FAQ's

FAQ's

Adrenal Cancer

What is Adrenal Cancer?

Adrenal

The Adrenal glands are also called suprarenal gland as it is situated above the kidneys and are a part of the endocrine system. They are yellowish, triangular shaped organs located on top of each kidney. Adrenal glands are small, approximately 2.5 inches long and 1 inch wide. They produce a number of vital hormones essential for survival.

Adrenal gland consists of three major parts:

  • The Capsule: This is a protective layer of fat that surrounds each Adrenal gland.
  • The Cortex: The cortex encloses the medulla and comprises around 80% of the volume of Adrenal gland. It produces different types of hormones called steroids viz minerals, corticoids, glucocorticoids and gonadocorticoids.
  • The Medulla: It is the innermost part of the Adrenal gland contributing 20% of its volume. The Adrenal medulla produces the Adrenaline (epinephrine)  and norAdrenaline (norepinephrine) hormones.

Functions:

  • Adrenal glands produce two most important hormones:  cortisol and aldosterone.
  • Aldosterone helps control blood pressure by managing the balance of potassium and sodium in the body.
  • Cortisol helps to maintain stress and regulate metabolism, sugar levels, and blood pressure.
  • The Adrenal glands also produce Adrenaline and small amounts of sex hormones called androgens.
  • The medulla secretes stress hormones that generate the primitive stress response.

Adrenal Cancer

Adrenal Cancer is a rare tumor that originates in one or both of the Adrenal glands. Since these glands are located deep inside the body so it becomes difficult to spot early symptom of the disease.

When cells in the Adrenal cortex become Cancerous, they start malfunctioning, synthesizing hormones more than required by the body. This results in several ailments like high blood pressure, weakening of the bones, or diabetes. 

Types of Adrenal Cancer

Depending on the place of birth of these Cancerous cells, Adrenal Cancer is categorized as:

  • Adrenocortical carcinoma: Originating in the outer layer of the cortex, it is the most common type of Adrenal Cancer. These tumors are usually discovered at a later stage when they have grown larger and cause prominent symptoms like pain, weight alterations or peculiar hormonal changes.
  • Pheochromocytoma: This is a relatively rare tumor of the Adrenaline-producing cells and only about 10% of pheochromocytomas are malignant. This is a familial Cancer with genetic predeposition. Hence, regular check-up will help the family members in early detection of the disease. An increased Adrenaline level, high blood pressure, excess sweating, and anxiety may be alarming signals about this disease.
  • Neuroblastoma: This originates in the nerve cells of medulla, Adrenal Cancer usually affects infants or children below the age of 10.

 Adrenal Cancer Occurrence Rate in India

Adrenal adenoma, a benign tumor is a common disease of the Adrenal glands but Adrenal Cancer, which is malignant in nature is a rare form. It accounts for only 0.2% of deaths due to Cancer.

Anatomy of Adrenal Cancer

Anatomy of Adernal Cancer

What are the general symptoms of Adrenal Cancer?

The Adrenal glands are the production center for regulatory hormones such as Adrenaline and cortisone. So, most of the symptoms are related to hormonal imbalances resulting from abnormal secretion of a particular hormone. However, sometimes there may not be any distinct symptom until the tumor has grown big and presses against other organs causing a hindrance in their functionality.

Symptoms caused by a large size of the tumor:

  • Pain in the stomach or back.
  • Feel pressure or fullness soon after you eat.
  • A lump.

Symptoms caused by high level of androgen or estrogen:

  • Rapid growth of facial and body hair.
  • Enlarged penis in young boys or the clitoris in girls.
  • Depression, anxiety and loss of emotional control
  • Cognitive difficulties
  • Early periods or breast development in young girls.
  • Breast growth or impotence in men.
  • Loss of sexual desire.
  • Irregular periods and change in voice.

Symptoms caused by high level of aldosterone

  • Conn’s disease: It is caused by excessive production of aldosterone, a steroid hormone responsible for regulating electrolytes. In the case of Conn's disease, aldosterone becomes more active and sodium levels in the blood may increase thus affecting the blood pressure. Other prominent symptoms of this condition are frequent urination and excessive thirst.

Symptoms caused by an excess of stress hormone cortisol:

  • Unexplained alterations in body weight.
  • Stretch marks.
  • Weaker bones and muscles that get bruised easily.
  • Mood swings and depression.
  • High blood pressure or high blood sugar.
  • Cushing's syndrome develops when a functioning adrenocortical tumor produces excess cortisol. Also, called the stress response hormone, cortisol also plays a significant role in regulating blood pressure and metabolic function.

The symptoms may vary depending on the type of Adrenal Cancer and the size of the tumor. Often, the warning signs of Adrenal Cancer are not obvious or the symptoms seem unrelated, thus making its diagnosis difficult. Blood and urine tests may help detect elevated hormone levels. However, physicians more often find an Adrenal tumor during a scan for an unrelated condition.

What are the general causes of Adrenal Cancer?

Till date, the exact causes of Adrenal Cancer are not known to precision, though there are many assumptions about the same. Throughout these years, it has been noted that one may be at a higher risk if they have any of the following conditions:

  • Genetic Conditions:
    • Li-Fraumeni syndrome
    • Beckwith-Wiedemann syndrome
    • Carney complex
    • Multiple endocrine neoplasia
    • Familial adenomatous polyposis
    • Lynch syndrome
  • Lifestyle Conditions:
    • Smoking: Tobacco use may increase the risk of developing Adrenal Cancer.
    • High-fat diet
  • Other
    • Exposure to Cancer causing radiations

Can Adrenal Cancer be prevented?

Since the root cause of Adrenal Cancer is not known so, it is difficult to coin down the preventive measures. However, leading a healthy life does eliminate some risk of developing any disease including Adrenal Cancer.

What are the stages of Adrenal Cancer?

Stages of Cancer are assigned to indicate the spread and severity of the disease. Based on the stage of Cancer the treatment and prognosis are decided. Adrenal Cancer can be staged into:

  • Stage I (T1,N0,M0): The tumor is smaller than 2 inches and has not spread beyond the Adrenal gland.
  • Stage II(T2,N0,M0): The tumor is larger than 2 inches but has not yet spread.
  • Stage III The tumor has spread to nearby tissues or lymph nodes. Depending on the size it is further subdivided into:
  • T1,N1,M0 : The tumor is 5 cm or smaller and has spread to the regional lymph nodes.
  • T2,N1,M0: The tumor is larger than 5 cm and has spread to the regional lymph nodes.
  • T3, N0,M0:  The tumor may be of any size and has spread beyond the Adrenal glands.
  • Stage IV: The tumor may be any size, and tumors have spread throughout the body.
  • T3,N1.M0: The tumor has spread beyond the Adrenal gland to regional lymph nodes but not to distant organs.
  • T4,N0,M0: The tumor has spread to nearby organs, but not to lymph nodes
  • T4,N1,M0: The tumor has spread to nearby organs but not beyond them.
  • Any T, any N, M1: The tumor may have spread to any part of the body.

Survival rates of Adrenal Cancer?

The survival rate is an analysis that reveals the percentage of people in a treatment group still alive for a given period after diagnosis. Survival rates are important to determine the prognosis.

The survival rate of Adrenal Cancer is high if it is detected at an early stage before Cancer has metastasized and the statistics gradually decreases with each passing stage.

However, the survival rate for each individual may vary to some extent based on their overall health condition, and treatment routine followed.

Stage 5 year Survival Rate
Localized 65%
Regional 44%
Distant 7%

Can Adrenal Cancer be detected early?

Adrenal glands are located deep within the body which makes it difficult to detect the growing tumors. However, if the tumor interferes with the regulation of hormones then some symptoms might be visible. There are multiple tests and examinations to ascertain the cause of these symptoms.

  • Physical exam and medical history. The patient’s health habits and medical problems are scrutinized thoroughly. The doctor checks for menstrual and sexual functions along with the familial history of the patient.
  • Blood and urine tests: These tests are done to check for the amount of synthesis of sex hormones or steroids, such as low levels of potassium or high levels of cortisol or estrogen.
  • Imaging tests: Imaging tests are suggested if an Adrenal tumor or Cancer is suspected. Imaging tests are very useful to view the interior of the body and see if there are any tumors or Cancer cells. Some of the imaging tests are:
    • X-rays: An x-ray shows if the Cancer has spread.
    • Ultrasound: Ultrasound tests use sound waves with the help of a transducer to take pictures of parts of the body. This test can show if there is a tumor mass in the Adrenal gland.
    •  Computed tomography scan: The CT scan produces detailed cross-sectional images of the body. It shows the Adrenal glands clearly and often confirms the location of the Cancer. It can also help show whether the Cancer has spread
    • MRI: MRI scans use radio waves and strong magnets instead of x-rays. MRI scans give very detailed image of parts of the body.
    • Positron Emission Tomography (PET) scan: A radioactive glucose is injected into the vein because Cancer cells use sugar much faster than normal tissues, radioactivity will tend to concentrate in the Cancer. A scanner can spot the radioactive deposits. This test can be helpful in spotting small collections of Cancer cells and may be used to find Cancer that has spread.
  • Laparoscopy: A very thin tube with a tiny video camera is inserted into your body. A laparoscopy test shows places where the Cancer is growing.
  • Biopsy:  A tiny sample of tissue is extracted from the tumor with the help of a needle. The cells are then viewed under a microscope to see if there is any Cancerous development.

What are the Treatments available?

The treatment plan usually depends on the stage and patient’s preferences.  Based on these factors a complete treatment plan is prepared and the treatment may consist of one of the following procedures:

Surgery: Surgery is the most preferred treatment option that is able to provide a complete cure. In surgery, one or both of the Adrenal glands may be removed. If the Cancer cells have spread beyond the Adrenal glands then nearby lymph nodes are also taken out.

Radiation: Radiation is a treatment procedure can kill Cancer cells or inhibit the growth of the tumor. Radiation may be given internally by inserting radioactive seeds inside the body or externally through a machine. 

Chemotherapy: Chemotherapy is the  use of drugs  to control the growth of Cancerous cells. For Adrenal Cancer, doctors most often prescribe a drug called mitotane (Lysodren), that blocks Adrenal gland from making hormones. It also destroys Cancer cells.

Some chemotherapy drugs that go through the whole body to kill Cancer cells, but they can also harm healthy cells, too.

Targeted therapy drugs look for and kill Cancer cells without harming good ones.

Tumor ablation. In this procedure, heat or cold is used to kill Cancer cells. This helps in relieving the symptoms and give a better quality of life.

Is there curative treatment for Adrenal Cancer?

Adrenal Cancer is highly curable when detected early. In some cases, an operation to remove the tumor cures the disease. There are several other procedures to keep the recurrence of Cancer in check.

How frequently should one visit a doctor for an early diagnosis?

In case of experiencing any of the mentioned symptoms, it is advisable to visit the doctor at the earliest. Also, a person having a high risk of developing Adrenal Cancer should go for a diagnosis once or twice a year.

How can I as a patient know it early?

Being aware of the symptoms, and any health issue that might indicate the presence of the disease needs to be examined thoroughly. Also, a few lab tests and regular tests can also sometimes unveil the presence of the hideous disease.

Bile Duct Cancer

What is Bile Duct Cancer?

Bile Duct

The Bile Ducts are a series of thin tubes that collect bile from the liver and gall bladder and pass it to the small intestine. Two Bile Ducts originate from the liver and one comes from the gallbladder, they join to form the common Bile Duct.

Bile Ducts collect this bile, draining it into the gallbladder and finally into the small intestine where it aids in the digestion process.

Functions:

  • The major function of the Bile Ducts is to move a fluid called bile from the liver and gallbladder to the small intestine.
  • Bile is needed for digesting food. Its main role is to break down fats.

Bile Duct Cancer

Bile Duct Cancer also known as Cholangiocarcinoma is a rare form of cancer that arises from the cells that line the Bile Ducts . Cholangiocarcinoma occurs when cells in the Bile Ducts develop mutations in their DNA. Due to which, cells may begin to grow out of control and eventually develop into a tumor. Cholangiocarcinoma are most commonly found just outside the liver in the perihilar area. It is a slow-growing cancer that invades local structures, so the diagnosis is often delayed till the Bile Duct gets blocked. This blockade prevents bile drainage from the liver into the gallbladder and intestine. Depending upon where the blockage occurs, this can lead to inflammation of the liver (hepatitis) and/or pancreas (pancreatitis).

Types of Bile Duct Cancer

Bile Duct Cancer can start anywhere along the Bile Ducts . It is classified into different types depending on the location of origin.

  • Intrahepatic cholangiocarcinoma : It develops in the smaller Bile Duct branches inside the liver. They contribute only a small number of total occurrences of Bile Duct Cancers.

    Intrahepatic cholangiocarcinoma

  • Extrahepatic Bile Duct Cancers
    The extrahepatic Bile Duct is made up of the hilum region and the distal region. Cancer can form in either region:

    • Perihilar Bile Duct Cancer : It occurs in the hilum region. Perihilar Bile Duct Cancer is also called Klatskin tumor or perihilar cholangiocarcinoma.
    • Distal extrahepatic Bile Duct Cancer : These cancers are found further down the Bile Duct, closer to the small intestine.

      Distal extrahepatic Bile Duct Cancer

    • Multifocal Bile Duct Cancer : means that there's more than one tumor and they're in different sections of the bile.

Anatomy of Bile Duct Cancer

bile-duct-anatomy

(We can add link to the next topic i.e. Symptoms of Bile Duct Cancer)

What are the general symptoms of Bile Duct Cancer?

Bile Duct Cancer is a rare form of cancer and the signs and symptoms are not specific to Bile Duct Cancer only. They may be triggered by some other illness as well. The initial symptoms of Bile Duct Cancer occur mostly because of the blockage that interrupts bile to drain normally from the liver. Unfortunately, Bile Duct tumors may not cause any symptoms until they have grown in size and the cancer has spread beyond its original location. Some of the symptoms of Bile Duct Cancer include:

  • Jaundice
    Jaundice is often the most common symptom of Bile Duct Cancer. Jaundice occurs when the liver can’t get rid of bile, which contains a greenish-yellow chemical called bilirubin.
  • Light-colored/greasy stools
    Bilirubin contributes to the brown color of bowel movements. If the cancer blocks the release of bile and pancreatic juices into the intestine, the digestion of fatty foods becomes difficult. The undigested fat can also cause stools to be unusually pale. They might also be bulky, greasy and float in the toilet.
  • Dark urine
    When bilirubin levels in the blood get high, it can also come out in the urine giving it a dark shade.
  • Itching
    Most people with Bile Duct Cancer notice itching caused by the excess bilirubin.
  • Abdominal (belly) pain
    Early Bile Duct Cancers usually do not cause pain, but more advanced cancers may cause abdominal pain, especially below the ribs on the right side.
  • Loss of appetite/weight loss
  • Fever
  • Nausea and vomiting

Bile Duct Cancer is a rare form of Cancer and there is a possibility of encountering these symptoms in many other health problems including gall stones.

What are the general causes of Bile Duct Cancer?

For most cases of Bile Duct Cancer, it is very difficult to trace the exact cause of the disease. However, there are certain factors that are known to have increased the risk. People with long-term swelling or irritation in the Bile Ducts are more likely to get this cancer. People with a bowel disease called ulcerative colitis are also at higher risk. Infection with the liver fluke parasite is also a cause of large number of Bile Duct Cancers. Some other risk factors are discussed below:

  • Chronic liver disease :
    Scarring of the liver caused by a history of chronic liver disease increases the risk of cholangiocarcinoma. Primary Sclerosing Cholangitis that causes long-term inflammation of the liver, Biliary Stones within the Liver are some common liver troubles that end up in Cancer.
  • Choledochal cyst :
    It causes dilated and irregular Bile Ducts , and increases the risk of developing cholangiocarcinoma severely.
  • Older age :
    Cholangiocarcinoma occurs most often in adults over age 50.
  • Inflammatory bowel disease :
    Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease. People with these diseases have an increased risk of Bile Duct Cancer.
  • Family history :
    A history of Bile Duct Cancer in the family seems to increase a person’s chances of developing this cancer, but the risk is still low because this is a rare disease.
  • Exposure to certain chemicals and toxins,
    including thorotrast (a special dye that used to be used in medical scans)
  • Other possible risk factors :
    Studies have found several other factors that might increase the risk of Bile Duct Cancer, but the links are not as clear. These include:
    • Smoking
    • Alcohol
    • Diabetes
    • Obesity
    • Infection with HIV
    • Exposure to chemicals and other radioactive chemicals

Can Bile Duct Cancer be prevented?

There is no proven theory to prevent Bile Duct Cancers. As with all diseases that tend to develop at an older age, living a healthy lifestyle may extend one’s lifespan. This includes not smoking, eating a balanced diet, keeping physically active, and maintaining a healthy weight.

Many of the known risk factors for Bile Duct Cancer, such as age, ethnicity, and Bile Duct abnormalities, are beyond our control. However, there are certain factors that could definitely be checked to keep the risk low. Some of them are:

  • Getting vaccinated against the hepatitis B virus (HBV) to prevent infection with this virus and the cirrhosis it can cause.
  • Take precautions to avoid blood-borne or sexually transmitted infections by HBV and other viruses to help prevent cirrhosis.
  • Treat hepatitis infections.
  • Avoid exposure to certain chemicals

What are the stages of Bile Duct Cancer?

Stage of cancer refers to the severity and spread of cancer cells. Once the specific type of cancer is diagnosed, it is assigned a particular stage ranging from 0 to IV. Stage 0 is also referred as carcinoma in situ. Depending on several factors and based on the stage, most effective treatment is planned.

Stages of Intrahepatic Bile Duct Cancer

  • Stage 0: Abnormal cells are found in the innermost layer of tissue lining the intrahepatic Bile Duct. These abnormal cells may become cancer and spread into nearby normal tissue.
  • Stage I: A tumor is spotted in the intrahepatic Bile Duct.
  • Stage II: This stage is assigned either when a tumor has spread through the wall of the Bile Duct and into a blood vessel, or there are multiple tumors that may have spread into blood vessel.
  • Stage III: The tumor has spread through the tissue that lines the abdominal wall or has spread to organs or tissues near the liver such as the duodenum, colon, and stomach.
  • Stage IV:
    • Stage IVA: The cancer has spread along the outside of the intrahepatic Bile Ducts or the cancer has spread to nearby lymph nodes.
    • Stage IVB: The cancer has spread to organs in other parts of the body.

Stages of Perihilar Bile Duct Cancer

  • Stage 0: Abnormal cells are found in the innermost layer of tissue lining the perihilar Bile Duct. These abnormal cells may become cancer and spread into nearby normal tissue.
  • Stage I: Cancer has formed in the innermost layer of the wall of the perihilar Bile Duct and has spread into the muscle layer or fibrous tissue layer of the wall.
  • Stage II: Cancer has spread through the wall of the perihilar Bile Duct to nearby fatty tissue or to the liver.
  • Stage III:
    • Stage IIIA: Cancer has spread to branches on one side of the hepatic artery or of the portal vein.
    • Stage IIIB: Cancer has spread to nearby lymph nodes. Cancer may have spread into the wall of the perihilar Bile Duct or through the wall to nearby fatty tissue, the liver, or to branches on one side of the hepatic artery or of the portal vein.
  • Stage IV:
    • Stage IVA: Cancer has spread to one or more of the following:
      • main part of the portal vein and/or common hepatic artery
      • branches of the portal vein and/or common hepatic artery on both sides
      • right hepatic duct and the left branch of the hepatic artery or of the portal vein
      • left hepatic duct and the right branch of the hepatic artery or of the portal vein.
      • Cancer may have spread to nearby lymph nodes.
    • Stage IVB: Cancer has spread to lymph nodes in more distant parts of the abdomen, or to organs in other parts of the body.

Stages of Distal extrahepatic Bile Duct Cancer

  • Stage 0: Abnormal cells are found in the innermost layer of tissue lining the distalextrahepatic Bile Duct.
  • Stage I:
    • Stage IA: Cancer cell is found in the distal extrahepatic Bile Duct wall only.
    • Stage IB: Cancer cells have spread through the wall of the distalextrahepatic Bile Duct but has not spread to nearby organs.
  • Stage II:
    • Stage IIA: Cancer has spread from the distal extrahepatic Bile Duct to the gallbladder, pancreas, duodenum, or other nearby organs.
    • Stage IIB: Cancer has spread from the distal extrahepatic Bile Duct to nearby lymph nodes. Cancer may have spread through the wall of the duct or to nearby organs.
  • Stage III: Cancer has spread to the large vessels that carry blood to the organs in the abdomen. Cancer may have spread to nearby lymph nodes.
  • Stage IV: Cancer has spread to organs in distant parts of the body.

Survival rates of Bile Duct Cancer?

Stage 5 year Survival Rate
Localized (Stage I) 15%
Regional Spread (Stage II & III) 6%
Distant Spread (Stage IV) 2%
Stage 5 year Survival Rate
Localized (Stage I) 30%
Regional Spread (Stage II & III) 24%
Distant Spread (Stage IV) 2%

Can Bile Duct Cancer be detected early?

Bile Ducts are located deep inside the body, so early tumors can’t be felt during routine physical exams. There are no specific tests that aids in early detection of Bile Duct Cancer. Furthermore, Bile Duct Cancer does not show any early stage symptoms. Hence, most Bile Duct Cancers are found only after the cancer has grown enough to cause signs or symptoms leaving only a small number of Bile Duct Cancers cases that have been detected early.

However, if there is any reason to suspect Bile Duct Cancer, complete medical history is checked for risk factors and symptoms.

Several tests may be needed to help diagnose Bile Duct Cancer. Most common tests are:

  • History and physical exam: Physical exam is conducted focusing mostly on the abdomen to check for any lumps, tenderness, or buildup of fluid. The skin and the white part of the eyes are also checked for jaundice.
  • Liver function tests: Blood sample is checked to measure the amounts of bilirubin and alkaline phosphatase released into the blood by the liver. A higher than normal amount of these substances can be a sign of liver disease that may be caused by Bile Duct Cancer.
  • Laboratory tests: Several tests may be done to check samples of tissue, blood, urine, or other substances in the body.
  • Blood test: is carried out to check level of bilirubin in the blood, as high level of bilirubin may indicate Bile Duct issues. Tests for albumin, liver enzymes (alkaline phosphatase, AST, ALT, GGT), in the blood are also taken into account. These tests are called liver function tests. High level of these substances might point to blockage of the Bile Duct, but they can’t ascertain the reason as Cancer.
  • Biopsy : where a small sample of tissue is removed so it can be looked at under a microscope for signs of Cancer
  • Scans : ultrasound scan, computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan
  • Ultrasound : High-energy sound waves are bounced off internal tissues or organs. The echoes form a picture of body tissues called a sonogram.
    • Abdominal ultrasound: This is helpful for cases with symptoms like jaundice or abdominal pain.
    • Endoscopic or laparoscopic ultrasound: An ultrasound transducer is placed near the Bile Duct, to get detailed images. The transducer is either passed through the mouth, and into the small intestine near the Bile Ducts (endoscopic ultrasound) or through a small surgical cut (laparoscopic ultrasound).
  • Computed tomography (CT) scan: A series of detailed pictures of areas inside the body are taken from different angles. The pictures are studied in a computer linked to an x-ray machine. CT scans can have several uses:
    • Highlights the area of tumor.
    • They can help stage the cancer.
    • CT angiography can be used to look at the blood vessels around the Bile Ducts . This can help determine if surgery is a treatment option.
    • CT scans can also be used to guide a biopsy needle into a suspected tumor or metastasis.
  • Magnetic resonance imaging (MRI) scan: MRI scans provide detailed images of soft tissues in the body using radio waves and strong magnets. A contrast material called gadolinium may be injected into a vein before the scan to better see details. Special types of MRI scans may also be used in people who may have Bile Duct Cancer:

    1. MR cholangiopancreatography (MRCP)
    2. MR angiography (MRA)
    • Cholangiography: A cholangiogram is an imaging test that looks at the Bile Ducts to see if they are blocked, narrowed, or dilated (widened). It can also be used to help plan surgery.
    • Magnetic resonance cholangiopancreatography (MRCP): This is a non-invasive way to image the Bile Ducts .
    • Endoscopic retrograde cholangiopancreatography (ERCP): In this procedure, an endoscope is passed down the throat, through the esophagus. A small catheter is passed into the common Bile Duct. A contrast dye is injected through the tube to help outline the Bile Ducts as x-rays are taken. The images can show narrowing or blockage of these ducts.
    • Percutaneous transhepatic cholangiography (PTC): In this procedure, a thin, hollow needle is placed through the skin of the belly into a Bile Duct within the liver. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the Bile Ducts . Because it is more invasive, PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.
    • Angiography: Angiography is an x-ray procedure for looking at blood vessels. For this test, a small amount of contrast dye is injected into an artery to outline blood vessels before x-ray images are taken. The images show if blood flow in an area is blocked or affected by a tumor, and any abnormal blood vessels in the area.

What are the Treatments available?

Treatment for Bile Duct Cancer depends upon where the cancer is located and whether it is possible for it to be completely removed by surgery. Unfortunately, those afflicted with this cancer tend to be older and may be unable to tolerate and recover from a major operation.

  • Surgery
    • Removal of the Bile Duct: A surgical procedure to remove part of the Bile Duct if the tumor is small. Lymph nodes are removed and tissue from the lymph nodes is viewed under a microscope .
    • Partial hepatectomy: The liver where cancer is found is removed.
    • Whipple procedure: The head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the Bile Duct are removed. Enough of the pancreas is left to make digestive juices and insulin.
  • 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
    • Internal radiation therapy
  • Chemotherapy
    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by retarding their growth.
  • Photodynamic therapy
    A light-sensitive chemical is injected into a vein and accumulates in the fast-growing cancer cells. Photodynamic therapy can help relieve the signs and symptoms.
  • Biliary drainage
    It is a procedure to restore the flow of bile. It can involve bypass surgery to reroute the bile around the cancer or stents to hold open a Bile Duct being collapsed by cancer. Biliary drainage helps relieve signs and symptoms of cholangiocarcinoma.
  • Liver transplant
    In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant is helpful mostly for perihilar Bile Duct Cancer.

Is there curative treatment for Bile Duct Cancer?

Bile Duct Cancer is mostly detected at a later stage when the cancer cell spreads and interrupts the normal functionality of the organs. Thus, making it very difficult to control and cure the cancer cells.

However, today there are several treatment options that can help control the symptoms for months or possibly years.

How frequently should one visit doctor for early diagnosis?

If there is any reason to suspect the occurrence of Bile Duct Cancer, consulting the doctor to get clarity is important. Also, if one is prone to the mentioned risk factors then regular blood tests and lab tests can aid in early detection of the disease thereby facilitating curative treatment.

How can I as a patient know it early?

Being aware of the symptoms, and any health issue that might indicate the presence of the disease needs to be examined thoroughly. Also, a few lab tests and regular tests can also sometime unveil the presence of the hideous disease.

Bladder Cancer

What is Bladder Cancer?

Bladder

Bladder is a hollow muscular balloon-shaped organ, located in the lower part of the abdomen behind the pubic bone.

Layers of the Bladder

Blader

Functions

  • The primary function of the Bladder is to store urine.
  • Urine made by the kidneys is passed to the Bladder through the ureters. The Bladder is lined by layers of muscle tissues that can stretch to accommodate the urine. During urination, the muscles of the Bladder contract to release the urine.

Bladder Cancer

Cancer is the uncontrolled growth of abnormal cells in any part of the body. These cells accumulate and form a tumor. The tumor may be benign or malignant in nature. Benign tumors are less invasive and their growth is limited to the site of origin, whereas malignant tumors are the ones that possess a greater threat. Malignant tumors grow and continue to spread through different parts of the body if left untreated.

When such tumor is formed in the Bladder then it is termed as Bladder Cancer. Bladder Cancer refers to several types of malignant growth of the urinary Bladder. Depending on the cells, Bladder Cancer is categorized into different types and each type demands unique prognosis.

Types of Bladder Cancer

  • Urothelial carcinoma(transitional cell carcinoma):Urothelial is the most prevalent Bladder Cancer and it accounts for more than 90% of all Bladder Cancers. This Cancer begins in urothelial cells that line the interior of the Bladder and are responsible for stretching and changing shape, when the Bladder is full. Urothelial carcinoma is further classified into:
    • Non-invasive urothelial carcinoma: The Cancer is limited to the urothelium and has not spread to the muscle layer, though it may spread into the lamina propria beneath the transitional cells.
    • Invasive urothelial carcinoma: The Cancer spreads to the Bladder's muscularis propria and sometimes to the surrounding tissues.
    • Papillary urothelial carcinoma: A noninvasive papillary tumor grows into the hollow center of the Bladder on a stalk. Invasive papillary urothelial carcinoma can spread into the lamina propria or muscle layer.
    • Flat urothelial carcinoma: Noninvasive flat urothelial carcinoma grows in the layer of cells closest to the inside of the Bladder and appears as flat lesions on the inside surface of the Bladder. Invasive flat urothelial carcinoma may invade the deeper layers of the Bladder, particularly the musclular layer.

blader

  • Squamous cell carcinoma: These Cancers are rare but invasive and account for 3 – 8% of Bladder Cancers. It is mainly caused due to Bladder inflammation or irritation for a long period. These cells grow in flat masses of interconnected cells.
  • Adenocarcinoma: It is a rare and invasive form of all Bladder Cancer and accounts for only 2% of all Bladder Cancer cases. These Cancers occur in the glandular cells.
  • Small cell carcinoma: Small-cell carcinomas contribute to less than 1% of Bladder Cancer. It origins in nerve-like cells called neuroendocrine cells. These Cancers often grow quickly and are very invasive.

Occurrence Rate of Bladder Cancer in India

Bladder Cancer is one of the most common urinary tract Cancers. According to the recent reports from National Cancer Registry Programme, the overall occurrence of Bladder Cancer in India is 2.25%. According to Cancer statistics of the world, Bladder Cancer ranks 9th in occurrence. Detailed statistics revealed, it is the 7th most common malignancy in men and 17th in women.

India is one of the most preferred destinations for treatment of Bladder Cancer. The improved prognosis, advance diagnosis and therapies along with low cost facilitates are the perks of the healthcare facilities in the country.

Anatomy of Bladder

Bladder Cancer Anatomy

The above image is used for educational purpose only.

What are the general symptoms of Bladder Cancer?

A symptom is any abnormal sign that a person experiences when any of the organs fail to perform its functions perfectly. Bladder Cancer  often shows early symptoms facilitating an early detection. Some of the symptoms that demands a cross-check for the presence of any malicious cells are:

Symptoms of early Bladder Cancer

  • Hematuria i.e blood in the urine with or without clots.
  • Changes in Bladder habits or symptoms of irritation
  • Increased frequency and urgency of urination
  • Pain or burning during urination

Symptoms of advanced Bladder Cancer

  • Being unable to urinate
  • Lower back pain on one side
  • Loss of appetite and weight loss
  • Swelling in the feet
  • Bone pain

Any blood in urine should be reported to the doctor immediately, though this does not certainly claim the presence of Bladder Cancer . Less than 0.1% cases of Hematuria are caused by Bladder Cancer . However, this sign should not be ignored. Blood in urine may be a sign of several other medical conditions, as well as Bladder Cancer .

What are the general causes of Bladder Cancer?

The exact cause of Bladder Cancer  has not yet been coined down. However, over the years certain factors have been identified to have increased the risk of developing Bladder Cancer. Bladder Cancer  can be caused by multiple factors. An unhealthy lifestyle, familial history and ignorance are the most common modes of getting this disease. However, there are certain factors that are natural and are beyond one’s control.

  • The greatest risk factor of Bladder Cancer  is smoking of cigarettes, bidis and hookah.
  • Exposure to certain chemicals such as dyes, metal, paints, leather, textile and organic chemicals is another causative factor.
  • Gender and age also play an important role. Men are four times more likely to develop this disease. Also, the risk increases with increasing age.
  • Infection with schistosomiasis is a cause of this Cancer.
  • Unhealthy diet and no or limited physical activities also increase the risk of developing Bladder Cancer.
  • Personal history of Bladder or other urothelial Cancer  may cause recurrence of Bladder Cancer.
  • Bladder birth defects
  • Genetics and family history
  • Arsenic in drinking water
  • Low Fluid Consumption

Can Bladder Cancer be prevented?

Due to ambiguity in the exact causes of Bladder Cancer , preventions of Bladder Cancer is difficult. However avoiding the risk factors do provide a shielding to some extent. Some of the precautions are listed below:

  • Chemicals like aromatic amines, such as benzidine and beta-naphthylamine can cause Bladder Cancer. So staying away and taking preventive measures may help in preventing Bladder Cancer.
  • Quit smoking.
  • Maintaining a healthy diet and indulging in regular physical activities.

What are the stages of Bladder Cancer?

Bladder Cancer  is staged by TNM system.

  • Tumor (T): It describes the size of the tumor and the location of the tumor.
  • Node (N): It depicts the extent to which the malignant cells have spread.
  • Metastasis (M): It denotes if the Cancer  cells have metastasized to other parts of the body.

Bladder Cancer  is staged into 5 groups, which is determined by the extent of the tumor and its spread. The following list describes its various stages.

  • Stage 0 (Ta, N0, M0): This is the earliest stage of Bladder Cancer. Cancer  cells are diagnosed only on the inner surface of the Bladder. Cancer  cells are grouped together and can easily be removed by surgery.
  • Stage 0is (Tis, N0, M0) : At this stage, Cancer  cells are found only on the inner lining of the Bladder. This is a high-grade Cancer  and is an aggressive one as it often leads to muscle-invasive disease.
  • Stage I (T1, N0, M0): Cancer  cells have penetrated the inner lining of the Bladder but have not reached the muscular layer.
  • Stage II (T2, N0, M0): Cancer  cells have spread into the thick muscle wall of the Bladder. It is also called invasive Cancer  or muscle-invasive Cancer.
  • Stage III (T3/T4a, N0, M0): Cancer  cells have spread beyond the Bladder muscle and into the outer layer of tissue surrounding the Bladder. It may also have spread to the prostate in a man or the uterus and vagina in a woman. 
  • Stage IV: Cancer  cells have spread towards the abdominal or pelvic wall. In men, the Cancer  cells may spread to the prostate. In women, the Cancer  cells may spread to the uterus or vagina. Cancer  cells may have also spread to the lymph system and metastasized to other parts of the body. 

Survival rates of Bladder Cancer?

Survival rates indicate an average outcome of a large number of people who had the disease, but they cannot precisely predict the expectancy of any particular case. The survival rate of Bladder Cancer when detected at an early stage is quite high.

The rate decreases progressively with the passage of each stage. Stage III is considered critical, while stage IV is, more often than not, fatal. The 5-year survival rate refers to the percentage of patients who live at least 5 years after their Cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).

The numbers below are based on thousands of people diagnosed with Bladder Cancer from 1988 to 2001. These numbers come from the National Cancer Institute's SEER database.

Stage Survival Rate
0 98%
I 88%
II 63%
III 46%
IV 15%

stage of bladder

Can Blader Cancer be detected early?

The advancement in science and technology has facilitated multiple convenient ways to diagnose Bladder Cancer at a very early stage thus making its prognosis easier. Here are a few tests which are used to diagnose Bladder Cancer :

Urine Sample: Urine tests are conducted to check for abnormal cells, this called a urinary cystography. Though this test reveals some important information, however the accuracy of the same is doubtful.

Physical examination : This may include an examination of the rectum and vagina for women, and just the rectum for men.

Imaging Tests: These tests allow the doctor to observe the structures of the urinary tract. A dye is either injected into a vein or swallowed directly, to highlight the Bladder, uterus and kidneys. An X-ray is then taken to get a clear view of the suspected organs.

Cystoscopy: A long-thin flexible tube is inserted through the patient's urethra into the Bladder to look inside it. A cystoscope has a lens for viewing, and a fiber-optic lighting system which allows observind the inside of the Bladder and urethra.

Biopsy: Biopsy is a procedure in which a few cells or tissues are removed and observed under a powerful microscope. This procedure is also called TURBT (transurethral resection of Bladder tumor). TURBT is sometimes used to treat Bladder Cancer. The patient is usually given a general anesthetic.

What are the Treatments available?

There are different types of treatments available to cure Bladder Cancer. Depending on the overall health condition, age, and health history of the patient the most suitable treatment plan is selected by the oncologists. Some of the advanced treatment options are:

Surgery: It is the most preferred treatment option when Cancer  is detected at an early stage. Surgery involves removal of the tumor and some surrounding healthy tissues.  There are different types of surgeries categorized based on stage and grade of the disease.

  • Transurethral resection (TUR): In this surgery, a cystoscope is inserted into the Bladder through the urethra. An optical tool is then used to remove the Cancer  or to burn the tumor with high-energy electricity. This process is also known as fulguration.
  • Transurethral Bladder tumor resection (TURBT): In this procedure, a cystoscope is inserted through the urethra into the Bladder. The surgeon then removes the tumor using a laser, or fulguration.
  • Radical cystectomy: This is a surgery to remove the whole Bladder along with any lymph nodes and nearby organs having Cancer ous cells. This surgery is generally opted when the Bladder Cancer  invades the muscle wall, or a large portion of the Bladder. In men, generally the prostate and the seminal vesicles are removed while in women, the uterus, the ovaries, and part of the vagina are removed.
  • Partial cystectomy: This involves removing  a part of the Bladder. This surgery is usually opted for those patients who have a low-grade tumor that has invaded the wall of the Bladder but is limited to one area of the Bladder. This is also called segmental cystectomy.
  • Urinary diversion: This surgery is conducted to route a new path for the urine to pass out of the body. This becomes necessary if a major portion of the Bladder is removed through surgery as a treatment to Bladder Cancer.

Chemotherapy:

Chemotherapy is the use of drugs to inhibit the growth of Cancer  cells. A chemotherapy regimen typically consists of a specific number of cycles given over a set period of time.

There are 2 types of chemotherapy that may be used to treat Bladder Cancer.

  • Intravesical chemotherapy: In this therapy, drugs are delivered into the Bladder through a catheter that has been inserted through the urethra. Local treatment only destroys superficial tumor cells that come in contact with the chemotherapy solution.
  • Systemic chemotherapy:  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 then it is called systemic chemotherapy.
  • Regional chemotherapy: When chemotherapy is placed directly into an organ, or a body cavity such as the abdomen, the drugs mainly affect Cancer  cells in those areas then it is called regional chemotherapy.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight Cancer. It boosts the body’s natural defenses to fight the Cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. This type of Cancer  treatment is also called biotherapy or biologic therapy.

The standard immunotherapy drug for Bladder Cancer  is a weakened bacterium called bacillus Calmette-Guerin. BCG is placed directly into the Bladder through a catheter. This is called intravesical therapy. BCG attaches to the inside lining of the Bladder and stimulates the immune system to destroy the tumor.

Radiation therapy

Radiation therapy uses high-energy beams to destroy the Cancer  cells. Radiation therapy can be used after surgery to kill any remaining Cancer  cells. Depending on the method of imparting radiation, it is categorized into:

  • External-beam radiation therapy: This is  the most common type of radiation treatment. In this radiation therapy given from a machine outside the body to send radiation towards the Cancer.
  • Internal beam radiation therapy: If radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. In this a radioactive substance sealed in needles, seeds, wires, or catheters is placed directly into or near the Cancer

Is there curative treatment for Bladder Cancer?

Bladder Cancer is highly treatable when diagnosed at an early stage, when fortunately most diagnoses are made. However, Bladder Cancer has a high rate of recurrence. Hence, post therapy the patients are recommended to go for regular screening atleast once a year.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a prior or familial history of Bladder Cancer , a physical examination by a specialist is highly recommended.

How can I as a patient know it early?

Being aware of the symptoms and keeping a vigilant eye on the health conditions and any particular changes in the body behavior helps in discovering the disease at an early stage.

Bone Cancer

What is Bone Cancer?

Bone is a rigid organ that constitutes part of the vertebrate skeleton. It consists majorly of collagen and calcium phosphate. Collagen is a protein that provides a soft framework and calcium phosphate is a mineral that provides strengths and hardens the framework. This combination of collagen and calcium makes bone strong and flexible enough to withstand stress. An adult human body consists of 260 bones each serving a unique purpose.

Bones are composed of two types of tissue:

  • A strong, dense and hard outer layer, called cortical bone.
  • A spongy inner layer called trabecular bone.

Functions:

Bone serves multiple purposes in the human body. A few major functions are cited below:

  • It provides structural support for the body.
  • Bones protect internal organs from damage
  • Bone marrow makes and stores blood cells.
  • It also acts as a storage area for minerals.
  • Bones play a key role in body movement.

Bone Cancer

Bone Cancer begins as an error in a cell's DNA. The error directs the cell to grow and divide in an uncontrolled way. These cells go on living, rather than dying at a set time. The accumulating mutated cells form a mass (tumor) that can invade nearby structures or spread to other areas of the body. Bone cancer is classified into primary and secondary Bone Cancer.

Primary Bone Cancer originates in the bone cells and secondary Bone Cancer migrates to the bone cells. Primary Bone Cancer is far less common than Cancer that spreads to the bones.

Types of Bone Cancer

Bone Cancer is categorized into several subtypes depending on the area of their origin. Each of the subtypes is unique and need different treatment. Some of the most common types of Bone Cancer are as follows:

  • Osteosarcoma : It is the most common type of Bone Cancer accounting for 22 % of primary Bone Cancer in adults and 56% in children. It arises in the osteoid tissue of the bone. This tumor occurs mostly in the knee and upper arm areas of the body.
  • Chondrosarcoma : It is the second most common Bone Cancer , accounting for 35% of Bone Cancer occurrences. It occurs in the cartilaginous tissue. People older than 40 years are at a higher risk of developing this cancer. Chondrosarcoma is most commonly found in the bones of the hips and pelvis. Since it is largely resistant to chemotherapy and radiation treating planning the prognosis often poses a challenge.
  • The Ewing Sarcoma Family of Tumors (ESFTs): It is an aggressive and rare Bone Cancer that accounts for 8% of all Bone Cancer s in adults and 34% in children. ESFTs occur most commonly along the backbone and pelvis and in the legs and arms.
  • Pleomorphic sarcoma: Pleomorphic sarcomas are cancers of soft tissues. It is also a rare type of Bone Cancer and accounts for only 5% of cases.
  • Fibrosarcoma: It is an uncommon type of Bone Cancer and mostly arises behind the knee in adults.
  • Chordoma: Chordoma is a very rare cancer that poses a higher risk to people over 30 years of age. The lower or upper ends of the spinal column are the area where it is often located.
  • Spindle cell sarcoma: Spindle cell sarcoma is a rare type of Bone Cancer and tends to occur in adults over the age of 40.

Occurrence rate

There is no statistical report revealing the population-based incidence of Bone Cancer s in India. Bone sarcomas are rare tumours, approximating 0.2% of all cancers but malignant Bone Cancer cause significant morbidity and mortality. However, due to the advancement in surgical and medical oncology there have been some improvements in the survival of patients over the past few decades. Among the various types of bone sarcoma, Ewing sarcoma is the most common in India. The other common types being osteosarcoma (OGS), chondrosarcoma and synovial sarcoma.

 

Anatomy of Bone Cancer

Atonomy bone-cancer

Most common locations of Bone Cancer

bone-cancer

What are the general symptoms of Bone Cancer?

People with Bone Cancer may experience some symptoms at a later stage when the cancer cells have spread to different organs of the body. The symptoms of Bone Cancer vary from one person to person depending on the location and size of the Bone Cancer and the previous health record of the patient. Generally, there is a gradual increase in the severity of the symptoms with time. Also, many of these symptoms might indicate some other health issue rather than Bone Cancer . So, it is recommended to consult a doctor, in case of spotting these symptoms, before reaching any conclusion.

When a bone tumour grows, it presses on healthy bone tissue and can destroy it, which causes the following symptoms:

  • Sustaining pain – Pain is the most common symptom of Bone Cancer . The pain starts off as occasional and then becomes severe and constant. This pain might get worsened by exercise or the pain hits back at night when the muscles are relaxed. In children, this symptom is often mistaken for a sprain. If a child or teenager has bone pain that persists during the night then it′s always best to have it checked out by a doctor.
  • Swelling - The swelling may not be felt until the tumour is quite large. It becomes more difficult to spot if the affected bone is deep within the body tissues.
  • Reduced movement - If the cancer is near a joint, then the patient might face difficulty in movement.
  • Broken bone – Cancer cells invade the healthy cells of the bone and make them fragile, which results in a fracture called pathological fracture.
  • General symptoms - These may include tiredness, a high temperature or sweats and weight loss.

What are the general causes of Bone Cancer?

The exact cause of Bone Cancer is yet not known. Over the course of time, some factors that might increase the risk of Bone Cancer are unveiled. Some risk factors known till date are discussed below:

  • Radiotherapy treatment
    Exposure to high doses of radiation may cause cancerous changes in the bone cells.
  • Bone conditions
    Certain conditions of the bone may increase the chances of developing Bone Cancer .
    • Paget’s disease of the bone sometimes increases the risk of Bone Cancer especially in older people over 50-60 years of age. Paget disease makes the bone heavy, thick, and brittle. They are weaker than normal bones and more likely to fracture. Bone Cancer develops in about 1% of those with Paget disease, usually when many bones are affected.
    • Ollier's disease is a rare condition of the bones that cause tumors to grow which can increase the risk of Bone Cancer .
  • Genetic conditions
    • A rare genetic condition called hereditary cancer predisposition, also known as Li-Fraumeni syndrome increases the risk of developing Bone Cancer to some extent. Li-Fraumeni creates a faulty version of a gene that usually helps stop the growth of tumours in the body. Sometimes, people with Li- Fraumeni develop multiple tumours often in their childhood or during adolescence.
    • Multiple exostose syndrome is an inherited condition that causes many bumps on a person’s bones. These bumps are made mostly of cartilage. They can be painful and deform and/or fracture bones. This disorder is caused by a mutation in any one of the 3 genes EXT1, EXT2, or EXT3. Patients with this condition have an increased risk of chondrosarcoma.
  • Other conditions
    • Retinoblastoma is a rare type of eye cancer which can sometimes lead to Bone Cancer , as the same inherited faulty gene can be responsible for both conditions. Also, if radiation therapy is used to treat the retinoblastoma, the risk of osteosarcoma in the bones around the eye is even higher.
    • Another syndrome that induces Bone Cancer is the Rothmund-Thomson syndrome
    • Babies born with an umbilical hernia are three times more likely to develop Ewing sarcoma.

Can Bone Cancer be prevented?

