tumor is larger than a stage I tumor, and is confined to the kidney
III. Tumor extends beyond the kidney to the surrounding tissue or the adrenal glands, and may also spread to a nearby lymph node
IV. Cancer spreads outside the kidney or to distant parts of the body

Treatments and drugs

Together, you and your treatment team will discuss all of your kidney cancer treatment options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your own preferences for treatment.

Surgery : –

Surgery is the initial treatment for the majority of kidney cancers.

 

Surgical procedures used to treat kidney cancer include : –

Removing the affected kidney (nephrectomy) : – Radical nephrectomy involves the removal of the kidney as well as the adrenal gland that sits atop the kidney, a border of healthy tissue and adjacent lymph nodes. Nephrectomy can be done through an incision, meaning the surgeon makes a large cut in your skin to access your kidney. Or nephrectomy can be done laparoscopically, using small incisions to insert a video camera and tiny surgical tools. The surgeon watches a video monitor in order to perform the nephrectomy.

Removing the tumor from the kidney (nephron-sparing surgery) : – During this procedure, the surgeon removes
the tumor, rather than the entire kidney. Nephron-sparing surgery may be an option if you have only one kidney or if you have an early-stage kidney cancer.

What type of surgery your doctor recommends will be based on your cancer and its stage, as well as your health and personal preferences. Surgery carries a risk of bleeding and infection. 

Treatments when surgery isn’t possible : – 

For some people, surgery may be too risky. 

These people have other options for treating their kidney cancers, including : –

Blocking blood flow to the tumor (embolization) : – In this procedure, a special material is injected into the main blood vessel leading to the kidney. By clogging this vessel, the tumor is deprived of oxygen and other nutrients. Arterial embolization also may be used before an operation or to relieve pain and bleeding when an operation isn’t possible. Side effects may include temporary nausea, vomiting or pain.

Treatment to freeze cancer cells (cryoablation) : – Recent studies show cryoablation may be useful for treating kidney tumors that can’t be removed through surgery. During cryoablation, one or more special needles (cryoprobes) are

inserted through small incisions in your skin and into the tumor. Gas in the needles creates extreme cold that causes the cells around the point of each needle to freeze.

Doctors use CT scans to monitor the procedure and to ensure that all of the visible cancer tissue and some of the surrounding healthy tissue is frozen. Another type of gas in the needles creates warmth to thaw the frozen tissue. Then the process is repeated. The cycles of freezing and thawing cause cancer cells to die. You may experience some pain after the procedure. Rare side effects may include bleeding, infection and damage to tissue surrounding the tumor.

 

Treatments for advanced and recurrent kidney cancer

Kidney cancer that recurs and kidney cancer that spreads to other parts of the body may be curable.

 

In these situations, treatments may include : –

Surgery to remove as much of the kidney tumor as possible : – Even when surgery can’t remove all of your
cancer, in some cases it may be helpful to remove as much of the cancer as possible.

Drugs that use your immune system to fight cancer (biological therapy) : – Biological therapy (immunotherapy) uses your body’s immune system to fight cancer. Drugs in this category include interferon and interleukin-2, which are synthetic versions of chemicals made in your body. These biological therapy drugs have serious side effects, including chills, fever, nausea, vomiting and loss of appetite. Biological therapy drugs are sometimes used alone, in combination or after surgery.

Treatment that targets specific aspects of your cancer (targeted therapy) : – Targeted treatments block specific abnormal signals present in kidney cancer cells that allow them to proliferate. These drugs have shown promise in treating kidney cancer that has spread to other areas of the body. Two targeted drugs, sorafenib (Nexavar) and sunitinib (Sutent), block signals that play a role in the growth of blood vessels that provide nutrients to cancer cells and allow cancer cells to spread. Temsirolimus (Torisel), another targeted drug, blocks a signal that allows cancer cells to grow and survive. Targeted therapy drugs can cause side effects, such as a rash that can be severe, diarrhea and fatigue. Targeted drugs can also be very expensive, sometimes costing over $1,000 a treatment.
Treatments for distant tumors : – Kidney cancer cells that travel to other parts of the body (metastasize) can sometimes be treated. This depends on the number of distant tumors, their locations and your general health. Treatment options vary based on where your cancer has spread. Options might include surgery for brain metastasis or radiation for kidney cancer that has spread to bones.