Most of the causes of Bone Cancer are hereditary or genetic that is beyond our control. However, leading a healthy life and taking certain precautions might aid in avoiding this deadly disease. Here are a few tips that are easy to follow and offer great resistance to the disease:

  • Being aware of the genes and locating if anyone in their bloodline has been diagnosed with the problem in the past.
  • Leading a healthy lifestyle and avoiding harmful habits like smoking, alcohol or stress helps in avoiding Cancer.
  • Diet and nutrition play a pivotal role in preventing any cancer. Keeping a track of caloric intake and sticking to a low-fat diet, including fruits and vegetables and reducing the intake of saturated fat and red meat helps in avoiding the disease.
  • Physical exercise and yoga are effective in maintaining a healthy body and controlling obesity. A healthy and fit body helps in preventing Cancer.
  • It is crucial for cancer to be diagnosed before metastasis. Consulting an expert for screening and detection of the condition before it spreads is very necessary.

Some herbal and organic tips can also be followed to prevent Bone Cancer . The use of turmeric and ginseng in preparing food helps in avoiding any form of cancer. Turmeric has a therapeutic compound called curcumin which possesses the properties to fight cancer and improve the immune system of the body. A clinical trial of curcumin proved that it could stop the precancerous changes becoming cancer. Ginseng is the herb which hinders the formation of cancer cells, while certain green tea extracts are also effective in hindering the growth of cancer tissue. Clinical research on the above topic is still in progress and an appropriate conclusion is yet to be reached.

What are the stages of Bone Cancer?

Bone Cancer is staged into 4 stages, based on the severity and spread of the Cancer cells. The treatment options for Bone Cancer are planned based on the stage of the Cancer and overall health of the patient.

  • Stage I: If the Cancer is limited to the bone and hasn′t spread to other areas of the body then it is termed as stage I. Cancer at this stage is considered low grade and not aggressive. It is further classified into two subgroups:
    • Stage IA: The tumor is low grade and is smaller than 8 cm. It has not spread to any lymph nodes or to other parts of the body and is marked as T1, N0, M0, G1/G2.
    • Stage IB: The tumor is low grade but is larger than 8 cm. It has not spread to any lymph nodes or to other parts of the body. It is marked as T2, N0, M0, G1/G2.
  • Stage II: If the cancer is limited to the bone and hasn′t spread to other areas of the body then it is characterized as stage II. In this stage, the cancer has turned high grade and aggressive. It is further categorized into:
    • Stage IIA: The tumour is of high grade and its size varies from 2 to 8 cm. It has not spread to any lymph nodes or to other parts of the body. It is marked as T1, N0, M0, G3/G4.
    • Stage IIB: The tumour is of high grade and is larger than 8 cm. It has not spread to any lymph nodes or to other parts of the body. The tumour is described as T2, N0, M0, G3/G4.
  • Stage III: At this stage, Bone Cancer has spread to two or more places on the same bone. The cancer is of high grade and is usually very aggressive. There are multiple high-grade tumours in the primary bone site, but they have not spread to any lymph nodes or to other parts of the body. It is described as T3, N0, M0, G3/G4.
  • Stage IV: This stage indicates that tumor may be of any size or grade and has spread beyond the bone to other areas of the body, such as the brain, liver or lungs.
    • Stage IVA: The cancer cells have spread to the lung(s) (any G, any T, N0, and M1a).
    • Stage IVB: The tumor has spread to the lymph nodes (any G, any T, N1, and any M), or to another organ besides the lung (any G, any T, any N, and M1b).

Survival rates of Bone Cancer?

The tremendous plunge in the development of science and technology has aided better treatment facility which resulted in more successful cases of Bone Cancer recovery in recent years. Survival rates are basically an indicator that helps in analyzing the expected life span of the patients based on previous records of patients with the same condition. However, these rates do not claim the same life expectancy for each individual.

survival rate of bone cancer

Can Bone Cancer be detected early?

Yes, today there are a number of ways that help in detecting Bone Cancer at a very early stage. Increased awareness among the people about this disease has helped in identifying the hideous disease at early stages. Some tests and procedures for Bone Cancer diagnosis are discussed below:

  • Bone scan: A liquid with radioactive material is injected into a vein which gets accumulated in the abnormal areas of the bone. The cancer cells can then be spotted by using a scanner.
  • Computerized tomography (CT): It is used to generate a clear 3-D image of the inside of a bone. It is a painless procedure and helps to identify if the cancer cells have metastasized and to which locations.
  • Magnetic resonance imaging (MRI): The device uses a magnetic field and radio waves to create detailed images of the specific bone or part of a bone.
  • Positron emission tomography (PET): In this procedure, a small amount of radioactive glucose is injected into a vein and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. As cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.
  • X-rays: An X - ray scan can detect damages caused by the cancer cells. It also gives information about the location, size and shape of the tumour. An X-ray also helps in detecting any new cells that have started to form around the tumour.
  • Blood tests: Certain blood tests may also be recommended by the doctor to determine the level of an enzyme called alkaline phosphatase. The presence of cancerous cells may cause the raised level of this enzyme. But this test alone cannot certify the presence of Bone Cancer as there are multiple scenarios where this enzyme is found at a high level.
  • Bone biopsy: A sample of bone tissue is extracted and examined for cancer cells. This is the most reliable way to diagnose Bone Cancer . A core needle biopsy involves inserting a long, thin needle into the bone and removing a sample, while an open biopsy involves making an incision in the target bone area and surgically removing a sample of tissue.

What are the Treatments available?

Treatment options for Bone Cancer depend on several factors, including the type, size, location, and stage of the cancer, as well as the person’s age and general health. Some of the most common and effective treatment options for Bone Cancer are given below:

  • Surgery is the usual treatment for Bone Cancer . The entire tumor along with negative margins is removed through surgery.
    • Limb-sparing surgery, have made it possible for many people to avoid amputation.
    • Even when the Bone Cancer has metastasized and spread to the lungs then also the patient may be cured using surgery. An operation to remove the part of the lung that′s affected is used to cure metastatic cancer. This operation is called a thoracotomy.
  • Neoadjuvant Chemotherapy: In this procedure, medicinal aid is used to shrink the size of tumour before surgery. Due to its effective results and good response, neoadjuvant chemotherapy is now included as a routine procedure to treat cancer. Research revealed that neoadjuvant chemotherapy can significantly improve the survival rate of the patient and so most often the therapy consists of neoadjuvant chemotherapy followed by wide surgical resection and subsequent adjuvant chemotherapy.
  • Chemotherapy: In this procedure, anticancer drugs are used to kill or inhibit the growth of cancer cells. Patients with Bone Cancer usually receive a combination of anticancer drugs. It is an important part of the treatment for most osteosarcomas, spindle cell sarcomas and Ewing’s sarcomas.
    Common drugs for osteosarcoma include:
    • Cisplatin (Platinol)
    • Doxorubicin (Adriamycin)
    • Ifosfamide (Ifex)
    • Methotrexate
    Common drugs for Ewing sarcoma include:
    • Vincristine (Oncovin, Vincasar)
    • Doxorubicin (Adriamycin)
    • Cyclophosphamide (Cytoxan, Neosar)
    • Ifosfamide (Ifex)
    • Etoposide (Toposar, VePesid)
    • Dactinomycin (Cosmegen)
  • Radiation therapy: In this procedure, high-energy x-rays are used to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, in which radiation is given from a machine outside the body. If radiation is given using implants, then it is called internal radiation therapy or brachytherapy. For Bone Cancer , radiation therapy is most often used if the tumour cannot be removed by surgery. Radiation therapy may also be done before surgery to shrink the tumour, or it may be done after surgery to destroy any remaining cancer cells as per doctor’s recommendation. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements.
  • Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells. This technique can sometimes be used to destroy the tumour.

Is there curative treatment for Bone Cancer ?

Yes, Bone Cancer is curable through surgery when detected at an early stage. Even at a later stage, surgery, chemotherapy, radiation therapy and several modern treatments help in curing the disease.

How frequently should one visit doctor for early diagnosis?

We would suggest visiting the doctor if there is persistent, severe or worsening bone pain, or if you experience any of the symptoms mentioned above. Also, if you have a high risk of developing Bone Cancer then keeping up a regular check on the health factors, helps in early diagnosis. While it's highly unlikely that the symptoms are caused by cancer, it's best to be sure by getting a proper diagnosis.

How can I as a patient know it early?

Being aware of the health updates and knowing about your family health history helps in identifying the risk factors that might lead to the development of Bone Cancer .

Brain Cancer (Adult)

What is Brain Cancer? (Adult)

Brain

The brain is one of the most complex and magnificent organs in the human body. It is a delicate organ consisting of billions of nerves protected by the skull. The brain receives input from the sensory organs and in response, sends output to the muscles. It controls the functions of all the other organs.

The brain is the processing center of a constant stream of sensory data. It controls all the muscle movements, the secretions of glands, breathing and internal temperature. Every creative thought, feeling, and plan is developed by the brain. The brain’s neurons record the memory of every event.

The brain contains-

  • about 86 billion nerve cells (neurons) — the "gray matter"
  • billions of nerve fibers (axons and dendrites) — the "white matter"
  • The neurons are connected by trillions of connections called synapses.

Parts and Functions

The brain is segmented into specialized areas that perform specific functions:

  • The cortex is the outermost layer of brain cells. Thinking and voluntary movements are controlled in the cortex.
  • The brain stem is located between the spinal cord and the brain. Functions like breathing, sleeping etc are monitored by this part.
  • The basal ganglia are a cluster of structures located at the center of the brain. The basal ganglia coordinate messages between multiple other brain areas.
  • The cerebellum is situated at the base and the back of the brain. It is responsible for coordination and balance.

The brain is surrounded by a layer of tissue called the meninges. The skull (cranium) helps protect the brain from injury.

Left brain vs. right brain

The human brain is divided into two hemispheres, the left and right, connected by a bundle of nerve fibers called the corpus callosum. The two hemispheres are almost symmetrical. The left brain controls all the muscles on the right-hand side of the body; and the right brain controls the left side.

The left brain contains regions involved in speech and language (Broca's area and Wernicke's area), and is also associated with mathematical calculation and fact retrieval. The right brain plays a role in visual and auditory processing, spatial skills and artistic ability — more instinctive or creative things.

What is Brain Cancer (Adult?)

Brain and spinal cord tumors are masses of abnormal cells in the brain or spinal cord that have grown out of control.

These tumor may be either benign (non-cancerous) or malignant (cancerous). Benign tumors do not grow into nearby tissues or spread to distant areas, and are generally not life threatening. But the malignant tumors can spread throughout the body thus posing a danger to life. Sometimes, tumors that start out less aggressive can change their behavior and become aggressive.

Although brain tumors rarely spread to other parts of the body, most of them can spread through the brain tissues. The tumors can grow and destroy normal brain tissue, causing damage that is often disabling and sometimes fatal. Brain and spinal cord tumors tend to be different in adults and children. They often form in different areas, develop from different cell types, and may have a different outlook and treatment.

Types of Brain Cancer

Brain tumors are classified into several different types depending on various factors like location of the tumor, type of tissue involved, benign or malignant etc. The prognosis, occurrence and survivorship differ for each type. Some of the major types are:

  • Gliomas is a general term for a group of tumors that start in glial cells. It is one of the most common types of brain cancer among adults in the age group 40 - 70. Gliomas accounts for about 33% of all brain tumors. Most fast-growing brain tumors are gliomas. It is further divided into three types:
  • Astrocytic tumors: Astrocytomas are tumors that start in glial cells called astrocytes. About 20% of all brain tumors are astrocytomas. Most astrocytomas can spread widely throughout the brain and blend with the normal brain tissue, thus making it very hard to treat with surgery. Astrocytomas are often classified as -
    • High grade astrocytomas (glioblastomas) are the fastest growing. These tumors make up about two-thirds of astrocytomas and are the most common malignant brain tumors in adults.
    • Intermediate-grade astrocytomas (anaplastic astrocytomas) grow at a moderate rate.
    • Low-grade astrocytomas tend to be slow growing, but they can become more aggressive and fast growing over time.
  • Oligodendroglial tumors: These tumors are rare and slow growing and accounts for only 2% of brain tumors. Oligodendrogliomas may sometimes spread within the brain cells but rarely spread outside the brain or spinal cord. They may tend to become more aggressive over time. Very aggressive forms of these tumors are known as anaplastic oligodendrogliomas.
  • Schwannomas: It develops from Schwann cells of any cranial nerve and accounts for about 8% of all CNS tumors and is most prevalent in the age group 40 – 70. Schwannomas are almost always benign tumors but can still cause serious complications and owing to their size or location. When they form on the cranial nerve responsible for hearing and balance near the cerebellum they are called vestibular schwannomas. They can also start on spinal nerves and can press on the spinal cord, causing weakness, sensory loss, and bowel and bladder problems.
  • Ependymomas: These tumors arise from ependymal cells, which line the ventricles and accounts for only 2% of brain tumor cases. They can range from low-grade tumors to higher grade ones, which are called anaplastic ependymomas. Usually, ependymomas do not grow into normal brain tissue and can be removed completely and cured by surgery. But if they spread within the brain, then treating them becomes difficult. Spinal cord ependymomas have the greatest chance of being cured with surgery, but treatment can cause side effects related to nerve damage.
  • Meningiomas: Meningiomas begin in the meninges, the layers of tissue that surround the outer part of the brain and spinal cord. Meningiomas accounts for 33% of primary brain and spinal cord tumors. They are the most common brain tumors in adults. The risk of these tumors increases with age and occur about twice as often in women. Sometimes these tumors run in families.
    Meningiomas are often assigned a grade:
    • Grade I (benign) tumors have cells that appears like normal cells. They make up about 80% of meningiomas. Though most of these can be cured by surgery, but some grow very close to vital structures in the brain or cranial nerves and cannot be cured through surgery.
    • Grade II (atypical or invasive) meningiomas usually have cells that look slightly abnormal. About 15% to 20% of meningiomas are grade II. They can grow directly into nearby brain tissue and may recur even after surgery.
    • Grade III (anaplastic) meningiomas have cells that look abnormal. They make up only about 1% to 3% of meningiomas. They tend to grow quickly, can grow into nearby brain tissue and bone, and are the most likely to recur after treatment. Some may even spread to other parts of the body.
  • Craniopharyngiomas: These slow-growing tumors start above the pituitary gland but below the brain. They may press on the pituitary gland and the hypothalamus, causing hormone problems. Because they start very close to the optic nerves, they can also cause vision problems. Their tendency to stick to these important structures can make them hard to remove completely without damaging vision or hormone balance. Craniopharyngiomas are more common in children, but they are sometimes seen in adults.

Occurrence Rate of Kidney cancer in India

The largest part of the human brain is the cerebrum, which is divided into two hemispheres. Underneath lies the brainstem, and behind that sits the cerebellum. The outermost layer of the cerebrum is the cerebral cortex, which consists of four lobes: the frontal lobe, the parietal lobe, the temporal lobe and the occipital lobe.

The human brain develops from three sections known as the forebrain, midbrain and hindbrain. Each of these contains fluid-filled cavities called ventricles. The forebrain develops into the cerebrum and underlying structures; the midbrain becomes part of the brainstem; and the hindbrain gives rise to regions of the brainstem and the cerebellum.

Anatomy of Brain Cancer

Anatomy of brain-cancer

 

Copyright © : The above image is copyright of respective author and being used for educational purpose only.

What are the general symptoms of Brain Cancer?

The symptoms of a brain tumor may develop gradually or rapidly depending on the type of tumor. Generally, headache is the most common symptom but it is not the only symptom. Absurd changes in personality traits and having a seizure are other general symptoms. The other major symptoms are sickness, vomiting and confusion.

Mostly the symptoms depend on the size of the tumor, its location and the spread of tumor. Tumors in the cerebrum can cause weakness of the body, problems with speech, vision and memory. Tumors in the cerebellum and in the brain stem can lead to problems with coordination and unsteadiness. A tumor in the pituitary gland can cause different hormone related symptoms, such as infertility but can also cause tunnel vision. A tumor that affects the hearing nerve causes hearing loss.

However, spotting any of these symptoms do not ascertain brain tumor, these can be caused by other conditions as well. So, it is advised to visit a doctor and go through complete screening before jumping into conclusions.

Symptoms in details:

  • Headaches: Brain tumor related headaches are usually severe, throbbing, worse in the morning and aggravated by straining or coughing. Even painkillers are ineffective in reducing these. Headaches caused by brain tumors may:
    • Be worse when the person wakes up in the morning
    • Occur during sleep
    • Vomiting, confusion, double vision, weakness, or numbness
    • Get worse with coughing or exercise, or with a change in body position
  • Seizures: Seizures or ‘fits’ are one of the common symptoms of a brain tumor. Severe seizures can cause loss of consciousness for the duration. Subtle seizures are more common than severe seizures in people with brain tumors. Subtle seizures cause the limbs to twitch, changes in sensation, or adopting an unusual posture.
  • Change in Vision: Blurred vision is also a symptom of brain tumor. The patient may also experience fleeting loss of vision ('greying out'), especially while standing up or changing posture with a sudden jerk. Other eye problems such as eyelid drooping, pupils of different sizes, uncontrollable eye movement are also important indicators of brain tumor.
  • Weakness: Nausea and drowsiness are also associated with brain tumor. Nausea is at its worse in the morning or while changing position suddenly. Drowsiness usually indicates a brain tumor at later stage. As the tumor grows and the pressure increases, the tendency to sleep increases.
  • Change in personality: Patients may experience a change in alertness including sleepiness, unconsciousness, and coma. Also, the functioning of sensory organs may be affected thus causing changes in hearing, taste, smell, touch and the ability to feel pain, pressure, different temperatures, or other stimuli.
  • Some other symptoms may include:
    • Confusion or memory loss
    • Difficulty swallowing
    • Hand tremor
    • Lack of control over the bladder or bowels
    • Loss of balance or coordination, clumsiness, trouble walking
    • Muscle weakness in the face, arm, or leg
    • Numbness on one side of the body
    • Personality, mood, behavior, or emotional changes
    • Trouble speaking or understanding
    Other symptoms that may occur with a pituitary tumor:
    • Abnormal nipple discharge
    • Irregular menstruation (periods)
    • Breast development in men
    • Enlarged hands, feet
    • Excessive body hair
    • Facial changes
    • Low blood pressure
    • Obesity
    • Sensitivity to heat or cold

What are the general causes of Brain Cancer?

The exact causatives of tumors that originate primarily in the brain are still unknown. However, over the years of observation certain risk factors are considered to play a role:

  • Radiation therapy increases the risk of brain tumor.
  • Certain hereditary traits increase the risk of brain tumors, e.g. neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome.
  • Exposure to radiation at work, to power lines, cell phones, cordless phones, or wireless devices
  • Head injuries
  • Smoking
  • Hormone therapy

Can Brain Cancer be prevented?

Since, the factors responsible for causing brain cancer are not precise, so the precautionary measures are also not clear at this point of time. However, avoiding radiations or smoking may offer some shield in certain cases. The causes and preventions are still under scrutinization and very soon we would have some information about them.

What are the stages of Brain Cancer?

Staging of the tumor is a way of describing the size and spread of the tumor. Once cancer is diagnosed, several tests and scans are conducted to confirm the stage of the cancer. Once the stage is assigned, it becomes clearer to start the prognosis and determine the most effective treatment routine.

Brain cancer staging systems is different from the traditional staging system of other cancer types as it is very rare to see primary brain cancer spreading to other organs of the body. Tumors may migrate within the brain or central nervous system but it is rare to spread outside the brain. Consequently, brain cancer is usually graded rather than staged. Grading describes how similar a cancer cell is to a normal cell.

  • Grade I: The tumor grows slowly and rarely spreads into nearby tissues. The cancer cells can be completely removed with surgery.
  • Grade II: The tumor grows slowly, but may gradually spread into nearby tissue or recur.
  • Grade III: The tumor grows rapidly and might spread into nearby tissue. The tumor cells look very different from normal cells.
  • Grade IV: The tumor grows and spreads very quickly. The tumor cells look abnormal when viewed carefully. Usually more complicated treatment is needed to cure cancer at this stage. Metastatic brain tumors

Metastatic brain tumors are the tumors that have spread to the brain from another location in the body. Some cancers that commonly spread to the brain are lung, breast, colon, kidney, melanoma, thyroid and uterine. Lung cancer is the most common form of metastatic brain cancer. Metastatic brain cancers will likely be accessed through the Tumor, Node, and Metastasized staging system (TNM).

  • T refers to the size and spread of cancer into nearby tissue.
  • N refers to the spread of cancer to the lymph nodes
  • M refers the spread of cancer to another part of the body

Survival rates of Brain Cancer?

Survival rates present a generic view of the outlook of a large number of people with the same conditions. However, survival rates cannot precisely predict the expectancy of any particular case. The survival rate greatly depends on the patients health history, his/her response to certain medications and the type of cancer.

Type of Tumor 5-Year Relative Survival Rate
Age
20-44 45-54 55-64
Low-grade (diffuse) astrocytomas 65% 43% 21%
Anaplastic astrocytoma 49% 29% 10%
Glioblastoma 17% 6% 4%
Oligodendroglioma 85% 79% 64%
Anaplastic oligodendrogliomas 67% 55% 38%
Ependymoma /anaplastic ependymomas 91% 86% 85%
Meningioma 92% 77% 67%

Can Brain Cancer be detected early?

As of now, there are no widely recommended tests to screen for brain and spinal cord tumors. Most brain tumors are diagnosed when a person sees a doctor because of signs or symptoms they are having. Most often, the outlook for people with brain and spinal cord tumors depends on their age, the type of tumor, and its location, not by how early it is detected. But as with any disease, earlier detection and treatment is likely to be helpful.

If the signs and symptoms indicate the presence of a brain tumor, then the doctor would recommend a complete medical examination. Based on the results of these tests further neurological tests are conducted. Some of the commonly opted tests are:

Imaging Tests: Imaging tests use x-rays, strong magnets, or radioactive substances to create pictures of the brain and spinal cord. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are also done most often for brain diseases. These scans will show a brain tumor, if one is present, in almost all cases.

MRI Scan: MRI scans use radio waves and strong magnets and produces a detailed picture of the brain and spinal cord. It is considered the best way to look for tumors in these areas. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image. A contrast material called gadolinium may be injected into a vein before the scan for better visibility. But MRIs do not image the bones of the skull and therefore may not show the effects of tumors on the skull.

  • Magnetic resonance angiography (MRA): This special form of MRI may be done to look at the blood vessels in the brain. This is especially helpful to observe details before surgery.
  • Magnetic resonance spectroscopy (MRS): MRS highlights some features of brain tumors that are not clearly seen by MRI. It creates graph-like results called spectra. This might give clues as to the type of tumor, but in most cases a biopsy of the tumor is still needed to get an accurate diagnosis.
  • Magnetic resonance perfusion: In this test, a contrast dye is injected into a vein. A special type of MRI is then obtained to look at the amount of blood going through different parts of the brain and tumor. Tumors often have a bigger blood supply than normal areas of the brain. A faster growing tumor may need more blood.
    Perfusion MRI gives an idea of the best place to take a biopsy. It can also be used after treatment to help determine if an area that still looks abnormal is remaining tumor or if it is more likely to be scar tissue.

Computed tomography (CT) scan: It is an x-ray that produces detailed cross-sectional images of brain and spinal cord. Instead of taking one picture, like a regular x-ray, a CT scanner takes multiple pictures from different angles. A computer then combines these pictures into images of slices of the body. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body. Before the scan, an injection of a contrast dye is applied to help better outline any tumors that are present.

  • CT angiography (CTA): In this test, a contrast material is injected through an IV line. The scan creates detailed images of the blood vessels in the brain, which can help doctors plan surgery. CT angiography can provide better details of the blood vessels in and around a tumor than MR angiography in some cases.
  • Positron emission tomography (PET) scan: In this test, a radioactive substance is injected into the blood. As tumor cells in the body grow quickly, they absorb larger amounts of the sugar than most other cells. A special camera creates a picture of areas of radioactivity in the body. The picture provides helpful information regarding whether abnormal areas are likely to be tumors or not.

Brain or spinal cord tumor biopsy: Imaging tests highlights an abnormal area that is likely to be a brain or spinal cord tumor. But these scans can’t give details regarding the type or stage of tumor. To obtain these details some of the tumor tissue is removed in a procedure called a biopsy.

The tissues removed are then observed under a microscope to determine if the tumor is benign or malignant (cancerous) and exactly what type of tumor it is. There are 2 main types of biopsies for brain tumors.

  • Stereotactic (needle) biopsy: It is used when the risks of surgery to remove the tumor is too high. A rigid frame may then be attached to the head. This helps make sure the surgeon is targeting the tumor precisely. An incision (cut) is made in the scalp and a small hole is drilled into the skull. An MRI or CT scan is often used along with the frame to help the neurosurgeon guide a hollow needle into the tumor to remove small pieces of tissue.
    The removed tissue is then observed under a microscope to determine the type of tumor. This is very important in determining the prognosis (outlook) and the best course of treatment .
  • Surgical or open biopsy (craniotomy): If the tumor can be treated with surgery, then a needle biopsy is not conducted. Instead, an operation called a craniotomy to remove all or most of the tumor is preferred.
    Small samples of the tumor are looked at right away by the pathologist while the patient is still in the operating room, for a preliminary diagnosis. This can help guide treatment, including whether further surgery should be done at that time. A final diagnosis is made within a few days in most cases.

Lumbar puncture (spinal tap): This test is used to look for cancer cells in the cerebrospinal fluid (CSF), the liquid that surrounds the brain and spinal cord. The doctor first numbs an area in the lower part of the back near the spine. A small, hollow needle is then placed between the bones of the spine to withdraw some of the fluid. This fluid is then observed under a microscope for cancer cells.

What are the Treatments available?

The treatment protocols vary widely according to the location of the tumor, its size and type, your age, and any additional medical problems that you may have.

Often, low-grade tumors, which are not aggressive, are treated with surgery alone. Though all tumors are monitored with repeat scans, grade II tumors are watched more closely after surgery and over time to make sure there is no recurrence.

Higher grade tumors, which are malignant and can grow quickly, are more difficult to remove and require additional treatments beyond surgery, such as radiation, chemotherapy, or a clinical trial. Microscopic tumor cells can remain after surgery and will eventually grow back.

Treatment of brain cancer is usually complex. Most treatment plans involve several consulting doctors. The most widely used treatments are surgery, radiation therapy, and chemotherapy. In most cases, more than one of these is used.

  • Brain Cancer Surgery: Surgery is done to confirm that the abnormality seen is indeed a tumor and to remove the tumor. In some cases specifically in benign tumors, symptoms can be completely cured by surgery. You may undergo several treatments and procedures before surgery. For example:
  • Radiation therapy: X-rays and other forms of radiation can destroy tumor cells or delay tumor growth.
  • Chemotherapy: The use of drugs to kill rapidly dividing cells. It can be taken orally or intravenously.
  • Targeted therapy: The focus on a specific element of a cell, such as molecules or pathways required for cell growth, in order to use them as a target.
  • Tumor Treating Fields: (A wearable device) locally or regionally delivered treatment that produces electric fields to disrupt the rapid cell division exhibited by cancer cells by creating alternating, “wave-like” electric fields that travel across their region of usage in different directions. Because structures within dividing cells have an electric charge, they interact with these electric fields.
  • Palliative Treatment: You may be given a steroid drug, such as dexamethasone (Decadron), to relieve swelling. You may be treated with an anticonvulsant drug to relieve or prevent seizures.

Is there curative treatment for Brain Cancer?

Most cases of the brain cancers can be treated with surgery. But, for more complicated tumors other treatment options like radiation, chemotherapy etc. should be opted.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a history of cancer, an examination by a specialist is recommended once in a year.

How can I as a patient know it early?

Acknowledging the symptoms and visiting a doctor for examination helps in early diagnosis.

Brain Cancer (Child)

What is Brain Cancer?

Brain

The brain is one of the most complex and magnificent organs in the human body. It is a delicate organ consisting of billions of nerves protected by the skull. The brain receives input from the sensory organs and in response, sends output to the muscles. It controls the functions of all the other organs.

The brain is the processing center of a constant stream of sensory data. It controls all the muscle movements, the secretions of glands, breathing and internal temperature. Every creative thought, feeling, and plan is developed by the brain. The brain’s neurons record the memory of every event.

The brain contains-

  • about 86 billion nerve cells (neurons) — the "gray matter"
  • billions of nerve fibers (axons and dendrites) — the "white matter"
  • The neurons are connected by trillions of connections called synapses.

Parts of the brain:

The main parts of the brain are:

  • The cerebrum – Cerebrum is located at the top of the head and is the largest part of the brain. It’s made up of two hemispheres. The cerebrum is responsible for controlling thinking, learning, memory, problem solving, emotions and touch.
  • The cerebellum – The cerebellum is the back part of the brain, and it controls movement, balance and coordination.
  • The brain stem – The brain controls the flow of messages between the brain and the body, it also takes care of breathing, body temperature, heart rate and blood pressure, eye movements and swallowing.

What is Brain Cancer (Children)?

Brain and spinal cord tumors are masses of abnormal cells in the brain or spinal cord that have grown out of control. Brain tumours are the most common form of solid tumours among children. Brain tumors destroy brain cells indirectly by pushing on other parts of the brain.

This pressure gradually gives way to several symptoms of brain cancer. Brain tumors are classified based on the location of the tumor, the type of tissue involved, and the type of tumor. The tumors that originate in the brain are called primary brain tumors and they are further classified into:

  • Benign (Not cancerous)
  • Malignant (Invasive)

Benign tumors do not spread into nearby tissues or spread to distant areas, and are generally not life threatening. But the malignant tumors can spread throughout the body thus posing a danger to life. Sometimes, tumors that start out less aggressive can change their behaviour and become aggressive.

Types of Brain Tumors

There are many different types of brain tumors. Some are cancerous while others aren't. Brain tumors are categorized based on its location, the type of cells involved, and the pace of growth. Based on multiple factors tumors are grouped into the following categories:

  • Astrocytomas or low grade tumors are slow-growing tumors most common among children in the age group of 5 to 8. Pilocytic astrocytomas are generally benign tumors but diffuse astrocytomas are usually slow growing, but may not be benign.
  • Medulloblastomas are the most common type of brain cancer found in children below the age of 10.
  • Ependymomas can be benign or malignant. These are further subcategorized based on their location and type. The therapy and prognosis varies for each subtype.
  • Brainstem gliomas are very rare tumors that occur only in children. The average age at which they develop is about 6. These tumors usually do not cause any prominent symptom until they grow very large in size.
  • Craniopharyngiomas are non-cancerous tumors that form at the base of the brain near the pituitary gland. Though these tumors are more common among children but may also occur in adults in late 50’s or 60’s.
  • Germ cell tumors usually form in the testes or ovaries but can also form in the brain and central nervous system. Childhood central nervous system (CNS) germ cell tumors rarely spread outside of the brain and spinal cord
  • Pontine gliomas are cancerous, high-grade tumors that form in a part of the brainstem called the pons.
  • Optic nerve gliomas form in or around the optic nerve, which connects the eye to the brain. Most optic nerve gliomas are noncancerous and slow-growing.

Occurrence Rate of Brain Cancer among children

Tumors of the central nervous system are the second most common childhood tumor after leukemia, accounting for about 35% of all childhood malignancies. They are also the leading cause of cancer-related deaths in children. Childhood central nervous system (CNS) tumors differ significantly from adult brain tumors in reference to their sites of origin, clinical presentation, tendency to disseminate early, histological features and their biological behaviour. A recent study on paediatric cancer concluded that childhood cancer incidence appears to be increasing in India.

In India, due to lack of registration of newly diagnosed cases with local cancer registries, the exact number of tumor cases goes unnoticed and is underestimated. Due to the high incidence and mortality of childhood CNS tumors, they form the most demanding group of tumors for neuro-oncologists. According to a recent study, the most common brain tumors in the pediatric age group in descending order are astrocytoma, medulloblastoma, craniopharyngioma followed closely by ependymoma.

Tumor type in Childhood AAR per million
(0-14 years) Boys Girls
Leukemia 35.7-61.3 22.3-40.2
Lymphoma 9.9-25.6 2.9-10.1
Central-nervous-system tumor 6.6-19.8 3.0-16.0
SNS tumor 1.5-12.6 1.8-5.3
Retinoblastoma 1.9-12.3 1.3-6.7
Renal tumor 3.1-9.5 1.8-7.0
Hepatic tumor 0.5-2.0 1.0-1.8
Bone tumor 2.8-9.0 2.3-6.2
Soft tissue Sarcoma 2.8-7.2 1.6-7.6
Germ cell tumor 1.3-12.9 0.2-1.3
AAR : Age-adjusted rates; Source: NCRP report 2009–2011 [4].

Anatomy of Brain

 

Copyright © : The above image is copyright of respective author and being used for educational purpose only.

What are the general symptoms of Brain Cancer?

Brain tumours can cause many different signs and symptoms. There is a difference between a sign and symptom. Patient will feel a symptom, but a sign is usually detected in medical tests. Both signs and symptoms are assessed when making a diagnosis.

The symptoms of brain tumor are caused due to the tumor growth pressing on the surrounding parts of the brain, or by causing a build up of spinal fluid, a condition known as hydrocephalus. Signs or symptoms vary depending on a child's age and the location of the tumor; however headaches are often the most common symptom.

But any general headache does not assure the presence of a tumor. Headache patterns that may occur with brain tumors include:

  • Headaches that are worse when waking up in the morning and go away within a few hours
  • Headaches that get worse with coughing or exercise, or with a change in body position
  • Headaches that occur while sleeping and with at least one other symptom such as vomiting or confusion.

Sometimes, the only symptoms of brain tumors are mental changes, which may include:

  • Changes in personality and behaviour
  • Unable to concentrate
  • Increased sleep
  • Memory loss
  • Problems with reasoning

Other possible symptoms include:

  • Gradual loss of movement or feeling in an arm or leg
  • Hearing loss with or without dizziness
  • Speech difficulty
  • Unexpected vision problem, including vision loss in one or both eyes.
  • Problems with balance
  • Weakness or numbness

Depending on the location of tumor in different parts of the brain or spinal cord the symptoms vary. But these symptoms can be caused by any disease in that particular location – they don’t certify the presence of a brain or spinal cord tumor. Brain and spinal cord tumors often cause problems with the specific functions of the region they develop in. For example:

  • Tumors in the parts of the cerebrum can cause weakness or numbness in a part of the body.
  • Tumors in or near the parts of the cerebrum responsible for language can cause problems in speech or understanding words.
  • Tumors in the front part of the cerebrum can sometimes affect thinking, personality, and language skills.
  • Tumors in an area of the brain called the basal ganglia typically cause abnormal movements.
  • Tumors in the cerebellum can cause trouble walking or with other normal functions.
  • Tumors in the back part of the cerebrum, or around the pituitary gland, the optic nerves, or certain other cranial nerves can cause vision problems.
  • Tumors in or near other cranial nerves might lead to loss of hearing, balance problems, weakness of some facial muscles, or trouble swallowing.
  • Spinal cord tumors may cause numbness, weakness, or lack of coordination in the arms and/or legs, as well as bladder or bowel problems.

In most cases, brain tumor symptoms are subtle and gradually become worse as the size of the tumor increases. Because of the subtle nature of symptoms, they may appear like common childhood conditions, thus making brain tumors diagnosis difficult. It is highly recommended to see a doctor, if the child is facing any of the mentioned difficulty.

What are the general causes of Brain Cancer?

The exact causes of most brain and spinal cord tumors are yet to be unveiled. However, researchers have discovered some of the changes that occur in normal brain cells which may lead to the formation of tumors. Though clear causes for Brain and Spinal Cord tumours are still debatable, certain risk factors have been recognized.

Inherited Genetic Condition: Brain and spinal cord tumors are usually caused by unaccounted mutations in the DNA. Genes in our DNA that controls cell growth and division are called oncogenes. The other genes that slow down cell division, or cause cells to die at the right time, are called tumor suppressor genes. Sometimes mutations in the DNA turn on oncogenes or turn off tumor suppressor genes thus leading to growth of cancer cells. These gene changes can be either inherited from a parent or they occur spontaneously during a person’s lifetime.

Some of the more well-known syndromes include:

  • Neurofibromatosis type 1 (von Recklinghausen disease)
  • Neurofibromatosis type 2
  • Tuberous sclerosis
  • Von Hippel-Lindau disease
  • Li-Fraumeni syndrome
  • Gorlin syndrome (basal cell nevus syndrome)
  • Turcot syndrome
  • Cowden syndrome
  • Hereditary retinoblastoma
  • Rubinstein-Taybi syndrome

Excessive Radiation exposure: Other than radiation, there are no known lifestyle-related or environmental causes of childhood brain tumors.

Can Brain Cancer be prevented?

As of now, there are no known life style related or environment related factor except exposure to radiation that would cause brain and spinal cord tumors in children. Hence, there is no known way to protect against most of these Cancers.

What are the stages of Brain cancer?

Since, most tumors in the brain or spinal cord do not usually spread, they are not formally staged. Some of the most important factors that determine your child’s prognosis include:

  • The type of tumor
  • The grade of the tumor
  • The location and size of the tumor
  • If the tumor can be removed by surgery
  • Child’s age
  • Child’s functional level
  • The spread of tumor through the cerebrospinal fluid (CSF) to other parts of the brain or spinal cord.
  • Spread of tumor beyond the central nervous system.

Survival rates of Brain Cancer?

Survival rate is a generic view of the data collected over a period of time depicting the percentages of patient that survived the disease. But, since there are multiple unique factors with each case, it is important to better understand his or her condition and prognosis. The age of the child, his/her health conditions and the extent to which the tumor has affected the child’s ability to function are also important factors.

The survival rate for brain tumor varies depending on the type of tumor. Here is the data showing a 5 year survival rate estimate.

Type of Tumor 5-Year Survival Rate
Pilocytic astrocytomas About 95%
Fibrillary (diffuse) astrocytomas About 80% to 85%
Anaplastic astrocytomas About 30%
Glioblastoma About 20%
Oligodendroglioma About 90% to 95%
Ependymoma/anaplastic ependymomas About 75%
PNETs About 60% to 65%

Today, more children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Medicine is evolving everyday to meet these challenges and to keep you happy, healthy and alive!

Can Brain Cancer be detected early?

At this time there are no widely recommended screening tests for most children to look for brain or spinal cord tumors before they start to cause symptoms. These tumours are usually detected as a result of signs or symptoms the child is having. However, through genetic tests, one may find out whether one is at an increased risk of developing Brain Cancer. If yes, the doctor might suggest other tests to detect the Cancer early.

CT or MRI scan: The CT scan uses x-rays to produce detailed cross-sectional images of the child’s brain and spinal cord. It is quick and often is the best first-line investigation, but it does not give as detailed pictures as an MRI.

An MRI scan uses no X-rays, and gives more detailed pictures, but takes much longer. Machines are noisy, and often children cannot lie still long enough to get proper images. It is sometimes necessary to have an anaesthetic for this scan.

Blood tests: These are usually done to make sure it is safe to do an operation, and can also be used to help diagnose certain types of tumour.

Biopsy: It is the process of removing a small specimen of the affected cells and examining under a microscope to find out the details like the type of tumour. A biopsy report helps the doctors to plan for the most accurate treatment strategy.

What are the Treatments available?

Treatment depends on the size and type of tumor and the child's general health. Because there are different types of brain tumours, treatment will not be the same for everyone. The goals of treatment may be to cure patients, relieve symptoms, and improve brain function or the child's comfort.

Surgery is the most preferred treatment option for most primary brain tumors. Some tumors may be completely removed. In cases where the tumor cannot be removed, surgery may help reduce pressure and relieve symptoms. Chemotherapy or radiation therapy may be used for certain tumors.

Chemotherapy uses drugs to get rid of cancer cells. Chemotherapy is given into the veins, and sometimes as a liquid or tablets by mouth.

Radiotherapy is used to treat cancer by using high energy radiation beams. The radiation beams are simply the energy that passes inside the body, and causes damage to tumour cells. Radiotherapy is delivered extremely carefully, using machines linked to the MRI scans of your child’s brain. The process usually takes a few minutes each time, but often needs to continue for five or six weeks.

Other medicines your child may need to take

Steroids

These are medicines that reduce swelling and inflammation in the brain and can help deal with the symptoms.

Anticonvulsants

These are medicines used to help prevent fits, which can be a problem before or after operations on the brain.

Treatments for specific types of tumors:

  • Astrocytomas: Surgery to remove the tumor is the main treatment. Chemotherapy or radiation therapy may also be necessary.
  • Brainstem gliomas: In this case, surgery is usually not possible because of the tumour’s location deep in the brain. Radiation is used to shrink the tumor and prolong life.
  • Ependymomas: Surgery is the most preferred treatment option. However, radiation and chemotherapy may also be necessary.
  • Medulloblastomas: Surgery alone does not cure this type of tumor. Chemotherapy with or without radiation is often used in combination with surgery.
    Medicines used to treat primary brain tumors in children include:
    • Corticosteroids to reduce brain swelling
    • Diuretics (water pills) to reduce brain swelling and pressure
    • Anticonvulsants to reduce or prevent seizures
    • Pain medicines


    Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps may be required to improve quality of life.

What are the possible side effects of treatment?

Treatment of cancer is a tough process as the medicines or radiations used to cure or suppress cancer often causes multiple side effects. Some possible common side effects of radiotherapy and chemotherapy include:

Hair loss: Both radiotherapy and chemotherapy can cause hair loss. But the good thing is hair usually grows back again once chemotherapy is completed, but radiotherapy causes permanent hair loss.

Tiredness: Tiredness is very common with both treatments and may continue for weeks after chemotherapy or radiotherapy finishes.

Feeling sick: Radiotherapy and chemotherapy may make the child feel sick. This can usually be controlled well with anti-sickness drugs, which the oncologist will prescribe for your child.

Increased risk of an infection: Chemotherapy can increase the risk of infection, so it is important to contact the oncologist or specialist nurse straightaway if your child has a temperature, any signs of infection or suddenly feels unwell.

Skin changes in the treated area if your child is having radiotherapy: Radiotherapy can cause a mild form of sunburn. Skin may become red, flaky or sore if your child has fair skin and may become darker and flaky if your child has dark skin. You’ll be given advice on looking after the skin in the treated area.

Is there curative treatment for Brain Cancer?

Most cases of the brain cancers can be treated with surgery. But, for more complicated tumors other treatment options like radiation, chemotherapy etc. should be opted. Children with tumors may also have a much better prognosis than adults with a similar condition.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a history of cancer, an examination by a specialist is recommended once in a year.

How can I as a patient know it early?

Acknowledging the symptoms and visiting a doctor for examination helps in early diagnosis.

Breast Cancer

What is Breast Cancer?

Breast

Breasts made of glandular and fatty tissues are located on the chest. The amount of fat determines the size of the breast. Connective tissue and ligaments provide support to the breast and determines its shape. Nerves provide sensation to the breast. The breast also contains blood vessels, lymph vessels, and lymph nodes.

Functions:

  • Women's breasts are made of specialized tissue that produces milk (glandular tissue).
  • Breasts milk provides complete nutrition to an infant.
  • Breast milk contains carbohydrate (lactose), fats and proteins as well as micronutrients.
  • Breast secretions also ensure that the newborn has a significant amount of immunological protection in the form of maternal antibodies, chemical mediators, vitamins, and enzymes.

Breast Cancer

Cancer is caused due to uncontrollable growth of abnormal cells that start invading the normal cells around them. When these abnormal tumor cells are present in the breast, they lead to breast cancer. Majority of breast cancers have ductal or lobular origin and only a small number of breast cancers originate in other tissues. In Breast Cancer, apart from the primary tumor, the involvement of Lymph Nodes assumes great importance with respect to the spread of cancer to different tissues (metastases).

Though it is a disease that affects primarily women, men can get it, too. But don’t worry! Regular screenings and mammograms (an x-ray exam of the breast that is used to detect and evaluate breast changes) can help in early detection and prevention of the cancer’s spread through timely or early treatment.

Types of Breast Cancer

  • Ductal carcinoma in situ
    It is a non–invasive breast cancer. Cancer cells can be found in the lining of the breast milk duct. Ductal carcinoma in situ is very early cancer that is highly treatable, but if it’s left untreated or undetected, it can spread to the surrounding breast tissue.
  • Invasive ductal carcinoma
    Also referred as infiltrative ductal carcinoma, it is the most common type of breast cancer. It starts in a milk duct of the breast, breaks through the wall of the duct, and grows into the fatty tissue of the breast.
  • Invasive lobular carcinoma
    It is the second most common type of Breast Cancer. It starts in the milk-producing glands (lobules) and cancer cells in the lobules have spread into the surrounding breast tissue.
  • Inflammatory breast cancer
    It is a rare type of inflammatory Breast Cancer, aggressive and fast growing in which cancer cells infiltrate the skin and lymph vessels of the breast. It often produces no distinct tumor or lump that can be felt. But when the lymph vessels become blocked by the breast cancer cells, symptoms begin to appear.
  • Metastatic Breast Cancer
    Metastatic breast cancer is also classified as Stage 4 breast cancer. The cancer has spread to other parts of the body. This usually includes the lungs, liver, bones or brain.
  • Paget’s disease of the breast
    An uncommon type of Breast Cancer condition affecting the skin of the nipple and often the areola, which is the darker circle of skin around the nipple. Most people with Paget disease evident on the nipple also have one or more tumors inside the same breast.
  • Tubular
    It accounts for almost 2% of all Breast Cancer diagnosis. Tubular carcinoma cells have a distinctive tubular structure when viewed under a microscope. It is usually found on a mammogram and appears as a collection of cells that can feel like a spongy area of breast tissue. Typically, this type of breast cancer is found in women aged 50 and above and usually responds well to hormone therapy.
  • Mucinous Carcinoma
    Mucinous carcinoma represents approximately 1% to 2% of all breast cancers. The main differentiating features are mucus production and cells that are poorly defined. It also has a favorable prognosis in most cases.

Occurrence rate

In India, we are now witnessing more and more numbers of patients being diagnosed with breast cancer to be in the younger age groups (in their thirties and forties). Breast cancer is now the most common cancer in most cities in India, and 2nd most common in the rural areas.

Breast cancer

Anatomy of Breast Cancer

What are the general symptoms of Breast Cancer?

Signs and Symptoms of Breast Cancer

  • Lump in the breast
    The most common and usually the first sign of Breast Cancer is the ‘Lump’ in the breast. Usually, the lady herself finds it out first.
    • The lump related to Breast Cancer may be tender but usually without pain.
    • The lump may sometimes feel hard and irregular in shape. It may appear distinctly different from the rest of the breast tissue.
    • Peculiarly, the lump does not disappear or change in size with the menstrual cycle.
    • Cancer related lump is firmly attached to the skin or the chest wall and does not move.
  • Lump in the Armpit
    • A lump in the armpit may be spotted because of the axillary lymph node involvement.
    • Axillary lump occurs mostly because of the spread of cancer.
    • The lump may be hard, tender, or painless.
  • Skin Changes
    • Dimpled Skin: It means hollowness or formation like a pit or depression in the breast.
    • Puckered Skin: It means with creases or crumpled.
    • A thickening and dimpling of the skin may occur.
  • Inflammatory Breast Cancer
    • Inflammatory Breast could be an indicator of breast cancer.
    • Persistent itching in the breast or the nipple, which is (often) not relieved by medications or medicated ointments or creams for local application.
  • Nipple Changes
    • Nipples are normally pointed outwards. However, nipples may also be pointed inwards (inverted). However, if normal nipples get inverted, it could be a cause of concern and the person should ideally see a doctor for consultation and medical opinion.
  • Discharge from Nipples
    • Although many noncancerous conditions may cause it, better to find out the reasons.
    • Discharge from a single nipple, especially if it occurs without squeezing it, and especially if containing blood may be a sign of Breast Cancer.
  • Paget’s Disease (a type of Breast Cancer):
    • Crusting, ulcers or scaling on the nipple may be a sign of some rare types of breast cancer, such as Paget disease of the nipple.

LATE SIGNS AND SYMPTOMS

  • Bone Pain
  • Nausea
  • Loss of Appetite
  • Weight Loss
  • Jaundice
  • Pleural Effusion: (buildup of fluid around the lungs)
  • Shortness of Breath
  • Cough
  • Headache
  • Double Vision
  • Muscle Weakness

It is important to note that pain can more often be a symptom of non-cancerous (benign) tumor. Yet, one should not be complacent but needs to be vigilant and get examined by a doctor to ascertain it.

While any or all these symptoms may not always end in breast cancer, it is advisable to consult a healthcare professional when any of these symptoms appear. Mammograms may help in detecting breast cancer before the appearance of a symptom. However, it must be stressed that mammograms are not always successful in discovering breast cancer. That does not mean you should not take one! Any prevention is better than cure. So, go out there, make that visit, consult your doctor and take a step closer to knowledge and, perhaps, relief!

What are the general causes of Breast cancer?

A person’s chances of getting breast cancer are calculated based on certain “risk factors”. Risk factor may refer to anything from age to habits to genetics. However, the presence of these risk factors doesn’t necessarily mean that one shall definitely be diagnosed with Cancer, but the probability of getting affected by Cancer increases many folds.

  • Gender: Women are 100 times more likely to get Breast Cancer than men.
  • Ageing: The chances of breast cancer increases with increasing age. Hence, going for mammogram tests in the 40’s is a smart move.
  • Early onset of menstruation (before age 12) and/or late onset of menopause (post-55).
  • Late or no pregnancy: Having children after the age of 30 can be a cause of breast cancer.
  • Genes: Breast Cancer is considered to be hereditary 5-10% of the time. If there is any occurrence of Breast Cancer in the family tree then cancer diagnostic tests can be done for early detection and action. Inherited mutations in certain genes, such as BRCA1 and BRCA2 increase the risk of breast and ovarian cancer.
  • If the Cancer is present in one breast, then the chances of developing cancer in the other breast are 3 times more likely.

Other risk factors include:

  • Dense breast tissue: Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get Breast Cancer.
  • Hormone Therapy: Taking hormones to replace missing estrogen and progesterone in menopause for more than five years raises the risk for Breast Cancer. The hormones that have been shown to increase risk are estrogen and progestin when taken together.
  • Contraceptives: Certain forms of oral contraceptive pills have been found to raise Breast Cancer risk.
  • Diethylstilbestrol: a drug given to women to lower chances of miscarriage in the mid-90s.
  • Intake of alcohol/tobacco is directly proportional to the increase in risk of getting breast cancer.
  • Obesity: Older women who are overweight or obese have a higher risk of getting Breast Cancer than those at a normal weight.

Lowering the risk of Breast Cancer

Breastfeeding may lower the risk of Cancer, according to research. Exercises seem to lower chances of developing Breast Cancer. According to a study in Women’s Health Initiative brisk-walking as little as 1.25 to 2.5 hours per week can reduce the risk by 18%! So grab those running shoes!

What are the stages of Breast Cancer?

Stage or Grade of Breast Cancer is largely determined by the findings such as

  • whether the tumor is local
  • spread to the nearby lymph nodes
  • spread to the distant organs.

TNM system is widely used to stage Breast Cancer:

  • T refers to tumor size.
  • N describes lymph node status.
  • M indicates whether the cancer has metastasized.

The stages of Breast Cancer are explained in details below:

  • Stage 0:
    Describes non-invasive Breast Cancers. There is no evidence of cancer cells out of the part of the breast, in which they started.
  • Stage I:
    Describes invasive Breast Cancer in which cancer cells are invading surrounding breast tissues.
    • Stage IA:
      • the tumor measures up to 2 centimeters
      • the cancer has not spread outside the breast and no lymph nodes are involved
    • Stage IB:
      • Small groups of cancer cells ranging from 0.2 millimeters - 2 millimeters are found in the lymph nodes.
      • There is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells ranging from 0.2 millimeter to 2 millimeters in the lymph nodes.
  • Stage II:
    • Stage IIA:
      • No tumor can be found in the breast, but cancer (larger than 2 millimeters) is found in 1 to 3 axillary lymph nodes or in the lymph nodes near the breast bone.
      • The tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes.
      • The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.
    • Stage IIB:
      • The tumor ranges from 2 cm to5 cm and small groups of Breast Cancer cells ranging from 0.2 mm to 2 mm are found in the lymph nodes.
      • The tumor ranges from 2 cm to 5 cm, it has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone
      • The tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes
  • Stage III:
    • Stage IIIA:
      • Tumor of any size could be spotted in the breast or sometimes there might not be a tumor at all. Cancer is found in 4 to 9 axillary lymph nodes or in the lymph nodes near the breastbone.
      • The tumor is larger than 5 cm and small groups of Breast Cancer cells ranging from 0.2 mm to 2 mm are found in the lymph nodes.
      • The tumor is larger than 5 centimeters; cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone.
    • Stage IIIB:
      • The tumor may be any size and has spread to the chest wall and/or skin of the breast.
      • May have spread to up to 9 axillary lymph nodes OR
      • May have spread to lymph nodes near the breastbone
    • Stage IIIC:
      • There may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast AND
      • The cancer has spread to 10 or more axillary lymph nodes OR
      • The cancer has spread to lymph nodes above or below the collarbone OR
      • The cancer has spread to axillary lymph nodes or to lymph nodes near the breastbone
  • Stage IV:
    Stage IV describes invasive Breast Cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain.

Survival rates for Breast Cancer?

Survival rates indicate an average outcome of large number of people who had the disease, but they cannot precisely predict the expectancy of any particular case. The survival rate of Breast Cancer when detected at an early stage is quite high and if the detection is delayed till the last stage then the chances of survival drop significantly. Since, the symptoms of Breast Cancer are quite evident being aware of the condition aids in early detection.

survival rate of breast cancer

Can Breast Cancer be detected early?

Breast Cancer is sometimes found after symptoms appear, but many women with Breast Cancer have no symptoms. This is why regular Breast Cancer screening is so important.

  • Physical exam and history: The body is thoroughly examined 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.
  • Clinical breast exam (CBE): The breast is closely observed by a doctor or health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
  • Mammograms: A mammogram is an x-ray of the breast that looks for changes that may be signs of Breast Cancer. Mammograms are the best Breast Cancer screening tests and all women are recommended to get it done to ensure complete safety. Women with any of the risk factors are recommended to go for a mammogram once every year.
  • Breast Ultrasound: Breast ultrasound uses sound waves to make a computer picture of the inside of the breast. A gel is put on the skin of the breast and an instrument called a transducer is moved across the skin to show the underlying tissue structure.
  • Breast MRI Scans: The MRI machine is called an MRI with dedicated breast coils. MRI uses strong magnets instead of radiation to make very detailed, cross-sectional pictures of the body.
  • Biopsy: Biopsy is the removal of a small amount of tissue for examination under a microscope. There are different kinds of breast biopsies. Some of them are mentioned below:
    • Fine needle aspiration biopsy: In this procedure, a very thin, hollow needle attached to a syringe is used to withdraw a small amount of tissue from a suspicious area.
    • Core needle biopsy: In this procedure, a larger needle is used to sample breast changes
    • Surgical (open) biopsy: In rare cases, surgery is needed to remove all or part of the lump for testing. This is called a surgical biopsy or an open biopsy. Most often, the surgeon removes the entire mass or abnormal area as well as a surrounding margin of normal- breast tissue.

      There are 2 types of surgical biopsies:
      • Incisional biopsy The removal of part of a lump or a sample of tissue.
      • Excisional biopsy The removal of an entire lump of tissue.
  • Lymph node biopsy: If the lymph nodes under the arm are enlarged, a doctor may need to check them for cancer spread. Most often, an enlarged lymph node is biopsied at the same time as the breast tumor.

Earlier the detection the better is the outcome of therapy (prognosis).About 70% of the patients are offered Breast Conservation Surgery and approximately 5% overall also undergo breast reconstruction.

About 35% of those cases are Locally Advanced cancers requiring Multi-Modality Treatment.

What are the Treatments available?

Right Diagnosis is the first step towards getting Right Treatment as various treatment options exist, which vary depending upon the spread of the disease, whether to nearby region or to distant organs (metastases) and the stage of the disease. Tata Memorial Hospital (TMH) from Mumbai is one of the leading cancer treatment centers in the world and amongst the oldest in India.

The Breast (Cancer) Unit of the Tata Memorial Hospital diagnoses about 4400 new Breast Cancer cases per year, 60% of which are operable ones. The unit performs on an average 45 Breast Cancer surgeries per week.

Treatments available are dependent on the stages of cancer. Primary treatments available are as follows:

  • Surgery to remove the breast. It is the most effective treatment when the spread of cancer is limited to the cells of the breast.
    • Breast-conserving: Surgery is an operation to remove the cancer and some normal tissue around it, but not the breast itself.
    • Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy
    • Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
  • 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.
  • 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.
  • Hormone therapy: It is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing.
    • Hormone therapy with tamoxifen is often given to patients with early localized Breast Cancer.
    • Hormone therapy with a luteinizing hormone-releasing hormone (LHRH) agonist is given to some premenopausal women who have just been diagnosed with hormone receptor positive Breast Cancer.
    • Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone receptor positive Breast Cancer.
    • Other types of hormone therapy include megestrol acetate or anti-estrogen therapy such as fulvestrant.
  • Targeted therapy: It is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and PARP inhibitors are types of targeted therapies used in the treatment of Breast Cancer.

Is there curative treatment for Breast Cancer?

Diagnosing Breast Cancer early is the key to optimum treatment and a better prognosis, i.e. outcome of therapy Breast Cancer is highly treatable when detected at an early stage. However, the recurrence rate of Breast Cancer is also high, so proper care needs to be taken even after complete treatment and regular inspections and examinations needs to be done at least once a year to avoid the turmoil again.

How frequently should one visit a doctor for an early diagnosis?

In case of experiencing any of the mentioned symptoms or having a prior or familial history of Breast Cancer, a physical examination by a specialist is recommended once in a year.

How can I as a patient know it early?

Diagnostic methods include a screening mammogram and clinical breast examination. Sometimes, Breast Cancer can even be diagnosed with a simple self-examination, when lumps on or near the breasts are felt. However, not every change in the breast is a sign of Breast Cancer. It is advisable to visit the doctor nonetheless as more information is needed for an accurate diagnosis.

Breast Self Examination (BSE) One can use this method at home to check for lumps once a month.

(Adapted from the American Cancer Society by Health Gate Editorial Staff)

For a menstruating woman, the best time to do BSE is 2 or 3 days after the period ends. These are the days when the breasts are least likely to be tender or swollen. For woman who have undergone menopause, any day of the month is suitable to do a BSE. For those taking hormones, consulting the doctor about BSE would be helpful.

Here are 5 efficient self examination tests that can be done at home:

Step 1

Stand in front of a mirror that is large enough for you to see your breasts clearly. Check each breast for anything unusual. Look for a discharge from the nipples and check the skin for

  • puckering,
  • dimpling, or
  • scaliness.

Steps 2 and 3

Check for changes in the shape or contour of your breasts. As you do these steps, you should feel your chest muscles tighten.

Step 2 - watching closely in the mirror, clasp your hands behind your head and press your hands forward.

Step 3 - press your hands firmly on your hips and bend slightly toward the mirror as you pull your shoulder and elbows forward.

Step 4 - gently squeeze each nipple and look for a discharge.

Step 5 - raise one arm. Use the pads of the fingers of your other hand to check the breast and the surrounding area—firmly, carefully, and thoroughly. Some women like to use lotion or powder to help their fingers glide easily over the skin. Feel for any unusual lump or mass under the skin.

Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime. To be sure you cover your whole breast, take your time and follow a definite pattern: lines, circles, or wedges.

Pay special attention to the area between the breast and the underarm, including the underarm itself. Check the area above the breast, up to the collarbone and all the way over to your shoulder.

Here are some tips on patterns that you can use:

  • Lines:
    • Start in the underarm area and move your fingers downward little by little until they are below the breast.
    • Then move your fingers slightly toward the middle and slowly move back up.
    • Go up and down until you cover the whole area.
  • Circles:
    • Beginning at the outer edge of your breasts, move your fingers slowly around the whole breast in a circle.
    • Move around the breast in smaller and smaller circles, gradually working toward the nipple.
    • Don't forget to check the underarm and upper chest areas, too.
  • Wedges:
    • Starting at the outer edge of the breast, move your fingers toward the nipple and back to the edge.
    • Check your whole breast, covering one small wedge-shaped section at a time.
    • Be sure to check the underarm area and the upper chest.

Step 6 - repeat step 5 while you are lying down. Lie flat on your back, with one arm over your head and a pillow or folded towel under the shoulder.

Step 7 - you may want to repeat step 5 in the shower. Your fingers will glide easily over soapy skin, so you can concentrate on feeling for changes underneath.

It is recommended that all women over the age of 20 examine their breasts once a month. One must not forget that delaying the diagnosis of Breast Cancer would not change the diagnosis, it can only worsen the outcome.

Cancer in Children

What is the difference between adult cancers and cancers in children?

Unlike many cancers in adults, childhood cancers are not strongly linked to lifestyle or environmental risk factors. Also, children’s bodies tend to handle chemotherapy better than those of adults. Hence, they respond better to chemo treatment. However, cancer treatments such as chemo and radiation therapy can cause long-term side effects, so children who have had cancer need careful follow-up for the rest of their lives.

What are the most common cancers seen in children?

  • Leukaemia
  • Brain and other central nervous system tumors
  • Neuroblastoma
  • Wilms tumor
  • Lymphoma (including both Hodgkin and >non-Hodgkin)
  • Rhabdo-myo-sarcoma
  • Retinoblastoma
  • Bone cancer (including >osteosarcoma and >Ewing sarcoma)

What are the causes of cancers in children?

Lifestyle factors are not considered to play much of a part in childhood cancers but environmental factors, such as radiation exposure, have been linked with some types. Parental exposures (such as smoking) might increase a child’s risk of certain cancers, but there is still much research going on to find conclusive results. So far, most childhood cancers have not been shown to have outside causes.

Changes in the DNA, inherited or developed, increase the risk of cancer in children.

Can childhood cancers be prevented?

Since childhood cancers are usually not lifestyle and environment-related, change in habit or location will probably not make a difference. However, if it is due to a mutated gene, preventive surgery may be sought. However, this is very rare.

Possible signs and symptoms of cancer in children

Each type of cancer has its own symptoms. However, some common symptoms are as follows.

  • An unusual lump or swelling
  • Unexplained paleness and loss of energy
  • Easy bruising
  • An ongoing pain in one area of the body
  • Limping
  • Unexplained fever or illness that doesn't go away
  • Frequent headaches, often with vomiting
  • Sudden eye or vision changes
  • Sudden unexplained weight loss

How are childhood cancers treated?

Treatment options depend on the type and stage of cancer. Treatment options might include surgery, radiation therapy, chemotherapy, and/or other types of treatment. In many cases, more than one of these treatments is used.

CervicalCancer

What is Cervical Cancer

Cervix

Cervix is the narrow part of the lower uterus that opens into the vagina. It is often referred to as the neck of the womb.
Functions

  • The cervix allows the flow of menstrual blood from the uterus into the vagina
  • It also directs the sperms into the uterus during intercourse.

Cancer

Cancer is the uncontrolled growth of abnormal or mutated cells in any part of the body.

Cervical Cancer

When the cells in the cervix become malicious and start growing in an uncontrolled way, resulting in a lump or tumour then this condition is termed as Cervical Cancer.

Types:

Cervical Cancer is categorized into two main types based on the cells that get mutated. They are:

  • Squamous cell carcinoma: Cancer that begins in the thin, flat cells that line the bottom of the cervix is termed as Squamous cell carcinoma. This is the most common type of Cervical Cancer accounting to 80-90%.
  • Adenocarcinoma: Cancer that occurs in the glandular cells lining the upper portion of the cervix is called adenocarcinoma. 10 to 20 % of Cervical Cancers are under this group.

Anatomy of Cervical

cervical-cancer

What are the general symptoms of Cervical Cancer?

In most cases, Cervical cell abnormality rarely causes any notable early symptoms. But with the passage of time as the Cancer spreads and grows following symptoms can be spotted:

  • Unusual bleeding from the vagina.
  • Bleeding after sex or after menopause.
  • Pain in the lower belly or pelvis.
  • Pain during sexual intercourse.
  • Unusual Vaginal discharge.

What are the general causes of Cervical Cancer?

  • Most Cervical Cancer is caused by a virus called human papillomavirus, or HPV. One may get infected by HPV by
    • Having sexual contact with someone who has it.
    • Unsafe sexual practices with multiple people.
  • Giving birth to many children
  • Having first sexual intercourse at a young age
  • Smoking cigarettes.
  • Using oral contraceptives.

There are many types of the HPV virus. Not all types of HPV cause Cervical Cancer. Some of them cause genital warts, but other types may not cause any symptoms.

Can Cervical Cancer be prevented?

Some of the causes of Cervical Cancer are known while some causes are yet under the veil. So we have a few precautionary measures that might help in avoiding the disease.

  • As the most prevalent cause of Cervical Cancer is HPV virus, getting HPV vaccination before the age of 26 comes as a precautionary measure.
  • Going through a Pap test is the best way to find Cervical cell changes that can lead to Cervical Cancer. Most women are advised to get a Pap test starting at age 21.
  • Regular Pap tests almost always show these cell changes before they turn into Cancer. This may help prevent Cervical Cancer.
  •  Practicing safe sex using condoms/protection; limiting the number of sex partners.

What is a Pap Smear Test?

Pap Smear Test:

A Pap smear test is a microscopic examination of cells taken from the uterine cervix. It tests for the presence of preCancerous or Cancerous cells on the cervix. Having regular Pap tests is the best way for women to protect themselves against Cervical Cancer. A Pap test looks for changes to the cells of the cervix that, if left untreated for a number of years, could develop into Cancer.

A Pap test is conducted to detect certain viral infections or abnormal cells, which is known to cause Cervical Cancer. Early treatment of preCancerous changes detected on the Pap smear helps in stopping Cervical Cancer before it fully develops.  Pap tests are very accurate, and regular Pap screenings reduce Cervical Cancer rates and mortality by 80 percent.

The incidence of Cancer and deaths from Cervical Cancer has significantly declined over the years because of prevention, screening, and early detection by the Pap smear. Most abnormal Pap smear results indicate the early stages of the disease.

Preparing for Pap test

On the day of the Pap test, it is highly suggested to stay as relaxed as possible as this will help ensure any physical discomfort is kept to a minimum. For most accurate results of the Pap test one must ensure that:

  • She is not menstruating as Pap test conducted during menstruation might be less accurate.
  • Avoid intercourse/vaginal medicines/vaginal contraceptives the day before the test.
  • Pap Test can be done in the first 24 weeks of pregnancy.

Procedure for Pap Smear Test

  • The patient is laid flat on the back on an examination table with legs spread, knees bent and feet resting in supports called stirrups.

pep smear test

  • A device called a speculum is slowly inserted into your vagina to keep the vaginal walls open and get access to the cervix.

pep smear test

  • Then a small sample of mucus and cells is scraped from the cervix using either a spatula, or a spatula and a brush, or a cytobrush.
  • The sample is then preserved properly and is sent to the lab for tests.
  • This procedure takes about 10 - 15 minutes to be completed.
  • It may cause a slight discomfort due to the scrapping in most of the women. However, it should not be painful, if any pain is experienced it is advised to discuss it with the doctor.

Result of Pap Smear Test

The result of the test is either normal i.e. negative or abnormal i.e. positive.

Normal Pap smear: It means that no abnormal cells were identified and there is no need of a Pap smear for another three years.

Abnormal Pap smear: Abnormal doesn’t necessarily signify the presence of Cancer. Rather, it might indicate the presence of abnormal cells or inflammation of cells on the cervix, some of which could be preCancerous. There are several levels of abnormal cells:

  • atypia
  • mild
  • moderate
  • severe dysplasia
  • carcinoma in situ

Pap Test is highly recommended for:

  • Those diagnosed with HIV-positive
  • People having Multiple sexual partners
  • Having been exposed to diethylstilbestrol (DES) before birth
  • Those who have a weakened immune system from chemotherapy or an organ transplant

How often the Pap Smear Test needs to be done?

PapScreen Victoria recommends all women aged 18 to 70 who have ever been sexually active have a Pap test every two years. Sexual activity includes genital-skin to genital-skin contact, not just intercourse. This is why even if you are a virgin you may still need to have Pap tests.

Age Sexual Status Frequency
<21 Inactive Not needed
<21 Active every 3 years
21-29 Active/Inactive every 3 years
30-65 Active/Inactive 3-5 years
>65 Active/Inactive Not needed

What are the stages of Cervical Cancer?

Cervical Cancer is staged using the TNM system of staging.

  • T(Tumour):  It describes the size of the tumour
  • N(Node): indicates if the lymph nodes are affected
  • M (Metastasis): denotes the spread of Cancer to distant part.
  • Stage 0 : Cancer cells are confined to the surface of the cervix.
  • Stage I: Cancer cells have grown deeper into the cervix. Stage I is categorized as:
    • Stage IA (T1a, N0, M0): The area of Cancer spread is less than 3 mm deep and 7 mm wide.
    • Stage IB (T1b, N0, M0): The area of Cancer cells spread is between 3 mm to 5 mm and less than 7mm wide.
  • Stage II : The Cancer has grown beyond the cervix and uterus, but has not reached the walls of the pelvis or the lower part of the vagina. This type is further sub typed as
    • Stage IIA (T2a, N0, M0): The Cancer has not spread into the tissues next to the cervix, but it may have grown into the upper part of the vagina. It’s size is not larger than 4 cm.
    • Stage IIB (T2b, N0, M0): The Cancer has spread into the tissues next to the cervix and its size is usually larger than 4cm.
  • Stage III: The Cancer has spread to the lower part of the vagina or the walls of the pelvis, but not to nearby lymph nodes or other parts of the body. At this stage, the Cancer might start blocking the uterus. Stage III is further sub typed as
    • Stage IIIA (T3, N0, M0): The Cancer has spread to lower part vagina but not to the walls of the pelvis.
    • Stage IIIB (T3b, any N, M0): The Cancer has grown into the walls of the pelvis and/or has blocked one or both ureters. This gives rise to several kidney problems.
  • Stage IV : This is the last or final stage of Cervical Cancer stage, the disease has spread to nearby organs or other parts of the body. It is classified into two subcategories:
    • Stage IVA (T4, any N, M0): The Cancer has spread to the bladder or rectum, but not to distant sites.
    • Stage IVB (any T, any N, M1): The Cancer has spread to other parts of the body.
  • Stage IVA (T4, any N, M0): The Cancer has spread to the bladder or rectum, but not to distant sites.
  • Stage IVB (any T, any N, M1): The Cancer has spread to other parts of the body.

Survival rates of Cervical Cancer?

Survival rate speaks about the general statistics based on the outcome of large groups of patients. However, these survival rates can’t precisely predict the outcome or prognosis of any individual case. A number of factors like age, health and family record etc., play a vital role in determining an individual’s survival rate.

Cervical Cancer is highly curable when detected at an early stage and the chances gradually decline with each passing stage and may prove to be fatal if waited till the last stage. However, it might bring some relief to know that most cases of Cervical Cancer are detected at an early stage through Pap test.

The statistics for 5 year survival rate are as follows:

Stage of Cancer 5 year Survival Rate
Stage I 95%
Stage II 50%
Stage III 40%
Stage IV 5%

Can Cervical Cancer be detected early?

The good thing is that Cervical Cancer can be found at a very early stage through a Pap test.

  • Pap test : In a pap test, a small sample of cells is scraped from the surface of the cervix to look for cell changes.
  • Pelvic examination : In this examination, the patient’s uterus, vagina, ovaries, fallopian tubes, cervix, bladder, and rectum are checked thoroughly for any unusual changes.
  • Biopsy: Sometimes a pap test is followed by a biopsy to confirm the presence of Cervical Cancer.
    Some other tests to detect Cancer are:
    • X Ray
    • CT scan
    • MRI
    • PET scan
    • Cystoscopy
    • Proctoscopy 
    • Laparoscopy

What are the Treatments available?

Cervical Cancer can often be successfully treated when it's found early. Treatment options depend on several factors including:

  • The stage of the Cancer.
  • The type of Cervical Cancer.
  • The patient's desire to have children.
  • The patient’s age.

The treatment for most stages of Cervical Cancer includes:

  • Surgery: Surgery is the procedure of removal of the tumour and some surrounding healthy tissue during an operation. For treating Cervical Cancer, following procedures can be opted:
    • Conization is the procedure of removing all of the abnormal tissue. It can be used to remove micro invasive Cervical Cancer.
    • LEEP is the use of an electrical current passed through a thin wire hook. The hook removes the tissue. It can be used to remove micro invasive Cervical Cancer.
    • Hysterectomy is the removal of the uterus and cervix. Hysterectomy can be either a simple hysterectomy or a radical hysterectomy. A simple hysterectomy is the removal of the uterus and cervix. A radical hysterectomy is the removal of the uterus, cervix, upper vagina, and the tissue around the cervix.
    • Bilateral salpingo-oophorectomy is the removal of both fallopian tubes and both ovaries. It is done at the same time as the hysterectomy. This is usually not performed if not utmost necessary as this leads to infertility.
    • Radical trachelectomy is surgery to remove the cervix that leaves the uterus intact with pelvic lymph node dissection. It may be used for young patients who want to preserve their fertility. This procedure has gained acceptance as an alternative to a hysterectomy for some patients.
    • Exenteration: This involves the removal of the uterus, vagina, lower colon, rectum, or bladder. This is rarely required and is usually used in case of recurrence of Cancer.
  • Chemotherapy: Chemotherapy is the use of drugs to destroy Cancer cells or inhibit their growth.  For treating Cervical Cancer, chemotherapy is given with radiation therapy to increase the effectiveness of radiation therapy.
  • Radiation therapy: Radiation therapy is the use of high-energy x-rays to destroy Cancer cells. Radiation therapy imparted externally through a machine is called external radiation therapy and if it is given using implants then it is called internal radiation therapy.
  • Targeted Therapy : Targeted therapies are drugs that interfere with one specific property or function of a Cancer cell, rather than acting to kill all rapidly growing cells indiscriminately. This means there is less damage to normal cells with targeted therapy than with chemotherapy. One common targeted therapy drug used to treat Cervical Cancers is bevacizumab a monoclonal antibody and angiogenesis inhibitor that may be used in combination with cisplatin a chemotherapy treatment.

How frequently should one visit doctor for early diagnosis?

It is highly recommended to visit the doctor and take a Pap test before the age of 21. If one is detected with Cervical Cancer then the regular sessions as recommended by the doctor should not be skipped!

How can I as a patient know it early?

As mentioned time and again, go for the Pap test and don’t let this health hazard skip your notice.

Kidney Cancer

What is Kidney Cancer?

Kidney

The kidneys are a pair of bean-shaped organs, about 4 or 5 inches long, located in the back of the abdomen, protected by the lower rib cage.

Functions:

  • They filter the blood.
  • The kidney is responsible for removing wastes, controlling body's fluid balance, and regulating the balance of electrolytes.
  • The kidneys create urine.
  • They help control blood pressure by synthesizing a hormone called renin.

Kidney Cancer

Cancer that originates in the kidneys is called Kidney Cancer. Cancer is a serious health condition caused by an uncontrolled division of abnormal cells in any part of the body. These abnormal cells grow to form a lump called tumor.

The tumor is said to be benign i.e. non-cancerous if it lacks the ability to grow and spread to other parts of the body. Whereas, if the tumor continues to multiply uncontrollably, and spread to various parts of the body then it is called malignant or cancerous tumors.

Benign tumors respond well to treatment and the prognosis is usually favorable but in some rare scenarios, they may grow to become malignant tumors. Malignant tumors are innately dangerous and the chances of recovery declines with each passing stage.

Types of Kidney Cancer

  • Renal cell carcinoma
    This is the most common type of kidney cancer accounting 90% of occurrence. Although RCC usually grows as a single tumor within a kidney, sometimes multiple tumors may be spotted in one or both kidneys at the same time.
    • Clear cell renal cell carcinoma: Cancer cells that first appear in the lining of tiny tubes in the kidney are called clear cell renal cell carcinoma. This is the most common form of renal cell carcinoma amounting to 70% of occurrences.
    • Papillary Renal Cell Carcinoma: This is the second most common sub type amounting to 10% of occurrences. These cancers form little finger-like projections (called papillae).
    • Chromophobe renal cell carcinoma: This sub type accounts for about 5% of RCCs.
    • Rare types of renal cell carcinoma: These sub types are very rare, each making up less than 1% of RCCs:
      • Collecting duct RCC
      • Multilocular cystic RCC
      • Medullary carcinoma
      • Mucinous tubular and spindle cell carcinoma
      • Neuroblastoma-associated RCC
  • Transitional cell carcinoma:
    Also called urothelial carcinomas, transitional cell carcinomas generally initiate in the lining of the renal pelvis. This lining is made up of cells called transitional cells.
  • Wilms tumor:
    It is also known as nephroblastoma and occurs mostly in children. This type of cancer is very rare among adults.

Occurrence Rate of Kidney Cancer in India

In India, renal cell carcinoma is more frequent in younger people. One-third of the patients are less than 50 yrs of age and only 10.4% patients had tumor of less than 4 cm (T1a). Younger patients less than 39 years of age have relatively lower survival rates.

kidney cancer

Anatomy of Kidney Cancer

Kidney Cancer

Kidney Cancer

What are the general symptoms of Kidney Cancer?

Symptoms for Kidney Cancer may not appear until it’s too late. However, some of the common signs and symptoms are as follows:

  • Blood in the urine.
  • Persistent low back pain on one side.
  • A mass on the side or lower back.
  • Fatigue.
  • Loss of appetite.
  • Weight loss not caused by dieting.
  • Fever that is not caused by an infection and that doesn’t go away.
  • Anaemia.
  • Fever.

However, some of these symptoms may be caused due to less serious ailments as well. Do visit the doctor if you have any of the symptoms.

What are the general causes of Kidney cancer?

The chances of occurrence of kidney cancer increases with certain factors. These risk factors for Kidney Cancer include:

  • Smoking: Smoking increases the risk of developing renal cell carcinoma (RCC).
  • Obesity: Obesity may cause changes in certain hormones that can lead to RCC.
  • Gender: It is more common in man than woman.
  • Family history of Kidney Cancer: People with a strong family history of renal cell cancer have a higher chance of developing this Cancer.
  • High Blood Pressure: The risk of kidney cancer is higher in people with high blood pressure.
  • Medicines: Certain medicines like Phenacetin and Diuretics increase the risk of developing Kidney Cancer.
  • Genetic and hereditary risk factors: Some rare inherited conditions may increase the risk of kidney Cancer. Some genetic and hereditary conditions that are thought to increase the risk are listed below:
    • von Hippel-Lindau disease
    • Hereditary papillary renal cell carcinoma
    • Hereditary leiomyoma-renal cell carcinoma
    • Birt-Hogg-Dube (BHD) syndrome
    • Familial renal Cancer
    • Hereditary renal oncocytoma

Can Kidney Cancer be prevented?

The exact cause of a particular case of Kidney Cancer cannot be traced accurately, and hence there is no clarity to the preventive measures of this Cancer. However, being alert and taking a few precautions’ comes as a life savior. Here are a few precautions:

  • Quit Smoking.
  • Weight Control.
  • Avoiding being exposed to harmful chemicals.
  • Eating healthy and exercising regularly.
  • Managing Blood Pressure
  • Consulting your doctor before taking medications.

What are the stages of Kidney Cancer?

Kidney Cancer is staged by measuring the size of the tumor, the location of the Cancer cells either confined to the kidney, locally spread or widespread beyond the fibrous tissue surrounding the kidney

Stage I (T1, N0, M0)

  • Stage 1 is the least aggressive stage and has the highest survival and recovery rate.
  • The tumor only appears in one kidney and there’s no evidence that it has spread to lymph nodes or other organs.
  • Stage 1 tumor can be further classified into:
    • T1a: The tumor is 4 cm or smaller.
    • T1b: The tumor is larger than 4 cm but not larger than 7 cm.
  • In this stage generally, the cancerous kidney is removed through surgery.

Stage II (T2, N0, M0)

  • The growth of cancerous cells is restricted within the Kidney.
  • There’s no evidence that it has spread to nearby lymph nodes or other organs.
  • Cancerous kidney will probably be removed, and follow-up therapy might not be necessary.
  • Stage 2 cancer can be further classified into:
    • T2a: The tumor size ranges between 7 cm to10 cm.
    • T2b: The tumor is larger than 10 cm but not more than 12 cm.

Stage III(T3, M0, N0)

  • The tumor may be of any size and has grown into a major vein and into tissues surrounding the kidney.
  • The tumor has not spread into the adrenal gland or beyond Gerota’s fascia.
  • The tumor has not spread to lymph nodes or distant organs.
  • In this stage, treatment is aggressive.

Stage IV

  • Cancer has spread beyond the fatty layer of tissue around the kidney, and it may also be in nearby lymph nodes
  • Cancer may have spread to other organs, such as the bowel, pancreas, or lungs
  • Cancer has spread beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland)

Survival rates of Kidney Cancer?

Survival rates indicate an average outcome of a large number of people who had the disease, but they cannot precisely predict the expectancy of any particular case. The survival rate of Kidney Cancer when detected at an early stage is quite high. People with Kidney Cancer tend to be older and may have other serious health conditions. Therefore, the percentage of people surviving the Cancer itself is likely to be higher.

Stage 5 year Survival Rate
I 81%
II 74%
III 53%
IV 8%

Can Kidney Cancer be detected early?

Kidney cancer might be indicated by several symptoms like pain, weight loss, fatigue or a lump. In case any of these signs are visible it is recommended to visit a doctor and go for an examination.

  • Physical exam and history: In this, the doctor conducts an examination of the body to check general signs of health, including health habits, any past illnesses, and types of treatment. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Urine and Blood Test: A urine or blood test is conducted to check for any signs of the disease.
  • Intravenous pyelogram (IVP): In this procedure a dye is injected that travels to the urinary tract, highlighting any tumors and an X-ray of the kidney is taken.
  • Ultrasound: In this procedure, sound waves are implemented to create a picture of the kidneys that helps to tell if a tumor is solid or fluid-filled.
  • CT Scan: In this procedure, X-rays and a computer are used to create a series of detailed pictures of the kidneys. This may also require an injection of dye. CT scans have virtually replaced pyelogram and ultrasound as a tool for diagnosing Kidney Cancer.
  • Magnetic resonance imaging: In this strong magnets and radio waves are used to create detailed images of soft tissues in the body.
  • Renal arteriogram: This test is used to evaluate the blood supply to the tumor.

What are the Treatments available?

Once the stage of cancer and its spread is located then the treatment can be planned. Today owing to the advancement in science and technology, there are several treatment options for Kidney Cancer. Treatments available are dependent on the stages of Cancer; however, surgery to remove the kidney is the most preferred treatment for Kidney Cancer as most of the people can survive well with just 1 kidney or a part of the kidney. Primary treatments available are as follows:

  • Surgery for Kidney Cancer
    Depending on the stage of advancement of cancer, one of the following types of surgery is recommended.
    • Radical nephrectomy It is the most common surgery for kidney cancer, done through a small incision with a laparoscope. In this surgery, the surgeon removes the kidney, adrenal gland, surrounding tissue and sometimes the nearby lymph nodes.
    • Simple nephrectomy In this surgery only the kidney is removed.
    • Partial nephrectomy This surgery is done to remove Cancer in the kidney along with some tissue around it. This procedure is used for patients with smaller tumors (less than 4 cm) or in those patients in which a radical nephrectomy might hurt the other kidney.
  • Cryotherapy: In this procedure, extreme cold temperature is used to kill the Cancer.
  • Radiofrequency ablation: It uses high-energy radio waves to "cook" the tumor.
  • Arterial embolization: This procedure involves inserting material into an artery that leads to the kidney. This blocks blood flow to the tumor. This procedure may be done to help shrink the tumor before surgery.
  • Targeted Therapy: This therapy uses drugs or other substances to find and target cancer cells with less toxicity to normal cells. One type of targeted therapy is anti-angiogenic agents. These keep blood vessels from feeding a tumor, causing it to shrink or stop growing. Another type of targeted agent is known as multikinase inhibitors or tyrosine kinase inhibitors. These are oral drugs that block an enzyme pathway which allows cancer cells to grow. The third type of targeted therapy is known as m-TOR inhibitors.
  • Radiation Therapy for Kidney Cancer: This treatment uses high-energy X-rays or other types of radiation to kill cancer cells or halt their growth. External radiation therapy sends radiation to the Cancer from a machine outside the body.
  • Chemotherapy for Kidney Cancer: This therapy uses drugs to kill cancer cells or stop them from multiplying.

Is there curative treatment for Kidney Cancer?

Most of the Kidney Cancers are found before they spread (metastasize) to distant organs. And Cancers caught early are easier to treat successfully. However, when Kidney Cancer spreads, or metastasizes, to other parts of the body, it goes from being one of the most curable types of Cancer to one of the least.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a prior or familial history, a physical examination by a specialist is recommended once in a year.

How can I as a patient know it early?

The Kidneys are so deep inside the body; it’s harder to find Kidney Cancer just by looking or feeling for growths. Kidney Cancer often doesn’t cause symptoms until the tumor has already grown. The most common symptom of Kidney Cancer is blood in the urine or hematuria. Being aware of the symptoms and going for regular urine and blood test once a year is highly recommended.

Liver Cancer

What is Liver Cancer?

Liver

The Liver  is the largest internal organ, weighing about 1.3 kg and is located on the right side of the belly. It is reddish-brown in color and feels rubbery when touched. Normally, we cannot feel the Liver  as it is located deep inside the body and is protected by the rib cage. The Liver , gall bladder, pancreas and the intestine together process the food for digestion and absorption. Furthermore, the Liver  is the most important organ for detoxification of toxins (chemicals) and for metabolism of drugs. The Liver  secrets bile juice and is also responsible for the production of proteins responsible for clotting. Liver  is sectioned into two large portions, the right and the left lobes.

Functions:

The Liver  is one of the vital organs of the body, responsible for hundreds of chemical actions necessary for life. It is also cited as a gland since it secretes digestive enzymes.

  • It synthesizes multiple chemicals required by the body to function normally.
  • It breaks down and detoxifies the nutrients. Some nutrients must be metabolized in the Liver  before they can be used.
  • It also acts as a storage unit for glycogen, iron, copper and fat-soluble vitamins (especially A, D and B12)
  • The Liver  generates proteins important for blood clotting that protects us from bleeding too much when there is a cut or injury.
  • It secretes bile into the intestines to help absorb fats.
  • It breaks down alcohol, drugs, and toxic wastes, which are then excreted in urine and stool.

Liver Cancer

Liver  Cancer is a condition that happens when the normal life cycle of the cell is interrupted and instead of dying they keep growing uncontrollably and forms a tumor. This tumor may be restricted only to the Liver  (benign tumor) or the Cancer cells may spread to other parts of the body (malignant tumor).

Liver  Cancer is the third most frequent cause of Cancer death.

Types of Liver  Cancer

Types of Benign Liver  Cancers

Benign tumors are usually small, however sometimes they may grow large enough to cause problems, but they do not spread to nearby tissues or distant parts of the body. Surgery is the most preferred treatment option for such type of Cancer.

Hemangioma: It starts in the blood vessels and is the most common type of benign Liver  tumor. In most cases, no symptoms are spotted and treatment is also not essential. However, in some cases, the tumor may bleed and need to be removed surgically.

Hepatic adenoma: Hepatic adenoma begins in the main type of Liver  cell (hepatocytes). Usage of certain drugs like birth control pills or anabolic steroids may increase the risk of getting this tumor. Adenomas may shrink when the drugs are stopped. In most cases of hepatic adenoma, symptoms are not evident and treatment is also not needed. But, some of the tumors may eventually cause symptoms like pain or blood loss. Also, there is a risk that the tumor could rupture and could eventually develop into Liver  Cancer; hence surgery is recommended to remove the tumor when possible.

Focal nodular hyperplasia: Focal nodular hyperplasia (FNH) is a tumor-like growth made up of several cell types. Although FNH tumors are benign, it can be hard to tell them apart from true Liver  Cancers, and doctors sometimes remove them when the diagnosis is unclear.

Types of Primary Liver  Cancer

Cancer that starts in the Liver  is called primary Liver  Cancer. Some of the primary Liver  Cancers are discussed below:

Hepatocellular Cancer: This is the most common form of Liver  Cancer in adults. Malignant Cancer cells are called hepatocellular carcinoma.

Hepatocellular Cancer (HCC) can have different growth patterns but the prognosis remains almost the same.

  • It may begin as a single tumor that eventually grows larger. In later stages, it may start spreading to other parts of the Liver .
  • It may start as many small Cancer nodules throughout the Liver . This is seen most often in people with cirrhosis (chronic Liver  damage).

Fibrolamellar It is a rare type, making up less than 1% of HCCs. This type is most often seen in women younger than age 35, and often the rest of the Liver  is not diseased. This subtype generally has a better outlook than other forms of HCC.

Cholangiocarcinoma: Cancer that arises in the small bile ducts within the Liver  is called cholangiocarcinoma. It accounts for 10 to 20 % of Liver  Cancers.

Angiosarcoma and hemangiosarcoma: These are very rare, fast growing and almost incurable Cancers that begin in cells lining the blood vessels of the Liver .

Exposure to vinyl chloride or thorium dioxide increases the risk of developing these Cancers. Other factors which may be responsible for these Cancers are exposure to arsenic or radium. In about half of the cases, no likely cause is identified.

These tumors grow quickly and are usually too widespread to be removed surgically by the time they are found. Chemotherapy and radiation therapy may help slow the disease, but these Cancers are usually very hard to treat. 

Hepatoblastoma: This is a very rare kind of Cancer that develops in children, usually younger than 4 years old. The cells of hepatoblastoma are similar to fetal Liver  cells. It can be treated successfully with surgery and chemotherapy. However, the tumors are harder to treat if they have spread outside the Liver .

Metastatic Liver  Cancer

Cancer that has originated in some other part of the body and has spread to the Liver  is called metastatic Liver  Cancer. Liver  metastases are very common in many types of Cancers, especially in case of GI tract Cancer, breast, lung and pancreas. Though, theoretically, any Cancer can spread to the Liver .

Occurrence rate

Occurrence rate liver cancer

India accounts for the country with lowest Cancer incidence rates in males among all the Asian countries. Among the 9,48,858 total number of Cancer cases registered in India, 20,144 cases contributed to Liver  Cancer. The mean incidence of Liver  Cancer is 2.77% for males and 1.38% for females. The prevalence of Liver  Cancer in India varies from 0.2% to 1.6%. Hepatitis B virus (HBV) infection is the most prevalent etiologic factor in high incidence areas, while hepatitis C (HCV) infection is the most common in the low incidence areas

Anatomy of Liver Cancer

liver cancer

Copyright © Terese Winslow, U.S. Govt, The above image is used for educational purpose only.

What are the general symptoms of Liver Cancer?

Liver  is located deep inside the body and hence usually the signs and symptoms of Liver  Cancer can’t be felt until the later stages of the disease. However, in some cases it can be detected earlier. Some of the most common symptoms of Liver  Cancer are:

  • Unaccounted weight loss and loss of appetite.
  • Vomiting
  • An enlarged Liver  
  • Pain and swelling in the abdomen
  • Jaundice
  • High blood calcium levels – hypercalcemia, that causes nausea, confusion, constipation, weakness, or muscle problems
  • Low blood sugar levels – hypoglycemia, which can cause fatigue.
  • Breast enlargement – gynecomastia and/or shrinkage of the testicles in men
  • High counts of red blood cells – erythrocytosis which can cause someone to look red and flushed
  • High cholesterol levels

Some other symptoms include fever, enlarged veins on the belly that can be seen through the skin, and abnormal bruising or bleeding. But many of the signs and symptoms of Liver  Cancer can also be caused by other conditions and experiencing any of these do not ascertain Liver  Cancer. Still, if any of these problems is spotted it’s important to consult a doctor right away so the cause can be found and treated if needed.

What are the general causes of Liver Cancer?

There are several factors that might be responsible for the development of Cancer. Since the Liver  filters blood from all parts of the body, Cancer cells from elsewhere can lodge in the Liver  and start to grow. The causes of Liver  Cancer may also be linked to environmental, dietary, or lifestyle factors.

A recent study involving 140 patients, hepatitis B was the most common cause of Liver  Cancer affecting as many as 56 (39%) patients, followed by alcohol which affected 31 (22%) patients. T he prevalence of diabetes was found to be 25% in Liver  Cancer patients. 

Some such risk factors are listed below:

  • Anabolic steroids: These steroids are specially used by athletes and weight lifters. However, regular use can raise the risk of developing Liver  Cancer considerably. 
  • Cirrhosis: This is a condition in which Liver  cells are damaged and are replaced with scar tissue. People with cirrhosis of the Liver  have a higher risk of developing Liver  Cancer. 
  • Diabetes: People having diabetes, especially if they also have hepatitis, or regularly consume a lot of alcohol, are more likely to develop Liver  Cancer. 
  • Vinyl chloride and thorium dioxide (Thorotrast): Exposure to these chemicals raises the risk of angiosarcoma of the Liver . It also increases the risk of developing cholangiocarcinoma and hepatocellular Cancer, but to a far lesser degree. Vinyl chloride is a chemical used in making plastics. Thorotrast is a chemical that in the past was injected into some patients as part of certain x-ray tests.
  • Arsenic: Drinking water contaminated with arsenic over a long period of time increases the risk of Liver  Cancer.
  • Infection with parasites: Infection with the parasite that causes schistosomiasis can cause Liver  damage and is linked to Liver  Cancer.
  • Family history: Any track record of the disease in the family raises an alarm.
  • L-carnitine deficiency
  • Obesity: Being overweight is harmful to health. It may cause several issues including Liver  Cancer.
  • Smoking: This factor needs no justification. The package comes with a clear warning and reading the package gives enough information about this.
  • Alcohol: While limited use of alcohol causes no harm, excess consumption is very harmful.