Clinical trials : – Clinical trials are studies of new treatments and new techniques for treating kidney cancer and other diseases. Participating in a clinical trial may give you a chance to try the latest treatments, but it can’t guarantee a cure. Discuss the available clinical trials with your doctor and carefully weigh the benefits and risks. Many kidney cancer clinical trials are studying new and existing targeted therapies to determine the best ways to use this new class of drugs.

Treatment for transitional cell cancer

Treatment for transitional cell cancer typically involves an extensive operation to remove the tumor, ureter, kidney and a portion of the bladder. Surgery to remove only the tumor may be an option in some cases.

Chemotherapy may be useful in treating transitional cell cancer that has spread or that recurs. Chemotherapy is a drug treatment that uses chemicals to kill quickly growing cells, such as cancer cells. Other rapidly growing cells, such as those in your gastrointestinal tract and your hair follicles, also are killed by chemotherapy drugs, which can cause side effects including nausea, vomiting and hair loss.

Laryngeal Cancer

What is the Larynx ?

The larynx is an organ at the front of your neck. It is also called the voice box. It is about 2 inches long and 2 inches wide. It is above the windpipe (trachea). Below and behind the larynx is the esophagus. The larynx has two bands of muscle that form the vocal cords. The cartilage at the front of the larynx is sometimes called the Adam’s apple.

 

The larynx has three main parts : –

The top part of the larynx is the supraglottis.
The glottis is in the middle. Your vocal cords are in the glottis.
The subglottis is at the bottom. The subglottis connects to the windpipe.

 

The larynx plays a role in breathing, swallowing, and talking. The larynx acts like a valve over the windpipe.

 

The valve opens and closes to allow breathing, swallowing, and speaking : –

Breathing : – When you breathe, the vocal cords relax and open. When you hold your breath, the vocal cords shut tightly.

Swallowing : -The larynx protects the windpipe. When you swallow, a flap called the epiglottis covers the opening of your larynx to keep food out of your lungs. The food passes through the esophagus on its way from your mouth to your stomach.
Talking : – The larynx produces the sound of your voice. When you talk, your vocal cords tighten and move closer together. Air from your lungs is forced between them and makes them vibrate. This makes the sound of your voice. Your tongue, lips, and teeth form this sound into words.

Who’s at risk for larynx cancer ?

No one knows the exact causes of cancer of the larynx. Doctors cannot explain why one person gets this disease and another does not. We do know that cancer is not contagious. You cannot “catch” cancer from another person.

People with certain risk factors are more likely to get cancer of the larynx. A risk factor is anything that increases your chance of developing this disease.

Studies have found the following risk factors : –

Age : – Cancer of the larynx occurs most often in people over the age of 55.

Gender : – Men are four times more likely than women to get cancer of the larynx.

Race : -African Americans are more likely than whites to be diagnosed with cancer of the larynx.

Smoking : – Smokers are far more likely than nonsmokers to get cancer of the larynx. The risk is even higher for smokers who drink alcohol heavily. People who stop smoking can greatly decrease their risk of cancer of the larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus. Also, quitting smoking reduces the chance that someone with cancer of the larynx will get a second cancer in the head and neck region. (Cancer of the larynx is part of a group of cancers called head and neck cancers.)

Alcohol : -People who drink alcohol are more likely to develop laryngeal cancer than people who don’t drink. The risk increases with the amount of alcohol that is consumed. The risk also increases if the person drinks alcohol and also smokes tobacco.

A personal history of head and neck cancer : – Almost one in four people who have had head and neck cancer will develop a second primary head and neck cancer.

Occupation : – Workers exposed to sulfuric acid mist or nickel have an increased risk of laryngeal cancer. Also, working with asbestos can increase the risk of this disease. Asbestos workers should follow work and safety rules to avoid inhaling asbestos fibers

Other studies suggest that having certain viruses or a diet low in vitamin A may increase the chance of getting cancer of the larynx. Another risk factor is having gastroesophageal reflux disease (GERD), which causes stomach acid to flow up into the esophagus.

Most people who have these risk factors do not get cancer of the larynx. If you are concerned about your chance of getting cancer of the larynx, you should discuss this concern with your health care provider. Your health care provider may suggest ways to reduce your risk and can plan an appropriate schedule for checkups.

 

Symptoms of Laryngeal Cancer

The symptoms of cancer of the larynx depend mainly on the size of the tumor and where it is in the larynx.

 

Symptoms may include the following : –

Hoarseness or other voice changes
A lump in the neck
A sore throat or feeling that something is stuck in your throat
A cough that does not go away
Problems breathing
Bad breath
An earache
Weight loss

These symptoms may be caused by cancer or by other, less serious problems. Only a doctor can tell for sure.

Diagnosis of Laryngeal Cancer

 

If you have symptoms of cancer of the larynx, the doctor may do some or all of the following exams : –

Physical exam : – The doctor will feel your neck and check your thyroid, larynx, and lymph nodes for abnormal lumps or swelling. To see your throat, the doctor may press down on your tongue.

Indirect laryngoscopy : – The doctor looks down your throat using a small, long-handled mirror to check for abnormal areas and to see if your vocal cords move as they should. This test does not hurt. The doctor may spray a local anesthesia in your throat to keep you from gagging. This exam is done in the doctor’s office.

Direct laryngoscopy : – The doctor inserts a thin, lighted tube called a laryngoscope through your nose or mouth. As the tube goes down your throat, the doctor can look at areas that cannot be seen with a mirror. A local anesthetic eases discomfort and prevents gagging. You may also receive a mild sedative to help you relax. Sometimes the doctor uses general anesthesia to put a person to sleep. This exam may be done in a doctor’s office, an outpatient clinic, or a hospital.

CT scan : – An x-ray machine linked to a computer takes a series of detailed pictures of the neck area. You may receive an injection of a special dye so your larynx shows up clearly in the pictures. From the CT scan, the doctor may see tumors in your larynx or elsewhere in your neck.

Biopsy : – If an exam shows an abnormal area, the doctor may remove a small sample of tissue. Removing tissue to look for cancer cells is called a biopsy. For a biopsy, you receive local or general anesthesia, and the doctor removes tissue samples through a laryngoscope. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if a tumor is cancerous.

Treatment for larynx cancer

Staging

To plan the best treatment, your doctor needs to know the stage, or extent, of your disease. Staging is a careful attempt to learn whether the cancer has spread and, if so, to what parts of the body. The doctor may use x-rays, CT scans, or magnetic resonance imaging to find out whether the cancer has spread to lymph nodes, other areas in your neck, or distant sites.

Treatment

People with cancer of the larynx often want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. However, shock and stress after a diagnosis of cancer can make it hard to remember what you want to ask the doctor

Here are some ideas that might help : –

Make a list of questions.
Take notes at the appointment.
Ask the doctor if you may use a tape recorder during the appointment.
Ask a family member or friend to come to the appointment with you.

Your doctor may refer you to a specialist who treats cancer of the larynx, such as a surgeon, otolaryngologist (an ear, nose, and throat doctor), radiation oncologist, or medical oncologist. You can also ask your doctor for a referral. Treatment usually begins within a few weeks of the diagnosis. Usually, there is time to talk to your doctor about treatment choices, get a second opinion, and learn more about the disease before making a treatment decision.

Preparing for treatment

The doctor can describe your treatment choices and the results you can expect for each treatment option. You will want to consider how treatment may change the way you look, breathe, and talk. You and your doctor can work together to develop a treatment plan that meets your needs and personal values. The choice of treatment depends on a number of factors, including your general health, where in the larynx the cancer began, the size of the tumor, and whether the cancer has spread.

Methods of treatment

Cancer of the larynx may be treated with radiation therapy, surgery, or chemotherapy. Some patients have a combination of therapies.

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells. The rays are aimed at the tumor and the tissue around it. Radiation therapy is local therapy. It affects cells only in the treated area. Treatments are usually given 5 days a week for 5 to 8 weeks.

Laryngeal cancer may be treated with radiation therapy alone or in combination with surgery or chemotherapy : –

Radiation therapy alone : – Radiation therapy is used alone for small tumors or for patients who cannot have surgery.

Radiation therapy combined with surgery : – Radiation therapy may be used to shrink a large tumor before surgery or to destroy cancer cells that may remain in the area after surgery. If a tumor grows back after surgery, it is often treated with radiation.