Can Liver Cancer be prevented?

Most cases of Liver  Cancer could be prevented with simple lifestyle changes such as avoiding excess alcohol, having protected sex and getting vaccinated against the hepatitis B virus. A few measures to prevent Liver  Cancer are:

Preventing hepatitis infections

Chronic infection with hepatitis B virus and hepatitis C virus is the most significant risk factor for Liver  Cancer. These viruses can spread from person to person through contaminated needles or unprotected sex. Thus some cases of Liver  Cancer may be prevented by taking care of these things.

Limiting alcohol and tobacco use

Heavy consumption of alcohol damages the Liver  thus increasing the risk of developing Liver  Cancer. Limiting or avoiding alcohol may help in avoiding Liver  Cancer. Smoking increases the risk of developing many Cancers including Liver  Cancer, thus saying no to smoking is a smart move.

Maintaining healthy weight

Avoiding obesity is another way to protect Liver  Cancer. People who are obese are more likely to have fatty Liver  disease and diabetes, both of which have been linked to Liver  Cancer.

Limiting exposure to Cancer-causing chemicals

Maintaining and implementing health and safety standards to protect consumers and workers from certain chemicals offers shielding to Liver  Cancer.

What are the stages of Liver Cancer?

Staging is important to understand the severity, spread and probability of cure of the disease. Once the type of Cancer is diagnosed, a stage is assigned that helps in planning the treatment for the disease.

Liver  Cancer is categorized into four stages:

  • Stage 1 – The spread of the tumor is limited to the Liver .
  • Stage 2 - Either there are several small tumors, within the Liver , or one tumor that has reached a blood vessel
  • Stage 3 - either there are various large tumors, or there is just one that has reached the main blood vessel(s). Cancer may have also reached the gallbladder
  • Stage 4 - The Liver  Cancer has spread to other parts of the body.

Survival rates of Liver Cancer?

Survival rate of Liver Cancer is determined by analyzing and studying the cases of patient’s having the same disease at the same stage. However, these rates cannot predict precisely the probability of cure or survival of any patient, as each patient is unique and their survival depends on a lot of other factors like immunity, response to treatment, health record etc. These statistics of survival rate is just a reference to understand the severity and criticality of the disease. Below are some details on the survival rate for 5 years:

  • Localized i.e. stage I, II or some cases of III where the Cancer is still confined to the Liver  and has not spread outside of it. The 5-year relative survival rate for localized Liver  Cancer is about 31%.
  • Regional i.e. stage IIIC and IVA, where Cancer has grown beyond the Liver  and into nearby organs or has spread to nearby lymph nodes. The 5-year survival rate for this stage is about 11%.
  • Distant i.e. stage IVB, means that the Cancer has spread to distant organs or tissues. The 5-year relative survival rate for distant stage Liver  Cancer is about 3%.

Hepatitis B-related cases have extremely poor prognosis with median survival less than 16 months—36% to 67% after one year and 15% to 26% after five years of diagnosis

Due to the asymptomatic nature of these infections, about 60% of infected individuals remain unaware until they show symptoms of cirrhosis or Liver  Cancer which may take over 20 years. Both cirrhosis and Liver  Cancer are irreversible and cause death.

Can liver Cancer be detected early?

It is often hard to find Liver  Cancer early because signs and symptoms often do not appear until it is in its later stages. Small Liver  tumors are hard to detect on a physical exam because most of the Liver  is covered by the right rib cage. By the time a tumor can be felt, it might already be quite large.

For people at higher risk of Liver  Cancer due to cirrhosis or chronic hepatitis B infection, some experts recommend screening for Liver  Cancer with alpha-fetoprotein (AFP) blood tests and ultrasound exams every 6 to 12 months. Ultrasound uses sound waves to take pictures of internal organs.

Once a suspicion of Liver  Cancer arises, a physician will order one the following to confirm a diagnosis:

Blood tests: Alfa-fetoprotein (AFP) is a protein present in the blood, whose presence may be elevated in patients with Liver  Cancer. But looking at AFP levels isn’t a perfect test for Liver  Cancer. Many patients with early Liver  Cancer have normal AFP levels. Also, AFP levels can be increased from other kinds of Cancer as well as some non-Cancerous Liver  conditions.

Imaging studies: The best way to detect Liver  Cancer is through surveillance ultrasound of the Liver  done every 6 months in a patient with a diagnosis of cirrhosis. As with most forms of Cancer, it is best to treat the Liver  Cancer as soon as it is detected.

Liver  biopsy is performed to by extracting sample tissues from the Liver , which are then analyzed under a microscope to look for Cancer cells. But Liver  biopsy is not the most preferred option as it carries several risks like infection, bleeding, or seeding of the needle. Seeding is when Cancer cells get on the needle used for a biopsy and spread to other areas touched by the needle. Liver  biopsy of suspected Liver  Cancer carries the added risk of seeding the Liver  biopsy needle track in 1% to 3% of cases.

HCC screeningx - high risk individuals for HCC should have regular screenings for Liver  Cancer. Liver  Cancer, if not diagnosed early is much more difficult to remove. The only way to know whether you have Liver  Cancer early on is through screening because symptoms are either slight or non-existent. 

What are the Treatments available?

The medical treatment chosen depends on how much Cancer has spread and the general health of the Liver .

Surgery: Surgery is one of the most common treatment options if the Cancer is small and is limited to some part of the Liver .

Liver  transplant: In this procedure, the Cancerous Liver  of the patient is removed and is replaced with a healthy Liver  from another person. It is usually used in cases where the Cancer cells are unresectable.

Ablation therapy: In this procedure the Cancer cells in the Liver  are killed without any surgery. Heat, laser, or injecting a special alcohol or acid directly into the Cancer are used to kill the Cancer cells. This technique may be used in palliative care when Cancer is unresectable.

Embolization: Blocking the blood supply to Cancer can be done using a procedure called embolization. This technique uses a catheter to inject particles or beads that can block blood vessels that feed Cancer. Starving the Cancer of the blood supply prevents the growth of the Cancer. This technique is usually used on patients with large Liver  Cancer for palliation.

Radiation therapy: Radiation uses high-energy rays directed to the Cancer to kill Cancer cells. Normal Liver  cells are also very sensitive to radiation. Complications of radiation therapy include skin irritation near the treatment site, fatigue, nausea, and vomiting.

Chemotherapy: Chemotherapy is a technique that kills Cancer cells by the use of drugs given either orally or by injections. Complications of chemotherapy include fatigue, easy bruising, hair loss, nausea and vomiting, swollen legs, diarrhea, and mouth sores. These side effects are usually temporary.

Targeted Agent: Sorafenib (Nexavar) is an oral medication that can prolong survival (up to 3 months) in patients with advanced Liver  Cancer. Side effects include fatigue, rash, high blood pressure, sores on the hands and feet, and loss of appetite

Is there curative treatment for Liver Cancer?

A complete curable treatment of Liver  Cancer is quite difficult. Also, in most of the cases of Liver  Cancer, the detection is delayed till later stages, where Cancer has spread to different organs.  While Liver  Cancer is usually difficult to cure, treatment consists of chemotherapy and radiation. In some cases, surgical resection or Liver  transplantation is performed.

How frequently should one visit doctor for early diagnosis?

People with a high risk of Liver  Cancer are recommended to visit the doctor in every 6 months for regular screening tests that might help in the early detection of this silent disease.

How can I as a patient know it early?

Being aware of the symptoms, and any health issue that might indicate the presence of the disease needs to be examined thoroughly. Also, going for screening tests might unveil the  presence of the disease in an early stage thus making treatment easier.

Leukaemia Cancer

What is Leukaemia Cancer?

Bone Marrow

Bone marrow is a soft, fatty tissue that stores “stem cells”, which on maturing turns into blood cells. Stem cells are specialized cells that have the potential to grow and develop into various other types of cells. Thus, marrow is said to be the body’s blood factory where a single type of multi-protein stem cells divides and matures to give rise to different kinds of blood cells.

Functions

  • Bone marrow is the production house of 12 different types of blood cells viz.
    • Platelets,
    • RBC,
    • WBC,
    • Mast cell,
    • Eosonophil,
    • Basophil,
    • Neutrophil,
    • Macrophage,
    • Lymphoid dendritic,
    • Myeloid dendritic,
    • B – cell,
    • T – cell
    • NK cell.
  • Each of these blood cells has their own specific functions.
  • Red blood cells deliver oxygen throughout the body
  • White blood cells fight pathogens in the blood
  • Platelets help in clotting of blood

Cancer

Cancer occurs when genetic mutations cause abnormal cells to divide and multiply in an uncontrolled way.

Leukemia

Unlike most Cancers, leukemic cells don’t belong to an organ and don’t result in the growth of a tumor. Instead, the uncontrolled cell growth takes place in the bone marrow. The leukemic cells are generally immature and do not carry out any physiological function of use to the body.

The word leukemia is derived from the Greek words “Leukos” meaning white and “aima” meaning blood.

Millions of blood cells are made every day and millions die at the end of their lifespan. There is a fine balance between the number of new blood cells and the number of worn out cells which gets phased out or die. Various factors help to maintain this balance. For example, certain hormones in the bloodstream and chemicals in the bone marrow called 'growth factors' help to regulate the number of blood cells. However, the abnormal blood cells do not follow this cycle; they continue to grow uncontrollably crowding out space in the blood, thereby impeding the function and growth of healthy blood cells.

Types :

Leukemias are grouped based on the rate of growth of Cancerous cells (acute or chronic) as well as the type of blood cell that is affected (lymphocytes or myelocytes). It is very important to know the type of leukemia as the outlook (prognosis) and treatment varies according to its types.

1. Lymphocytic or Myeloid Leukemia
The marrow synthesizes hematopoietic stem cells which may become a myeloid stem cell or a lymphoid stem cell. These are the precursor cells, also called “blasts”. These cells further give rise to several other cell types including monocytes, macrophages, neutrophils, basophils, eosinophils, erythrocytes(RBC), dendritic cells and megacariocytes. Each myeloid cell eventually becomes a Red blood cell, a platelet or an infection-fighting macrophage. When Cancer occurs in these cells then it is calledmyeloid leukemia. Lymphoid cells develop into T, B and natural killer cells (NK cells). Cancer occurring in these cells is calledlymphocytic leukemia or lymphoblastic leukemia.

2. Acute or chronic
If Cancerous cells build up in the blasts cells rapidly filling the marrow and interfering with normal functions then it is called asacute leukemia. As Cancerous cells proliferate, the rate of normal blood cells production plunges.  Acute leukemia is a fast-growing Cancer that usually gets worse quickly and so it demands fast and aggressive treatment. Normally, a person’s bone marrow contains 1 – 2 % of blast cells but in case of acute leukemia, the blast cell count increases over 20 %.
Chronic leukemia occurs in more mature lymphoid or myeloid cells. The irregular cells build up in the bone marrows over a period of years, interrupting the production of normal blood cells and spreading to other parts of the body.
These categories acute and chronic, lymphoid and myeloid are used to assign cases of leukemia to one of four subtypes

Acute lymphocytic leukemia (ALL) or Acute Lymphoblastic Leukemia 

The build up of immature lymphoblasts is called acute lymphoblastic leukemia. In order to confirm if the affected cells are lymphoid cells, TdT is checked. TdT is a DNA polymerase that’s present only in the lymphoblasts.  ALL is the most common type of leukemia accounting to almost 80% of all leukemia cases. It primarily occurs in young children between the ages of 1 and 4 but the prognosis is quite good and although it is rare among adults in whom the prognosis is generally poor.

ALL is further subtyped based on B cells or T cells.

  • Precursor B-ALL: It is the most common subtype accounting for 84% of ALL. Chemotherapy is the most preferred treatment option to treat B-ALL.
  • Precursor T-ALL: It accounts for almost 14% of all ALL cases. It occurs most often in teenagers.

Acute Myelogenous Leukemia (AML)

The build up of immature myeloid blasts is calledacute myeloid leukemia. To verify if the affected cells are myeloblasts, the presence of enzyme myeloperoxidase is checked. AML is more common among adult men between the ages of 50 and 60. Chemotherapy is the most preferred treatment option for this Cancer.

Chronic lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is a type of Cancer that starts fromlymphocytes in the bone marrow. This is most common leukemia among men over 55 years, although younger adults can get it as well. In CLL, the leukemia cells often build up slowly over time, and many people don't have any symptoms for initial few years. Though rarely able to be cured, most patients with CLL survive without treatment for years. On progression of the disease, they must be treated properly.

Chronic Myelogenous Leukemia (CML)

This Cancer occurs mostly in adults. A drug called imatinib is commonly used to treat CML.

Occurrence Rate:

Leukemia is one of the most deadly diseases which are very hard to treat. Almost 350282 people are diagnosed with leukemia each year around the globe.

Anatomy of Leukaemia Cancer

What are the general symptoms of Leukaemia Cancer?

A symptom is any abnormality shown by the body due to improper functioning of a single or group of organs. Since there are different types of leukemia so the symptoms of each type also differ.

Symptoms of Acute Leukemia :

Acute leukemia is an aggressive form and it develops very rapidly which causes some eminent symptom at an early stage.

Anemia – Due to the shortage of healthy red blood cells the patient usually suffers from anemia which causes weakness and fatigue. The patient may also suffer from labored respiration and pallor or paleness i.e. an unusual lightness of skin color as compared to normal complexion.

Blood clot - As the immature blast cells crowd out the platelets, which are crucial for blood clotting, the patient tends to bruise or bleed easily and heal slowly.

Affected immune system – In leukemia, the production of good white blood cells ceases to occur which leads to frequent infections, high temperature.

Pain in bones and joints

Symptoms of Chronic Leukemia

Chronic leukemia develops gradually over a long period without giving any signal at the early stages. However, it may become more active and more like acute leukemia after several years. The symptoms of chronic leukemia may include:

  • swollen or enlarged lymph nodes, spleen and liver
  • Anemia may also be a symptom of chronic leukemia
  • fevers or night sweats
  • discomfort or swelling in the abdomen,
  • Unaccounted weight loss  
  • Red spots on the skin

However, in most cases the symptoms are not clear enough for suspicion of chronic leukemia; it can be confirmed only by a medical examination.  So it is highly recommended visiting a doctor in case of experiencing any of the mentioned symptoms.

What are the general causes of Leukaemia Cancer?

While the exact cause(s) of leukemia is not known, risk factors have been identified, which increases the chance that certain leukemia may develop. But these risk factors account for only a few cases. Some of the risk factors are:

  • Radiation exposure
  • Certain chemotherapy for Cancer
  • Smoking
  • Family history of leukemia. However, ALL does not appear to be inherited.
  • Exposure to certain chemicals such as benzene.
  • Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus)
  • Alkylating chemotherapy agents used in previous Cancers
  • Maternal-fetal transmission (rare)

Can Leukaemia Cancer be prevented?

There is no known way to prevent most types of leukemia. Some types of leukemia may be prevented by avoiding high doses of radiation, exposure to the chemical benzene, smoking and other tobacco use, or certain types of chemotherapy used to treat other types of Cancer.

What are the stages of Leukaemia Cancer?

Staging of Cancer is essential for determining the location and spread of the Cancerous cells. Also, it is based on this stage that the complete prognosis of the patient can be planned. Usually, a numbered staging system is used to describe most types of Cancer/solid tumors and their spread throughout the body.

But for Acute lymphocytic leukemia, staging is done in a bit different way. Since the disease originates within the bone marrow and it is likely spread to other organs before detection, the staging method needs to take into account several other factors.

B-cell ALL staging

B lymphocytes that are produced and matured in the bone marrow are responsible for coordinating humoral immune responses and synthesizing antibodies against antigens. B – cell ALL can be staged as -

  • Early pre-B AL: It accounts for 10 % of ALL Cancer.
  • Common ALL: It accounts for 50 % of ALL Cancer.
  • Pre-B ALL: 10% of ALL leukemia is reported to be of this type.
  • Mature B-cell ALL: Also called Burkitt leukemia. It is a rare type and accounts for only 4% of cases.

T-cell ALL staging

T lymphocytes are produced in the bone marrow and they leave the bone marrow before maturation and move to the thymus. T cells play a central role in cell-mediated immunity. There are several subsets of T cells that have distinct functions. The different subsets of T cells include Helper, Cytotoxic, Memory, Regulatory, Natural killer and Gamma Delta T cells.

  • Pre-T ALL: Approximately 5 to 10 percent of cases
  • Mature T-cell ALL: Approximately 15 to 20 percent of cases

Acute myelogenous leukemia stages

As AML starts in the bone marrow and spreads really quickly so there is no specific staging for AML. AML is further classified using a cellular system and the treatment is planned based on this classification.

AML is classified into eight subtypes, M0 through M7, based on:

  • The number of healthy blood cells
  • The size and number of leukemia cells
  • The changes that appear in the chromosomes of the leukemia cells
  • Any other genetic abnormalities that have occurred

Chronic lymphocytic leukemia stages

CLL may be staged according to the following staging systems:

Rai staging system

  • Stage 0 CLL: The levels of the lymphocytes are too high, usually more than 10,000 in one sample. Stage I CLL: The levels of lymphocytes is high and the lymph nodes are swollen.
  • Stage II CLL: The number of lymphocytes is high and the liver or spleen might be swollen.
  • Stage III CLL: The excess amount of lymphocytes begins to crowd out the red blood cells, resulting in anemia. The lymph nodes may be swollen and the liver or spleen may be larger than normal.
  • Stage IV CLL: The levels of red blood cells and platelets drop below normal, causing anemia and thrombocytopenia. The lymph nodes may be swollen and the liver or spleen may be larger than normal.

Binet staging system

  • Stage A: Lymph nodes may be swollen, but the Cancer is limited to fewer than three areas.
  • Stage B: More than three areas of lymphoid tissues are swollen.
  • Stage C: Either one or both of the blood disorders, anemia and thrombocytopenia, are present.

Chronic myeloid leukemia stages

There are three stages of CML.

  • Chronic: This is the earliest phase of CML. The majority of CML patients are diagnosed during this phase as a result of mild symptoms, particularly fatigue.
  • Accelerated: If CML has not responded to treatment well during the chronic phase, it becomes more aggressive, which can lead to the accelerated phase. At this point, symptoms may become
  • more noticeable.
  • Blastic: This is the most aggressive stage of chronic myeloid leukemia. Blastic refers to having more than 20 percent myeloblasts or lymphoblasts. Symptoms are similar to those of acute myeloid leukemia.

Survival rates of Leukaemia Cancer?

Mortality (death) rates for leukemia are higher in the elderly than in younger adults and children. In many cases, leukemia can be cured with treatments available today. The survival rate, however, cannot predict the outcome of any particular patient as the outlook varies largely on the basis of overall health condition, age and several other factors.

Modern treatments have led to a greater than fourfold increase since 1960 in five-year survival rates for leukemia. Five-year survival rates for different types of leukemia are approximately:

Type of Leukaemia 5 year survival rate
ALL 85%
CLL 83%
CML 60-80%
AML 60-70%

Can Leukaemia Cancer be detected early?

As many types of leukemia do not show any early symptoms so it becomes a bit tricky to detect the disease at an early stage. However, being alert and not neglecting any minor signal regarding your health many a times proves to be life saviour. In case of any doubt about the disease, there are several tests that aid to clear the air.

Physical Examination: This is the first step of diagnosing leukemia. During the physical examination, the overall health record of the patient is taken into account and any sign of swollen glands is checked. If the person appears pale or complains about any of the mentioned symptoms then the doctor should suspect leukemia.

Routine Blood Test: Since leukemia is the Cancer of blood, a blood test gives a lot of information.  Leukemia is suspected if a blood test shows large numbers of abnormal white blood cells and low numbers of normal white blood cells, red blood cells or platelets. If leukemia is detected then blood test is repeated after every three months for at least two years.

Bone Marrow Biopsy: A biopsy is done if leukemia is suspected and this test helps to identify the type of leukemia. In this procedure, a small amount of the Cancerous cell from the marrow is removed using a syringe and is observed under a microscope. Bone marrow biopsy may be uncomfortable and so sometimes the use of anesthesia is preferred.

Lymph Node Biopsy: In case of enlarged lymph, a lymph node biopsy is suggested. Tissues from the affected lymph are removed and examined under a microscope.

Imaging Tests: Several imaging tests like CT scan, X- ray, MRI may be performed to ascertain the spread of leukemia.

Chromosome testing: The genetic changes that occur in leukemia often involve chromosome changes, which can be seen under a microscope or using laboratory tests.

Lumbar puncture: This is done to check for leukemic cells in the spinal cord and brain. In this procedure, a fine needle is inserted between the bones in the lower back to take out a sample of fluid which are then evaluated under a microscope.

What are the Treatments available?

The treatment plan for leukemia depends largely on its type, age and health status of the patient. There are a number of different medical approaches to the treatment of leukemia.

Treatments for leukemia include chemotherapy (major treatment modality for leukemia), radiation therapy, biological therapy, targeted therapy, and stem cell transplant. Combinations of these treatments may be used. Surgical removal of the spleen can be a part of treatment if the spleen is enlarged.

  • Chemotherapy
    Chemotherapy is the most preferred treatment in case of leukemia. It involves the use of drugs to kill the rapidly dividing cells. Chemotherapy may be taken orally or it may be delivered via a catheter or intravenous line directly into the bloodstream. Combination chemotherapy is usually given, which involves a combination of more than one drug.
  • Biological therapy
    Biological therapy is the use of substances of biological origin or synthetic versions of these substances to treat Cancer. Biological therapies may include antibodies, immunotherapy, tumor vaccines, or cytokines.
  • Targeted therapy
    Targeted therapies are drugs that interfere with one specific property or function of a Cancer cell, rather than acting to kill all rapidly growing cells indiscriminately. This means there is less damage to normal cells with targeted therapy than with chemotherapy. Targeted therapies may cause the target cell to cease growing rather than to die. Targeted Cancer therapies are also referred to as molecularly targeted drugs, molecularly targeted therapies, or precision medicines.
  • Radiation therapy
    Radiation therapy uses high energy radiation to target Cancer cells. Radiation therapy may be used in the treatment of leukemia that has spread to the brain, or it may be used to target the spleen or other areas where leukemia cells have accumulated.
  • Stem cell transplant
    In stem cell transplantation, high doses of chemotherapy and/or radiation are given to destroy leukemia cells along with normal bone marrow. Then, transplant stem cells are delivered by an intravenous infusion. The stem cells travel to the bone marrow and begin producing new blood cells.
    Autologous stem cell transplantation refers to the situation in which the patient's own stem cells are removed and stored. The malignant cells are then targeted and destroyed. Once the malignant cells are completely destroyed then the patient’s own cells that were previously stored are reinfused.
  • Supportive treatments
    Because many of the treatments for leukemia deplete normal blood cells, increasing the risk of bleeding and infection, supportive treatments may be needed to help prevent these complications of treatment. Supportive treatments may also be needed to help minimize and manage unpleasant side effects of medications or radiation therapy.
    Types of supportive and preventive treatments that can be used for patients undergoing treatment for leukemia include the following:
    • Vaccines against the flu or pneumonia
    • Blood or platelet transfusions
    • Anti-nausea medications
    • Antibiotics or antiviral medications to treat or prevent infections
    • White blood cell growth factors to stimulate white blood cell production (such as granulocyte-colony stimulating factor [G-CSF], made up of filgrastim [Neupogen] and pegfilgrastim [Neulasta] and granulocyte macrophage-colony stimulating growth factor [GM-CSF], made up of sargramostim [Leukine])
    • Red cell growth factors to stimulate red blood cell production (darbepoetin alfa [Aranesp] or epoetin alfa [Procrit])
    • Intravenous injections of immunoglobulins to help fight infection Continue Reading

Is there curative treatment for Leukaemia Cancer?

Acute leukemia can often be cured with proper treatment but chronic leukemia is unlikely to be cured with treatment. Treatments are often able to control the Cancer and manage symptoms in case of chronic leukemia.

How frequently should one visit doctor for early diagnosis?

Going for regular checkups and being attentive to even the slightest of health hazards may prove to be a life saving habit.

Lung Cancer

What is Lung Cancer?

Lungs

The lungs are a pair of large, spongy, air-filled respiratory organs located on either side of the chest (thorax). They are specialized for gas exchange between our blood and the air. The lungs are covered by a thin layer of tissue called the pleura. A thin layer of fluid acts as a lubricant allowing the lungs to slip smoothly as they expand and contract with each breath.

The lungs expand and contract up to 20 times a minute to supply oxygen all over the body and expel carbon dioxide that has been generated throughout the body.

Parts of the Lungs

The lungs are divided into different parts which are called lobes.

  • The right lung has three lobes called upper, middle and lower lobes.
  • The left lung has only two lobes, the upper and lower lobe.

Functions of Lungs

The main function of the lungs is to facilitate exchange of oxygen and carbon dioxide between the air we breathe and the blood. There are a number of other jobs carried out by the lungs that include:

  • Maintaining the pH of blood by maintaining the amount of Carbon dioxide in the body.
  • Air is warmed, humidified, and cleaned by the nose and lungs.
  • Filtering out small gas bubbles that may occur in the bloodstream.
  • Converting a chemical in the blood called angiotensin I to angiotensin II. These chemicals are important for controlling blood pressure.

Lung Cancer

Cancer is the uncontrollable growth of abnormal cells that may lead to the formation of a lump or tumor. Cancer starts when any change in the gene forces the cell to grow and multiply uncontrollably. Thus resulting in the growth of a hard mass called tumour. When the cells in the lungs start behaving in an unaccounted manner and continue to grow without dying then it is termed as primary lung cancer. As tumors become larger and more numerous, they undermine the lung’s ability to provide the bloodstream with oxygen.

These tumors may be either benign or malignant. Benign tumors (non cancerous) are comparatively less destructive and cannot spread from its primary location. Malignant tumour is a group of cancer cells that can invade and destroy nearby tissue. They are more dangerous and spread to other parts of the body either through the bloodstream or the lymphatic system. Metastasis refers to cancer spreading beyond its site of origin to other parts of the body. When cancer spreads it is much harder to treat successfully. 

Types of Lung Cancer

Lung Cancer is divided into non-small cell Lung Cancer and small cell Lung Cancer based on the type of cells that is mutated. Non-small cell Lung Cancer is much more common than small cell Lung Cancer.

  • Non–small cell Lung Cancer: Also known as adenocarcinoma or Squamous cell carcinoma, they account for 80% of Lung Cancer cases. Adenocarcinoma usually starts in glandular cells on the outer part of the lung. They can also start in flat, thin cells called squamous cells. These cells line the bronchi, which are the large airways that branch off from the windpipe (trachea) into the lungs. There are four different types of non–small cell Lung Cancer and each of them have different treatment options:
    • Squamous cell carcinoma: This is the most common type Lung Cancer in men. This cancer forms in the lining of the bronchial tubes.
    • Adenocarcinoma. This is the most common type of Lung Cancer in women and in non smokers, adenocarcinoma forms in the mucus-producing glands of the lungs.
    • Bronchioalveolar carcinoma. This is a rare type of adenocarcinoma that forms near the lungs' air sacs.
    • Large-cell undifferentiated carcinoma. A rapidly growing cancer, large-cell undifferentiated carcinomas form near the outer edges or surface of the lungs.
  • Small cell Lung Cancer: These cancers usually start in cells that line the bronchi in the centre of the lungs. The main types of small cell Lung Cancer are small cell carcinoma and combined small cell carcinoma. Small cell Lung Cancer accounts for 20% of Lung Cancer cases and is mostly caused due to smoking.

 Occurrence Rate of Lung Cancer

According to National Center for Biotechnology Information (NCBI) reports, Lung Cancer is the second most common cancer and the most common cause of cancer related deaths all over the world. It accounts for 13% of all new cancer cases and 19% of cancer related deaths worldwide. In India, Lung Cancer constitutes 6.9% of all new cancer cases and 9.3% of all cancer related deaths in both sexes. The highest reported incidences of Lung Cancer are from Mizoram in both males and females. The time trends of Lung Cancer show a significant rise in Delhi, Chennai and Bangalore in both sexes.

Anatomy of Lung Cancer

lung cancer

What are the symptoms of Lung Cancer?

Unfortunately, there are no prominent symptoms of early Lung Cancers. For about 25% of people with Lung Cancer, symptoms are not diagnosed even after having a chest X-ray or CT during a routine test or as a procedure for other problems. Lung Cancer symptoms that may be detected are listed below.

  • Persistent Cough that may sound a bit different or be painful. Coughing up phlegm that contains blood also indicates something serious.
  • Fatigue or breathlessness or wheezing
  • Loss of appetite and unaccounted weight loss are also signaling something that needs your attention.
  • Chest pain or pain in the shoulder. It could be a dull ache or a sharper pain.
  • Ongoing chest infections which may occur often or doesn’t get better with treatment.
  • Some types of Lung Cancer cells produce Ectopic hormones that go into the bloodstream. These hormones can cause symptoms that don’t seem related to the Lung Cancer. These symptoms are also called paraneoplastic syndrome. Some of the hormone symptoms are:
    • pins and needles or numbness in the fingers or toes
    • muscle weakness
    • drowsiness, weakness, dizziness and confusion
    • breast swelling in men
    • blood clots

What are the general causes of Lung Cancer?

Lung Cancer occurs when a lung cell's gene mutation damages the cell’s DNA. Mutations can occur for a variety of reasons. The exact cause of Lung Cancer is still being investigated. However, certain risk factors have been identified to play a major role in causing cells to become cancerous.

  • Inhaling of carcinogenic substances is the major cause of Lung Cancer. Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and compounds in car exhaust fumes are all examples of carcinogens. These substances are directly responsible for damaging DNA and aiding cancer.
  • Smoking: About 87% of Lung Cancers are related to smoking. According to an article published in newscientist.com, theverge.com one genetic mutation is induced in every 50 cigarettes smoked. Even exposure to second-hand smoke can damage cells and result in cancer. Radon gas, pollution, toxins, and other factors contribute to the remaining 10%.
    Cigarettes and cigarette smoke contain over 70 cancer-causing chemicals (carcinogens). Some of the carcinogens found in cigarette smoke include:
    • Lead (a highly poisonous metal)
    • Arsenic (an insecticide)
    • Cadmium (a battery component)
    • Isoprene (used to make synthetic rubber)
    • Benzene (a gasoline additive)
  • Indoor radon exposure is now the second most common cause of Lung Cancer.
  • Genes: Genetic predisposition that is inherited from family members is also a known cause of Lung Cancer. A child may be born with certain genetic mutations that make him/her more likely to develop cancer later in life. Genetic predispositions are thought to either directly cause Lung Cancer or greatly increase one's chances of developing Lung Cancer from exposure to certain environmental factors.

Other known risk factors are

  • Occupational and environmental carcinogens
  • Asbestos
  • Arsenic
  • Plycyclic Hydrocarbon

Cigarette Smoking, Lung Cancer and Cilia

Cigarette smoke damages and can kill hair-like projections called cilia. The cilia normally sweep out toxins, carcinogens, viruses, and bacteria. As the cilia get destroyed by continuous smoke, it fails to perform its functions thus allowing items to accumulate in the lungs that may lead to troubles like lung infections or Lung Cancer.

Can Lung Cancer be prevented?

There's no certain way to prevent Lung Cancer, but the risk of getting Lung Cancer can definitely be reduced. Some of the ways to keep in control Lung Cancer risks are:

  • Smoking cessation is the most important measure that can prevent the development of Lung Cancer. About 90% of the cases of Lung Cancer are attributed to smoking and inhaling of carcinogenic substances so avoiding these factors definitely lowers the risk of getting cancer. For smokers who quit within 10 years the risk of getting Lung Cancer drops to about the same risk as if they had never smoked.
  • Avoid second hand smoke Even continual inhalation of the air contaminated with smoke increases the risk of getting Lung Cancer. Avoiding areas where people smoke, such as bars and restaurants, and seek out smoke-free options comes to aid.
  • A radon free home High radon levels can be remedied to make your home safer.
  • Avoid carcinogens at work. Carcinogenic substances increase the risk of Lung Cancer. It is very important to take precautions to protect from exposure to toxic chemicals at work.
  • Eat a diet full of fruits and vegetables Opting for a healthy diet with a variety of fruits and vegetables rather that any supplements is a good way to prevent Lung Cancer.

What are the stages of Lung Cancer?

The stage of Lung Cancer refers to the extent to which the cancer has spread in the body. Once the type of the Lung Cancer is determined, then the stage of the cancer is assigned. Stages for non-small cell Lung Cancers are different from small cell Lung Cancers. The stages listed below are taken from the National Cancer Institute’s Lung Cancer staging information:

1.  Small Cell Lung Cancer Stages

Small cell Lung Cancer is a comparatively rare Lung Cancer type accounting to less than 20% of Lung Cancers. It often starts in the bronchi, and spreads to other parts of the body, including the lymph nodes. Small cell Lung Cancer stages are classified in two ways:

  • Limited stage: At this stage, cancer is restricted to only one side of the chest, typically in the lungs and lymph nodes. About 33% of cases with small cell Lung Cancer have limited stage cancer upon the first diagnosis.
  • Extensive stage: At this stage, the cancer has spread throughout one lung, spread into both lungs, to lymph nodes on the other side of the chest or to other body parts. About 66% of small cell Lung Cancer cases have extensive stage cancer upon first diagnosis.

2. Non-Small Cell Lung Cancer Stages

Non-small cell Lung Cancer is a more common type of Lung Cancer. Non-small cell Lung Cancer staging uses the TNM system with numbers X, 0, 1, 2, 3, or 4 after each letter:

  • Tumor (T) denotes the size of the tumor.
  • Lymph node (N) indicates the presence of cancer in the lymph nodes.
  • Metastasis (M) refers to whether cancer has spread to other parts of the body.

A number (0-4) or the letter X is added as a suffix to each factor indicating the severity of the disease. The letter X indicates that the information could not be assessed while 4 speaks of the high criticality of the disease. Once the T, N and M scores have been revealed, an overall stage is assigned.

Stages of Non Small Cell Lung Cancer

Occult (hidden) stage: In this stage, cancer cells can be spotted in a sputum cytology exam or other test, though the tumor location could not be pinned.

Stage 0 (carcinoma in situ): Cancer cells are only found in the top layer of cells lining air passages and has not crept deeper into the lungs or spread beyond the air passages.

Stage I: A tumor size may be either less than 3cm or range between 3 - 5 cm, but it has not spread to lymph nodes, making it possible for a surgeon to completely remove it. Stage I is divided into 2 sub-stages based on the size of the tumor:

  • Stage IA tumors are less than 3 cm wide.
  • Stage IB tumors are more than 3 cm but less than 5 cm wide.

Stage II: There are several ways that stage II Lung Cancer may be diagnosed. One is that the Lung Cancer has spread to lymph nodes near the lungs.

  • Stage IIA: The Stage IIA tumor is discovered to be between 3 cm and 5 cm.
  • Stage IIB: At this stage, the tumor is between 5 cm and 7 cm.

Stage III: Stage III Lung Cancer is found in both the lung and lymph nodes in the middle of the chest. This stage is further divided into two subsets.

  • Stage IIIA: This defines a Lung Cancer that has spread on the same side of the chest from where it started.
  • Stage IIIB: This defines a Lung Cancer in which the cancer has spread to either the opposite side of the chest or above the collar bone.

Stage IV: The 4th stage is the last and most advanced stage of Lung Cancer. The cancer can be any size, with any of the following characteristics:

  • The cancer has spread to the opposite lung from where it began.
  • Cancer cells have been discovered in the fluid surrounding the lung.
  • Cancer cells have been discovered in the fluid surrounding the heart

Survival rates of Lung Cancer?

With no significant symptoms this hideous disease is difficult to detect in its early stages, and treatments for Lung Cancer in its later stages provide a poor prognosis. Lung Cancer has emerged as the leading killer of men and women stricken with invasive cancer.

Non-small cell Lung Cancer (NSCLC)

Stage 5 year Survival Rate
1A 49%
1B 45%
2A 30%
2B 31%
3A 14%
3B 5%
4 1%

Small cell Lung Cancer (SCLC)

Stage 5 year Survival Rate
1 31%
2 19%
3 8%
4 2%

Can Lung Cancer be detected early?

As already mentioned, detecting Lung Cancer at an early stage is not that easy due to its silent nature. A screening test i.e. a procedure for critical evaluation for determining the presence, or spread of the tumor is sometimes helpful in early detection of Lung Cancer. At best, the screening methods find about 30% of Lung Cancers leaving the bulk i.e. rest 70% undetected. In addition, some test results are not clearly diagnostic which can lead to patient concerns and possibly unnecessary biopsies or surgeries. Screening for Lung Cancer is usually accomplished using three methods.

Physical Exam

A physical exam is conducted to look for signs of wheezing, shortness of breath, cough, pain and other possible signs of Lung Cancer. The physical exam will also include the patient’s history of smoking and a chest X-ray.

Sputum Cytology Exam

A sputum cytology exam involves a microscopic examination of a patient’s mucus (sputum).

Spiral CT Exam

In this procedure, a detailed image of the body’s internal workings is taken. The images are then linked to an X-ray machine to create 3D images of the internal organs. These images may reveal potentially cancerous tumors.

Lung Cancer Diagnosis

If the screening tests suggest the possibility of Lung Cancer, definitive diagnostic tests may be done by a pathologist. The pathologist will examine the patient’s lung cells in sputum, phlegm, or from a biopsy sample to type and stage the Lung Cancer.

Lung Cancer: Biopsy

In biopsy, a tissue sample is taken from the suspected cancer. In general, lung biopsies are obtained by either needle biopsy, a lung bronchoscopy technique, or by surgical removal of tissue. Many other tests may be done to get more information about the cancer’s spread.

What are the Treatments available?

  • Surgery to remove the entire lobe, in which the tumor is located, is the primary treatment for patients with early-stage cancer. The goal of surgery is to totally eliminate all the tumor cells and thereby provide a cure. The location and size of a lung tumor dictate how extensive the operation must be. Open thoracotomy or less invasive video-assisted thoracic surgery, using smaller incisions, may be recommended for appropriately selected patients.
  • Lobectomy means the removal of an entire lobe of the lung. The mortality risk is 3% to 4%, and tends to be highest in older patients.
  • Sublobar resection: In some cases a small cancer confined to a limited area can be removed with a small portion of surrounding lung tissue. Sublobar resections cause less loss of lung function, as a smaller portion of lung is removed, and carries an operative mortality risk of 1.4 %.
  • Radiation therapy: In this procedure, high-energy x-rays are used to destroy rapidly dividing cancer cells. Radiation therapy is very useful in Lung Cancer treatment and can be implemented at different phases:
    • As primary treatment
    • Before surgery to shrink the tumor
    • After surgery to eliminate any cancer cells that remain in the treated area
    • To treat Lung Cancer that has spread to the brain or other areas of the body
  • Advanced Lung Cancer Treatment: Most small cell and non-small-cell Lung Cancers can be treated with chemotherapy; they may also be treated with radiation therapy and surgery. In many patients with advanced disease, these methods may be used together, depending on the patient's condition and recommendations by their cancer doctors.
  • Chemotherapy: Chemotherapy is the use of anti cancer drugs to inhibit the growth of cancer cells. The most common chemotherapy drugs used for treating NSCLC are:
    • Cisplatin
    • Carboplatin
    • Paclitaxel
    • Albumin-bound paclitaxel
    • Docetaxel
    • Gemcitabine
    • Vinorelbine
    • Irinotecan
    • Etoposide
    • Vinblastine
    • Pemetrexed
  • Targeted Lung Cancer Therapies: Targeted therapies are designed to prevent or stop Lung Cancer cells from growing by targeting the new blood vessels that are needed to allow the cancer cells to survive and grow; other treatments target growth and multiplication of Lung Cancer cells by interfering with chemical signals required by growing or multiplying cancer cells.
    • Erlotinib: Erlotinib is an epidermal growth factor receptor (EGFR) inhibitor - protein-tyrosine kinase inhibitor. It is used in treatment of patients with locally advanced or metastatic non-small cell Lung Cancer.
    • Gefitinib: It is classified as a signal transduction inhibitor (epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor). It is used for the treatment of locally advanced or metastatic non-small cell Lung Cancer, after failure of both platinum-based and taxane-based chemotherapies.
    • Afatinib: In 2013, the FDA approved afatinib for the initial treatment of metastatic NSCLC. These drugs can be used along without chemo as first line of treatment.
    • Gefitinib: In 2015, the FDA approved gefitinib for the first-line treatment of patients with NSCLC. Gefitinib is a tyrosine kinase inhibitor that can stop tumors from growing by blocking signals inside cancer cells.
    • Bevacizumab: These are monoclonal antibodies (a man-made version of a specific immune system protein) that can kill cancer cells, block their growth, and keep cancer from spreading. These drugs are used to treat advanced NSCLC by targeting vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form.
    • Crizotinib: A treatment that has shown benefits for people with advanced non–small cell Lung Cancer who have the ALK gene mutation. Crizotinib works by blocking ALK and stopping the growth of the tumor.
    • Ceritinib: This was approved in 2014 for people with metastatic ALK-positive Lung Cancer who cannot tolerate crizotinib or whose cancer continued to grow while being treated with crizotinib.
    • Ramucirumab: This drug is also be used to treat advanced NSCLC. VEGF has to bind to cell proteins called receptors to act. This drug is a monoclonal antibody that targets a VEGF receptor. This helps stop the formation of new blood vessels. This drug is most often given after another treatment stops working. It is often combined with chemo.

Immunotherapy

Immunotherapy has recently made its way as a successful treatment option for certain Lung Cancers. While most cancer treatments have known side effects, immunotherapy is generally well-tolerated. In general terms, immunotherapy uses the immune system as a treatment against cancer.

  • In March 2015, the FDA approved the immunotherapy nivolumab for the treatment of metastatic squamous NSCLC which could not be treated with chemotherapy.
  • In 2016, the FDA approved a new immunotherapy called pembrolizumab for the treatment of advanced NSCLC. Its therapeutic activity is similar to that of nivolumab.

What are the possible side effects of Lung Cancer treatment?

The side effects of Lung Cancer treatment depend on the type of treatment opted and the tenure of the treatment. Some common side effects include:

  • Hair loss
  • Mouth sores
  • Loss of appetite, tiredness, nausea and vomiting
  • Diarrhea or constipation
  • Increased chance of infections (from having too few white blood cells)
  • High blood pressure
  • Cough
  • Bleeding
  • Headaches
  • Diarrhea
  • Skin problem
  • Changes in vision
  • Constipation

These side effects are usually non persistent and fades away after treatment is finished. There are ways to lessen these side effects. For example, drugs can be used to help prevent or reduce nausea and vomiting.

In most cases the side effects goes away once treatment is over, but in some rare case it may last a long time. If the side effects persist then it is advised to report immediately so that they can be treated promptly.

Is there curative treatment for Lung Cancer?

Lung Cancer generally goes undetected till later stages when it becomes almost incurable. Also, Lung Cancers can't be removed completely by surgery, there is a fair chance of resurrection. In cases when fortunately the cancer gets detected at an early stage, treatment depends on the patient's overall health. If the patient is in fairly good health then chemotherapy (chemo) combined with radiation therapy is the preferred line of treatment.

Oesophagus Cancer

What is Oesophagus Cancer?

Cancer is the growth of abnormal cells that take over neighbouring cells and tissues and, at later stages, also spread to organs. When such cells start in the oesophagus, they cause oesophagus cancer.

Anatomy of Oesophagus

oesophagus Cancer

What are the general symptoms of Oesophagus Cancer?

Most common symptoms are:

  • Pain/difficulty when swallowing
  • Weight loss
  • Pain behind the breastbone
  • Hoarseness and cough
  • Indigestion and heartburn

What are the general causes of Oesophagus cancer?

Every type of Cancer has risk factors, but they don’t tell us everything. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.

  • Tobacco use
  • Heavy alcohol use
  • Barrett esophagus
  •  Older age
  • Being male

Can Oesophagus Cancer be prevented?

It can be prevented to a certain extent by avoiding the risk factors.

 

What are the stages of Oesophagus cancer?

Cancer has different stages, each depicted by a Roman numeral from 1 to 4 (I, II, III and IV). Stage I is the first stage where the tumor is still small while at Stage IV, the patient’s condition is said to be critical because the tumor has spread to other organs of the body. Hence, a cancer’s stage refers to the tumor’s size and extent of spread. This is the simplest form of staging.

 

In Oesophagus cancer, the stage depends on whether it is confined to the origin of the cancer (localized cancer, Stage I) or whether it has spread to other organs (metastatic cancer).

 

The stage decides the kind of treatment you need to get. The greater the stage number, the more complex the treatment.

 

Survival rates of Oesophagus cancer? – Please advise (This is the same as breast cancer)

Needless to say, if the cancer is detected while it is still in Stage I, survival rate is higher. The rate decreases progressively with the increase in stage. Stage III is considered critical, while stage IV is, more often than not, fatal.

 

Medicine is evolving everyday to meet these challenges and to keep you happy, healthy and alive!

Can Oesophagus Cancer be detected early?

The best bet is to pay attention to the signs and symptoms. Some tests may help detect the cancer at an early stage. These include:

  • Physical exam and history
  • Chest x-ray
  • Barium swallow
  • Oesophagoscopy
  • Biopsy

What are the Treatments available?

Based on the type and stage of the cancer and other factors, primary treatment options include:

    • Surgery
    • Radiation therapy
    • Chemotherapy
    • Targetted therapy
    • Endoscopic treatments

Treatment is based on the type of tumor and other factors, and often more than one type of treatment is used. Discuss all of your treatment options as well as their possible side effects with your treatment team to help make the decision that best fits your needs.

How frequently should one visit doctor for early diagnosis?

If you have any of the symptoms, please do visit the doctor.

How can I as a patient know it early?

If you feel any of the symptoms mentioned in the Symptoms section , you should probably visit a doctor.
 

All matter is for informational purposes only and has been collated from www.cancer.gov and www.cancer.org. Zuvius Lifesciences does not claim authorship of the above.

Oral Cancer

What is Oral Cancer?

The uncontrolled growth of mutated cells in the oral region is called Oral Cancer. The term Oral Cancer includes cancers of the mouth and the pharynx. It encompasses the lips, the inside lining of the lips and cheeks, the teeth, the gums, most of the tongue, the bottom of the mouth, and the bony roof of the mouth, or hard palate.