Radiation therapy combined with chemotherapy : – Radiation therapy may be used before, during, or after chemotherapy.

After radiation therapy, some people need feeding tubes placed into the abdomen. The feeding tube is usually temporary.

 

Surgery

Surgery is an operation in which a doctor removes the cancer using a scalpel or laser while the patient is asleep. When patients need surgery, the type of operation depends mainly on the size and exact location of the tumor.

There are several types of laryngectomy (surgery to remove part or all of the larynx) : –

Total laryngectomy : – The surgeon removes the entire larynx.

Partial laryngectomy (hemilaryngectomy : – The surgeon removes part of the larynx

Supraglottic laryngectomy

3. 3. •  : – The surgeon takes out the supraglottis, the top part of the larynx.

Cordectomy

3. 3. •  : – The surgeon removes one or both vocal cords.

 

Sometimes the surgeon also removes the lymph nodes in the neck. This is called lymph node dissection. The surgeon also may remove the thyroid.

During surgery for cancer of the larynx, the surgeon may need to make a stoma. (This surgery is called a tracheostomy.) The stoma is a new airway through an opening in the front of the neck. Air enters and leaves the windpipe (trachea) and lungs through this opening. A tracheostomy tube, also called a trach (“trake”) tube, keeps the new airway open. For many patients, the stoma is temporary. It is needed only until the patient recovers from surgery. More information about stomas can be found in the “Living with a Stoma” section.

After surgery, some people may need a temporary feeding tube. This picture shows the pathways for air and food after a total laryngectomy. The stoma is the new opening into the trachea.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Your doctor may suggest one drug or a combination of drugs. The drugs for cancer of the larynx are usually given by injection into the bloodstream. The drugs enter the bloodstream and travel throughout the body.

 

Chemotherapy is used to treat laryngeal cancer in several ways : –

Before surgery or radiation therapy : – In some cases, drugs are given to try to shrink a large tumor before surgery or radiation therapy.

After surgery or radiation therapy : -Chemotherapy may be used after surgery or radiation therapy to kill any cancer cells that may be left. It also may be used for cancers that have spread.

Instead of surgery : – Chemotherapy may be used with radiation therapy instead of surgery. The larynx is not removed and the voice is spared.

Chemotherapy may be given in an outpatient part of the hospital, at the doctor’s office, or at home. Rarely, a hospital stay may be needed.

Nasopharyngeal Cancer

 

What is the nasopharynx ?

The nasopharynx is made up of the upper part of the pharynx (throat) behind the nose. The pharynx is a hollow tube that begins behind the nose and ends at the top of the trachea (windpipe) and esophagus (tube that goes from the throat to the stomach). The nostrils lead into the nasopharynx, while an opening on each side of the nasopharynx leads into each ear via the Eustachian tubes.

What is nasopharyngeal cancer ?

Nasopharyngeal cancer occurs when malignant (cancerous) cells form in the tissues of the nasopharynx. Cancer is the uncontrollable growth of cells that invade and cause damage to surrounding tissue. In most cases, nasopharyngeal cancer begins in the thin, flat cells (squamous cells) that line the oropharynx (the part of the throat behind the mouth).

What are the risk factors for the development of Nasopharyngeal cancer ?

In many cases, nasopharyngeal cancer occurs during adolescence. This type of cancer affects more males than females

Other risk factors include : –

Epstein-Barr virus (EBV) : – This common virus, which remains dormant (inactive) in most people, has been linked to cancers including nasopharyngeal cancer.

Genetic factors : – Recent studies have found that people with certain inherited tissue types are at increased risk of

developing nasopharyngeal cancer.

What are the symptoms of nasopharyngeal cancer ?

 

The following symptoms might be potential symptoms of nasopharyngeal cancer : –

Difficulty hearing, breathing, or speaking
Sore throat, recurrent nosebleed
Pain or ringing in the ear
Headaches

How is nasopharyngeal cancer diagnosed ?

Doctors might use various tests to diagnose nasopharyngeal cancer.

Physical exam of the throat : – This exam might involve palpation (feeling) of the neck and looking down the throat.
Nasoscopy : – During this procedure, a doctor will use a nasoscope (thin lighted tube) to look inside the nose. The doctor might take tissue samples for a biopsy.

Biopsy : – This procedure involves the removal of tissue so it can be viewed under a microscope to check for cancer.

Neurological exam :- This exam might be made up of questions and tests to check the brain, spinal cord, and body’s nerve function.

Head and chest X-rays :- These might include an X-ray of the skull, as well as the organs and bones in the chest.

Laboratory tests : – These procedures might test samples of blood, urine, tissue, or other substances.

CT or CAT scan (also called computed tomography, computerized tomography, or computerized axial tomography) :- This as a scan that involves taking a series of detailed pictures of areas inside the body. The images are created by a computer linked to an X-ray machine.

MRI (also called magnetic resonance imaging) : – This is a procedure during which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body.

What are the stages of nasopharyngeal cancer ?

Stage 0 : – In this stage of nasopharyngeal cancer, cancer is found only in the lining of the nasopharynx.

Stage I : – Cancer is contained within the nasopharynx only.

Stage II : – Cancer is divided into Stage IIA and Stage IIB. In Stage IIA, cancer has spread from the nasopharynx to the oropharynx (the middle part of the throat that includes the soft palate) and/or to the nasal cavity. In stage IIB, one of two situations might occur: The cancer is found in the nasopharynx and has spread to the lymph nodes in one side of the neck, or has spread to the area surrounding the nasopharynx and might have spread to lymph nodes on one side of the neck.

Stage III

 

In this stage, the cancer : –

Is found in the nasopharynx and has spread to lymph nodes on both sides of the neck
Has spread into the soft tissues (oropharynx and/or nasal cavity) and to lymph nodes on both sides of the neck
Has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on both sides of the neck
Has spread to nearby bones or sinuses and might have spread to lymph nodes on one or both sides of the neck

Stage IV

 

Cancer is divided into Stage IVA, Stage IVB, and Stage IVC as follows : –

Stage IVA

 

3. 3. • The cancer has spread beyond the nasopharynx and might have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer might also have spread to lymph nodes on one or both sides of the neck, and the involved lymph nodes are smaller than 6 centimeters.

Stage IVB

 

3. 3. • This stage of cancer has spread to lymph nodes above the collarbone, and/or the involved lymph nodes are larger than 6 centimeters.

Stage IVC

 

3. 3. • The cancer has spread beyond nearby lymph nodes to other parts of the body.

 

Nasopharyngeal cancer treatment by stage

Nasopharyngeal cancer can be treated with radiation therapy, chemotherapy, and occasionally surgery. In some cases, the best approach involves two or more of these strategies.
The treatment of Stage I nasopharyngeal cancer usually involves radiation treatment of the tumor in the lymph nodes in the neck. In Stage II nasopharyngeal cancer, chemotherapy might be combined with radiation therapy. This stage also involves radiation therapy to the tumor and lymph nodes in the neck.

The treatment of Stage III nasopharyngeal cancer might include : –

Chemotherapy combined with radiation therapy
Radiation therapy to the tumor and lymph nodes in the neck
Radiation therapy, followed by surgery to remove cancer-containing lymph nodes in the neck that persist or recur after radiation therapy
A clinical trial of chemotherapy before, combined with, or after radiation therapy.

The treatment of Stage IV nasopharyngeal cancer can include : –

Chemotherapy combined with radiation therapy
Radiation therapy to the tumor and lymph nodes in the neck
Radiation therapy, followed by surgery to remove cancer-containing lymph nodes in the neck that persist or recur after radiation therapy
Chemotherapy for cancer that has spread to other parts of the body
A clinical trial of chemotherapy before, combined with, or after radiation therapy

Oropharyngeal Cancer

What is the oropharynx ?

The oropharynx is the middle part of the pharynx (throat). The pharynx is a hollow tube that begins behind the nose and goes down to the neck, becoming part of the tube that extends into the stomach (esophagus). The oropharynx includes the base of the tongue, the tonsils, the soft palate (back of the mouth), and the walls of the pharynx.

Oropharyngeal cancer

Oropharyngeal cancer is a disease in which cancer cells are found within the anatomical borders of the oropharynx. The majority of oropharyngeal cancers are squamous cell carcinomas.