  • Squamous cell carcinoma: The throat and mouth are lined with flat and scale-like squamous cells. Cancer in this region is called squamous cell carcinoma and it accounts for more than 90 percent of the Oral Cancers.
  • Verrucous carcinoma: About 5 percent of all oral cavity tumors are verrucous carcinoma, which is a type of very slow-growing cancer made up of squamous cells.
  • Minor salivary gland carcinomas: This includes several kinds of Oral Cancer that can develop on the minor salivary glands, found throughout the lining of the mouth and throat. It includes:
    • Adenoid cystic carcinoma,
    • Mucoepidermoid carcinoma,
    • Polymorphous low-grade adenocarcinoma.

Lymphomas: Oral Cancers that develop in lymph tissue are known as lymphomas. The tonsils and base of the tongue both contain lymphoid tissue.

Anatomy of Mouth

Oral Cancer

What are the general symptoms of Oral Cancer?

The symptoms of oral cancer may include:

  • A persistent red or white patch on the gums, tongue, tonsil, or lining of the mouth.
  • Constant pain in the mouth.
  • Having a sore throat or mouth sore for a long time.
  • Difficulty in swallowing or chewing.
  • A lump or thickening in the cheek or neck.
  • Numbness in the mouth.
  • Unexplained bleeding.
  • Frequent pain in the ear (rare).
  • Persistent bad breath.
  • Weight loss.
  • Difficulty moving the jaw or tongue.
  • Irregular Voice changes.

What are the general causes of Oral Cancer?

Oral Cancer may at times develop in patients without any prominent causative. But the following risk factors increase the probability of occurrence of the disease.

  • Smoking – 60 % of the cases of Oral Cancer are caused by smoking. Smoking highly increases the risk of developing mouth and oropharyngeal cancer.
  • Alcohol – Drinking alcohol increases risk of mouth and oropharyngeal cancer, especially when combined with smoking. 30 % of Oral Cancers are caused by drinking alcohol.
  • Human papillomavirus (HPV) – It is a sexually transmitted disease. HPV 16 and HPV 18 highly increase the risk of Oral Cancer.
  • Chewing tobacco or betel quid – Chewing tobacco or betel quid (gutkha) is known to cause mouth and oropharyngeal cancer.
  •  Diet – Lack of vitamins and minerals, such as iron or folic acid, in the diet may result in the development of Oral Cancer.
  • Family history – Geneticconditions and earlier instances of the disease in the family increases the risk.
  • Gender – Men are twice as likely to develop Oral Cancer as women.
  • Ultraviolet light: Excessive sun exposure increases the risk of lips cancer.
  • Age – Oral cancers are more common among people above 50 years.
  • Immune system– Immune systems weakened by certain medications can easily be attacked.

Can Oral Cancer be prevented?

Not all cases of Oral cavity and oropharyngeal Cancer can be prevented, but the risk of developing these Cancers can be greatly reduced by avoiding certain risk factors.

  • Avoid the use tobacco in any form.
  • Limit the use of alcohol.
  • Stay out of the sun.
  • Eat lots of fruits and vegetables and maintain a healthy diet.
  • Avoid HPV infection.
  • Treat pre-cancerous growths.

What are the stages of Oral Cancer?

The most common system used for staging Oral Cancer is TNM staging.

  • Tumor (T) describes the size of the original tumor.
  • Node (N) indicates whether the cancer is present in the lymph nodes.
  • Metastasis (M) refers to whether cancer has spread to other parts of the body.

A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. The letter X means the information could not be assessed. Once the T, N and M scores have been assigned, an overall stage is assigned. The stages range from 0 to 4:

  • Stage 0: The tumor has not invaded tissue beyond you the origin and is not more than 2cm long.
  • Stage 1: The tumor is less than 4 cm.
  • Stage 2: The tumor is slightly larger than 4 cm, but still limited to the area of origin.
  • Stage 3: The tumor has grown and spread to nearby tissues and organs.
  • Stage 4: The tumor has spread to your lymph nodes or distant organs.

Survival rates of Oral Cancer?

The survival rate and diagnosis usually go hand in hand. If the symptoms and stage of throat cancer are discovered earlier, the individual will have a greater chance of survival. The 5-year relative survival rates for Oral Cancers are:

  • 83% for cancer that has not spread
  • 62% for cancer that has spread to nearby lymph nodes
  • 38% for cancer that has spread to distant parts of the body

Can Oral Cancer be detected early?

With the development of science and technology, today there are several tests that aid in the diagnosis of Oral Cancer. These tests include:

  • Physical exam: The lips and mouth areas are examined to look for abnormalities — areas of irritation, such as sores and white patches.
  • X-rays of the mouth and throat, including CAT (computed tomography) scans
  • PET scans (positron emission tomography) - It uses radioactive materials to identify excessive activity in an organ.
  • Biopsy: A small sample of tissue is removed from a tumor to diagnose cancer. Oral Cancer usually requires a biopsy. There are different methods to obtain a biopsy:
    • Fine Need Aspiration (FNA) biopsy. A thin needle is inserted into the tumor mass and a sample is aspirated (drawn out by suction) into a syringe.
    • Incisional biopsy. A sample is removed with a scalpel (surgical knife).
    • Punch biopsy. A small circular blade removes a round area of tissue.
  • Image Testing: A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, among others.

What are the Treatments available?

Today there are several treatments that can cure Oral Cancer and increase the life expectancy of the patients. Some of the common treatments are surgery, radiation therapy.

Surgery

Tumor resection involves an operation to remove the entire tumor. Minimally invasive surgical techniques are used to treat the cancer. Neck dissection removes any cancer cells that may have spread to the lymph nodes. Once the surgery is done, a surgery to reconstruct the mouth might be conducted.

Radiation Therapy

Radiation therapy stops cancer cells from dividing and slows the growth of the tumor. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors. Radiation therapy involves 5-6 weeks of daily treatments.

Chemotherapy

Chemotherapy uses anticancer drugs to destroy cancer cells throughout the body. It may be an option if the cancer has spread to nearby lymph nodes. Chemotherapy is prescribed for different reasons:

  • Chemoradiation – A combination of chemotherapy and radiotherapy as an alternative to surgery.
  • After surgery to decrease the risk of the cancer returning
  • Palliative treatment - To slow the growth of a tumor and control symptoms when the cancer cannot be cured.

Targeted drug therapy

Targeted drug therapy targets cancerous cells to interfere with cell growth on a molecular level. Cetuximab is one targeted therapy approved for treating head and neck cancers in certain situations. Cetuximab stops the action of a protein that's found in many types of healthy cells, but is more prevalent in certain types of cancer cells. Targeted drugs can be used in combination with chemotherapy or radiation therapy.   

How frequently should one visit doctor for early diagnosis?

Visiting a doctor for regular mouth check up is recommended. If you spot any of the symptoms or have high risks of the disease then periodic diagnosis aids in detecting the cancer at early stage.

How can I as a patient know it early?

Being aware of the causatives and symptoms helps in identifying the signs of the disease.

Ovarian Cancer

What is Ovarian Cancer?

Ovary

The ovary is a ductless reproductive gland about the shape and size of an almond in which the female reproductive cells are produced. Females have a pair of ovaries, held by a membrane beside the uterus on each side of the lower abdomen. The ovaries are located on opposite sides of the uterus in the pelvic cavity and are attached to the uterus by the ovarian ligament

Functions:

The ovaries play two central roles in the female reproductive system by acting as both glands and gonads.

  • Acting as glands, the ovaries produce several female sex hormones including estrogens and progesterone.
  • Estrogen controls the development of the mammary glands and uterus during puberty and stimulates the development of the uterine lining during the menstrual cycle.
  • Progesterone acts on the uterus during pregnancy to allow the embryo to implant and develop in the womb.
  • The ovary is needed in reproduction since it is responsible for producing the female reproductive cells, or ova.

Cancer

Our body is made up of zillions of cells, and there is a continuous process where the cells of our body gets worn out after certain duration and gets replaced by new cells.

Cells in our body divide by a process called mitosis, where they replicate their DNA and divide into two halves. However, normal cells don’t divide infinitely, they stop dividing generally after 50 or 60 generations and commit apoptosis. This process is called senescence. Cancer cells don’t obey senescence, they are immortal and they keep dividing over and over again, giving rise to a tumor.

The National Cancer Institute defines cancer as “ a term used for diseases in which abnormal cells divide without control and invade nearby tissues”. Cancer is a collective term used for a number of diseases. There are multiple different types of cancer that show up in different parts of the body and every type of cancer works difffernetly, caused by different factors and demands unique prognosis.

Ovarian Cancer

Ovarian cancer refers to any cancerous growth that occurs in the ovary.

Types of Ovarian Cancer

There are many different types of ovarian tumors classified by the types of cells and tissue they originate from.

Epithelial ovarian cancers (EOC)

It is the most common type of ovarian cancer accounting to 90% of occurrences. Epithelial ovarian cancer means the cancer started in the surface layer covering the ovary. Epithelial cell tumors usually occur in women older than 50 years. These are sometimes referred to as carcinomas.

The four most common cell types of epithelial ovarian cancer are serous, mucinous, clear cell, and endometrioid. These cancers arise due to DNA changes in cells. The serous cell type is the most common variety.

Stromal tumors

The stroma is the supportive tissue of the ovary. They account for 5 – 8 % of ovary cancer. Stromal cell tumors are rare and may occur in women of any age, although certain tumors, such as androblastomas, may be more common in adolescence. These cancers come from various types of cells within the ovary. Stromal ovarian cancers include granulosa-stromal tumors and Sertoli-Leydig cell tumors.

Germ cell tumors

Germ cell tumors arise from the reproductive cells of the ovary and they accounts for 3 - 5 % of ovarian cancer. These tumors are uncommon and are seen most commonly in teens or young women. This type of tumor includes different categories: dysgerminomas, yolk sac tumors, embryonal carcinomas, polyembryomas, non-gestational choriocarcinomas, immature teratomas, and mixed germ cell tumors.

Ovarian Cancer Occurrence Rate in India

Ovarian cancer is among top three killers among adults in both rural and urban India. Though cancer incidence rates in India is lower as compared to western countries, but the rates are changing rapidly over recent decades. During the year 2002, it ranked third in frequency (4.1%) among all cancers in women.

In India, during the period 2004-2005, proportion of ovarian cancer varied from 1.7% to 8.7% of all female cancers in various urban and rural populations.

Anatomy of Ovarian Cancer

Ovarian Cancer

What are the general symptoms of Ovarian Cancer?

Ovarian cancer may not produce symptoms, particularly in the early stages. Some of the symptoms are mentioned below. However, they can be very subtle and vague, as well as very common.

  • fatigue
  • clothes suddenly not fitting
  • leg swelling
  • changes in bowel habits
  • changes in bladder habits
  • shortness of breath
  • Persistent pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Increased abdominal size/persistent bloating

These symptoms, of course, occur with many different conditions and are not specific to cancer. Consulting the doctor and discussing the symptoms is important, especially if they occur frequently and persist for more than a few weeks.

What are the general causes of Ovarian cancer?

The risk of developing Ovarian Cancer in the course of their lifetime for the general population of women is 2 %. However, some women have an increased risk of developing Ovarian Cancer. All women should be aware of the risk factors and of the symptoms of Ovarian Cancer.

"When you know the risk, you're empowered to make choices to reduce that risk. It’s not about scaring people; it’s about giving them the chance to be realistic."

There are a number of possible causes of Ovarian Cancer but these are not yet fully understood. The most important risk factors are age and a family history of ovarian or breast Cancer.

Age

The risk of developing Ovarian Cancer increases with increasing age. Women over the age of 50 have a higher risk, and most cases of Ovarian Cancer occur in women who have already gone through the menopause. Although it is not common for younger women to get Ovarian Cancer, there are instances of Ovarian Cancer in pre-menopausal women. This is especially important if women have a family history of ovarian or breast Cancer.

Family history

About 85 % of Ovarian Cancer cases are 'sporadic'. This means they are one-offs, not inherited and close female relatives face no significant increase in their risk of developing the disease themselves.

The remaining 15 – 20 % of cases are believed to be caused by an inherited faulty gene, which is often the BRCA1 or BRCA2 gene.

Other Ovarian Cancer risk factors

The risk of Ovarian Cancer may also be linked to various activities, foods or physical traits, though these theories have no evident proofs to be backed by. Some such factors are cited below:

Being overweight:

There is a slight increased risk of developing Ovarian Cancer for an obese person.

Use of Hormone Replacement Therapy (HRT):

Taking HRT increases a woman’s risk of developing Ovarian Cancer by 40 % compared to a woman who has never taken HRT. The lifetime risk of developing Ovarian Cancer is 2 %.

Endometriosis:

There is evidence to suggest that women with endometriosis have an increased risk of developing Ovarian Cancer.

Smoking:

Smoking can increase the risk of certain types of Ovarian Cancer. 3% of Ovarian Cancer seems to be linked to exposure to tobacco smoke.

Diabetes:

Research has shown that diabetics have an increased risk of up to 25 % compared with non-diabetics of developing Ovarian Cancer. Additionally the risk may be slightly higher in diabetics who use insulin as opposed to diet or tablet controlled diabetics.

Childbearing status:

Women who have delivered at least one child, especially before age 30, are at a lower risk for developing the disease. The more children a woman has, the more her Ovarian Cancer risk declines. Women who breastfeed further reduce their risk.

Breast, colorectal or endometrial Cancer:

Women who’ve been diagnosed with one of these Cancers have a higher risk of developing Ovarian Cancer.

Can Ovarian Cancer be prevented?

Some of the risk factors that might lead to ovarian cancer can be controlled by taking preventive measures. Some of the precautions are mentioned below:

Pregnancy and breastfeeding:

These combine to reduce the chance of developing ovarian cancer but they do not guarantee that one will not develop ovarian cancer. It is recognised that an increased number of ovulatory cycles raises the risk of ovarian cancer and conversely a decreased number of cycles reduces the risk.

Hysterectomy and/or having tubes tied:

Some women opt to have their fallopian tubes tied because they do not want any more children – this is called sterilisation. It is known to reduce ovarian cancer risk. Previously it was also thought that women who had had a hysterectomy (surgical removal of the womb) had a lower risk of developing ovarian cancer – however the benefits of this are now unclear and depend on factors such as the age at which surgery is done. Having a hysterectomy is known to reduce the risk of ovarian cancer.

Contraceptive Pills:

If a woman takes birth control pills for more than 10 years, then her risk of ovarian cancer drops significantly. Tubal ligation has long been known to decrease the risk of ovarian cancer.

What are the stages of Ovarian cancer?

Ovarian cancer can be staged using TNM system.

T - The size of the tumor.

N - The spread to the lymph glands/lymph nodes (N).

M - The tumor has spread anywhere else in the body.

Stage I (T1-N0-M0): The tumor is limited to the ovaries or fallopian tubes.

  • Stage IA (T1a-N0-M0): Only one ovary or fallopian tube is affected by the tumor. No cancer is detected on the surface of the ovary or fallopian tube and there are no malignant cells detected in fluid taken from the abdomen.
  • Stage IB (T1b-N0-M0): Both ovaries (or fallopian tubes) are affected by the tumor. No cancer is detected in either the surface of the ovaries or fallopian tube, or in the fluid from the abdomen.
  • Stage IC: The tumor is limited to one or both ovaries or fallopian tubes, with any of the following:
  • Stage IC1: (T1C1-N0-M0):The ovary capsule is ruptured as a result of the surgery.
  • Stage IC2: (T1C2-N0-M0): The ovary capsule ruptured before surgery, or there is a detectable tumour on the ovary or fallopian tube surface.
  • Stage IC3: (T1C3-N0-M0): Cancerous cells are detected in the fluid taken from the abdomen.

Stage II (T2-N0-M0): The tumor is in one or both ovaries, or fallopian tubes, and has extended into the pelvis or the peritoneum (thin flexible sheet of transparent tissue that covers the organs inside your abdomen).

  • Stage IIA (T2a-N0-M0): The cancer is also affecting the uterus and/or fallopian tubes
  • Stage IIB (T2b-N0-M0): The cancer is affecting other organs in your pelvis

Stage III (T1/T2-N1-M0): The tumor is in one or both ovaries, or fallopian tubes, or the peritoneum, and has also extended to the lining of the pelvis and abdomen and/or nearby lymph nodes.

  • Stage IIIA1 (T1/2-N1-M0): Very tiny cancer cells are detected in the lymph nodes in the lining of the abdomen. (Stage IIIA1(i) the tumour is up to 10 mm in dimension, and Stage IIIA1(ii) the tumour is more than 10 mm in greatest dimension).
  • Stage IIIA2 (T3a2-N0/N1-M0): Very tiny cancer cells are detected above the pelvis, with or without the tumour detectable in the lymph nodes in the lining of the abdomen.
  • Stage IIIB (T3b-N0/N1-M0): Small tumours (less than 2cm in diameter) are detectable beyond the pelvis, and the lymph nodes may or may not contain cancerous cells.
  • Stage IIIC (T3c-N0/N1-M0): Small tumours (more than 2cm in diameter) are detected beyond the pelvis, including into the non-functional part of the liver and spleen and/or there is cancer.

Stage IV

Stage IV – A and B (any T–any N–M1): The cancer cells have spread to another organ such as the liver, the brain or the lungs.

Survival rates of Ovarian cancer?

Survival depends on many different factors. It depends on your individual condition, type of cancer subtype, treatment and level of fitness.

Epithelial Ovarian Cancer is the most deadly of the gynecologic cancers. Approximately 80% of patients will eventually die of the disease. However, survival in the short term is quite good. With the addition of IP chemotherapy, the survival of ovarian cancer has been significantly extended. According to recent studies, if a patient undergoes optimal debulking, followed by IP chemotherapy, then they have a greater than 50% chance to still be alive in six years. This is quite good compared to other advanced stage cancers. Even in the recurrent setting, epithelial Ovarian Cancer is often very sensitive to chemotherapy. The disease can often go in to complete remission (no detectable disease) many times. However, once it recurs, it is not curable and will continue to come back.

Germ cell and stromal tumors have a much better prognosis. They are often cured because they are more often detected at early stages

Stage Survival Rate
StageI 90%
StageIA 94%
StageIB 92%
StageIC 85%
StageII 70%
StageIIA 78%
StageIIB 73%
StageIII 39%
StageIIIA 59%
StageIIIB 52%
StageIIIC 39%
StageIV 17%

The survival rate is higher than 90 percent when the cancer is found early and treated right away. Doctors diagnose 15 percent of Ovarian Cancers at the earliest stages. Scientists are currently researching more improved and reliable ways to detect ovarian cancer early.

Can Ovarian Cancer be detected early?

It’s much easier to treat ovarian cancer when diagnosed at an early stage. However, it’s not easy to detect. Ovaries are situated deep within the abdominal cavity, so it is unlikely to feel a tumor. There’s no routine diagnostic screening available for Ovarian Cancer. That’s why it’s so important to report unusual or persistent symptoms to your doctor.

If a woman has Ovarian Cancer symptoms, a strong family history, or a genetic predisposition such as a BRCA mutation, following tests are suggested:

  • Blood Test - Though blood test is not the best test for diagnosing Ovarian Cancer, but it is helpful if a woman has symptoms of Ovarian Cancer or has already been diagnosed with ovarian cancer.
  • Transvaginal Ultrasound - A transvaginal ultrasound is a test used to examine a woman’s reproductive organs and bladder.
  • Pelvic Exam - A pelvic exam should be a part of a woman’s regular female health exam. A pelvic examination may reveal an Ovarian or abdominal mass. Ovarian cancer is rarely detected in a pelvic exam and usually it is detected if it is in an advanced stage.

Often vague symptoms eventually lead to a clinical diagnosis, or one based on suspicion generated by exams, laboratory tests, and imaging. However, an accurate diagnosis requires some of the tumor to be removed, either by biopsy (less often), or preferably, surgery to verify the diagnosis.

Various types of imaging studies can be used to diagnose this disease and lead to tissue sampling. Ultrasound and CT scans are the most commonly done studies. These often can give images that show masses in the abdomen and pelvis, fluid in the abdominal cavity (ascites), obstructions of the bowels or kidneys, or disease in the chest or liver. PET scans can be used, but often are not necessary if a CT scan is able to be performed.

What are the Treatments available?

The treatment depends on how far the cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:

  • chemotherapy
  • radiation
  • surgery to stage the cancer and remove the tumor
  • targeted therapy
  • hormone therapy

Surgery

Surgery is the main treatment for Ovarian Cancer. The goal of surgery is to remove the tumor, but a hysterectomy, or complete removal of the uterus is often necessary. It is often recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue. Identifying all tumor locations is difficult.

Chemotherapy

Chemotherapy is typically given after surgery for all stages of Ovarian Cancer. Chemotherapy drugs are usually given intravenously, or administered directly into the abdominal cavity (intraperitoneal chemotherapy).

Targeted Therapies

New therapies for Ovarian Cancer may be directed at blocking tumor growth by interfering with the formation of blood vessels to supply the tumor. The process of blood vessel formation is known as angiogenesis. The drug Avastin works by blocking angiogenesis, causing tumors to shrink or stop growing.

How frequently should one visit doctor for early diagnosis?

Having a symptoms associated with Ovarian Cancer may not necessarily indicate the presence of the disease. However, expert advice to rule out the possibility is prudent, making curative treatment possible. So, regular self examination and a physical examination at least once a year is recommended to facilitate early diagnosis of the disease.

How can I as a patient know it early?

Being aware of the symptoms, and any health issue that might indicate the presence of the disease needs to be examined thoroughly. Also, a few lab tests and regular tests can also sometime unveil the presence of the hideous disease.

Pancreatic Cancer

What is Pancreatic Cancer?

Pancreas

Pancreas is a long, flat, pear shaped glandular organ that lies in the abdomen. The pancreas consists of exocrine and endocrine glands which secrete pancreatic juices, hormones, and insulin.

  • Endocrine gland is responsible for the secretion of the hormones insulin and glucagon that controls our blood sugar level.
  • Exocrine gland secret pancreatic juices that are released into the intestine by pancreatic ducts in order to help digest fat, proteins, and carbohydrates.

Functions

  • It serves as two glands in one: a digestive exocrine gland and a hormone-producing endocrine gland.
  • The pancreas secretes enzymes to break down the proteins, lipids, carbohydrates, and nucleic acids in food.
  • The pancreas secretes the hormones insulin and glucagon to control blood sugar levels.

Pancreatic Cancer:

Cancer is a class of disease characterized by mutated cell growth in an uncontrolled way. Pancreatic cancer occurs when this uncontrolled cell growth begins in any part of the pancreas. Rather than developing into normal, healthy pancreas tissue, these abnormal cells continue dividing and form lumps or masses of tissue called tumours. Tumours then interfere with the main functions of the pancreas.

If a tumour stays in one spot and demonstrates limited growth, then it is considered to be benign. The tumor which sheds cells that migrate to different parts of the body is called a malignant tumor.

When a tumour successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a more serious condition that is very difficult to treat.

Types of Pancreatic Cancer:

Pancreatic Cancer is classified into two types, based on the part of pancreas that is affected -

  • Exocrine tumors: Most tumours affecting the exocrine gland are called adenocarcinomas. This type of cancer forms in the pancreas ducts and treatment for these tumours is based on stage of growth. About 95 % of Pancreatic Cancers begin in the exocrine cells of the pancreas.
    Other less common types of exocrine tumors are :
    • Adenosquamous carcinoma
    • Squamous cell carcinoma
    • Giant cell carcinoma
    • Acinar cell carcinoma
    • Small cell carcinoma
  • Endocrine tumors : These tumors are less common and are most often benign. Though rare, cancer stemming from a pancreatic endocrine tumor (PET) affects the hormone-producing cells. These tumors are also called islet cell tumours or neurendocrine tumours.
    Endocrine Pancreatic Cancers are uncommon, and are named according to the type of hormone produced:
    • Insulinomas
    • Glucagonomas
    • Somatostatinomas
    • Gastrinomas
    • VIPomas
    • Non-secreting islet tumors.

Occurrence Rate of Pancreatic Cancer

Pancreatic Cancer is more common in western countries as compared to developing countries like India. However, data from recent studies and surveys have revealed that there is an alarming rise in Pancreatic Cancer cases.

The one year survival rate for this rare and aggressive form of cancer is about 20% and 5 year survival rate declines to 7%. Though the 5 year survival rate is low, it can rise upto 20% – 35%, if the tumor is detected at early stage (before metasizing) and is removed completely.

Anatomy of Pancreas Cancer

pancreas cancer

Copyright © Terese Winslow, U.S. Govt, The above image is used for educational purpose only.

What are the general symptoms of Pancreatic Cancer?

Pancreatic Cancer is aggressive with few symptoms until the cancer is advanced. In the early stages, the cancer doesn’t usually show any signs or symptoms. By the time the symptoms are visible, the cancer has already spread beyond the pancreas.

  • Jaundice and related symptoms
    • Dark urine
    • Light-coloured stools
    • Itchy skin
  • Abdominal or back pain
  • Loss of appetite, nausea, and vomiting
  • Digestive problems
    • Pale, greasy stools
    • Nausea and vomiting
  • Gallbladder enlargement
  • Blood clots
  • Fatty tissue abnormalities
  • Diabetes

These symptoms of Pancreatic Cancer have numerous other causes, making it difficult to diagnose the disease before it is in an advanced stage.

What are the general causes of Pancreatic cancer?

Cancer is the result of cells that grows uncontrollably and do not die naturally. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, it results into cancer.

Pancreatic Cancer cells do not experience programmatic death, but instead continue to grow and divide. Although scientists do not know exactly what causes these cells to behave this way, they have identified several potential risk factors. Some of the causes are discussed below:

DNA Cells

DNA cells may sometime experience uncontrolled growth due to mutations in the DNA, and damage the genes involved in cell division. Four key types of genes are responsible for the cell division process:

  • Oncogenes tell cells when to divide,
  • Tumour suppressor genes tell cells when not to divide,
  • Suicide genes control apoptosis and tell cells to kill themselves if something goes wrong,
  • DNA-repair genes instruct cells to repair damaged DNA.

Cancer occurs when a cell's gene mutations results in permanent DNA damage. DNA mutations that lead to Pancreatic Cancer are mostly a resultant of factors that affected DNA after birth rather than a merely inheritance from parents.

Genes - the family type

Pancreatic Cancer can be the result of a genetic predisposition inherited from family members. About 10% of Pancreatic Cancers are caused by inherited gene mutations. Genetic syndromes that are associated with Pancreatic Cancer include hereditary breast and ovarian cancer syndrome, melanoma, pancreatitis, and non-polyposis colorectal cancer (Lynch syndrome).

Carcinogens

Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Certain pesticides, dyes, and chemicals used in metal refining are thought to be carcinogenic, increasing the risk of developing Pancreatic Cancer.

When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. These free radicals damage cells, affecting their ability to function normally, and the result can be cancerous growths.

Other lifestyle factors that might lead to Pancreatic Cancer are:

Tobacco use: The risk of getting Pancreatic Cancer increases with the use of tobacco. It is twice as high among smokers compared to those who have never smoked. The good thing is that it is a controllable factor and one can choose to avoid it.

Overweight and obesity: Obese people are about 20% more likely to develop Pancreatic Cancer. Extra weight around the waistline may be a risk factor. People who exercise regularly have about half the risk of Pancreatic Cancer as sedentary people do.

Workplace exposure to certain chemicals : Heavy exposure at work to certain pesticides, dyes, and chemicals used in metal refining may increase the risk of developing Pancreatic Cancer.

Age : Most of the patients reported for Pancreatic Cancer are above 45 years of age.

Gender : Men are about 30% more likely to develop Pancreatic Cancer than women.

Diabetes : Pancreatic Cancer is more common in people who have diabetes. In some people, though, the cancer seems to have caused the diabetes. This can happen when cancer spreads through the pancreas and damages enough of the insulin-making cells to cause diabetes.

Chronic pancreatitis : This condition is linked with an increased risk of Pancreatic Cancer, but most people with pancreatitis never develop Pancreatic Cancer.

Stomach problems : Infection of the stomach with the ulcer-causing bacteria Helicobacter pylori (H. pylori) may increase the risk of getting Pancreatic Cancer.

Can Pancreatic Cancer be prevented?

The best way to lower the risk of Pancreatic Cancer is to avoid risk factors and get an early diagnosis, with regard to natural factors. Some of the lifestyle changes mentioned below do offer some shielding to the disease:

  • Exercising and maintaining healthy weight.
  • Staying away from tobacco, smoking and alcohol.
  • Controlling diabetes.
  • Ensuring workplace safety.

What are the stages of Pancreatic Cancer?

The “stage of cancer” is a term used to describe the spread and extent of the Cancer cells. During diagnosis, a stage is assigned to the cancer to facilitate planning and proper treatment of the disease. The stages of Pancreatic Cancer are categorized as follows:

Stage 0 (Tis, N0, M0):

Pancreatic Cancer is limited to a single layer of cells in the pancreas. The Pancreatic Cancer is not visible on imaging tests.

Stage I(T1/T2, N0, M0)

Pancreatic Cancer is limited to the pancreas, but has grown to less than 2 centimeters across (stage IA) or greater than 2 centimeters (stage IB). It has not spread to lymph nodes or other parts of the body.

Stage II (T1, T2, or T3; N0/N1; M0)

A tumor of any size may have extended beyond the pancreas, but the tumor has not spread to nearby arteries or veins. It has not spread to any lymph nodes or other parts of the body.

 

Stage III (T4, N1, M0): 

A tumor has spread to nearby arteries, veins, and/or lymph nodes but has not spread to other parts of the body.

Stage IV (any T, any N, M1):

Any tumor that has spread to other parts of the body.

Survival rates of Pancreatic Cancer? – Please advise (This is the same as breast cancer)

Survival rate is a calculation of the probability of surviving the disease based on the earlier track records of a number of patients having the same disease at the same stage. Since, the prognosis and treatment of each individual may vary based on a number of other factors like health history, immunity, family history etc., so predicting the outcome of any particular case to precision is not possible.

Exocrine Pancreatic Cancer

Stage 5 year Survival Rate
Stage IA 14%
Stage IB 12%
StageIIA 7%
Stage IIB 5%
Stage III 3%
Stage IV 1%

Neuroendocrine Pancreatic Tumors

Stage 5 year Survival Rate
Stage I 61%
Stage II 52%
Stage III 41%
Stage IV 16%

Can Pancreatic Cancer be detected early?

Pancreatic Cancer is hard to find early. The pancreas is located deep inside the body, so early tumors can’t be seen or felt during routine physical exams. People usually have no symptoms until the cancer has already spread to other organs. Screening tests are used to look for a disease in people with no evident symptoms.

Tests for Pancreatic Cancer

If a person has spotted any of the signs and symptoms that might be caused by Pancreatic Cancer, certain exams and tests needs to be done at the earliest.

Medical history and physical exam

The signs of Pancreatic Cancer along with other health problems are examined. The examination mostly focuses on the belly. Pancreatic Cancers can sometimes cause the liver or gallbladder to swell. Skin and the whites of the eyes will also be checked for jaundice (yellowing).

Imaging tests

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the pancreas. Imaging tests might be done for a number of reasons both before and after a diagnosis of Pancreatic Cancer, including:

  • To look for suspicious areas that might be cancer
  • To learn if and how far cancer has spread
  • To help determine if treatment is working
  • To look for signs of cancer coming back after treatment.

Computed tomography (CT) scan

The CT scan makes detailed cross-sectional images of the body. CT scans are often used to diagnose Pancreatic Cancer because they can show the pancreas clearly. They can also help show if cancer has spread to organs near the pancreas, as well as to lymph nodes and distant organs. A CT scan can help determine if surgery might be a good treatment option.

Magnetic resonance imaging (MRI)

MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Ultrasound

Ultrasound tests use sound waves to create images of the pancreas.

  • Abdominal ultrasound: A wand-shaped probe called ultrasound transducer is moved over the skin of the abdomen. It gives off sound waves and detects the echoes as they bounce off organs. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms.
  • Endoscopic ultrasound (EUS): In this procedure, an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves off internal tissues or organs and make echoes to produce the sonogram. This procedure is also called endosonography.

Endoscopic retrograde cholangiopancreatography (ERCP): An endoscope is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine.

A small amount of dye is then injected into the common bile duct, and x-rays are taken. This dye outlines the bile and pancreatic ducts. The x-rays can show narrowing or blockage in these ducts that might be due to Pancreatic Cancer. Sometimes, a small brush is put through the tube to remove cells for a biopsy.

Percutaneous transhepatic cholangiography (PTC): In this procedure, a thin, hollow needle is put through the skin of the belly and into a bile duct within the liver. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile and pancreatic ducts. As with ERCP, this approach can also be used to take fluid or tissue samples. Because it is more invasive, PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.

Somatostatin receptor scintigraphy (SRS)/OctreoScan

It can be very helpful in finding pancreatic neuroendocrine tumors (NETs). A hormone-like substance called octreotide that is bound to a radioactive substance is injected into a vein. Octreotide travels through the blood and attaches to the tumor cells of many types of NETs. A special camera is then used to trace the radioactivity in the body.

Positron emission tomography (PET) scan

For a PET scan, a slightly radioactive form of sugar is injected. A special camera is then used to create a picture of areas of radioactivity in the body.

This test is sometimes used to look for spread from exocrine Pancreatic Cancers, but because NETs grow slowly, they do not show up well on PET scans.

Angiography

This is an x-ray test that looks at blood vessels. A small amount of contrast dye is injected into an artery to outline the blood vessels, and then x-rays are taken.

An angiogram can show if blood flow in a particular area is blocked or compressed by a tumor. It can also show abnormal blood vessels in the area. This test can be useful in finding out if a Pancreatic Cancer has grown through the walls of certain blood vessels. Mainly, it helps surgeons decide if the cancer can be removed completely without damaging vital blood vessels, and it can also help them plan the operation.

Blood tests for

A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, 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.

Liver function tests: Jaundice (yellowing of the skin and eyes) is often one of the first signs of Pancreatic Cancer, but it can have many causes other than cancer.

Tumor markers: In this procedure a sample of blood, urine , or tissue is checked to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA). Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers.

Biopsy

A small sample of tumor is removed and observed closely under the microscope. This procedure is called a biopsy. Biopsies can be done in different ways.

  • Percutaneous biopsy: A thin, hollow needle is inserted through the skin over the abdomen and into the pancreas to remove a small piece of a tumor. This is known as a fine needle aspiration (FNA).
  • Endoscopic biopsy: An endoscope is passed down the throat and into the small intestine near the pancreas. At this point, either endoscopic ultrasound (EUS) is used to pass a needle into the tumor or endoscopic retrograde cholangio pancreatography (ERCP) to remove cells from the bile or pancreatic ducts.
  • Surgical biopsy: Surgical biopsies are useful to find if cancer has spread beyond the pancreas and to other organs in the abdomen. The most common way to do a surgical biopsy is to use laparoscopy.

What are the Treatments available?

Once the cancer is diagnosed and its stage is determined then the treatment is planned based on the type of tumor and patients’ overall health condition. The treatment plan may indulge multiple phases involving more than one type of treatment.

Before rooting for a specific treatment plan, the doctor conducts multiple tests of the genes, tumor and other factors. Based on the results of these tests the most acute treatment strategy is formulated. Some of the advanced treatment options are discussed below:

  • Surgery
    Surgery is the most preffered treatment when the tumor is restricted to the pancreas only and has not spread beyond it. Surgery includes removing all or part of the tumour depending on its location, size and extent of spread. It is highly efficient for treating cancers of early stages. However, the later stages of Pancreatic Cancer is difficult to treat and may involve more complex treatment plan
  • Neoadjuvant therapy
    Neoadjuvant treatments are the preliminary treatment that aids in shrinking the tumor before proceeding for surgerical treatments. Some of the most commonly used neoadjuvant therapies are chemotherapy, radiation therapy and hormone therapy.
  • Adjuvant therapy
    Adjuvant therapy refers to the after surgery treatments that helps to decrease the risk of recurring cancer incidences. Adjuvant therapy may begin within 8 weeks after surgery, based on the recovery rate and the overall health condition of the patient. Adjuvent therapy may include chemotherapy, radiation therapy, targeted therapy and palliative treatment.

Is there a curative treatment for Pancreatic Cancer?

Pancreatic Cancer is a very rare and aggressive type of Cancer. It grows very fast and does not show any sign and symptom at the earlier stages and hence finding a cure for the same becomes a bit difficult. There are several options for treatment but the outcome of the treatment may not be favourable.

How frequently should one visit doctor for early diagnosis?

If you encounter any of the symptoms then consulting a doctor is the smartest move though the symptom might not necessarily indicate the presence of the fatal disease. Also having any prior history or familial history of the disease calls for a regular examination alteast once a year. If one is suffering from diabetes or jaundice it is better to test for Pancreatic Cancer to be on the safer side.

How can I as a patient know it early?

Considering the location of the pancreas and the nature of Pancreatic Cancer it is very difficult to detect it at an early stage. However, being alert and going for regular examinations can definitely help one in diagnosing the disease.

Penile Cancer

What is Penile Cancer?

Penis

The penis is a rod-shaped external male reproductive organ. It is made up of skin, nerves, smooth muscle, and blood vessels. The penis is categorized into different parts

  • Glans: The glans is the tip of the penis that is covered by skin called mucosa.
  • Shaft: The main part of the penis is referred to as the shaft and houses the corpus cavernosum and the corpus spongiosum.
  • Corpus cavernosum: It is the two cylindrical shaped tissues that run along the sides of the penis.
  • Corpus spongiosum: It is the sponge-like tissue that lies in the front part of the penis and ends at the glans.
  • Meatus: The opening on the glans of the penis where semen and urine exit the body is called the meatus.
  • Urethra: The urethra is a thin tube that is attached to the bladder and its function is to excrete urine and semen to the outside of the body.

Function of Penis

  • This organ facilitates sexual functions in male.
  • The penis acts as a conduit for urine to leave the body.

Penile Cancer

Penile Cancer is a rare but aggressive type of Cancer that occurs on the skin of the penis or within the penis. Penile Cancer usually occurs on the foreskin of the penis, however in some cases it can also occur on the shaft of the penis. It deeply affects the person’s self-esteem.

Types of Penile Cancer

  • Epidermoid/squamous cell carcinoma. Epidermoid occurs on the foreskin of the penis while squamous cell carcinoma can begin anywhere on the penis. More than 9 out of 10 penile Cancers are squamous cell Cancers making it the most common type.
  • Basal cell carcinoma. Basal cells can sometimes become Cancerous. Basal cell carcinoma is a type of non-melanoma skin Cancer. They are slow growing and highly unlikely to spread. 
  • Melanoma. Melanocytes cells make the melanin that gives skin color. Melanoma starts in melanocytes. This Cancer sometimes occurs on the surface of the penis.
  • Sarcoma. Sarcomas develop in the tissues that support and connect the body, such as blood vessels, muscle, and fat. Sarcomas of the penis are extremely rare but they tend to grow more quickly than other types of penile Cancer.
Type Occurrence Rate
Epidermoid/squamous cell carcinoma 95%
Basal cell carcinoma 2%
Sarcoma 1%

Occurrence Rate of Testicular Cancer in India

Penile Cancer is one of the most common genitourinary Cancers encountered in India. The incidence of carcinoma of the penis varies according to circumcision practice, hygienic standard, phimosis, the number of sexual partners, HPV infection, exposure to tobacco products, and other factors. The statistical report of penile Cancer states that it is encountered in 3.32 per 100,000 inhabitants in India.

Anatomy of Penile Cancer

What are the general symptoms of Penile Cancer?

 Detection of penile Cancer at an early stage is aided by the following symptoms:

  • Skin changes
    • An area of skin becoming thicker and/or changing color
    • A lump on the penis
    • A reddish, velvety rash
    • Small, crusty bumps
    • Flat, bluish-brown growths
  • Sore on the penis.
  • Persistent discharge of fluid with a foul odor beneath the foreskin
  • Blood coming from the tip of the penis or from under the foreskin
  • Unexplained pain in the shaft or tip of the penis
  • Small, crusty bumps beneath the foreskin
  • Swollen lymph nodes in the groin
  • Irregular swelling at the end of the penis

What are the general causes of Penile Cancer?

Risk factors when not taken care of can result in penile Cancer. Some penile Cancer risk factors, like smoking, HPV, circumcision can be controlled, but others like age or family history, can’t be changed.  Some of the risk factors are discussed below.

  • Human papilloma virus (HPV) infection
    The most important risk factor for penile Cancer is infection with HPV virus. Sexual activity with a person who has HPV is the most common way of getting infected. There are different types of HPV, called strains. It is a group of more than 150 related viruses.
    • Limiting the number of sex partners.
    • Using a condom
    • Vaccination.
  • Not being circumcised
    Circumcision means removing all or part of the foreskin. This procedure is most often done in infants but it can also be done later in life.

    Men who were circumcised as children have a lower chance of getting penile Cancer than those who were not, but the same protective effect is not seen if the foreskin is removed as an adult.

    In men who are not circumcised, the foreskin can sometimes become tight and difficult to retract. This condition is known as phimosis. Penile Cancer is more common in men with phimosis.
  • Smegma
    Smegma is a thick substance that can build up under the foreskin and is caused by dead skin cells, bacteria, and oily secretions from the skin. Smegma may contain small amounts of Cancer-causing substances.

    Smegma is more common in men with phimosis. Uncircumcised men should pull back the foreskin and thoroughly wash the penis on a regular basis.
  • Smoking
    Men who smoke are more likely to develop penile Cancer. Smokers who have HPV infections have an even higher risk.
  • UV light treatment of psoriasis
    Men who have a skin disease called psoriasis are sometimes treated with drugs called psoralens, followed by exposing the body to an ultraviolet A (UVA) light source. This is known as PUVA therapy. Men who have had this treatment have been found to have a higher rate of penile Cancer.
  • Age
    The risk of penile Cancer goes up with age. The average age of a man when diagnosed is 68. It is rare in men under the age of 40.
  • HIV or AIDS
    Men with AIDS have a higher risk of penile Cancer. This higher risk seems to be related to their weakened immune system, which is a result of this disease. The prognosis in these patients is reported to be very poor.

Can Penile Cancer be prevented?

Although there is no proven way to completely prevent penile Cancer, a few precautions may be able to lower your risk.

Here are a few ways to lower the risk of penile Cancer.

  • Circumcision. Circumcision may provide some protection from penile Cancer because removing the foreskin helps keep the area clean. Epidermoid/squamous cell carcinoma of the penis almost never occurs in men who are circumcised.  Circumcision in childhood/adolescence is found to be protective against invasive penile Cancer.
  • Personal hygiene. Men who carefully and completely clean under the foreskin on a regular basis can lower their risk of developing penile Cancer.
  • Lifestyle factors. Not smoking and avoiding sexual practices that could lead to an HPV or HIV/AIDS infection can help lower your risk of penile Cancer.

What are the stages of Penile Cancer?

Penile Cancer originates in the shaft of the penis and with each passing stage the spread of Cancer goes on increasing. The most common sites of penile Cancer metastasis are the inguinal and iliac region, as lymph fluid carries the Cancer cells from the groin into the inguinal lymph nodes. These lymph fluid further drains into the pelvic

lymph nodes, thus spreading the Cancer cells from inguinal lymph nodes to pelvic lymph nodes.

The grade of penile Cancer is used to understand the stage of Cancer. Low grade Cancers usually grow very slowly. High grade Cancers tend to grow more quickly.

Grade x means the grade can't be assessed.

Grade 1 (low grade) Cancer cells looks very much like normal cells.

Grade 2 Cancer cells look a bit like normal cells.

Grade 3–4 (high grade) Cancer cells look very abnormal and not like normal cells.

Penile Cancer can be staged as:

Stage 0: The Cancer growth is limited to the surface layer of skin. It has not spread to lymph nodes or distant parts of the body (Tis or Ta; N0, M0).

Stage I: A low-grade Cancer that has grown just below the surface layer of skin. It has not spread to lymph nodes or distant parts of the body (T1a, N0, M0).

Stage II: The Cancer is invasive and is high grade. It might have grown into blood or lymph vessels and/or into the internal chambers of the penis and/or the urethra. It has not yet spread to lymph nodes or distant parts of the body (T1b, T2, or T3; N0, M0).

Stage IIIa: The tumor has grown up to the penis and urethra and has spread to 1 groin lymph node, but it has not spread to distant parts of the body (T1, T2, or T3; N1, M0).

Stage IIIb: The tumor has spread to the penis and urethra, and to more than 1 groin lymph node. It has not spread to pelvic lymph nodes or distant parts of the body (T1, T2, or T3; N2, M0).

Stage IV:

  • The Cancer has grown into nearby tissues such as the pubic bone, the scrotum, or the prostate (T4, any N, any M).
  • The Cancer has spread to 1 or more lymph nodes in the groin, and it has grown from that lymph node into the surrounding tissue in the groin (any T, N3, M0).
  • The Cancer has spread to at least 1 lymph node in the pelvis (any T, N3, M0) and/or to distant lymph nodes outside the pelvis or to other parts of the body (any T, any N, M1).

Survival rates of Penile Cancer?

Survival rates indicate an average outcome of large number of people who had the disease, but they cannot precisely predict the expectancy of any particular case. Multiple factors may affect a person's outlook.

Stages 5 year Survival Rate
Stage I 85%
Stage II 85%
Stage III and IV 59%
Last Satge 11%

Can Penil Cancer be detected early?

As almost all Penile Cancers start in the skin of penis which is very sensitive, so they are often noticed early in the course of the disease. Also the symptoms of penile Cancer start appearing from the early stages facilitating an early detection. Though at times these symptoms can be caused by other faculties as well, consulting a doctor is highly recommended.

Here are a few diagnostic tests/ procedures that can be followed to detect the presence of the disease.

Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. If Cancerous cells are seen in a tissue sample, then the biopsy is called positive for Cancer. If no Cancer is found, then the biopsy is called benign or negative for Cancer.
The following types of biopsies may be used for penile Cancer:

  • A punch biopsy or elliptical excision. In punch biopsy, a sharp round surgical tool is used to remove a circular piece of tissue. In an elliptical excision, a scalpel is used to cut out a piece of tissue.
  • A fine needle aspiration: In this procedure, the skin is usually made numb with a topical medication that blocks the sensation of pain. Then, a medication is injected into the area near the tumor to prevent pain in tissues beneath the skin. Then a thin needle is inserted into the tumor and some cells and fluid are removed. The procedure may be repeated 2 or 3 times to collect samples from different areas of the tumor.
  • A sentinel lymph node biopsy: In early stages, one cannot feel the lymph nodes, so the lymph nodes are removed and examined under a microscope. This procedure is done to find out if Cancer cells have spread to lymph nodes near the penis. In more advanced stages, a lump in the groin can be felt as the inguinal lymph nodes get bigger.
    For penile Cancer, the sentinel lymph nodes are located just under the skin in the groin. If Cancer cells are found in these lymph nodes, it means that the Cancer is more likely to have spread to other nearby lymph nodes or to other parts of the body through the blood and lymph vessels. Even if Cancer cells are not found during a sentinel lymph node biopsy, there is still a chance that the Cancer has spread.
  • Inguinal (groin) lymph node dissection. Groin is the area between the abdomen and the upper thigh on either side of the body. Dissection of the groin lymph node is the most accurate way to find out whether the Cancer has spread to any lymph nodes near the penis. In this procedure, the lymph nodes near the penis are removed and checked for Cancer.