Symptoms of oropharyngeal cancer

The following might be signs of oropharyngeal cancer or of other conditions.

 

See a doctor if any of the following symptoms are present : –

A sore throat that persists
Pain or difficulty with swallowing
Unexplained weight loss
Voice changes
Ear pain
A lump in the back of the throat or mouth
A lump in the neck

Risk factors for oropharyngeal cancer

Risk factors for oropharyngeal cancer include the following : –

Use of alcohol
Use of tobacco

Being infected with the human papilloma virus (HPV), especially HPV-type-16 (HPV-16)

How is oropharyngeal cancer diagnosed ?

A doctor can diagnose oropharyngeal cancer by examining the throat. The doctor will use a mirror and lights to look at the throat and will feel the neck for masses. If the doctor finds abnormal tissue, he or she will obtain a piece of tissue in a procedure called a biopsy. The tissue will be checked for cancer cells.

 

Stages of oropharyngeal cancer

The stages of oropharyngeal cancer span from Stage 0 to Stage IV. In Stage 0, cancer is found only in the cells that line the oropharynx

Additional stages are described as follows : –

Stage I : – The cancer is 2 centimeters or smaller and has not spread outside the oropharynx.

Stage II : – The cancer is larger than 2 centimeters, but not larger than 4 centimeters and has not spread outside the oropharynx.

Stage III : – In this stage, cancer is larger than 4 centimeters and has not spread outside the oropharynx. An alternate form of this stage is that cancer is any size and has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer is 3 centimeters or smaller.

Stage IV : – This stage contains the sub-stages of IVA, IVB and IVC.

Stage IVA : – 

In Stage IVA, one of the following is the case : –

The cancer has spread to tissues near the oropharynx, including the voice box, roof of the mouth, jaw, muscle of the tongue, or central muscles of the jaw. The cancer might have spread to one or more nearby lymph nodes, which are still not larger than 6 centimeters.

The cancer is any size, is only in the oropharynx, and has spread to one lymph node that is larger than 3 centimeters but no larger than 6 centimeters, or to more than one lymph node, none larger than 6 centimeters.

Stage IVB : – 

In Stage IVB, one of the following is true : –

The cancer appears in a lymph node that is larger than 6 centimeters and might have spread to other tissues around
the oropharynx.

The cancer surrounds the main artery in the neck or has spread to bones in the jaw or skull, to muscle in the side of the jaw, or to the upper part of the throat behind the nose. The cancer might have spread to nearby lymph nodes.

Stage IVC : – In Stage IVC, the cancer has spread to other parts of the body. The tumor might be any size and might have spread to lymph nodes.

Treatment of oropharyngeal cancer by stage

Stage I : – Treatment might be radiation therapy or surgery.

Stage II : – Treatment involves surgery to remove the cancer or radiation therapy.

Stage III : – Treatment for this stage of oropharyngeal cancer might include surgery to remove the cancer, followed by radiation therapy.

Other treatments might include : –

Radiation therapy alone
A clinical trial of chemotherapy that is followed by surgery or radiation therapy
A clinical trial of chemotherapy combined with radiation therapy
A clinical trial of new ways to provide radiation therapy

Stage IV

For cases in which oropharyngeal cancer can be removed by surgery, treatment might be one of the following : –

Surgery to remove the cancer that is followed by radiation therapy
Radiation therapy alone
A clinical trial combining radiation therapy and chemotherapy
A clinical trial of new ways to provide radiation therapy

For cases in which the cancer cannot be removed by surgery, treatment might include one of the following : –

Radiation therapy
A clinical trial during which chemotherapy is followed by surgery or radiation therapy
A clinical trial of radiation therapy given with chemotherapy or radiosensitizers (drugs to make the cancer cells more sensitive to radiation therapy)
A clinical trial of new ways of giving radiation therapy
A clinical trial of hyperthermia therapy plus radiation therapy

Prognosis (chance of recovery) for people with oropharyngeal cancers

The prognosis for people with oropharyngeal cancer depends on the age and health of the person and the stage of the disease. It is important for people with oral cancer or oropharyngeal cancer to have follow-up exams for the rest of their lives as cancer can occur in nearby areas. In addition, it is important to eliminate risk factors such as smoking and drinking, which increase the risk for second cancers.