X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation.

Computed tomography (CT or CAT) scan. A CT scan creates a 3-D picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. A CT scan can also be used to measure a tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

What are the Treatments available?

If a Cancer is found early, it can often be removed with little or no damage to the penis. But if it is not diagnosed until later, part of or the entire penis may need to be removed to treat the Cancer. It is also more likely to require other, more invasive treatments, and may even be life threatening.

Surgery: Surgery is the removal of the tumor and some surrounding healthy tissue. The types of surgery that may be used for penile Cancer are described below.

  • Extended Inguinal lymphadenectomy: It is the effective and preferred surgery for staging and curing inguinal metastasis in penile Cancer. However, in this techniques postoperatory complications such as cutaneous flap necrosis, lymphedema, and vascular lesions may be experienced.
  • Laser therapy: Laser therapy is the use of a very powerful beam of light to destroy Cancer cells. Laser therapy may be an option for some men with early-stage penile Cancer, including
    • Men with Tis and small T1 squamous cell carcinoma of the penis.
    • Men with small T2 tumors who do not wish to have surgery.
  • Cryosurgery: Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells.
  • Circumcision: Circumcision is generally used if the Cancer is only on the foreskin.
  • Excision: An excision is a removal of the tumor and some surrounding healthy tissue using a scalpel or other surgical tool.
  • Mohs surgery: This technique is used to remove the Cancer that can be seen on the surface of the penis. A small amount of healthy tissue around the edge is removed to make sure that no Cancer is left behind. This is most often used for small tumors that are only on the surface of the penis.
  • Penectomy: This is the surgical removal of part or the entire penis. It is the most common and effective procedure to treat penile Cancer that has grown inside of the penis.
    If a penectomy is needed to treat the Cancer effectively, a partial rather than total penectomy is a better option if the Cancerous tissue and a 2 cm margin of healthy tissue can be removed while leaving enough length of the penis for the patient to urinate naturally. When this is not possible, a total penectomy is performed, which is the removal of the entire penis. The surgeon will tunnel the urinary tract underneath the scrotum, requiring the patient to urinate in a sitting position.
  • Lymph node dissection: This is done even if there are no signs that the Cancer has spread to the lymph nodes. If the groin lymph nodes are larger before surgery, then surgery to remove these lymph nodes is generally more extensive.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy Cancer cells. Radiation therapy is of two types:

External-beam radiation therapy: It is the most common type of radiation treatment and is given from a machine outside the body.

Internal radiation therapy or brachytherapy: It is the radiation treatment given using implants.

Chemotherapy

Chemotherapy is the use of drugs to destroy Cancer cells, usually by stopping the Cancer cells’ ability to grow and divide.

There are 2 types of chemotherapy that may be used for penile Cancer: topical chemotherapy and systemic chemotherapy.

  • Topical chemotherapy
    For small noninvasive Cancers, or “carcinoma in situ,” lower doses of chemotherapy can be used on the surface of the skin.
  • Systemic chemotherapy
    Systemic chemotherapy gets into the bloodstream to reach Cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

Common systemic drugs for penile Cancer include:

  • Bleomycin (Blenoxane)
  • Cisplatin (Platinol)
  • Docetaxel (Docefrez, Taxotere)
  • Gemcitabine (Gemzar)
  • Ifosfamide (Ifex)
  • Methotrexate (multiple brand names)
  • Paclitaxel (Taxol)

Is there curative treatment for Penile Cancer?

Penile Cancer is highly treatable, when the Cancer is diagnosed at early stages. A surgery to remove part or entire penis can be useful to treat penile Cancer even at the later stages.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a prior or familial history of testicular Cancer, a physical examination by a doctor is highly recommended.

How can I as a patient know it early?

In most of the cases, men discover the signs and symptoms of penile Cancer and being aware of them aids in suspecting the presence of the disease. Consulting a doctor immediately and going for diagnosis will definitely make things clear.

Prostate Cancer

What is Prostate Cancer?

Prostate

Prostate is a gland found only in males and is a vital part of male reproductive system. The prostate gland makes fluid that forms part of semen. It lies just below the bladder in front of the rectum. It surrounds the urethra.

Functions:

  • Prostate gland produces a thick, clear fluid that makes the semen more fluid and protects and nourishes sperm cells in the semen.
  • The prostate mixes its fluids with those from the seminal vesicles to transport the sperm made in the testicles.
  • The prostate also filters and removes toxins for protection of the sperm, which enhances the chance of impregnation and ensures that men seed with the optimum quality of sperm.
  • The prostate erection nerves are responsible for erections. These nerves trigger the penis to swell and harden with extra blood flow into it, producing an erection.

Prostate Cancer

Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way. It is usually a very slow growing cancer and most patients do not have significant symptoms until the cancer reaches an advanced stage.

Types of Prostate Cancer

Acinar Adenocarcinomas: Adenocarcinomas are cancers that develop in the gland cells that line the prostate gland. They are the most common type of prostate cancer.

Ductal Adenocarcinoma: Ductal adenocarcinoma starts in the cells that line the ducts of the prostate gland. It tends to grow and spread more quickly than acinar adenocarcinoma.

Transitional cell cancer: Transitional cell cancer of the prostate starts in the cells that line the tube carrying urine to the outside of the body. This type of cancer usually starts in the bladder and spreads into the prostate.

Squamous cell cancer: These cancers develop from flat cells that cover the prostate. They tend to grow and spread more quickly than adenocarcinoma of the prostate.

Small cell prostate cancer: Small cell prostate cancer is made up of small round cells. It’s a type of neuroendocrine cancer.

Prostate Cancer Occurrence Rate in India

Previously it was thought, that prevalence of prostate cancer in India is far lower as compared to the western countries but with the changing life styles, increased awareness, and easy access to medical facility, more cases of prostate cancer are being picked up and it is coming to the knowledge that we are not very far behind the rate from western countries.

Prostate is the second leading site of cancer among males in large Indian and it is among the top ten leading sites of cancers in the rest of the PBRCs of India.

Incidence Mortality 5 years Prevalence
19,095 12,231 63,818

The incidence rates of this cancer are constantly and rapidly increasing in all the PBRCs. The cancer projection data shows that the number of cases will become doubled by 2020.

Anatomy of Prostate Cancer (Gastric)

prostate cancer

What are the general symptoms of Prostate Cancer?

Prostate cancer, at its early stage, usually causes no symptoms. But more advanced prostate cancers can sometimes cause symptoms, such as:

  • Problems passing urine, including a slow or weak urinary stream or the need to urinate more often, especially at night.
  • Urgency to pass urine.
  • Discomfort in the pelvic area.
  • Blood in the urine/ semen.
  • Erectile dysfunction.
  • Pain in the hips, back (spine), chest (ribs).
  • Weakness or numbness in the legs or feet.
  • Loss of bladder or bowel control from cancer pressing on the spinal cord.

What are the general causes of Prostate Cancer?

Every type of Cancer has risk factors, but they don’t tell us everything. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors. Some risk factors for Prostate Cancer include:

Age: Risk of Prostate Cancer increases with increasing age. Prostate Cancer is very rare in men below 40 and the risk increases rapidly after the age 50.

Family history: Men who have a family history of Prostate Cancer (father or brother) have a higher chance of developing it themselves. The risk is more in case of an effected brother than father.

Gene changes: Including inherited mutations of the BRCA1 or BRCA2 genes raises chances of developing Prostate Cancer and men with Lynch syndrome have an increased risk for a number of cancers, including Prostate Cancer.

Workplace exposures: Firefighters are exposed to substances (toxic combustion products) that may increase their risk of Prostate Cancer.

Cadmium: Cadmium and cadmium compounds are possible causes of Prostate Cancer. Cadmium is a type of metal that is in tobacco smoke and food. Non smokers are exposed to it through food. It is in most types of food including vegetables, meats, grains and fish.

Can Prostate Cancer be prevented?

The exact cause of Prostate Cancer is currently unknown. Hence, at this time it is not possible to prevent most cases of the disease. Natural and genetic factors are uncontrollable, but there are some precautions one may be able to take.

  • Maintain a healthy weight.
  • Regular physical activity.
  • Limited intake of high-calorie foods and drinks.
  • Eat at least 2½ cups of vegetables and fruits each day.
  • Limit the intake of processed meat and red meat.
  • Limit the alcohol intake to no more than 2 drinks per day.
  • Reduce intake of dairy foods and diets rich in calcium.

What are the stages of Prostate Cancer?

Stage I: Tumor is limited to prostate

  • The PSA level is lower than 10
  • Tumor is found in one-half or less of one lobe of the prostate.

Stage II: Tumor is limited to prostate but PSA levels are higher

  • The PSA level is more than 10 but lower than 20
  • Tumor is found in one-half or less of one lobe of the prostate.

Stage III: Tumor has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. The PSA can be any level.

Stage IV: Tumor has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder, lymph nodes, bones or pelvic wall. The PSA can be any level.

Survival rates of Prostate Cancer?

Survival depends on many different factors. It depends on your individual condition, type of cancer subtype, treatment and level of fitness. So it is difficult to predict as to how long a particular Prostate Cancer patient will live.

10 year survival rate according to AJCC staging

Stage Survival Rate
StageI 85%
StageII 72%
StageIII 55%
StageIV 30%

Can Prostate Cancer be detected early?

Various methods can be used for screening and diagnosis. Most important of them for screening high risk patients is the blood levels of Prostate specific Antigen (PSA). Other methods for confirming Prostate Cancer is digital rectal examination, CT, MRI or bone scan as recommended by a consultant.

Medical history and physical exam: A general physical examination is conducted by the doctor to investigate the signs and symptoms of the disease. Further, a digital rectal examination (DRE) is conducted where a lubricated gloved finger is inserted into the rectum to feel for any hard areas on prostate.

PSA blood test: Prostate specific antigen (PSA) blood test is mainly used as a screening test to detect Prostate Cancer early in asymptomatic men.

The levels of PSA are < 4 nanograms/mililitre (ng/ml) in most healthy men. As PSA levels go up, the chances of having Prostate Cancer increase. However, a PSA level of

Imaging tests: Imaging tests help to identify the spread of the Prostate Cancer.

Bone Scan: Prostate Cancer often spreads to bones first (metastases), among the various sites for distant spread, which is detected by bone scan.

Computed Tomography (CT) scan: Helps in detecting spread of Prostate Cancer to nearby lymph nodes or other organs.

Magnetic Resonance Imaging (MRI): Produces a clear picture of prostate and is useful to detect whether the cancer has spread outside the prostate into the seminal vesicles or nearby structures.

What are the Treatments available?

Prostate cancer is the most common cancer among men, but it can often be treated successfully. Depending on the stage of disease, prostate cancer can be treated in various ways.

Stage I and Stage II

  • Surgery for prostate cancer involves removing the prostate gland, some surrounding tissue and a few lymph nodes.
  • Radiation therapy: Uses non-invasive beam therapy using electron, proton, or neutron beams.

Stage III

  • Surgery
  • Radiation / hormonal therapy
  • Cryotherapy is a revolutionary minimally invasive therapy that uses ultrathin needles and freezing gases to destroy the cancerous tissue

Stage IV

  • Hormone therapy is treatment to stop the body from producing the male hormone testosterone. Medications that stop the body from producing testosterone are given.
  • Surgery to remove the testicles. Removing the testicles reduces testosterone levels in the body.
  • Chemotherapy: works by destroying quickly-dividing cells and is usually reserved for patients with advanced prostate cancer.

Is there curative treatment for Prostate Cancer?

This is dependent on the stage the Cancer has reached. However, if the Cancer is detected at an advanced stage, where the cancer cells have spread to distant parts of the body, then in spite of treatment it can be rarely cured.

How frequently should one visit doctor for early diagnosis?

Having some of the symptoms associated with Prostate Cancer may not necessarily indicate the presence of the disease. However, expert advice to rule out the possibility is prudent, making curative treatment possible. So, regular self examination and a physical examination at least once a year is recommended to facilitate early diagnosis of the disease.

How can I as a patient know it early?

If any of the symptoms mentioned in the Symptoms section is experienced, then consulting a doctor is highly recommended. Furthermore, a genetic make-up test can also be done to see if one is prone to Prostate Cancer.

Sinus Cancer

What is Nasal Cavity and Paranasal Sinus Cancer?

The nasal cavity is the space just behind the nose through which air passes to the throat. The Paranasal Sinuses are air-filled areas that surround the nasal cavity. There are several Paranasal Sinuses named after the bones that surround them:

  • Frontal Sinuses are in the lower forehead above the nose.
  • Maxillary Sinuses are in the cheekbones on either side of the nose.
  • Ethmoid Sinuses  are beside the upper nose, between the eyes.
  • Sphenoid Sinuses are behind the nose, in the center of the skull.

Nasal cavity and paranasal Sinus Cancer begins when healthy cells in the nasal area grows out of control, forming a mass called a tumor. A tumor can be malignant or benign. A malignant tumor is cancerous, which means it can grow and spread to other parts of the body. Sinus Cancer is categorized into different types depending on the different kind of cells they originate in. The categorization is important as it determines the rate of spread of the disease and the prognosis needed.

The types of Sinus Cancer include:

  • Squamous cell carcinoma: This is the most common type of nasal cavity and paranasal Sinus Cancer. Squamous cells are flat cells that make up the thin surface layer of the structures of the head and neck.
  • Adenocarcinoma. This is the second most common type of nasal cavity and paranasal Sinus Cancer. It begins in gland cells.
  • Melanoma. Melanoma develops from cells called melanocytes that give the skin its color. It is usually an invasive, fast-growing cancer. However, it only accounts for about 1% of tumors found in this area of the body.
  • Inverting papilloma. These are benign, wart-like growths that may develop into squamous cell carcinoma. Approximately 10% to 15% of these will develop into cancer.
  • Esthesioneuroblastoma. This type of cancer is related to the nerves that control the sense of smell. It occurs on the roof of the nasal cavity and involves a structure called the cribriform plate. The cribriform plate is a bone located deep in the skull between the eyes and the sinuses.
  • Midline granuloma. A group of several unrelated conditions that cause the breakdown of the healthy tissue of the nose, sinuses, and nearby tissues. Some cases are due to immune system problems, and many others are actually a type of lymphoma (see below).
  • Lymphoma. Lymphoma is a cancer of the lymphatic system. The lymphatic system carries lymph, a colorless fluid containing lymphocytes. Lymphoma may develop within the lymph tissue found in the lining of the nasal cavity and Paranasal Sinuses, called the mucosa.
  • Sarcoma. Sarcoma is a type of cancer that begins in muscle, connective tissue, or bone.

Occurrence Rates:

  • 30 to 40% will have it in their maxillary sinuses.
  • 40 to 50% will develop it in their nasal cavity.
  • 10 to 15% will have the cancer in their ethmoid sinuses.

Anatomy of Sinus Cancer

Sinus Cancer

What are the general symptoms of Sinus Cancer?

Possible symptoms of Sinus Cancer include:

  • A lump or sore inside the nose that does not heal.
  • A lump on the face or roof of the mouth.
  • Numbness or tingling in the face.
  • Swelling or other trouble with the eyes, such as double vision or the eyes pointing in different directions.
  • Pain or pressure in the ear.
  • Nasal obstruction or persistent nasal congestion and stuffiness, which is often called sinus congestion 
  • Chronic sinus infections that do not respond to antibiotic treatment.
  • Frequent headaches or pain in the sinus region.
  • Pain or swelling in the face, eyes, or ears.
  • Persistent tearing of the eyes.
  • Bulging of one of the eyes or vision loss.
  • Decreased sense of smell.
  • Pain or numbness in the teeth.
  • Loosening of teeth.
  • A lump on the face, nose, or inside the mouth.
  • Frequent nosebleeds.
  • Difficulty opening the mouth.
  • A lump or sore inside the nose or neck that does not heal.
  • Fatigue.

What are the general causes of Sinus cancer?

Sinus Cancer is associated to a number of artificial causatives that can be controlled to avoid the disease. However, many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.

There are 2 risk factors that greatly increase the risk of Nasal Cavity and Paranasal Sinus Cancer:

  • Tobacco use Use of tobacco is the single largest risk factor for head and neck cancer. Tobacco products include cigarettes, cigars, pipes, chewing tobacco, and snuff. Eighty-five percent (85%) of Sinus Cancer is linked to tobacco use. 
  • Alcohol Frequent and heavy consumption of alcohol is a high risk factor for Sinus Cancer. Using alcohol and tobacco together increases this risk even more.

Other factors can raise a person’s risk of developing Nasal Cavity or Paranasal sinus cancer.

  • Gender Nasal Cavity and Paranasal Sinus Cancer occurs twice as often in men as in women.
  • Age Nasal Cavity and Paranasal Sinus Cancer are most commonly found in people between the ages of 45 and 85. However, the development of this cancer is also found among younger people now a days.
  • Human papillomavirus (HPV) Infection with this virus is a risk factor for Nasal Cavity and Paranasal Sinus Cancer.
  • Specific inhalants Breathing in certain substances, most commonly found work environments, may increase the risk of developing Nasal Cavity or Paranasal Sinus Cancer. These substances include:
    • Dust from the wood, textiles, or leather industries
    • Flour dust
    • Nickel dust
    • Chromium dust
    • Mustard gas
    • Asbestos
    • Rubbing alcohol, also called isopropyl alcohol, fumes
    • Radium fumes
    • Glue fumes
    • Formaldehyde fumes
    • Solvent fumes used in furniture and shoe production
  • Exposure to air pollution Being exposed to air pollution may increase a person’s risk of developing Nasal Cavity and Paranasal Sinus Cancer.
  • Marijuana use Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer.

Can Sinus Cancer be prevented?

Though some of the causatives of sinus cancer are beyond our control but most of them are controllable.

  • The two major known causes of sinus cancer are usage of tobacco and alcohol. So, by lowering and controlling their consumption one can definitely be prevented.
  • Using marijuana also increases the risk, so saying no to marijuana drops the risk.
  • Ensuring safe sex reduces the risk of HPV.
  • Ensuring safe work and home environment free of air pollutants.

What are the stages of Sinus Cancer?

Sinus Cancer can be staged using the TNM staging system:

  • refers to the spread of cancer cells to tissues next to the testicle.
  • N describes the spread of cancer cells to regional lymph nodes.
  • M indicates whether the cancer has metastasized.

The results are combined to determine the stage of cancer for each person. There are 5 stages for nasal cavity and paranasal Sinus Cancer: stage 0 (zero) and stages I through IV (1 through 4).

Tumor

  • TX: Primary tumor cannot be evaluated.
  • T0: No evidence of a tumor could be found.
  • Tis: This is a very-early-stage cancer, cancer cells are found only in 1 layer of tissue. It is also called carcinoma in situ.

Primary tumor (T) in the maxillary sinus

  • T1: The spread of tumor is limited to the inside of the sinus.
  • T2: The tumor has spread to the bone surrounding the sinuses.
  • T3: The tumor invades the surrounding bone, the skin of the cheek, or the other sinuses.
  • T4a: The tumor has invaded the bone surrounding the eye, the skin of the cheek, or the throat.
  • T4b: The tumor might invade: the back of the eye, the brain area, or the bones of the skull.

Primary tumor (T) in the nasal cavity and ethmoid sinus

  • T1: The tumor is limited to the inside of the sinus and has no involvement with the bone.
  • T2: The tumor extends into the nasal cavity.
  • T3: The tumor extends into the maxillary sinus or to the bone surrounding the eye.
  • T4a: The tumor has spread throughout the facial bones or into the base of the skull.
  • T4b: The tumor invades any of the following: the back of the eye, the brain area, or the back of the head.

Node (N)

  • NX: The regional lymph nodes cannot be evaluated.
  • N0: There is no evidence of cancer in the regional lymph nodes.
  • N1: The cancer has grown up to 3 cm and has spread to a single lymph node on the same side as the primary tumor.
  • N2a: The cancer sizes from 3 cm to 6 cm and has spread to a single lymph node on the same side as the primary tumor.
  • N2b: The cancer has spread to more than 1 lymph node on the same side as the primary tumor, but none measures larger than 6 cm.
  • N2c: The cancer has spread to more than 1 lymph node on either side of the body, but none measures larger than 6 cm.
  • N3: The cancer is found in at least 1 nearby lymph node and is larger than 6 cm.

Metastasis (M)

  • MX: Distant metastasis cannot be evaluated.
  • M0: The cancer has not spread to other parts of the body.
  • M1: The cancer has spread to another part(s) of the body.

Grade (G)
It describes how much cancer cells look like healthy cells when viewed under a microscope.

  • GX: The grade cannot be evaluated.
  • G1: The cells look more like healthy tissue and are well differentiated.
  • G2: The cells are only moderately differentiated.
  • G3: The cells don’t resemble healthy tissue and are poorly differentiated.

Stage I: This is a noninvasive cancer (T1) with no spread to lymph nodes (N0) and no distant metastasis (M0).

 Sinus Cancer Stage I

@ 2005 American Society of Clinical Oncology

Stage II: This is an invasive cancer (T2) that has not spread to lymph nodes (N0) or to distant parts of the body (M0).

 Sinus Cancer Stage II

@ 2005 American Society of Clinical Oncology

Stage III: This includes invasive cancer (T3) with no spread to regional lymph nodes (N0) and no metastasis (M0), as well as invasive cancer (T1, T2, T3) that has spread to regional lymph nodes (N1) but shows no sign of metastasis (M0).

 Sinus Cancer Stage III

@ 2005 American Society of Clinical Oncology

Stage IVA: This is an invasive cancer (T4a) that either has no lymph node involvement (N0) or has spread to only 1 same-sided lymph node (N1) but with no metastasis (M0). It is also used for any cancer (any T) with more significant nodal involvement (N2) but with no metastasis (M0).

 Sinus Cancer Stage IVA

@ 2005 American Society of Clinical Oncology

Stage IVB: This is an invasive cancer (any T) that has spread to lymph nodes (any N) but has no metastasis (M0). It is also used for any cancer (any T) that is found in lymph nodes and is larger than 6 cm (N3) but has no metastasis (M0).

 Sinus Cancer Stage IVB

@ 2005 American Society of Clinical Oncology

Stage IVC: This refers to any tumor (any T, any N) when there is evidence of distant spread (M1).

 Sinus Cancer Stage IVC

@ 2005 American Society of Clinical Oncology

Survival rates of Sinus Cancer?

The survival rate and diagnosis usually go hand in hand. If the symptoms and stage of Sinus Cancer are discovered earlier, the individual will have a greater chance of survival. Here is an analysis of 5 year survival rate of different types of Sinus Cancer based on earlier history. However, these rates might go up and down when calculated for a particular area.

Stages 5-year relative survival rate
I 63%
II 61%
III 50%
IV 35%

Can Sinus Cancer be detected early?

Small cancers of the nasal cavity and paranasal sinuses usually do not cause any specific symptoms. Many of these cancers are not found until they have grown large enough to block the nasal airway or sinuses, or until they have spread to nearby tissues or even to distant areas of the body.

Here are a few diagnostic tests that might be recommended to detect the presence of this disease.

  • Screening : Screening refers to tests and exams used to detect cancer, in people who do not have any symptoms. Screening can find some types of cancer early, when treatment is most likely to be effective.
  • Physical examination: During a physical examination, any lump on the neck, lips, gums, and cheeks is checked. The doctor further inspects the nose, mouth, throat, and tongue for abnormalities, often using a light and/or mirror for a clearer view.
  • Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope.
    • Fine-needle aspiration (FNA) biopsy  : The removal of tissue or fluid using a thin needle.
    • Incisional biopsy  : The removal of part of an area of tissue that doesn’t look normal.
    • Excisional biopsy  : The removal of an entire area of tissue that doesn’t look normal.
  • Endoscopy: An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope.
  • Nasoscopy : It is a procedure to look inside the body for abnormal areas. A thin, tube-like instrument with a light and a lens for viewing is inserted into the nose.
  • X-ray: An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation
  • Computed tomography (CT or CAT) scan: A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles.
  • Laryngoscopy: It is a procedure to look at the larynx for abnormal areas. A mirror or a laryngoscope is inserted through the mouth to see the larynx.
  • Magnetic resonance imaging (MRI): An MRI uses magnetic fields, to produce detailed images of the body, especially images of soft tissue, such as the eye in its socket and the part of the brain near the sinuses.

What are the Treatments available?

Depending on the type of Cancer and how far it has spread, different treatments are employed to cure or retard the growth and spread of the disease. Here are a few treatment options usually opted by doctors or oncologists.

Here are a few diagnostic tests that might be recommended to detect the presence of this disease.

  • Surgery: Surgery is used to remove a tumor in the paranasal sinus or nasal cavity. During the operation, the tumor and some surrounding healthy tissue, called margin are removed.

    Common types of surgery for nasal cavity and paranasal sinus cancer include:

    • Excision: An operation to remove the cancerous tumor and some of the healthy tissue around it is conducted.
    • Maxillectomy:This is a surgery that removes part or all of the hard palate, the bony roof of the mouth. Artificial devices called prostheses or, flaps of soft tissue with and without bone can be placed to fill gaps.
    • Endoscopic sinus surgery: This is less destructive to healthy tissue than traditional operations. Occasionally, it can be used for benign tumors. The surgeon makes a small incision to remove the tumor using a thin, telescope-like tube inserted into the nasal cavity or sinus.
    • Neck dissection: This is the surgical removal of lymph nodes in the neck area.
    • Reconstructive surgery: It may be recommended when surgery requires removing large or specific areas of tissue.
  • Radiation therapy: It is the use of high-energy x-rays or other particles to destroy cancer cells. Radiation therapy is most often used in combination with surgery.
    • External-beam radiation therapy:  External-beam radiation therapy is the most common type of radiation given from a machine outside the body. Specific types of external radiation therapy include:
      • Intensity-modulated radiation therapy (IMRT)
      • Proton therapy.
    • Internal radiation therapy: Radiation treatment given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the tumor. The implant is left in place for several days while the person stays in the hospital.
  • Chemotherapy: Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).
  • Palliative care: It is a treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families.

Is there curative treatment for Sinus Cancer?

Early stage of the Sinus Cancer is small, localized, and highly curable when treated with surgery and/or radiation therapy or chemotherapy. Advancement in science and technology is facilitating modern methods of highly successful treatment.

How frequently should one visit doctor for early diagnosis?

Spotting any of the symptoms of nasal cancer or having a doubt in your mind calls for a visit to the doctor. Also, a familial history or personal history of the disease commands a regular examination at least once a year or as per the doctor’s advice.

How can I as a patient know it early?

Consulting a doctor or oncologist in case of any indication felt or experienced that might suggest the presence of the disease. Ignoring even a small indication might result in devastation. In early stages sinus cancer is highly curable but it gets complicated with passing time.

Skin Cancer

What is Skin Cancer?

Skin is a protective layer that covers our whole body. It shields us against heat, sunlight, injury, and infection.

The uncontrolled growth of mutated cells in the skin is called skin cancer. It occurs when unrepaired DNA damage skin cells triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors. These cancer cells can potentially invade the neighbouring cells and tissues and at the later stages can also spread to distant organs. Skin cancer is the most common type of cancer.

Types:

  • Melanoma: It is a rare and aggressive type of skin cancer. If it isn’t diagnosed early, it is likely to invade nearby tissues and spread to other parts of the body. It accounts for only 2% of skin cancer but causes most deaths from skin cancer
  • Nonmelanoma: Squamous cell and basal cell skin cancers are called nonmelanoma skin cancers. These are often found in areas exposed to sun, but may occur elsewhere. They usually respond to treatment and rarely spread to other parts of the body.

Less common types of skin cancer

    • Merkel cell carcinoma
    • Kaposi sarcoma
    • Cutaneous (skin) lymphoma
    • Skin adnexal tumors (tumors that start in hair follicles or skin glands)
    • Various types of sarcomas

Skin Cancer Occurrence Rate in India

The exact incidence of skin cancer in India is not known. However, skin cancers constitute about 1-2% of all diagnosed cancers. The incidence of skin cancer in India is quite low when compared to western countries. Most of the cases being reported in India are squamous cell carcinoma and basal cell carcinoma while the occurrence of non melanoma skin cancer is quite low among Asians.

Anatomy of Skin

Skin Cancer

Copyright © M Hssurgery.com, The above image is used for educational purpose only.

What are the general symptoms of Skin Cancer?

Different types of skin cancer shows different signs. Below mentioned are some of the symptoms that might indicate the presence of the disease but they do not necessarily ascertain the disease. However, if any of the symptoms is spotted then consulting a doctor is highly recommended.

Basal cell carcinoma:

  • A pearly or waxy bump
  • A flat, flesh-colored or brown scar-like lesion.

Squamous cell carcinoma:

  • A firm, red nodule.
  • A flat lesion with a scaly, crusted surface.

Melanoma signs and symptoms:

  • A large brownish spot with darker speckles
  • A mole that changes in color, size or feel or that bleeds
  • A small lesion with an irregular border and portions that appear red, white, blue or blue-black
  • Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, vagina or anus

Other Symptoms:

  • Red or purple patches on the skin or mucous membranes.
  • Firm, shiny nodules that occur on or just beneath the skin and in hair follicles.
  • Hard, painless nodules

What are the general causes of Skin cancer?

Skin cancer is associated to a number of causatives. However, many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.

  • Ultraviolet (UV) light exposure – One of the major risk factor for most skin cancers is high exposure to the sun. Tanning beds, lamps are another source of UV rays.
  • Having fair skin – Less pigment (melanin) in your skin provides less protection from damaging UV radiation.
  • Older age – The risk of getting basal and squamous cell skin cancers rises as people get older due to accumulated exposure to UV radiation. However, skin cancers are increasingly being found in younger individuals.
  • Male gender – Men are about twice as likely as women to have basal cell cancers
  • Exposure to chemicals – Certain chemicals, including Arsenic, coal tar, paraffin, and certain types of oil may also have an increased risk of skin cancer.
  • Increased Radiation exposure – Treatment with radiation can increase the risk for developing skin cancers in the exposed area.
  • Multiple or unusual moles – People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer.
  • Severe sunburns in the past – Having had one or more blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult
  • Long-term or severe skin inflammation or injury – Skin damaged by some severe inflammatory skin diseases is more likely to develop skin cancers, although this risk is generally small.
  • Xeroderma pigmentosum (XP) – This very rare inherited condition reduces the ability of skin cells to repair DNA damage caused by sun exposure.
  • Basal cell nevus syndrome (also known as nevoid basal cell carcinoma syndrome or Gorlin syndrome) – In this rare congenital (present at birth) condition, people develop many basal cell cancers over their lifetime.
  • Weakened immune system – People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/AIDS and those taking immunosuppressant drugs after an organ transplant.
  • Human papilloma virus (HPV) infection – Infection with certain types of HPV, particularly those that affect the anal or genital area, may increase your skin cancer risks.
  • Smoking – People who smoke are more likely to develop squamous cell skin cancer.
  • History of skin cancer

Can Skin Cancer be prevented?

The best ways to lower your risk of skin cancer are to avoid long exposure to intense sunlight and practice sun safety, with glares, hats, t-shirts and umbrellas. Wearing a good quality sun screen throughout the year also provides safety. Tanning beds and lamps should be avoided completely.

Regular, thorough skin examinations are also important, especially if there are a large number of moles or other risk factors. While this will not prevent skin cancer from developing, it may help to catch it early, when it can be treated more easily.

What are the stages of Skin cancer?

Non-melanoma skin cancers rarely spread and may not be staged. The chance that squamous cell carcinomas will spread is slightly higher and may be staged using the TNM System.

  • T refers to the spread of cancer cells to tissues next to the testicle.
  • N describes the spread of cancer cells to regional lymph nodes.
  • M indicates whether the cancer has metastasized.

Like all other cancers skin cancer is also staged into levels depending on the spread, size and severity of the disease.

  • Stage 0: The cancer cells are confined to the epidermis
  • Stage I: The cancer cells have grown deeper into the skin, but have not spread to the lymph nodes or other parts of the body.
  • Stage II: Cancer cells have grown deeper into the skin, or have more high-risk features, but have not spread to the lymph nodes or beyond.
  • Stage III: The cancer cells have spread to nearby lymph nodes, but not to distant organs.
  • Stage IV: The cancer cells have spread beyond the skin and regional lymph nodes to distant organs such as the liver, lungs or brain or distant lymph nodes and areas of the skin.

Survival rates of Skin cancer?

Needless to say, if the skin cancer is detected while it is still in Stage I, survival rate is higher. The rate decreases progressively with the increase in stage. Stage III is considered critical, while stage IV is, more often than not, fatal.

Melanoma Staging Survival Rate:

Stages 5 year Survival Rate
Stage I A 97%
Stage I B 92%
Stage IIA 81%
Stage IIB 70%
Stage IIC 53%
Stage IIIA 78%
Stage IIIB 59%
Stage IIIC 40%
Stage IV 15%

Can Skin Cancer be detected early?

Being aware of the signs and symptoms definitely aids in its early detection. Some other methods of diagnosis are discussed below:

  • Physical Examination : Skin Cancer can be detected early with screening or even, simply with a self-exam where you take note of the changes on your skin.
  • Skin biopsy : Removal of the suspicious-looking skin for lab testing.

What are the Treatments available?

Based on the type and stage of the cancer and other factors, treatment options may include:

  • Surgery
  • Other forms of local therapy
  • Radiation therapy
  • Systemic chemotherapy
  • Targeted therapy
  • Immunotherapy
  • Chemotherapy

Treatment is based on the type of tumor and other factors, and often more than one type of treatment is used. Discuss all of your treatment options as well as their possible side effects with your treatment team to help make the decision that best fits your needs.

How frequently should one visit doctor for early diagnosis?

If you have any of the symptoms, please do visit the doctor. Also, a familial history or personal history of the disease commands a regular examination at least once a year for the disease.

How can I as a patient know it early?

If you feel any of the symptoms mentioned in the Symptoms section, you should definitely visit a doctor. Ignoring even a small indication might result in devastation. In early stages Skin cancer is highly curable but it gets complicated with passing time.

Stomach Cancer

What is Stomach (Gastric) Cancer?

Stomach

Stomach is a hollow muscular sac like organ that plays a major role in the digestion of food. It is located in the left upper part of the abdomen just below the ribs. Stomach receives and holds the food and starts to digest it by secreting gastric juice. The food and gastric juice are mixed and then emptied into the first part of the small intestine called the duodenum.

Stomach Cancer

Stomach cancer, also called gastric cancer, is a disease in which malignant cells form in the lining of the stomach. Stomach cancer generally develops slowly and do not show any prominent sign or symptom.

Types of Stomach Cancer

  • Adenocarcinomas: These Cancers develop from the cells that form the innermost lining of the stomach (known as the mucosa). They account for 90 – 95 % of Stomach Cancers.
  • Lymphoma: These are Cancers of the immune system tissue that are sometimes found in the wall of the Stomach. They account for 4% of Stomach Cancer occurrences.
  • Gastrointestinal stromal tumor (GIST) : These are rare tumors that start in very early forms of cells in the wall of the stomach called interstitial cells of Cajal.
  • Carcinoid tumor: These are tumors that start in hormone-making cells of the Stomach. Most of these tumors do not spread to other organs. About 3% of Stomach Cancers are carcinoid tumors.
  • Other Cancers: Cancer such as squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma, can also start in the stomach, but these Cancers are very rare.

Stomach Cancer Occurrence Rate in India

A recent study conducted by Tata Memorial Centre (TMC) on cancer mortality in India has revealed that Stomach Cancer is the second biggest killer in India. An approximation of 22,200 men and 27,500 women die of Gastric Cancer every year in India. Experts revealed that this high rate of Stomach Cancer is contributed by unhealthy diet and lifestyle.

In many places in India the diet is low in fibre content. Spicy food and lots of non-vegetarian food can cause the chronic inflammation of the stomach lining, which if left untreated can turn cancerous.

Anatomy of Stomach (Gastric)

Stomach Cancer

What are the general symptoms of Stomach (Gastric) Cancer?

Most Stomach (Gastric)  cancers do not cause any symptoms until they have spread too far to be cured, but sometimes, we do get symptoms at an early stage.
Early stages:

  • Indigestion and stomach discomfort.
  • A bloated feeling after eating.
  • Mild nausea.
  • Loss of appetite.
  • Heartburn.
  • Fatigue

Advanced stages:

  • Blood in the stool that might or might not be visible to naked eyes.
  • Vomiting.
  • Weight loss for no known reason.
  • Stomach pain.
  • Jaundice
  • Ascites (build-up of fluid in the abdomen).
  • Trouble swallowing.

These symptoms are more likely to be caused by conditions other than Stomach (Gastric)  cancer. Still, it’s important to see your doctor right away so the cause can be found and treated, if needed.

What are the general causes of Stomach (Gastric) cancer?

The definite causatives of Stomach Cancer are yet under study. However, there is a strong correlation between a diet high in smoked and salted foods and Stomach Cancer.

Throughout these years of analysis and diagnosis of the disease certain risk factors have been identified that highly increases the probability of the occurrence of the disease. Some of them are discussed below:

  • Gender: Stomach Cancer is more common in men than in women.
  • Age: The risk of Stomach Cancer increases with increasing age. Most people diagnosed with Stomach Cancer are between their late 60s and 80s.
  • Helicobacter pylori (H. pylori) infection: It is a major cause of Stomach Cancer, especially cancers in the lower (distal) part of the stomach. Every one in three Stomach Cancer cases can be attributed to H pylori infection.
  • Stomach lymphoma: People who have had a certain type of lymphoma of the stomach known as mucosa-associated lymphoid tissue (MALT) lymphoma have an increased risk of getting adenocarcinoma of the stomach.
  • Diet: An increased risk of Stomach Cancer is seen in people with diets that have large amounts of smoked foods, salted fish and meat, and pickled vegetables. On the other hand, eating lots of fresh fruits and vegetables appears to lower the risk of Stomach Cancer.
  • Tobacco use: Tobacco usage is the major cancer causative. The rate of Stomach Cancer is almost doubled in smokers.
  • Previous stomach surgery: Stomach Cancers are more likely to develop in people who have had part of their stomach removed to treat non-cancerous diseases such as ulcers.
  • Hypertrophic Gastropathy: Excess growth of the stomach lining causes large folds in the lining and leads to low levels of stomach acid. This is a rare condition that accounts to Stomach Cancer.
  • Familial adenomatous polyposis (FAP): People with this syndrome are at greatly increased risk of getting colorectal cancer and have a slightly increased risk of getting Stomach Cancer.
  • Pernicious anemia: Certain cells in the stomach lining normally make a substance called intrinsic factor (IF) that we need to absorb vitamin B12 from foods. People without enough IF may end up with a vitamin B12 deficiency, which affects the body’s ability to make new red blood cells and can cause other problems as well. This condition is called pernicious anemia. Along with anemia (too few red blood cells), people with this disease have an increased risk of Stomach Cancer.

If you have any of the above symptoms, please get yourself checked. It may be noting, but it’s best to be sure!

Can Stomach (Gastric) Cancer be prevented?

Stomach Cancer can be prevented to an extent by avoiding the risk factors. One can lower the risk of developing Stomach Cancer by

  • Maintaining a healthy weight.
  • Eating a balanced, low-fat diet.
  • Dietary supplements
  • Quitting smoking.
  • Exercising regularly.
  • Treating Helicobacter pylori infection
  • Taking medicines to treat a precancerous condition or to keep cancer from starting.

What are the stages of Stomach (Gastric) cancer?

The stages of adenocarcinoma Stomach Cancer include:

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 a limited number of nearby lymph nodes.

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 more of the lymph nodes.

Stage III. At this stage, the cancer may have grown through all the layers of the stomach and spread to nearby structures. Or it may be a smaller cancer that has spread more extensively to the lymph nodes.

Stage IV. This stage indicates that the cancer has spread to distant areas of the body.

Survival rates of Stomach (Gastric) cancer?

Relative survival statistics compare the survival of patients diagnosed with cancer with the survival of people in the general population who are the same age, race, and sex and who have not been diagnosed with cancer. Because survival statistics are based on large groups of people, they cannot be used to predict exactly what will happen to an individual patient. No two patients are entirely alike, and treatment and responses to treatment can vary greatly.

Cancer stage at diagnosis highly determines treatment options and has a strong influence on the length of survival. The earlier Stomach Cancer is caught, the better chance a person has of surviving.

Can Stomach (Gastric) Cancer be detected early?

Since people with Stomach Cancer rarely show symptoms in the early stages, the disease is often not diagnosed until it’s more advanced.

However, with the advancement in science and technology a few tests and procedures aids in locating the disease at an early stage. Some of the tests are:

  • Physical Examination: The doctor checks the medical history of the patient and extracts the detailed information regarding the signs and symptoms.
  • Upper Endoscopy: A thin tube containing a tiny camera is passed down through the throat into the stomach. If any suspicious areas are found, a biopsy is performed.
  • Biopsy: It is the removal of a small amount of tissue for examination under a microscope.
  • Endoscopic ultrasound: An ultrasound uses sound waves to create a picture of the internal organs. The ultrasound image helps doctors determine the spread of cancer.
  • Imaging tests: Imaging tests used to look for Stomach Cancer include computerized tomography (CT) scans, positron emission tomography (PET) and X-ray exam.
  • Exploratory surgery: Exploratory surgery is usually done laparoscopically. 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.

What are the Treatments available?

The main treatments for Stomach Cancer are:

  • Surgery
    • Removing early-stage tumors from the stomach lining
    • Removing a portion of the stomach (subtotal gastrectomy)
    • Removing the entire stomach (total gastrectomy)
    • Removing lymph nodes to look for cancer
    • Surgery to relieve signs and symptoms
  • Chemotherapy: Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy can be given before surgery to help shrink a tumor so that it can be more easily removed. Chemotherapy is also used after surgery to kill any cancer cells that might remain in the body.
  • Targeted therapy Targeted therapy uses drugs that attack specific abnormalities within cancer cells. Targeted drugs used to treat Stomach Cancer include:
    • Trastuzumab (Herceptin) for Stomach Cancer cells that produce too much HER2.
    • Ramucirumab (Cyramza) for advanced Stomach Cancer that hasn't responded to other treatments.
    • Imatinib (Gleevec) for a rare form of Stomach Cancer called gastrointestinal stromal tumor.
    • Sunitinib (Sutent) for gastrointestinal stromal tumors.
    • Regorafenib (Stivarga) for gastrointestinal stromal tumors.
  • Radiation therapy: Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. Radiation therapy can be used before surgery to shrink a stomach tumor so that it's more easily removed. Radiation therapy can also be used after surgery to kill any cancer cells that might remain around your stomach.
  • Immunotherapy : In this procedure, vaccines and medication are used to stimulate the immune system of the body. It boosts the body's natural defenses to fight against cancer. Substances made by the body or in a laboratory are used to improve or restore immune system function. Immunotherapy works in either of the following ways:
    • Stops or slows down the growth of cancer cells
    • Inhibit cancer from spreading to other parts of the body
    • Helps the immune system to destroy cancer cells

Is there curative treatment for Stomach (Gastric) Cancer?

This is dependent on te stage the Cancer has reached. However, the Cancer is usually in an advanced stage when it is diagnosed. In such cases, it can be treated, but rarely cured.

How frequently should one visit doctor for early diagnosis?

If you have any of the symptoms, please do visit the doctor.

How can I as a patient know it early?

If you feel any of the symptoms mentioned in the Symptoms section , you should probably visit a doctor. You can also get your genetic make-up checked to see if you are prone to Stomach (Gastric) cancer or not.

Throat Cancer

What is Throat Cancer?

Throat is a 5-inch-long tube that runs from nose to neck. Throat Cancer is a compilation that includes Cancer of the mouth, tonsils, nose, sinuses, salivary glands and neck lymph nodes. Larynx (Laryngeal Cancer) that is the voice box and pharynx (Pharyngeal Cancer) which is the hollow tube running from nose to windpipe, are the two most prone areas of Throat Cancer.

Anatomy of Throat

Throat Cancer

What are the General Symptoms of Throat Cancer?

While it is easy to observe the common signs and symptoms of throat Cancer, its early detection still gets delayed because of negligence. Being aware of these common signs and symptoms is sure to aid.

  • Difficulty swallowing due to sore Throat (dysphagia)
  • Change in voice
  • Unexplainable weight loss
  • Swelling of the eyes, jaw, throat or neck
  • Bleeding in the mouth or through the nose
  • Constant urge to clear your throat
  • Chronic cough (may cough up blood)
  • Wheezing
  • Ear pain
  • Hoarseness

What are the general causes of Throat Cancer?

Throat Cancer is associated with various causes which range from excessive smoking, tobacco use, to exposure to chemicals. Among all, smoking has been the most prevalent cause contributing to Throat Cancer symptoms.

A few common likely causative factors of throat Cancer are:

  • Maintaining a low diet in fruits and vegetables
  • Rampant use of cigarettes, pipes and cigars.
  • Excessive consumption of alcohol.
  • Human papillomavirus (HPV), a sexually transmitted virus.
  • Chronic acid reflux called GERD.
  • Contracting Epstein - Barr virus (EBV) virus is transmitted via saliva.

Can Throat Cancer be prevented?

Though there’s no definitive formula to prevent Throat Cancer, but it can be definitely be prevented to an extent. Here are some of the measures that might protect you from the dreadful disease.

  • Saying no to smoking.
  • Reducing alcohol intake.
  • Eating plenty of fruits, vegetables, and lean meats while avoiding fat and sodium intake and take steps to lose excess weight.
  • Engaging in physical activity at least 150 minutes a week.
  • Reducing risk of HPV. Limiting the number of sexual partners and practicing safe sex. Also, the HPV vaccine might offer you some protection.

What are the stages of Throat Cancer?

Throat Cancer is staged on three key components:

  • Tumor (T) describes the size of the original tumor.
  • Node (N) indicates whether the Cancer is present in the lymph nodes.
  • Metastasis (M) refers to whether Cancer has spread to other parts of the body.

A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. The letter X means the information could not be assessed.

Once the T, N and M scores have been assigned, an overall stage is assigned. The stages range from 0 to 4:

  • Stage 0: The tumor has not invaded tissue beyond your throat.
  • Stage 1: The tumor is less than 7 cm and limited to your throat.
  • Stage 2: The tumor is slightly larger than 7 cm, but still limited to your throat.
  • Stage 3: The tumor has grown and spread to nearby tissues and organs.
  • Stage 4: The tumor has spread to your lymph nodes or distant organs.

Survival rates of Throat Cancer?

The survival rate and diagnosis usually go hand in hand. If the symptoms and stage of Throat Cancer are discovered earlier, the individual will have a greater chance of survival. Here is a analysis of 5 year survival rate of different types of Throat Cancer based on earlier history.

Stage Supraglottis Glottis Subglottis Hypopharynx
I 59% 90% 65% 59%
II 59% 74% 56% 39%
III 53% 56% 47% 36%
IV 34% 44% 32% 24%

Survival rates are based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any person’s case. Many other factors can affect a person’s outlook, such as their general health and how well the Cancer responds to treatment.

Can Throat Cancer be detected early?

Being aware of the symptoms and keeping an eye on your health will definitely help you detect Cancer at early stage. Also, screening tests may help finding some types of Cancer early, when treatment is most likely to be effective. There are a series of diagnostic tests for you to identify and beat it.

Throat Cancer Diagnostic Tests

  • Direct (flexible) laryngoscopy: In this,a fiber-optic laryngoscope, a thin, flexible, lighted tube is inserted through the mouth or nose to look at the larynx and nearby areas.
  • Indirect laryngoscopy: Special small mirrors are used to view the larynx and nearby areas.
  • Panendoscopy: It is a procedure that combines laryngoscopy, esophagoscopy, and bronchoscopy.
  • Biopsy: Different methods are used to obtain tissue for a biopsy, depending on where the tumor is located.
    • Conventional incisional biopsy: The doctor surgically removes part or all of the tissue where Cancer is suspected.
    • Fine-needle-aspiration biopsy (FNA): This is used if there is a lump in neck that can be felt. A thin needle is inserted into the area, and then cells are withdrawn and examined under a microscope.
    • Endoscopy: An endoscope is inserted through the mouth, nose or an incision. The endoscope has a tool to remove tissue samples.
  • Imaging tests, which includes
    • CT or CAT (computed axial tomography) scans
    • PET (positron emission tomography) scans
    • MRI (magnetic resonance imaging) scans
    • Chest and dental X-rays
  • Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for Cancer.
  • Laryngeal videostroboscopy: This test lets the doctor look at the larynx and see how well you swallow.
  • Fiberoptic endoscopic examination of swallowing (FEES): A small, flexible endoscope is inserted through the nose, allowing the doctor to examine swallowing.

What are the Treatments available?

Depending on the type of Cancer and how far it has spread, treated with one or a combination of therapies.

  • Surgery:
    The types of surgical procedures depend on the location and stage of your cancer. Options may include:
    • Surgery for early-stage Throat Cancer.
    • Surgery to remove all or part of the voice box (laryngectomy).
    • Surgery to remove part of the throat (pharyngectomy).
    • Surgery to remove cancerous lymph nodes (neck dissection).
  • Chemotherapy:
    Chemotherapy may be used to shrink a tumor before surgery or kill lingering Cancer cells after surgery and/or radiation treatment. A combination of chemotherapy and radiation therapy may be used as a primary treatment for patients with larger tumors or those who cannot tolerate surgery.
  • Radiation Therapy:
    Radiation therapy uses high-energy beams from sources such as X-rays and protons to deliver radiation to the Cancer cells, causing them to die. For early-stage Throat Cancers, radiation therapy may be the only treatment necessary. For more advanced Throat Cancers, radiation therapy may be combined with chemotherapy or surgery. In very advanced Throat Cancers, radiation therapy may be used to reduce signs and symptoms and make you more comfortable.
  • Targeted Therapies:
    These innovative new drugs stop the growth of Cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow. Targeted drugs treat Throat Cancer by taking advantage of specific defects in Cancer cells that fuel the cells' growth. These drugs can be used in combination with chemotherapy or radiation therapy.

Is there curative treatment for Throat Cancer?

Early stage of the Throat Cancer is small, localized, and highly curable when treated with surgery& or radiation therapy. It includes stage I, II, and some stage III Cancers.

How frequently should one visit doctor for early diagnosis?

Having some of the symptoms associated with Throat Cancer may not necessarily indicate the presence of the disease. However, expert advice to rule out the possibility is prudent, making curative treatment possible.

How can I as a patient know it early?

Being aware of the signs and symptoms will definitely help a patient to suspect the disease. And the going for a diagnosis or visiting a doctor will clear the air.

Thyroid Cancer

What is Thyroid Cancer

Thyroid

The Thyroid gland is about 2 inch long, butterfly shaped organ located on the front side of the throat. It is one of the largest endocrine glands.

Functions

The Thyroid gland synthesizes two vital hormones: triiodothyronine and thyroxine which are responsible for regulating body’s temperature, heartbeat, metabolism, growth, appetite, menstrual cycle etc.

Thyroid Cancer

Thyroid Cancer is a type of tumor located within the thyroid gland which may be in the benign or malignant state.  Four types of Thyroid Cancer could be differentiated till date – Papillary, Follicular, Medullary and Anaplastic Thyroid Cancer.

Types of Thyroid Cancer

  • Papillary CancerIt accounts for 80% of the thyroid cancer occurrences. It grows slowly and spreads gradually over different parts.  It can often be treated successfully and are rarely fatal.
  • Follicular Cancer: This cancer is mostly caused due to lack of Iodine in the diet.It accounts for 10% of the total thyroid cancer occurrences. They usually do not spread to the lymph nodes but they can spread to other parts of the body.  The prognosis of follicular cancer is good but the rates are lower than papillary cancer.
  • Medullary Cancer: It accounts for 4% of thyroid cancers. This type of thyroid cancer is more difficult to find and treat.  It can be further classified as:
    • Sporadic Medullary Thyroid Cancer:It accounts for about 8 out of 10 cases of Medullary Thyroid Cancer.  It occurs mostly in older adults. 
    • Familial Medullary Thyroid Cancer : It is an inherited condition accounting 20% to 25% occurances in each generation of a family.  These cancers often develop during childhood or early adulthood and spreads rapidly.
  • Anaplastic Thyroid Cancer: This is a rare form of thyroid cancer, amounting up to 2% of all thyroid cancers. This cancer is referred as undifferentiated. It often spreads quickly into the neck and to other parts of the body, and is difficult to treat.

Occurrences of Thyroid Cancer

A recent study on the topic, revealed that Thyroid Cancer is the most common type of endocrine- cancer amounting 3.8% of all cancer cases. Here is a depiction of the global occurrence of Thyroid Cancer.

Type Occurrence Rate
Papillary Cancer 80%
Follicular Cancer 15%
Medullary Cancer 3%
Anaplastic  cancer 2%

Thyroid Cancer is a common cancer type and its diagnosis tends to scare the patients, however most cases of Thyroid Cancers are highly treatable and can be cured with surgery and other advanced treatments.

Anatomy of Thyroid Cancer

Anatomy of thyroid gland

Thyroid Cancer

Anatomy of Thyroid Cancer

Thyroid Cancer

What are the General Symptoms of Thyroid Cancer?

The symptoms of thyroid cancer vary from person to person. Some people may not experience any symptom till the later stages until the physician diagnose the lump in the neck during routine health examination while some may experience prominent early symptoms. The most common symptoms of thyroid cancer are as

  • Lump in the neck
  • Hoarse voice
  • Pain in the neck or behind the ears
  • Swollen lymph nodes in the neck.
  • Difficulty in swallowing
  • Sore throat
  • Difficulty in breathing
  • Cough that lasts longer than 3 weeks

What are the general causes of Thyroid Cancer?

There are various causes which contribute towards the increased risk of developing Thyroid Cancer. Some of them are given below:

  • Exposure to radiation for a prolonged period probably during the childhood.
  • Individuals with certain health conditions like Cowden's syndrome, a rare autosomal disorder can easily fall a prey to Thyroid Cancer.
  • Abnormality or mutations in certain genes can result in the development of Thyroid Cancer.
  • Thyroid Cancers like other types of Cancers can develop in individuals who have a family history of Cancer.
  • Inadequate amount of iodine in the diet can also result in the development of Thyroid Cancer.

Can Thyroid Cancer be prevented?

Most cases of Thyroid Cancer cannot be prevented. However in some cases, certain preventive measures can reduce the risk of developing Thyroid Cancer to a great extent. Some of those measures are outlined below:

By avoiding exposure to radiation:

The cells of the Thyroid gland (and most other glands) are very sensitive to x-rays and other forms of radiation, and easily destroyed or mutated if exposed to it. If you are advised a CT scan by your healthcare professional for any underlying illness , consult with your physician for any other alternative measures like MRI etc since the amount of radiation emitted by CT SCAN is 50 times greater than that of the radiation emitted by MRI or X- rays.

Radiation exposure especially in children increases the risk of Thyroid Cancer. Imaging tests such as x-rays and CT scans also expose children to radiation, but at much lower doses. The exact measure of exposure that might raise the risk of Thyroid Cancer is yet not clear.

Avoid residing near a nuclear power plant:

The surroundings or neighbouring areas should be thoroughly scrutinized while selecting the place of residence. It is advised to select a place that is located at least 10 miles away from the resident area.

If an individual is residing in a place which is near to any nuclear power plant then extreme preventive measures should be taken in case of nuclear fallout. A suitable dosage of potassium iodide needs to be administered to those individuals who are residing in places of nuclear emergency.

Maintaining proper level of Iodine:

The Thyroid gland needs a steady supply of iodine to function properly and to synthesize its hormones.

Iodine deficiency causes the Thyroid gland to swell initially causing goiter, but chronic deficiency promotes nodules and highly increases the risk of Cancer. Iodine can be consumed through common salt or through fish / shellfish.

Blood tests for gene mutations:

If an individual have familial history of Thyroid Cancer, then it is highly recommended to opt for a blood test. A gene mutation can predominantly cause familial medullary Thyroid Cancer (MTC).

Regular Thyroid Screenings:

Most of the Thyroid Cancer cases can be found in the early stages. Oncologists recommend self examination of the neck area at least twice a year and a medical screening once a year.

Special precautions during child bearing age:

Gender or age cannot be prevented but we can be a bit more vigilant with self exams and screenings. Women are 3x more likely than men to develop Thyroid Cancer and about 65% of cases occur during childbearing years (20-45 years).

What are the stages of Thyroid Cancer?

Usually Thyroid Cancers are staged on the basis of TNM staging systems. Here are listed the number staging systems which doctor uses for Cancer staging.

T indicates the size of the main (primary) tumor and whether it has grown into nearby areas.

  • TX: Primary tumor cannot be accessed.
  • T0: No evidence of primary tumor.
  • T1: T1 stage is the earliest possible stage of Thyroid Cancer where the tumor is entirely within the Thyroid gland and the size of the tumor does not exceed 2cm.
    • T1a: The tumor is not over 1 cm and is limited to Thyroid gland.
    • T1b: The tumor size ranges from 1 cm to 2 cm and is limited to the Thyroid gland.
  • T2: In this stage the tumor is only inside the Thyroid gland but the size of the tumor is slightly larger than that of T1 stage. In T2 stage the tumor mass is within 4 cm.
  • T3: In this stage the size is larger than 4 cm and the Cancerous growth is seen spreading across the walls of the tissues surrounding the Thyroid gland.
  • T4: T4 stage ranges from moderately advanced stage to highly advanced stage.
    • T4a: The tumor can be of any size and it has grown excessively beyond the Thyroid gland into the nearby glands. It is called moderately advanced stage.
    • T4b: The tumor size is significantly larger and expanding the region beyond the Thyroid capsule to the surrounding vessels invading the adjacent soft tissues like pre vertebral fascia, larynx, esophagus etc. This is also called very advanced disease.

N: N denotes regional lymph nodes. Numerous lymph nodes are located in the region of head and neck. These can be further classified into N0 and N1.

  • N0: There are no lymph nodes involvement or the tumor is clinically or radio logically node negative.
  • N1: These denote that the Cancer has spread to the adjacent lymph nodes. It can be further referred to as clinically or radio logically node negative.
    • N1a: The Cancer has spread to lymph nodes around the Thyroid in the neck.
    • N1b: The Cancer has spread to other lymph nodes in the neck (called cervical) or to lymph nodes behind the throat or in the upper chest

M: Here M denotes distant metastasis which means that the Cancer has spread to the distant tissues and organs.

  • MX: Distant metastasis cannot be assessed.
  • M0: There is no distant metastasis.
  • M1: The Cancer has spread to other parts of the body, such as distant lymph nodes, internal organs, bones, etc

Survival rates of Thyroid Cancer?

It is difficult to estimate the exact survival rate of patient as the survival rates of patients suffering from Thyroid Cancer can vary from one individual to another. Here are outlined the survival analysis of 5 years study of patients who were victims of different branches of Thyroid Cancer.

Cancer stats at a glance

Papillary Thyroid Cancer

Based on patients diagnosed 1998 to 1999

Stage 5-Year Relative Survival Rate
I near 100%
II near 100%
III 93%
IV 51%

Follicular Thyroid Cancer

Based on patients diagnosed 1998 to 1999

Stage 5-Year Relative Survival Rate
I near 100%
II near 100%
III 71%
IV 50%

Medullary Thyroid Cancer*

Stage 5-Year Relative Survival Rate
I near 100%
II 90%
III 71%
IV 21%

Based on patients diagnosed between 1985 and 1991

Can Thyroid Cancer be detected early?

It comes to a relief, as most Thyroid Cancers can be detected early due to their prominent symptoms, like neck lumps or nodules. Early Thyroid Cancers are also sometimes diagnosed during ultrasound tests or blood tests. However, to be sure proper tests and diagnostics are essential also a few people may not experience the signs and symptoms at the early stages. Some of the investigation and diagnostic test which your doctor may advice to detect the TNM stages of Thyroid Cancer are as follows.

  • Physical examination of the tumor: The very first step in the detection of Thyroid Cancer is the physical examination of the affected area by your healthcare professional. In this process of examination, you will be asked questions related to your current condition, previous medical history, your present symptoms etc.
  • Biopsy: The FNAC biopsy is one of the most important tests to detect Cancer. This involves aspirating some of the tissues with fluid from the lymph node of the suspected tumor and observing the tissues under microscope. The whole process of biopsy is performed under local anesthesia to ease the pain and discomfort of the patient. In some insances where the FNA biopsies fail to detect the Cancerous growth than, other types of more invasive biopsies are performed. They include a ‘core’ biopsy or an open biopsy and in some rare cases, a lobectomy is performed which is the removal of the major portions of the effected Thyroid gland that is performed under general anaesthesia in operation theatre.
  • Imaging Tests: One or more imaging tests are usually advised by the physician to know about the benign or metastatic nature of the tumor, or to find any suspicious areas in the neck which might denote Cancer. These imaging test include
    • Ultrasound: This is an imaging test which creates images of the body parts by utilizing sound waves. This test is usually helpful in determining the physical state of the Thyroid nodule whether it is solid or a fluid filled mass.
    • Radio iodine scan: This test is mainly used in papillary or follicular Thyroid Cancer to determine if the Cancer has spread to other parts of the body. This scan is usually performed by injecting some amount of radioactive iodine. The areas affected by the Cancer readily absorb the radioactive solution which can be monitored under a special camera.
    • CT SCAN and MRI SCAN: Cross sectional images of the effected region can be generated by CT SCAN while detailed images of affected as well as adjacent soft tissues can be obtained from an MRI SCAN.
  • Blood Test: Blood tests are usually used to monitor if the Thyroid is functioning in a normal or abnormal manner. These tests may include TSH test (Thyroid stimulating hormone test), PTH test (paraThyroid hormone test), Thyroid hormone test etc. Some other blood tests are also advised which includes routine blood test, kidney function test and liver function test.

What are the Treatments available for Thyroid Cancer?

There are several treatment options which are alone or in combination implemented to treat Thyroid Cancer depending the severity of the disease. They include

  • Surgery:
    There are three types of standard surgical procedures which are used to remove the tumor surgically. They include lobectomy surgical procedure which removes the Thyroid Cancer induced lobe, Thyroidectomy which involves the partial or total removal of the whole Thyroid gland.
  • Radiation Therapy:
    Following surgery radiation therapy is implemented to prevent episodes of reoccurrence of Cancer cells. There are types of standard radiation therapy – the external as well as the internal radiation therapy. The former is the one in which a machine is used externally to kill the timorous growth while the latter implies the administration of radioactive substance internally which may be either incorporated in wires or needles. The radiation oncologist decides which therapy is required for a particular individual depending on the stage of the tumor.
  • Chemotherapy:
    Chemotherapy is administered either before or after surgical procedure to shrink the tumor size and to prevent it from spreading to nearby organs. Chemotherapy is given either through oral or intravenous route depending upon the severity of the disease.
  • Hormone Therapy:
    Hormonal therapy is usually given orally which stops the Cancer from growing by blocking the action of certain hormones required for the survival of tumor cells.
  • Targeted Therapies:
    These innovative new drugs stop the growth of Cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow. Targeted drugs treat Throat Cancer by taking advantage of specific defects in Cancer cells that fuel the cells' growth. These drugs can be used in combination with chemotherapy or radiation therapy.

Is there any curative treatment for Thyroid Cancer?

If the Cancer is detected in its early stage then proper measures can be taken to reverse it, extending the survival of the patient. However, for later stage diagnosis the treatment involves only conservative measures where palliative medicine aids in relieving the symptoms associated with it.

How frequently should one visit doctor for early diagnosis?

It is recommended that you perform TSH test at least once in six months. However if you notice any kind of symptoms associated with Thyroid Cancer, it is recommended to consult with your healthcare professional at the earliest.

How can I as a patient know it early?

Keep yourself updated with the symptoms as well the risk factors associated with this disease so that once something fishy is going on within your organs, seek medical help at the earliest.

Uterine Cancer

What is Uterine Cancer

Uterus

Uterus is a hollow pear shaped pelvic organ located between the bladder and rectum. The uterus is also known as the womb, where the fetus development occurs. The uterus sits in an inverted position within the pelvic cavity of the torso. It is located along the body’s midline posterior to the urinary bladder and anterior to the rectum. The narrow inferior region of the uterus, known as the cervix, connects the uterus to the vagina below it and acts as a sphincter muscle to control the flow of material into and out of the uterus.

Functions

  • It is responsible for the development of the embryo and fetus during pregnancy.
  • It plays a vital role in continuity of life.

Uterine Cancer

The uncontrolled growth of mutated cells in the lining of uterus is called Uterine Cancer. It is also called as endometrial cancer. Uterine Cancer can start in different parts of the uterus.

Types of Uterine Cancer

The walls on the interior of the uterus have 2 layers of tissues - endometrium (inner lining) and myometrium (outer muscles). Based on the affected tissue, cancer is broadly categorized into two types:

  • Endometrial Cancer:This is the most common type of Uterine Cancer with 95 % of cases. Most Uterine Cancers start in the endometrium. This is called endometrial Cancer. Most Endometrial Cancers are adenocarcinoma (Cancers that begin in cells that make mucus and other fluids).
  • Uterine sarcomas Sarcoma accounts for about 2% to 4% of Uterine Cancers. Uterine sarcoma is an uncommon form of Uterine Cancer that forms in the muscle and tissue that support the uterus.

Anatomy of Uterine Cancer

Anatomy of uterus

Uterine Cancer

What are the General Symptoms of Uterine Cancer?

Uterine Cancer generally shows the following symptoms but these symptoms might vary or there may not be any prominent initial symptom at all.

  • Abnormal vaginal bleeding or discharge.
  • Pelvic pain
  • Constipation
  • Pain, pressure or cramps in the lower abdomen
  • Problems during pregnancy, including premature contractions and spontaneous abortion.

What are the general causes of Uterine Cancer?

There are multiple factors that lead to the development of Uterine Cancer; some of them are controllable while many are beyond one’s control. Here we have listed the major risk factors that lead to the development of uterus Cancer:

  • Hormonal Changes – Any imbalance or fluctuations in the levels of two main female hormones namely estrogens and progesterone is a high risk.
  • Prolonged menstruation – Early puberty or late menopause increases the risk of Endometrial Cancer. Women having more menstrual cycles in their lifetime have an increased endometrial Cancer risk. This includes starting periods before age 12 and going through menopause after age 50.
  • Infertility – Infertility is a major risk for Uterine Cancer. Irregular menstrual cycles and infertility also may be related to imbalances in estrogen and progesterone levels, and this hormone imbalance may increase the risk for Endometrial Cancer.
  • Age – Women in later ages tends to develop Uterine Cancer, especially the ones who have undergone menopause.
  • Obesity - Excess body fat alters the body's balance of hormones. Fat cells produce estrogen, so obese women are at an increased risk for Uterine.
  • Tamoxifen - It acts as an anti-estrogen in breast tissue, but increases estrogen level in the uterus.
  • An inherited colon Cancer syndrome - Hereditary non polyposis Colorectal Cancer (HNPCC) is a syndrome that increases the risk of colon Cancer and other Cancers, including endometrial Cancer. HNPCC occurs because of a gene mutation passed from parents to children.
  • Family History - Women with a family history of endometrial, colon or Ovarian Cancer may be at a higher risk of developing Endometrial Cancer.

Can Uterine Cancer be prevented?

Though most of the causatives of Uterine Cancer are natural and cannot be controlled yet a few precautionary measures might help to lower the risk. Some of them are

  • Maintaining healthy diet.
  • Exercising regularly and maintaining a fit body.
  • Maintaining balanced level of hormones.
  • Consulting a doctor for endometrial problems or HNPCC cases.

What are the stages of Uterine Cancer?

Staging of Uterine Cancer helps in proper diagnosis and planning for the treatment. It is staged in 4 levels ranging from stage I to IV, the severity increasing with each passed stage. The stages are discussed in details below:

  • Stage 0 (Tis, N0, M0):
    This stage is also known as carcinoma in-situ. Cancer cells are only found in the surface layer of cells of the endometrium, without growing into the layers of cells below. The Cancer has not spread to nearby lymph nodes or distant sites. This is a preCancerous stage and is not included in the FIGO staging system.
  • Stage I (T1, N0, M0)
    Cancer is found only in the uterus. The Cancer has not spread to lymph nodes or distant sites.
    • Stage IA: In this earliest form of stage I Cancer and it lies in the endometrium only. It has not spread to lymph nodes or distant sites.
    • Stage IB: Cancer has spread halfway or more into the myometrium but has not gone beyond the body of uterus.
  • Stage II (T2, N0, M0)
    Cancer is present in both the uterus and cervix. The Cancer has not spread outside of the uterus. The Cancer has not spread to lymph nodes or distant sites.
  • Stage III (T3, N0, M0)
    Cancer has spread beyond the uterus, but not beyond the pelvis
    • Stage IIIA:
      Cancer has spread to the outer layer of the uterus or to the fallopian tubes, ovaries, and ligaments of the uterus. The Cancer has not spread to lymph nodes or distant sites.
    • Stage IIIB:
      Cancer has spread to the vagina or to the tissues around the uterus. The Cancer has not spread to lymph nodes or distant sites.
    • Stage IIIC:
      Cancer has spread to lymph nodes in the pelvis and/or around the aorta.
  • Stage IV (T4, any N, M0) or (any T, any N, M1)
    Cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of the body.
    • Stage IVA:
      The Cancer has spread to the inner lining of the rectum or urinary bladder. It may or may not have spread to nearby lymph nodes but has not spread to distant sites.
    • Stage IVB:
      The Cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or to organs away from the uterus. The Cancer can be any size and it may or may not have spread to lymph nodes.

Survival rates of Uterine Cancer?

Stage Survival Rate
0 90%
IA 88%
IB 75%
II 69%
IIIA 58%
IIIB 50%
IIIC 47%
IVA 17%
IVB 15%

Can Uterine Cancer be detected early?

Some of the ways to detect Cancer at an early stage are:

  • Pelvic examination: During pelvic examination doctor carefully observes the outer portion of the vulva. This can be done by inserting fingers through the vaginal opening or by inserting a speculum that opens up the vagina and lets the doctor view the vagina and cervix.
  • Ultra sound: Transvaginal ultrasound is used to look at the thickness and texture of endometrium. This is done by inserting the transducer into the vaginal opening and creating a video image of the uterus.
  • Heteroscopy: A lens on a special lighted microscope, called heteroscope is inserted through the vagina which allows the doctor to examine the Cancer.
  • Biopsy: A sample of endometrial cell/ tissue is removed from uterine line and observed under microscope.
  • Dilatation and curettage: When enough information couldn’t be obtained by biopsy then dilatation and curettage is used. In this procedure, the cervix is widened (dilated) so that a curette (a spoon-shaped instrument with a sharp edge) can be inserted into the uterus to remove cells, tissues or growths from the endometrium.

What are the Treatments available for Uterine Cancer?

The options for treating endometrial Cancer depend on multiple characteristics of the Cancer, such as the stage, health and root cause etc.

  • Surgery:
    Depending on the spread of the malignant cells, surgery is conducted to remove the uterus, fallopian tubes and ovaries. A hysterectomy causes menopause and infertility.
  • Radiation Therapy:
    Radiation therapy uses powerful energy beams, such as X-rays and protons, to kill Cancer cells. It reduces the risk of Cancer recurrence after surgery, and helps to shrink a tumour before surgery (down-staging the tumour) and make it easier to remove.
    Radiation therapy includes
    • External Radiation
    • Internal radiation (brachytherapy)
  • Hormone Therapy:
    This involves taking medications that affect hormone levels in the body. Hormone therapy is used to:
    • Increase the amount of progesterone
    • Reduce the amount of estrogen
  • ChemoTterapy:
    Chemotherapy uses chemicals to kill Cancer cells.
  • Supportive (palliative) care:
    Palliative care is specialized medical care that focuses on providing relief while undergoing aggressive treatments like surgery, chemotherapy or radiation therapy.

Is there any curative treatment for Uterine Cancer?

Uterine Cancer, if detected at early stages is easy to cure. Endometrial Cancer can usually be cured while uterine sarcoma is harder to cure. Removing the uterus along with the surrounding affected organs generally aids in curing the Cancer. But at the later stages when the Cancer spreads to distant body parts then different treatments needs to be implemented.

How frequently should one visit doctor for early diagnosis?

If you encounter any of the symptoms then consulting a doctor is the smartest move though the symptom might not necessarily indicate the presence of the fatal disease.

How can I as a patient know it early?

Endometrial Cancer is often detected at an early stage as it frequently produces abnormal vaginal bleeding, which prompts the patient to see a doctor. But at times, early stages are missed due to negligence or no evident symptoms.

Retinoblastoma Cancer

What is Retinoblastoma Cancer?

Retinoblastoma Cancer

Retinoblastoma (Rb) is a rare form of cancer that rapidly develops from immature cells of the retina. It is a malignant Cancer of the eye, found exclusively in young children below 7 years of age. In 75% of cases, the tumor is found only in one eye, while the rest 25% cases report tumor in both eyes.

Retinoblastoma is usually confined to the eye but, if left untreated, is capable of metastasis or spreading to other parts of the body. The tumor is highly curable if its growth is restricted to the eyes only, the outlook declines with the increase in the spread of the Cancer cells.

Occurrence Rate of Retinoblastoma Cancer

Retinoblastoma is a rare disease and is indicated by a white dot on the retina and a squint. It accounts for almost 2% of all cancer occurrences in children below the age of 15. Globally, there are 11 cases per million children below 5 years of age, who have retinoblastoma. It may relieve the mind of many to know the rarity of this disease.

However, a recent survey by AIIMS revealed that the occurrence rate of Retinoblastoma among Indian children is rapidly increasing. Statistics suggest that almost 20,000 new cases of the disease are reported every year. 9-10 % of all Pediatric Cancer patients in India have Retinoblastoma. Though the incidences are increasing at an alarming rate, yet it can be cured when detected early. Median age at diagnosis was 2 years for boys and 1 year for girls with unilateral retinoblastoma; it is less than 12 months for bilateral disease.

For a country of 3120 crores, the number of cases reported might seem small when compared with breast cancer or other head and Neck cancer. Hence, opening with such information puts it in proper perspective.

Retina

The Retina is a thin layer of tissues at the back of the eyeball that contains cells sensitive to light. It is the light-detecting tissue of the eye.

Functions:

  • The retina receives the light focused by the lens.
  • It converts the light into neural signals and sends these signals to the brain for visual recognition.

How does Retinoblastoma Cancer develop?

A baby’s eyes start developing in the womb early in the first trimester of pregnancy. Retina i.e the light detecting part of the eye is formed by rapidly growing cells called Retinoblasts. These growing cells eventually mature to form the retina. In some rare scenario, the growth of retinoblast cells goes on abnormally forming a tumor in the eye.

These tumors may continue to grow, filling almost the entire vitreous humor (the jellylike substances the fills the eyeball). These tumors can also break off and spread to other parts of the eye, and eventually to other distant organs of the body.

Types of Retinoblastoma Cancer

  • Congenital (hereditary) Retinoblastoma:
    For about 33% of children with Retinoblastoma, the abnormality in the RB1 gene is present at birth and is in all the cells of the body, including all the cells of both retinas. This is known as a germline mutation.

    In most of these children, there is no family history of this Cancer. Only about 25% of the children born with this gene change inherit it from a parent. Children born with a mutation in the RB1 gene usually develop retinoblastoma in both eyes (known as Bilateral Retinoblastoma), and there are often several tumors within the eye (known as multifocal retinoblastoma).
  • Sporadic (non-hereditary) Retinoblastoma
    In about 66% of children with Retinoblastoma, the abnormality in the RB1 gene develops on its own in only a cell in one eye. The causes of this change are still under scrutinization. A child who has sporadic retinoblastoma develops only one tumor in one eye. This type of Retinoblastoma is often found at a later age than the hereditary form.

    Children with this type of Retinoblastoma do not have the same increased risk of other Cancers as children with congenital Retinoblastoma.

Anatomy of Retinoblastoma Cancer

Retinoblastoma Cancer

What are the general symptoms of Retinoblastoma Cancer?

  • Leukocoria (cat's eye reflex or white pupil). This may be first observed in photographs where the eye appears white rather than reflecting the reddish-orange light from the eye's retina.

  • Leukocoria Misaligned eyes (strabismus)

  • Blurred vision
  • Squint, eyes appear to be looking in different directions (lazy eye).
  • Redness or inflammation of eyes
  • Infection around the eye.
  • The eyeball is larger than normal.
  • The colored part of the eye and pupil look cloudy.

What are the general causes of Retinoblastoma Cancer?

A risk factor is anything that affects a person’s chance of getting a disease such as cancer. There are very few known risk factors for Retinoblastoma.

Age: Most children diagnosed with retinoblastoma are younger than 3 years old. In most cases, hereditary retinoblastomas are found during the first year of life, while non-inherited Retinoblastomas tend to be diagnosed in 1- and 2-year-olds. Retinoblastomas are rare in older children and in adults.

Heredity: 40% of Retinoblastoma patients have a genetic defect that leads to multiple tumors in one eye or both eyes. This is known as hereditary or germline retinoblastoma. These patients are typically diagnosed before 1 year of age. Patients with hereditary Retinoblastoma may pass this disease to their children.

Gender: It is more common in boys than girls.

Non Heredity: 60% of patients have a nonhereditary form of retinoblastoma. Each of these patients develops a tumor in only one eye. Nonhereditary patients are diagnosed on average around 2 years of age.

Can Retinoblastoma Cancer be prevented?

Since the causative and risk factors for Retinoblastoma are all natural and we have no control over them, so it becomes almost impossible to prevent the occurrence of Retinoblastoma Cancer. However, it brings a sigh of relief to know that the success rate of treatment is quite high when the cancer is diagnosed at its early stage. So the best prevention is through early detection.

General eye exam of the eyes of babies at birth and after 6 -12 months helps in detecting any serious congenital problems. Adults are advised to take their babies for a regular eye examination at least once a year or more often if one has any eye issues.

What are the stages of Retinoblastoma Cancer?

It is very important to stage Cancer for a planned diagnostic and treatment of the disease. Cancer is staged based on the size and location of the tumor(s). Although currently there are several staging systems available, the most convenient method is staging by the location of tumor.

  • Intraocular Retinoblastoma: Cancer is found in one or in both eyes, but does not extend beyond the eye.
  • Extraocular Retinoblastoma: Cancer has extended beyond the eye, usually through the optic nerve. It may be confined to the tissues around the eye, or it may have spread to other parts of the body.
  • Trilateral Retinoblastoma: In Bilateral Retinoblastoma, a related tumor develops in the pineal gland at the base of the brain. The presence of these tumors can result in other neurological symptoms and require neuroimaging of the brain for diagnosis.
  • Recurrent Retinoblastoma: Recurrent disease means that cancer has come back or progressed after it has been treated. It may recur in the eye or elsewhere in the body.

Another most common staging system for Retinoblastoma based on the size and spread of cancer is given below:

Stage 0: The tumor is in the eye only. The eye need not be removed and the tumor can be treated without surgery.

Stage I: The tumor is in the eye only. The eye needs to be removed and no cancer cells remain.

Stage II: The tumor is in the eye only. The eye needs to be removed, yet there are cancer cells left that can be seen only with a microscope.

Stage III:

  • In stage IIIa, cancer has spread from the eye to tissues around the eye socket.
  • In stage IIIb, cancer has spread from the eye to lymph nodes near the ear or in the neck.

Stage IV:

  • In stage IVa, cancer has spread to the blood but not to the brain or spinal cord. One or more tumors may have spread to other parts of the body such as the bone or liver.
  • In stage IVb, cancer has spread to the brain or spinal cord. It also may have spread to other parts of the body.

Survival rates of Retinoblastoma Cancer?

The survival rate depends on several factors, including whether the Cancer has spread from the eye to other parts of the body.

  • If the tumor is contained within the eye (one or both eyes), more than 95 percent of treated patients can be cured.
  • For children with retinoblastoma in both eyes, about 70 to 80 percent of the eyes can be saved.

Can Retinoblastoma Cancer be detected early?

Retinoblastoma Cancer might be indicated by several symptoms like pain, fatigue or a lump. In case any of these signs are visible it is recommended to visit a doctor and go for an examination.

  • Eye exam:
    • Ophthalmoscopy: The inside of the eye is carefully observed using a small magnifying lens and a light to check the retina and optic nerve.
    • Slit-lamp biomicroscopy: The retina, optic nerve, and other parts of the eye are checked thoroughly using a strong beam of light and a microscope.
    • Fluorescein angiography: In this procedure, blood vessels and the flow of blood inside the eye is observed. An orange fluorescent dye called fluorescein is injected. As the dye travels through blood vessels, a special camera takes pictures of the retina and choroid to find any blockage or leakage.
  • Blood test: A laboratory test in which a sample of blood or tissue is tested for a change in the RB1 gene.
  • Ultrasound exam of the eye: In this procedure, high-energy sound waves are bounced off the internal tissues of the eye to make echoes. Eyedrops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a picture of the inside of the eye and the distance from the cornea to the retina is measured. The picture, called a sonogram, shows on the screen of the ultrasound monitor.
  • MRI (magnetic resonance imaging): In this procedure, a magnet, radio waves, and a computer are used to make a series of detailed pictures of the eye. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • CT scan (CAT scan): In this procedure, a series of detailed pictures of the eye are 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

What are the Treatments available?

The treatment depends on the number, position and size of the tumors in the eye. The aim of treatment is first to get rid of the cancer and secondly to try to protect the eyesight. Some treatments may cause changes in the vision in the affected eye.

Different types of treatment are available for patients with retinoblastoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.

Smaller tumours

Local Therapy: For smaller tumors, treatment is given to the eye itself. One of the following methods may be used:

  • Cryotherapy/Focal Therapy: It is the treatment with laser therapy or freezing treatments (cryotherapy) while under anesthesia. These focal therapies may continue even after chemotherapy is complete. Sometimes, the tumors in the eye are small enough to be treated with only focal therapy.
  • Laser Therapy: A laser is directed through the pupil and used to heat the tumour. A number of sessions of laser therapy are recommended at intervals of 3 to 4 weeks.
  • Plaque: A small radioactive disc is stitched over the tumor on the outside of the eye. The disc needs to stay in place for up to four days while the radiation destroys the cancer cells.
  • Thermotherapy: This process uses heat to destroy the cancer cells and may be combined with chemotherapy or radiotherapy, as heat can improve the effectiveness of these treatments. The heat is produced by a laser, which is directed at the tumor.

Larger tumours

  • Chemotherapy
    Anti-Cancer drugs are used to destroy Cancer cells. It may be given before the local treatments mentioned above, to help shrink the tumor and make treatment more successful. Chemotherapy can also be used if cancer has spread to other parts of the body, or if there’s a risk that it may spread. The chemotherapy drugs most commonly used to treat Retinoblastoma are carboplatin, etoposide and vincristine. Some of the most common chemotherapies used are:
    • Systemic chemotherapy
    • Regional chemotherapy
    • Ophthalmic artery infusion chemotherapy
    • Intravitreal chemotherapy
  • Enucleation (Surgery)
    If the tumor is very large and the vision in the eye is lost, an operation to remove the eye is recommended. The specialist will only do this if it is absolutely necessary. An artificial eye is then fitted.
  • Radiotherapy
    Radiotherapy treats Cancer by using high-energy rays from a machine to destroy the Cancer cells while doing as little harm as possible to normal cells. It can be given to the whole eye but does have some effect on the surrounding tissue. Radiotherapy for Retinoblastoma is normally only used when other treatments have not worked well.

Is there curative treatment for Retinoblastoma Cancer?

Retinoblastoma is a very rare disease having a high curative rate. When detected at an early stage it can be cured with surgery, chemotherapy, focal therapy and radiation without causing much harm to the eyes.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a familial history of Retinoblastoma Cancer, a complete diagnostic is recommended once in a year.

How can I as a patient know it early?

The age of the patients is generally very low, so the parents and relatives should take responsibility to keep a vigilant eye on the child’s behavior and consult the doctor in case of any suspicion.

Testicular Cancer

What is Testicular Cancer?

Testicles

Testicles are part of the male reproductive system. The testicles are 2 egg-shaped glands located inside the scrotum. The scrotum is a sac of loose skin that hangs beneath the base of the penis.

Functions:

  • They synthesize male hormones such as testosterone.
  • They make sperm.

Testicular Cancer

The growth of uncontrolled mutated cells in the testicles is called esticular Cancer. Almost all Testicular Cancers start in the germ cells. Compared with other types of Cancer, Testicular Cancer is rare and is highly treatable even when Cancer has spread beyond the Testicle.

Types of Testicular Cancer

  • Seminomas: Though this cancer is malignant, it is highly curable if detected at an early stage. Seminomas also have a good prognosis with patients stage I to stage IIB having a 5 year survival rate of 98% to 92%. These are very sensitive to radiation. Generally, it occurs in the age group 30-50 years.

    Types
    • Classical Seminoma: More than 95% of seminomas are classical. These usually occur in men between 25 and 45.
    • Spermatocytic Seminoma: This rare type of seminoma tends to occur in older men. The average age of men diagnosed with spermatocytic seminoma is about 65. Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body.
  • Nonseminomas: They tend to grow and spread more quickly than seminomas. A testicular tumor that contains both seminoma and nonseminoma cells are treated as a nonseminoma. They are more likely to affect between teenage to early 40s. They grow and spread rapidly and possibly faster than seminomas.

    Types
    • Embryonal Carcinoma: Pure embryonal carcinomas occur only 3% to 4% of the time. This type of non-seminoma tends to grow rapidly and spread outside the testicle.
    • Yolk sac Carcinoma: This is the most common form of testicular cancer in children (especially in infants), but pure yolk sac carcinomas are rare in adults. When they occur in children, these tumors usually are treated successfully.
    • Choriocarcinoma: This is a very rare and aggressive type of Testicular Cancer in adults. Pure choriocarcinoma is likely to spread rapidly to distant organs of the body, including the lungs, bones, and brain.
    • Teratoma: Pure teratomas of the testicles are rare and do not increase AFP (alpha-fetoprotein)or HCG (human chorionic gonadotropin) levels. More often, teratomas are seen as parts of mixed germ cell tumors. They are further classified as:
      • Mature teratomas are tumors formed by cells similar to cells of adult tissues. They rarely spread to nearby tissues and distant parts of the body. They can usually be cured with surgery, but some come back (recur) after treatment.
      • Immature teratomas are less well-developed cancers with cells that look like those of an early embryo. This type is more likely than mature teratomas to grow into surrounding tissues, to spread outside the testicle, and recur years after treatment.
      • Teratomas with somatic type malignancy are very rare Cancers.

Occurrence Rate of Testicular Cancer in India

Testicular Cancer is a rare tumor type accounting for 1% of malignancies in men. India had the lowest incidence of 0.5 per 100,000 men. Testicular Cancer is increasing in incidence in many countries; however, mortality rates remain low and most men are cured. An in-depth understanding of the risks and long-term side effects of treatment are important in prognosis.

Anatomy of Testicular Cancer

Testicular CancerTesticular Cancer

What are the general symptoms of Testicular Cancer?

Detection of testicular cancer at an early stage is aided by the following symptoms:

  • A lump or enlargement in either testicle.
  • A feeling of heaviness in the scrotum.
  • A dull ache in the abdomen or groin.
  • A sudden collection of fluid in the scrotum.
  • Pain or discomfort in a testicle or the scrotum.
  • Enlargement or tenderness of the breasts.
  • Back pain.

What are the general causes of Testicular Cancer?

The exact causes of testicular cancer are yet not confirmed. However, there are a few factors that considerably increase the chances of getting the disease. Some of the risk factors are discussed below.

An undescended testicle (cryptorchidism):

The testicles usually develop inside the abdomen of the fetus and they descend into the scrotum before birth. Sometimes the testicle remains in the abdomen. In other cases, the testicle starts to descend but remains stuck in the groin area. Cryptorchidism with at least one testicle is found to the extent of 3% in prematurely born babies.

Undescended testicles continue moving down into the scrotum during the child’s first year of life. If the testicle has not descended by the time a child is a year old, it probably won’t go down on its own.

Males with cryptorchidism are several times more likely to get Testicular Cancer than those with normally descended testicles. In 90% of the cases, the undescended testis is confined to inguinal canal. It can be rectified through surgery.

Abnormal testicle development or Carcinoma in situ:

Carcinoma in situ (CIS) means that there are abnormal cells in the testicle. It isn't Cancer. There is no lump and usually no other symptoms.

These abnormal cells are completely contained. Unlike cancer cells, they can't spread, if left untreated CIS develops into cancer in about half (50%) the men who have it.

CIS is most often found when a man has a testicular biopsy to check for infertility. It can be treated by removing the testicle to prevent testicular cancer from developing.

Family history: If family members have had testicular cancer, you may have an increased risk.

Age: Testicular Cancer affects teens and younger men, particularly those between ages 20 and 35. However, it can occur at any age.

Race: Testicular Cancer is more common in white men than in black men. It is 4 to 5 times more in white man than that of black men or Asian-American men.

HIV or AIDS: Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk.

Injury to the testicles: Severe injury to the testicles can also cause Testicular Cancer.

Hypospadias: A congenital condition in males in which the opening of the urethra is on the underside of the penis.

Can Testicular Cancer be prevented?

Many cases ofTesticular Cancer have no known factors. Also, the known factors of Testicular Cancer are natural and beyond one’s control. So it becomes quite impossible to prevent most cases of Testicular Cancer.

Regular examination and treating cryptorchidism might reduce the chances of occurrence of Testicular Cancer.

What are the stages of Testicular Cancer?

Testicular Cancer can be staged as:

  • T refers to the spread of Cancer cells to tissues next to the testicle.
  • N describes the spread of Cancer cells to regional lymph nodes.
  • M indicates whether the Cancer has metastasized.
  • S indicates the serum levels of tumor markers that are made by some Testicular Cancers.

These stages are explained in details below:

T suffixed with a numerical or letter indicates the size and location of the tumor.

  • TX: The primary tumor cannot be assessed.
  • T0: There is no prominent evidence indicating a primary tumor.
  • Tis: Carcinoma in situ i.e. non-invasive cancer cells are detected in the testicles.
  • T1: The tumor has not spread beyond the testicle. The cancer might have grown through the inner layer surrounding the testicle, but it has not reached the outer layer covering the testicle.
  • T2: The cancer has spread to blood or lymph vessels near the tumor, or the tunica vaginalis.
  • T3: The tumor is growing into the spermatic cord which contains blood vessels, lymph vessels, nerves, and the vas deferens.
  • T4: The tumor is growing into the skin surrounding the testicles.

N stands for lymph nodes. Lymph is a fluid that flows from different tissues and organs of the body and eventually drains into the bloodstream. N indicated the size of the cancer cells and its size in the lymph node.

  • NX: Regional lymph nodes cannot be assessed.
  • N0: The mutated cells did not spread to regional lymph nodes.
  • N1: The Cancer has spread to at least one lymph node, but the size is limited to 2 cm.
  • N2: The Cancer has spread to at least one lymph node and the size ranges between 2 cm to 5 cm.
  • N3: The Cancer has spread to at least one lymph node that is larger than 5 cm.

M indicates if the cancer cells have spread to distant cells of the body.

  • MX: Distant metastasis cannot be evaluated.
  • M0: The disease has not metastasized to distant parts of the body.
  • M1: There is atleast 1 distant metastasis present in the body.
  • M1a: The tumor has metastasized to distant lymph nodes or to the lung.
  • M1b: The tumor has metastasized to other organs, such as the liver, brain, or bone.

S indicates the level of serum makers.

  • SX: Tumor marker levels are not available, or the tests have not been done.
  • S0: Tumor marker levels are normal.
  • S1: At least 1 tumor marker level is above normal.
  • S2: At least 1 tumor marker level is substantially above normal.
  • S3: 1 or more tumor marker level is very highly elevated.

Survival rates of Testicular Cancer?

Survival rates indicate an average outcome of a large number of people who had the disease, but they cannot precisely predict the expectancy of any particular case. Multiple factors may affect a person's outlook; however, the survival rate of testicular cancer is quite high.

Stage 5 year Survival Rate
Localized 99%
Regional 96%
Distant 73%

Here,

Localized means the cancer is still only in the testicle.

Regional means that the cancer has spread to nearby lymph nodes or tissues

Distant means that the cancer has spread to organs or lymph nodes away from the tumor.

Can Testicular Cancer be detected early?

  • Physical exam and history: The testicles are physically examined to check for lumps, swelling or pain. A history of the patient's health habits, past illnesses and treatments are also taken in account.
  • Ultrasound exam: High-energy sound waves are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Serum tumor marker test: It is a procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. The following tumor markers are used to detect Testicular Cancer:
    • Alpha-fetoprotein (AFP).
    • Beta-human chorionic gonadotropin (β-hCG).
  • Inguinal orchiectomy: A tissue sample from the testicle is then viewed under a microscope to check for cancer cells. If cancer is found, the cell type seminoma or nonseminoma is determined in order to help plan treatment.
  • Biopsy: Biopsy is the removal of a small amount of tissue for examination under a microscope.

What are the Treatments available?

Depending on the type, stage of the cancer and other factors, treatment options for testicular cancer can include

  • Surgery
    • Surgery to remove the complete testicles is the primary treatment option for nearly all stages and types of testicular cancer. An incision in the groin is made and the entire testicle is extracted through the opening.
    • Surgery to remove nearby lymph nodes: An incision is made in the abdomen. Generally, extensive care is taken to avoid damaging nerves surrounding the lymph nodes but in some cases, it might be unavoidable.
  • Radiation therapy: Radiation therapy uses high-powered energy beams, such as gamma rays or X-rays, to kill Cancer cells. However, radiation therapy has got a few side effects as well that may include fatigue, as well as skin redness and irritation in your abdominal and groin areas. Radiation therapy is also likely to cause infertility.
  • Chemotherapy (chemo): 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. Chemotherapy is also likely to cause infertility, which can be permanent.
  • High-dose chemotherapy and stem cell transplant: A stem cell transplant is a highly effective treatment for Testicular Cancer.

Is there curative treatment for Testicular Cancer?

Testicular Cancer is highly treatable, even when cancer has spread beyond the testicle. The most common method to treat Testicular Cancer is through surgery.

How frequently should one visit doctor for early diagnosis?

In case of experiencing any of the mentioned symptoms or having a prior or familial history of testicular cancer, a physical examination by a doctor is highly recommended.

How can I as a patient know it early?

Being aware of the signs and symptoms will definitely help a patient to suspect the disease. In some cases, 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.

Acute Lymphoblastic Leukemia Cancer

What is Acute Lymphoblastic Leukemia Cancer?

Leukemia

Leukemia is a type of cancer that originates in cells that would normally mature to form different types of blood cells. Depending on the pace of growth leukemia can be categorized into – acute leukemia or chronic leukemia.

If cancerous cells build up in the blasts cells rapidly filling the marrow and interfering with normal functions then it is called as acute leukemia. Acute leukemia is a fast-growing cancer that usually gets worse quickly and it demands fast and aggressive treatment.

Chronic leukemia occurs in more mature lymphoid or myeloid cells. The irregular cells build up in the bone marrows over a period of years, interrupting the production of normal blood cells and spreading to other parts of the body.

Acute Lymphoblastic Leukemia

Also called acute lymphocytic leukemia or acute lymphoid leukemia, ALL is a condition in which the bone marrow makes too many immature lymphocytes. It is a cancer of the bone marrow and young white blood cells which if not treated on time, can progress rapidly.

Bone Marrow

Bone marrow constitutes the soft inner part of some specific bones such as the bones in the skull, shoulder blades, ribs, pelvic bones, and backbones.

In the bone marrow, blood stem cells develop to become mature blood cells. A blood stem cell may either become a myeloid stem cell or it may turn out to be a lymphoid stem cell.

The myeloid stem cell may produce any of the three blood cells viz.–

  • Red Blood Cell that carries Oxygen,
  • White Blood Cells that fights infection
  • Platelets play a crucial part in clotting of blood to stop bleeding.

A lymphoid stem cell becomes a lymphoblast cell which may then become one of three types of lymphocytes (white blood cells), viz.

  • B lymphocytes make antibodies to help fight infection,
  • T lymphocytes assist the B lymphocytes in making the antibodies.
  • Natural killer cells that attack cancer cells and viruses.

What happens in Acute Lymphoblastic Leukemia?

Acute lymphoblastic leukemia is a malignant disease of the bone marrow in which immature lymphoblasts or lymphocytes proliferate rapidly replacing the healthy cells of the marrow.

In Acute Lymphoblastic Leukemia, too many stem cells become lymphoblasts thus producing excess of B lymphocytes or T lymphocytes. These leukemic cells are immature and are not apt in their functionalities, i.e. they fail to make antibodies and fight infections. As the number of leukemic cells increase in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets, which may lead to infection, anemia, and easy bleeding.

These leukaemia cells gradually invade the blood and can further spill throughout the body to distant organs, like liver, spleen, central nervous system, testicles or the lymph nodes. Usually, ALL does not produce tumors. It’s the percentage of immature cells in the marrow which is used to classify the stages.

Types of ALL

Acute lymphoblastic leukemia is sub-typed into two broad categories –

  • B-cell ALL
  • T-cell ALL.

They are further categorized as:

  • Acute B-lymphoblastic leukemia: B-cell ALL makes one prone to infections, as the B lymphocytes are responsible for immunity of the body.
  • Acute precursor B-cell leukemia: It is a form of ALL in which a large number of B-cell lymphoblasts are crowded in the blood and bone marrow.
  • Philadelphia-positive ALL (Ph+ ALL): It occurs due to a mutation in genetic code that fuses two genes together. This BCR-ABL gene, also known as the Philadelphia Chromosome, can cause the white blood cells to become cancerous.
  • Acute T-lymphoblastic leukemia: It affects the lymphoid-cell-producing stem cells, a type of white blood cell called T lymphocytes
  • Natural killer (NK) cell leukemia: It is a rare neoplasm of mature natural killer cells, with an extremely poor survival rate.

According to World Health Organisation (WHO) system, ALL is sub-typed based on the type of lymphocyte (white blood cell). This aids in planning the treatment and predicting the prognosis. There are three different subtypes:

  • Pre (precursor) B cell ALL: This is the most common type of ALL found in adults.
  • Mature B cell ALL: Also called Burkitt type ALL, this occurs due to particular genetic changes.
  • Pre (precursor) T cell ALL: This is more likely to affect young adults and men.

Occurrence Rate of ALL:

Acute lymphoblastic leukemia is the most common pediatric malignancy accounting for 25% of overall childhood cancer and 75% of leukemia cancers. Though ALL can occur at any age, they are mostly found in children under the age of 15 or in adults over the age of 45. The risk of developing ALL is highest in children below the age of 5. The risk then declines in the mid-20s, and raises again after the age of 50.

In India, leukemia is the most common childhood cancer with relative proportion varying between 25 - 40%. Out of this, 60 - 85% of cases reported falls under acute lymphoblastic leukemia type.

The worldwide incidence rate of ALL is reported to be ~ 1 – 4.75/100,000 individuals with a male : female prevalence of roughly 1•3:1. In spite of significant progress made in the treatment of ALL, the adult survival rate is poorer (35% long term survival) against an overall survival of 80% at 5 years. (Bassan and Hoelzer 2011)

Anatomy of Acute Lymphoblastic Leukemia Cancer

Acute Lymphoblastic Leukemia

Acute Lymphoblastic Leukemia

What are the general symptoms of Acute Lymphoblastic Leukemia Cancer?

Most of the symptoms of acute lymphoblastic leukemia are caused due to the shortage of healthy blood cells. Acute Lymphoblastic Leukemia can cause a variety of symptoms depending on the type of cells and the spread of the disease:

  • Frequent infections or fever: As the number of healthy white blood cells declines the body’s immunity system starts breaking down. This results in regular invasion by pathogens causing frequent sickness.
  • Anaemia: It is a condition referring to a lower number of red blood cells which causes weakness, fatigue and shortness of breath. Symptoms of anaemia, such as pallor, fatigue, dizziness, palpitations, etc are also reported in some cases.
  • Bruising or bleeding easily: Inadequate number of red blood cells and platelets causes easy bleeding and bruising. Most often bleeding of gums while brushing can be witnessed.
  • Thrombocytopenia: Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes (platelets) in the blood. The low level of thrombocytes prevents clotting which results in heavy bleeding.
  • Neutropenia: It is a condition caused by low number of white cells and the immune system fails to protect the body against infection due to a lack of neutrophils (a type of white cell).
  • Pancytopenia: Low numbers of all three blood cell viz. red blood cells, white blood cells, and platelets is called pancytopenia.
  • Swelling and pain in joints: Too many abnormal white blood cells accumulating in the bones, joints or lymph glands may cause pain and swelling.
  • Breathlessness and dizziness: Lack of red blood cells may cause breathlessness.
  • Weakness, fatigue and unaccounted weight loss: Low count of red blood cells result in fatigue, weakness of the body and unaccounted weight loss.
  • Feeling cold: Blood cells play an important role in maintaining body’s temperature. Low functional blood cells result in coldness.
  • Skin Problems: The patient may suffer from pale skin and rashes from skin infiltration with leukemic cells. Black-and-blue marks (bruises) may appear on the skin without any apparent reason. Pinhead-size red spots under the skin (called petechiae) could also be spotted in some cases.

Signs of childhood ALL:

ALL is more common among children below the age of 5. The following signs and symptoms may suggest possibility of childhood ALL and visiting a doctor for an early diagnosis or to rule out the possibility is indicated.

  • Loss of appetite.
  • Easy bruising or bleeding.
  • Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding).
  • Bone or joint pain
  • Fever.
  • Painless lumps in the neck, underarm, stomach, or groin.
  • Pain or feeling of fullness below the ribs.
  • Weakness, fatigue, or pale look.

Other potential signs and symptoms of ALL may include:

  • Night sweats
  • Light-headedness
  • Aches in the arms, legs or hips
  • Nosebleeds
  • small dark red spots on your skin
  • Heavy periods or blood in urine

Depending upon the location of the leukemia cells other symptoms may include:

  • Swollen belly from leukemia cells in the liver or spleen
  • Enlarged lymph nodes such as in the neck or groin, underarms, or above the collarbone
  • Headache, vomiting, seizures, or poor eyesight problems are also reported in cases where the cancer cells have spread to the brain

Though experiencing one or more of these symptoms do not ascertain that one is suffering from acute lymphoblastic leukemia, yet visiting a doctor and getting the tests done would elucidate the root cause of these symptoms thus leading to proper diagnosis, treatment and better outcome.

What are the general causes of Acute Lymphoblastic Leukemia Cancer?

The exact causes of Acute Lymphoblastic Leukemia are still under scrutinization; however, ALL is typically associated with having more B lymphatic cells than T cells. B cells help prevent germs from infecting the body while T cells destroy the infected cells. B cells respond to pathogens by producing large quantities of antibodies which neutralize invading microorganisms like bacteria and viruses. In response to pathogens some T cells, called T helper cells, produce cytokines that direct the immune response, while other T cells, called cytotoxic T cells, produce toxic granules that contain powerful enzymes which induce the death of pathogen-infected cells.

ALL results from a genetic mutation to the DNA of a developing stem cell in the bone marrow. The damaged cell becomes a leukemic cell and multiplies uncontrollably into billions of cells called leukemic lymphoblasts. The leukemic lymphoblasts grow rapidly but fail to function normally and block the production of normal cells.

What are the risk factors for Acute Lymphoblastic Leukemia?

There are a few known risk factors associated with Acute Lymphoblastic Leukemia that may increase the chances of getting this disease. But it is not yet known whether these risk factors are actual causes of the disease. Risk factors associated with the disease include:

  • Radiation exposure: Exposure to very high doses of radiation either accidentally (nuclear accident) or therapeutically (to treat other cancers).
  • Chemical Exposure: Exposure to chemicals like benzene, smoking and other tobacco use, or certain types of drugs used to treat other types of cancer, exposure to certain cleaning products, detergents, and paints that contain ammonia or carcinogenic ingredients may increase the risk of developing ALL.
  • Gender: Males are more prone to ALL than females.
  • Genetic disorders: Although ALL does not appear to be an inherited disease, some genetic disorders, such as Down syndrome, neurofibromatosis, Klinefelter syndrome, Fanconi anemia, Schwachman syndrome, Bloom syndrome and ataxia telangiectasia are considered to be ALL risk factors.
  • Family history: Children with parents diagnosed with leukemia were reported to have a similar risk of ALL as that of general population. A higher risk of ALL is observed among children with affected siblings.

Can Acute Lymphoblastic Leukemia Cancer be prevented?

Since there are no known controllable risk factors except exposure to radiation and chemicals. Hence, there is no known way to prevent the naturally occurring cases of ALL.

What are the stages of Acute Lymphoblastic Leukemia Cancer?

The general approach to stage cancer is by using a standardized numbered staging system. The stage of a cancer describes the size of the tumor, spread of the disease and its relative possibility of getting cured. Staging is essential for determining the optimal treatment option.

However, in case of Acute Lymphoblastic Leukemia, this conventional method of staging does not work, as the disease originates within the bone marrow and spreads rapidly to other organs usually without the trace of any tumor. So, staging of ALL is mainly determined by the considering the subtype of ALL, percentage of leukemic cells in the bone marrow and the age of the patient.

Staging of ALL usually involves several tests to identify the subtype of ALL. Some of the approved staging systems are described below:

ALL classification based on immunophenotype

Immunophenotyping is a way to classify ALL based on the type of lymphocyte (T cell or B cell), and the maturity of the cells. The staging is elaborated below:

B-cell ALL staging

B cells originate and mature inside the bone marrow. B cells play a key role in coordinating humoral immune response and developing antibodies against antigens that later turns into memory B cells after they have been activated by antigen interaction.

  • Early pre-B ALL: It accounts to approximately 10% of ALL cases.
  • Common ALL: 50% of ALL cases are staged in this category
  • Pre-B ALL: About 10% of cases
  • Mature B-cell ALL: It constitutes about 4% of ALL cases.

T-cell ALL staging

T cells originate in the bone marrow but mature in the thymus. They are responsible for cell-mediated immunity. There are several different subsets of T cells including Helper, Cytotoxic, Memory, Regulatory, Natural killer and Gamma Delta T cells. T- cell ALL staging is done as:

  • Pre-T ALL: Accounting for about 5 - 10 % of cases
  • Mature T-cell ALL: About 15 - 20 % of cases belong to this category.

Survival rates of Acute Lymphoblastic Leukemia Cancer?

Mortality rates for Acute Lymphoblastic Leukemia are higher in the elderly than in children. For most cases, treatment works well to cure ALL. The survival rate gives a fair idea of the number of patients who were treated successfully; however, these rates cannot predict the outcome of any particular patient as the outlook varies largely on the basis of subtype of ALL, overall health condition, age and several other factors.

Here is the 5 year survival rate statistics based on the age groups of the patients:

Age group 5 year Survival Rate
14 or less 90%
15-24 years 40%
65 and above 15%

Can Acute Lymphoblastic Leukemia Cancer be detected early?

Diagnosis is identifying and understanding the nature of the disease. Based on the findings such as age of the patient, stage of the disease, other cytogenetic parameters and primary response or relapse the doctors would design the optimum therapy. These have a reflection on the Prognosis or the outcome of therapy.

Early diagnosis of cancer makes the treatment easier and has a better outlook. However, for most types of cancer early diagnosis turns out to be a bit tricky as the cancer may not give out any sign or symptom till it reaches a pressing stage where it starts impacting the functionality of one of more organs. So, it is advised to go for regular screening tests for early detection of some cancers even when there are no prominent symptoms.

In case of Acute Lymphoblastic Leukemia the scenario is a bit different. Currently, there are no special tests that could ascertain its early detection. As the name suggests, it is acute which means the cancer cells have a tendency to spread out at a very fast pace. The best way to find leukemia early is to report any possible signs or symptoms immediately. People having a higher risk of ALL should be more alert and vigilant and should go for regular medical checkups.

Some of the general tests that are conducted to detect leukemic cells are discussed below:

Physical Examination and Medical History: This is the first step of diagnosing leukemia. The patient may visit for a regular health check up or to consult regarding the symptoms of the disease. During the physical examination, the overall health record of the patient is taken into account and any sign of unusual swollen glands or lumps is checked. If the person appears pale or complains about any of the mentioned symptoms then the doctor suspects leukemia.

Blood Tests: Since leukaemia is the cancer of the blood, a blood test can be helpful in getting a lot of information. Blood test is done to check the following parameters:

A complete blood count gives the following details:

  • The amount of hemoglobin.
  • The number of red blood cells.
  • The portion of the sample made up of red blood cells.
  • The number and type of white blood cells.
  • The number of Platelets.

Usually, patients with ALL show lower red blood cells and platelets.

  • Blood Chemistry: Oncologists may ask for some tests such as lipid profile as it has been shown to be abnormal in Childhood ALL patients.
  • A peripheral blood smear examines the cells within the blood and checks the number of immature white cells. The blood smear sample can also be used for
    • Cytogenetic analysis, which identifies certain changes in the number and size of chromosomes within cells.
    • Immunophenotyping: identifies antigens or markers on the surface of a blood or bone marrow cell. The cells are also checked to confirm if the lymphocytes or myeloid are involved in malignancy and their subtype e.g. B lymphocytes or T lymphocytes.

Bone Marrow Tests

Bone marrow tests are helpful in confirming the presence of ALL along with giving details like the subtype and stage of ALL. It is done by inserting a hollow needle into the hipbone or breastbone that is done in two steps:

  • A bone marrow aspiration to remove a liquid marrow sample
  • A bone marrow biopsy to remove a small amount of bone filled with marrow

The extracted sample is checked under a powerful microscope to look for signs of cancer such as presence or absence of Philadelphia Chromosome.

Lymph node biopsy

Removing a lymph node or part of a lymph node is often done to help diagnose lymphomas, but this is rarely done in case of suspected ALL as the diagnosis is usually made looking at blood and bone marrow. Imaging tests

As leukemia does not form tumors, imaging tests aren’t as useful as they are for other types of cancer. However, imaging tests like CT scan, X- ray, MRI may be performed to detect infections or other problems, rather than for the leukemia itself. These imaging tests may use radioactive particles to highlight the spread of cancer cells. Imaging tests also give a fair idea of the extent of the disease.

Lumbar puncture

Spinal fluid may be withdrawn for checking presence of leukemia cells under microscope for spread of malignancy in the Cerebro-spinal fluid.

How is the treatment planned?

In case of childhood ALL the following parameters are considered to predict the response to the designed treatment.

  • The number of white blood cells in the blood at the time of diagnosis.
  • Age at the time of diagnosis, weight at diagnosis and during treatment, sex, race, and ethnic background of the patient.
  • Quicker or slower reduction in leukemic cell number after initiation of therapy.
  • Type of leukemia e.g. B lymphocyte or T lymphocyte Leukemia.
  • Presence or absence of Philadelphia Chromosome.
  • Whether the child has Down syndrome.
  • Whether leukemia cells are found in the cerebrospinal fluid.

Apart from the above factors, treatment options also depend on:

  • Whether it is a standard-risk, high-risk or very high–risk ALL.
  • Prior steroids therapy at induction therapy.
  • How quickly and how low the leukemia cell count drops during treatment.

What are the Treatments available?

The treatment of ALL mainly focuses on:

    • Killing leukemia cells
    • Returning blood counts to normal
    • Ridding the body of any signs of the disease

The treatment of childhood ALL usually has three phases. The fourth phase is CNS Directed therapy to prevent metastases to brain.

  • Intensive/Remission Phase: This is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
  • Consolidation /intensification: This is the second phase of treatment. It begins once the leukemia is in remission. It aims to kill any leukemia cells present in the body and may cause a relapse.
  • Maintenance: The third phase of treatment aims at killing any remaining leukemia cells that may re-grow and cause a relapse. Often the doses are lowered in this phase than used during the remission induction and consolidation phases.
  • CNS Directed Therapy is used to prevent metastases to the brain

Some of the most common treatment approach for ALL includes:

Induction Therapy:

Induction therapy is done to achieve remission, which means treating the patients by addressing all signs and symptoms related to ALL. Remission allows normal marrow cells to develop and the patient’s blood counts to return to normal levels. Generally, if blast cells are still evident after the first course of induction chemotherapy, a second course of chemotherapy, using different drugs, is given. Induction therapy is usually done over four to six weeks.

  • Chemotherapy: As in ALL the leukemic cells show rapid growth, most patients need to start chemotherapy soon after diagnosis. Chemotherapy is the process of using anticancer drugs to control the growth of cancer cells. Thses drugs can be either consumed orally or may be injected directly into the viens. Some of the chemotherapeutic drugs used for treatment of ALL are:
    • cyclophosphamide
    • cytarabine
    • daunorubicin or doxorubicin
    • etoposide
    • L-asparaginace or PEG-L-asapraginase
    • 6-mercaptopurine
    • methotrexate
    • methoterate oral / methotrexate
    • steroids
    • teniposide
    • vincristine
  • Targeted therapy: Targeted therapy refers to the use of drugs that target specific parts of cancer cells and tend to have less severe side effects. They can be used instead of or along with chemo in some situations. Some examples of targeted drugs are alemtuzumab and rituximab.
  • Radiation therapy: This involves the use of high-energy radiation to kill cancer cells.
  • A bone marrow transplant: This involves use of high doses of chemotherapy and radiation followed by a transplant of bone-forming stem cells. Stem cells usually come from a donor, or less likely, from your own bone marrow or peripheral blood.

Post remission Therapy

Once the induction therapy is completed, there should be no signs of leukemic cells in the body. However, further treatment is usually conducted to make sure that ALL does not recur.

Post-remission therapy consists of intensification therapy and maintenance therapy.

  • Consolidation therapy is usually given in cycles for four to six months.
  • Maintenance therapy is usually given for about two years.

Central Nervous System Prophylaxis

The ALL cells may have spread to the lining of the spinal cord and brain. A spinal tap is used to check the spinal fluid for ALL cells.

Allogeneic Stem Cell Transplantation

Allogeneic stem cell transplantation involves transferring stem cells from a healthy person (the donor) to the patient. The procedure follows high-intensity chemotherapy, potent drugs that must be toxic enough to kill leukemic cells.

The goals of an allogeneic transplant are to:

  • Restore the body’s ability to make normal blood cells after high-dose chemotherapy
  • Cure the patient of his or her ALL by killing any remaining ALL cells.

Reduced-Intensity Allogeneic Stem Cell Transplantation

A reduced-intensity allogeneic transplant uses lower doses of chemotherapy than a standard allogeneic transplant; it does not completely inactivate the patient’s immune system or treat the ALL as aggressively. This is beneficial for older and sicker patients.

Autologous Stem Cell Transplantation

An autologous transplant uses the patient’s own stem cells. It is not commonly used to treat ALL because of the high relapse rate.

Early diagnosis followed by well planned therapy improves chances of successful outcome. However, like other cancers sometimes the leukemic cells do not respond to the therapy. Such naturally resistant cancer is described as Refractory.

What are the adverse effects of treatment?

The treatment for ALL, involves some high intensity procedures such as stem cell transplant, chemotherapies and radiations to kill the leukemic cells and inhibit their growth. These medicines and radiations may result in several side effects. It is important to report any such side effect immediately.

ALL affects the ability of the bone marrow to produce adequate numbers of blood cells and platelets, and chemotherapy reduces this ability even further. Blood counts generally fall within a week of treatment and may take some time to recover, depending on the type and doses of drugs used. During this time, there is likely to be a need for antibiotics and other drugs to treat, or prevent infection. There is also likely to be a need for blood transfusions to treat severe anaemia, and platelet transfusions to reduce the risk of bleeding.

Other possible side-effects of chemotherapy include:

  • Feeling sick - nausea and/or vomiting.
  • Fatigue and constant weakness.
  • hair loss and thinning
  • mouth problems such as mucositis or ulcers
  • diarrhoea or constipation
  • skin problems such as dryness, rash or sensitivity to sunlight
  • fertility problems

Side-effects of steroids depend largely on how long they are used for, and the dose. Short-term use may cause increased appetite, restlessness or difficulty sleeping. Longer-term use may lead to fluid retention, raised blood sugars and increased susceptibility to infections.

What is the possibility of recurrence of ALL?

There is likelihood of recurrence of cancer after a period of time. This is called Relapse. It may happen in the blood and bone marrow, brain, spinal cord, testicles, or other parts of the body. In case of ALL, there is a risk of the leukemic cells entering the cerebro-spinal fluid further leading to brain metastases.

Is there a curative treatment for ALL?

Childhood ALL is a curable disease, aggressive therapy is planned to prevent metastases to testes and bone marrow, which are difficult to treat while that to brain is almost fatal. Hence the treatment protocol incorporates special CNS directed therapy to prevent brain metastases.

How frequently should one visit doctor for early diagnosis?

Going for regular checkups and being attentive to even the slightest of health hazards may prove to be a life saving habit.

Acute Myeloid Leukemia Cancer

What is Acute Myeloid Leukemia Cancer?

Leukemia

Leukemia is a type of cancer that originates in cells that would normally mature to form different types of blood cells.

Acute Myeloid Leukemia

Also known as acute myelocytic leukemia or acute myelogenous leukemia, AML is a cancer of blood and bone marrow. As the name suggests, it is acute which indicates that this leukemia can progress rapidly if left untreated.

AML is caused by acquired oncogenic mutations that impede the normal differentiation process of the blood cells. The accumulation of these immature blast forms suppress the formation of normal hematopoiesis which results in bone marrow failure and complications like anaemia, thrombocytopenia and neutropenia.

Bone Marrow

Bone marrow constitutes the soft inner part of some specific bones such as the bones in the skull, shoulder blades, ribs, pelvic bones, and backbones. The bone marrow is accountable for generating of new blood cells.

Inside the bone marrow, blood stem cells maturate into different types of new blood cells. During this process, the cells may become either lymphocytes (a kind of white blood cell), red blood cells, white blood cells (other than lymphocytes), or platelets.

What happens in Acute Myeloid Leukemia?

In healthy conditions, stem cells produce myeloblasts that mature into different type of blood cells but in Acute Myeloid Leukemia, the myeloid stem cells do not form mature blood cells rather they develop into a type of immature white blood cell called myeloblasts. These immature myeloblasts cannot form healthy white blood cells rather they grow abnormally and clog the bone marrow thus hindering the production of healthy blood cells. Most cases of AML develop from cells that would turn into white blood cells (other than lymphocytes), but some cases of AML develop in other types of blood-forming cells including red blood cells, or platelet-making cells (megakaryocytes).

Also, the cancer cells can travel in the bloodstream and further spread to distant organs, where they begin to form tumor in other parts of the body including the lymph nodes, liver, spleen, central nervous system, and testicles. Due to their immaturity, they are unable to function properly to prevent or fight infection. Inadequate numbers of red cells and platelets being made by the marrow results in several health hazards like anemia, and easy bleeding and/or bruising.

Types of Acute Myeloid Leukemia

AML has eight different subtypes classified on the basis of:

  • Degree of differentiation.
  • Lineage of the leukemic blasts

The subtypes of acute myelogenous leukemia include:

  • M0, M1 and M2: These are myeloblastic leukaemia and accounts up to almost 50% of all cases.
  • M3: In M3, numerous auer rods are seen in the cytoplasm. M3 leukemia is also called acute promyelocytic leukaemia and it accounts for 10% cases of AML.
  • M4 and M4eos: These are myelomonocytic leukaemia and accounts for 25% of AML.
  • M5: M5 or monocytic leukaemia is characterized by gum infiltration and makes up 10% of cases.
  • M6:This is erythro leukaemia and its occurrence is very rare.
  • M7: This is also called megakaryoblastic leukaemia and this is also very rare subtype.

Occurrence Rate of Acute Myeloid Leukemia

AML is the most chronic type of blood cancers in adults, but it can also affect children. It is more common among older people and is rarely encountered before the age of 45. The average age of a patient with AML is about 67 years. AML is slightly more common among men than among women, but the average lifetime risk in both sexes is less than 0.5%.

Anatomy of Acute Myeloid Leukemia Cancer

Acute Myeloid Leukemia

Acute Myeloid Leukemia

What are the general symptoms of Acute Myeloid Leukemia Cancer?

At the early stages, leukemia hardly shows any signs or symptoms. But as it progresses rapidly, the deficiency of healthy blood cells results in several health issues. The symptoms are generally related to the deficiency of a particular blood cell.

Symptoms related to deficiency in red blood cell

Red blood cells are responsible for transporting oxygen and removing carbon dioxide from the body. A shortage of red blood cells results in a lowered level of oxygen in the body which may cause:

  • Persistent fatigue
  • Dizziness or lightheaded
  • Headaches
  • Breathlessness

Symptoms due to low white blood cell

White blood cells are responsible for maintaining immunity and fighting infections, so a lowered count in WBC causes:

  • Frequent Infections
  • Lowered Immunity
  • Persistent sickness

Symptoms from low blood platelet counts

Platelets in the blood are responsible for clumping and clotting blood vessel injuries and preventing excess bleeding. A shortage of blood platelets can lead to:

  • Excess bruising and bleeding
  • Frequent or severe nosebleeds
  • Bleeding gums
  • Heavy menstruation bleeding
  • Blood in stools or urine
  • red, purple, or brown bruises called “purpura”
  • rashes with small red or purple dots called “petechiae”

Symptoms caused by high numbers of leukemia cells

The rapidly forming blast cells clog up the bone marrow and hinder the production of healthy functional blood cells. This condition is termed as leukostasis. Some of the symptoms related to leukostatis are:

  • Severe headache
  • Weakness
  • Slurred speech
  • Confusion
  • Bone or joint pain
  • Sleepiness
  • Shortness of breath
  • Blurry or loss of vision

Though experiencing one or more of these symptoms do not ascertain that one is suffering from acute myeloid leukemia, yet visiting a doctor and getting the tests done would elucidate the root cause of these indications.

What are the general causes of Acute Myeloid Leukemia Cancer?

For most cases of AML, the exact causes could not be traced. However, AML is thought to be linked with a gene mutation in the blood developing cells in the bone marrow. This mutation of genes interferes with the healthy production of blood cells and results in abnormal growth of immature blood cells that develop into leukemic white blood cells called myeloblasts. These leukemic cells are incapable of functioning as the healthy blood cells. This rapid production of immature blood cells crowd out the healthy cells resulting in leukemia.

It is yet under scrutinization as to what causes this DNA mutation. Throughout these years of study and research, it has been concluded that certain factors like radiations, tobacco, exposure to certain chemicals increase the risk of developing AML.

Can Acute Myeloid Leukemia be prevented?

Since the exact causatives of AML are not yet clear, so stating the precautions becomes a bit tricky. However, controlling the known risk factors is believed to provide some shielding to AML.

  • Quitting smoking helps in preventing AML as it is the most significant controllable risk factor of AML.
  • Avoiding known cancer-causing chemicals, such as benzene, can lower the risk of getting AML.
  • Taking precautions against exposure to workplace and environmental chemicals.
  • In case, if one is at a risk due to familial or health conditions, it is advised to go for regular screenings to facilitate early detection and cure against AML.

What are the stages of Acute Myeloid Leukemia Cancer?

The general approach to stage cancer is by using a standardized numbered staging system. The stage of cancer describes the size of the tumor, the spread of the disease and its relative possibility of getting cured. Staging is essential for determining the most viable treatment option and the prognosis of the same.

However, in case of Acute Myeloid Leukemia, this conventional method of staging does not work, as the disease originates within the bone marrow and spreads rapidly to other organs usually without the trace of any tumor. There is no standard staging system for AML. It is rather categorized as untreated, in remission, or recurrent.

Untreated AML

This stage is assigned for newly diagnosed AML. The leukemic cells are not yet treated except to relieve signs and symptoms such as fever, bleeding, or pain. At this stage the following conditions are checked:

  • The complete blood count is abnormal
  • At least 20% blast cells are found in the bone marrow
  • No prominent sign or symptom of leukemia is reported.

In Remission:

At this stage, treatment for leukemia has already began but it is not completely cured yet. Following conditions are checked:

    • The complete blood count has been restored to normal.
    • The percent of blast cells in the bone marrow has reduced to less than 5%.
    • There are no signs or symptoms of leukemia in the brain and spinal cord or elsewhere in the body.

Recurrent AML:

Recurrent AML indicates that the leukemic cells have reappeared in the bone marrow after it has been treated completely once.

Survival rates of Acute Myeloid Leukemia Cancer?

As already mentioned, age is a risk factor for AML, so the mortality rates are also higher in the elderly than in children. For most cases of early detection, treatment works well to cure AML. However, there are several factors that play a major role in determining the prognosis and outlook for a particular patient.

Without treatment, most patients with acute leukemia would live only a few months. Some types of AML may respond well to treatment and can be cured. The survival rate gives a general idea of the number of patients who were treated successfully in the past; but they cannot predict the outcome of any particular patient. Here is the 5 year survival rate statistics based on the age groups of the patients:

Age Group 5 year Survival Rate
less than 14 years 65%
15-24 years 60%
25-64 years 40%
Over 65 years 5%

What affects the outlook of AML?

The outlook for AML patients depends largely on several factors like type of AML, spread of the disease, other health conditions and response to treatment. What may work for one may not necessarily bring the same results for another. As each body is unique so is its response to treatment. Here are some of the key factors that impact the outlook for AML:

  • Age: AML is more severe in case of older patients and younger people have a better prognosis.
  • Gene alteration: Some specific genetic abnormalities in the leukaemia cells may make the treatment harder and the prognosis poor.
  • Stage of Leukemia: As with any other cancer, even in AML the earlier it is detected the better is the chances of recovery. As AML is a rapid cancer which means it spreads fast to the bloodstream and eventually to other organs, earlier detection and treatment aids in curing and inhibiting its spread to distant organs.
  • Response to treatment: As it is already mentioned the general health conditions of a patient determines his or her response to a specific treatment and the time taken for remission of leukemic cells. Remission means there are no more active leukemic cells in the bone marrow

Can Acute Myeloid Leukemia be detected early?

AML do not show any prominent sign or symptom at the earlier stages or until it has spread enough to cause health hazard, it is often possible that AML goes unnoticed.

However, going for regular health check-ups and screenings and reporting any symptom to the health care aids in early detection of AML. In case, AML is suspected following tests and procedures might be recommended:

Physical Examination and Medical History: This is the first step of diagnosing leukemia. The patient may visit for a regular health check-up or to consult regarding the symptoms of the disease. During the physical examination, the overall health record of the patient is taken into account. If the person complains about any of the mentioned symptoms then the doctor suspects leukemia

Blood Tests: Since leukaemia is the cancer of the blood, a blood test can be helpful in getting a lot of information. Blood test is done to check the following parameters:

  • A complete blood count showing the number of red cells, white cells and platelets is done.
  • A peripheral blood smear examines the cells within the blood and checks the number of immature white cells. The blood smear sample can also be used for
    • Cytogenetic analysis, which identifies certain changes in the number and size of chromosomes within cells.
    • Immunophenotyping: This is done to identify cells based on the types of antigensor markers on the surface of the cell.. E.g."Flow cytometry".

Bone marrow test: A blood test can suggest leukemia, but a bone marrow test is conducted to confirm the diagnosis. During a bone marrow biopsy, a sample of bone marrow usually from the hipbone is removed using a needle and is tested for leukemic cells. Bone marrow testing involves two steps:

  • A bone marrow aspiration to remove a liquid marrow sample
  • A bone marrow biopsy to remove a small amount of bone filled with marrow

Genomic testing: These tests are conducted to identify specific genes, chromosome changes, and other issues unique to leukemia and to find any genetic changes or mutations. This test helps in determining the prognosis.

Once AML has been diagnosed, several tests are done to determine the stage and spread the disease. The following tests are generally conducted to determine the spread of leukemia:

  • Lumbar puncture : In this procedure, a sample of cerebrospinal fluid (CSF) is collected from the spinal column which is then checked under a powerful microscope for determining if leukemic cells have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap.
  • Imaging Tests: As leukemia does not form tumors, imaging tests aren’t as useful as they are for other types of cancer. However, imaging tests like CT scan, X- ray, MRI may be performed to detect infections or other problems, rather than for the leukemia itself. These imaging tests may use radioactive particles to highlight the spread of cancer cells. Imaging tests also give a fair idea of the extent of the disease.

What are the Treatments available?

The treatment of AML mainly focuses on:

    • Killing leukemia cells
    • Returning blood counts to normal
    • Ridding the body of any signs of the disease

Treatment needs to begin soon after AML is diagnosed, as it progresses very quickly. The type of treatment used will depend on a number of factors including the sub-type of AML, the genetic make-up of the leukaemic cells, general health and age.

Chemotherapy

  • Remission induction therapy. The first phase of treatment i.e. remission induction is focused to kill the leukemia cells. However, it is not the full proof option to wipe out all of the leukemia cells. So further treatment is required to prevent the disease from returning.
  • Consolidation therapy. This is the post-remission therapy that is aimed at destroying the left over leukemia cells. It begins once the induction therapy is complete. The goal of post-remission therapy is to kill any remaining leukemia cells that may not be active but may re-grow and cause a relapse.
  • Targeted therapy: Targeted therapy refers to the use of drugs that target specific parts of cancer cells and tend to have less severe side effects. Monoclonal antibody therapy stops the action of an enzyme within the leukemia cells and causes the cells to die. Some of the widely used drugs for targeted therapies include :
    • Midostaurin: It blocks FLT3 and other proteins on cancer cells to starve off the cancerous cells.
    • Enasidenib: It is targeted to block IDH2 protein on leukemia cells and help the leukemia cells mature into more normal cells. It is also known as a differentiation agent.
    • Gemtuzumab ozogamicin: The antibody attaches to protein called CD33 and directs the chemo drugs towards the leukemia cells. The chemo drug then penetrates into the cancerous cells and kills them.
  • Bone marrow transplant. Also called stem cell transplant it aids in re-establishing healthy stem cells. Stem cells are removed from the blood or bone marrow of the patient or a donor and is infused once remission is completed. These re-infused stem cells are healthy and functional cells that grows into the body's blood cells.
  • Radiation therapy: Radiation therapy is the use of high-energy x-ray beams to kill cancer cells or inhibit its growth. Though Radiation therapy is not a part of the main treatment it might come to aid in a few situations like:
    • It may be used to treat metastatic leukemia that has spread to the brain and spinal fluid or to the testicles.
    • Radiation may be given before a stem cell transplant.
    • Radiation may be used to combat pain in the bone that is invaded by leukemia, in case chemotherapy has failed to solve the purpose.

Treatment of Acute Promyelocytic Leukemia – A subtype of AML

In Acute promyelocytic leukemia, immature granulocytes called promyelocytes gets accumulated. In most cases of APL, the treatment differs from usual AML treatment. Initial treatment may include the non-chemotherapy drug all-trans-retinoic acid (ATRA), often combined with a complementing chemotherapy drug.

Early diagnosis and treatment of APL is important because patients with APL can develop serious blood-clotting or bleeding problems at later stages. However, with the latest advent in cancer drugs today there are multiple procedures to treat APL. Some preferred treatment options are:

  • Use of differentiating drugs like all-trans-retinoic acid (ATRA)
  • Chemotherapy
  • Transfusions of platelets or other blood products.

What are the adverse effects of treatment?

Side effects are more of an individual thing rather than a general thing. The type and severity of side effects varies from individuals to individuals, depending on the type of treatment used and how each individual responds to it. In general, more intensive treatment is associated with more severe side-effects.

Other possible side-effects of chemotherapy include:

  • Chemotherapy reduces the ability of bone marrow to produce adequate number of blood cells. Blood transfusions and platelet transfusions are done to reduce the risk of anaemia and bleeding.
  • Sickness - nausea and/or vomiting
  • fatigue
  • hair loss and thinning
  • mucositis or ulcers
  • diarrhoea or constipation
  • skin problems including dryness, rash or sensitivity to sunlight
  • infertility

Is there a curative treatment for AML?

Acute leukemia can often be cured with proper treatment. Bone marrow transplantation can successfully enhance lifespan of a patient. Chronic leukemia is known to give much longer life if treated properly e.g. CLL or CML. Treatments are often able to control the cancer and manage symptoms in case of chronic leukemia.

How frequently should one visit doctor for early diagnosis?

Going for regular checkups and being attentive to even the slightest of health hazards may prove to be a life saving habit.

Colorectal Cancer

What is Colorectal Cancer?

The colon and rectum are the vital parts of the gastrointestinal (digestive) system. Colon is a muscular coiled tube stretching for the first 4 to 5 feet of the large intestine and rectum is about 12 cm long tube that constitutes the last part of the large intestine. The colon connects the small intestine and the rectum whilst the rectum connects the colon to the anus. The colon and rectum are highly specialized organs responsible for processing waste out of the body in a convenient way.

Functions

  • The main function of the colon is to absorb the remaining fluids and process waste products before preparing for its elimination.
  • Billions of bacteria that coat the colon break down the remaining material. Then the colon pushes the leftover material into the rectum.
  • Stool moves from the colon into the rectum, where it is stored temporarily before being expelled from the body.

What is colorectal cancer?

Colorectal cancer

Colorectal cancer, also known as bowel cancer occurs when cells lining the colon or rectum turn abnormal and continue to grow uncontrollably. If cancer originates in the colon then it is specified as colon cancer else if the site of origin is detected to be the rectum then it is rectal cancer. Due to the similarities in the features of both colon and rectal cancer, they are together cited as colorectal cancer.

The cancer cells can eventually grow and invade the nearby healthy tissues, in a process called metastasis. This results in a more serious, less treatable condition.

Types of Colorectal Cancer

  • Adenocarcinomas: Adenocarcinomas occurs in the cells that generate mucus to lubricate the interiors of the colon and rectum. Most colorectal cancers (92-95 %) are adenocarcinomas.
  • Lymphoma: It is cancer of immune system cells that typically start in lymph nodes, but they can also start in the colon, rectum, or other organs. It accounts for 1.3% of colorectal cancer.
  • Carcinoid: It starts from specialized hormone-making cells in the intestine and accounts for 0.4% colorectal cancer.
  • Sarcoma: It can start in blood vessels, muscle layers, or other connective tissues in the wall of the colon and rectum. Sarcomas of the colon or rectum are rare and account for 0.3% colorectal cancer.

Occurrence Rate

According to WHO and CDC, colorectal cancer is the second most common cancer. Approximately 40% of people diagnosed with colorectal cancer are at an advanced stage thus making it the third most common cause of cancer-related death.

However, it might bring a sigh of relief to know that colorectal cancer has the lowest incidence in India compared to the western world and other countries. Among all digestive cancers, colorectal cancer carries the best prognosis largely due to the multidisciplinary treatment options that have dramatically improved over the last decade. Low and stable incidence and mortality rates from colorectal cancers were observed in India in both men and women.

Anatomy of Colorectal Cancer

Colorectal

What are the general symptoms of Colorectal Cancer?

Generally, colorectal cancer does not cause any notable symptom in the early stages, but symptoms may develop as the cancer advances. Gastrointestinal problems are the most common symptoms. Also, the signs and symptoms of colorectal cancer depend on the location of the tumor in the bowel and the spread of the tumor. Some common complaints that might act as a symptom are:

  • Diarrhea or constipation
  • Frequent urination
  • Rectal bleeding or blood in the stool
  • Abdominal pain, cramps, bloating, or gas
  • Pain during bowel movements
  • Continual urges to defecate
  • Weakness and fatigue
  • A feeling of fullness in the abdomen
  • Unaccountable weight loss, vomiting, fatigue
  • Irritable bowel syndrome (IBS)
  • Iron deficiency, anaemia

However, the root cause of these symptoms is not always colorectal cancer. They may indicate some other illness or conditions. Hence, it is very important to consult the doctor for a proper diagnosis before jumping to conclusions. Experiencing any of these symptoms for four weeks calls for a visit to the doctor.

What are the general causes of Colorectal Cancer?

Normally, cells follow a systematic pattern of growth, division, and death. Cancer happens when this process is interrupted and the cells continue to grow and divide uncontrollably, without dying.

Till date, the exact cause of colorectal cancer resulting in a particular case could not be traced. However, there are several potential risk factors that have been identified. The major risk factors for colorectal cancer are family history, lifestyle and age of the person. Some other associated risk factors are discussed below:

  • Polyps: Colorectal cancer usually develops from precancerous polyps that exist in the large intestine. Adenomas are the most common polyps that lead to malignant cancer. Adenomas usually resemble the normal lining of the colon but may look different under a microscope. These polyps may turn to become cancerous over time, if they are not removed during the early stages of treatment.
  • Inflammatory bowel disease: Inflammatory bowel disease is another risk factor for colorectal cancer which includes Crohn's disease and ulcerative colitis. The risk increases with the increased tenure of the disease. People with inflammatory bowel disease account for less than 2% of colon cancer cases yearly.
  • Family History: Inherited genes increase colorectal cancer risks. The two most common inherited syndromes linked with colorectal cancers are Familial Adenomatous Polyposis (FAP) and Hereditary Non-Polyposis Colorectal Cancer (HNPCC). Other syndromes that may increase the risk of developing colorectal cancer include Lynch Syndrome, Turcot Syndrome and Peutz-Jeghers Syndrome. However, these represent less than 5% of cases.
  • Age and Lifestyle: Around 91% of cases of colorectal cancer consists of patients in the age group of over 50 years old. The risk is found to be increased in people following a sedentary lifestyle like those with obesity, less physical activity and those who smoke tobacco.
  • Dietary factors: Diets that are high in red and processed meats (e.g., beef, lamb, hot dogs) may increase colorectal cancer risks. Frying, grilling, broiling or other methods of cooking meats at very high temperatures create chemicals that may also contribute to an increased risk. Diets very high in animal protein, saturated fats, calories or alcohol possess a greater threat of colorectal cancer.
  • Smoking: Some cancer-causing substances associated with smoking may be swallowed, potentially increasing the risk of developing colorectal cancer. Studies revealed that smoking is significantly associated with an increased risk for colorectal cancer and death.
  • Certain other conditions: Some conditions and treatments have been associated with an increased risk of colorectal cancer. These include:
    • Diabetes
    • Obesity
    • Type II diabetes
    • Acromegaly, a growth hormone disorder
    • Exposure to ionizing radiation or asbestos

Can Colorectal Cancer be prevented?

Since colorectal cancer is associated with risk factors related to the lifestyle so altering to a healthy lifestyle offers some prevention against the same. Certain precautions to stay away from colorectal cancer are:

  • Maintaining a healthy diet: Including a variety of fruits, vegetables and whole grains may play a subtle role in cancer prevention. As the colon is part of the digestive system, so diet plays an important role in the prevention of colorectal cancer. Diets that are low in fiber and high in fat, calories, red meat, alcohol, and processed meats have been linked to a higher risk of colorectal cancer
  • Avoiding alcohol and Quitting Smoke: Alcohol should be consumed in moderation as consumption in excess amounts may lead to many complications including colorectal cancer. Smoking is associated with numerous cancers, so it is highly recommended to quit smoking and avoid the use of tobacco.
  • Maintaining a healthy weight: Following a healthy diet and maintaining a 30-minute workout regime every day has been shown to have a significant impact on lowering a person's risk of developing colorectal cancer.
  • Regular Screenings: If one is at a higher risk of developing colorectal cancer, then it is highly recommended to go for regular screenings at least once a year.

What are the stages of Colorectal Cancer?

Cancer staging is very important as the prognosis and outlook of the treatment largely depend on the stage of cancer. A common method used to describe the cancer stage is the TNM system.

  • Tumor (T): It describes the growth of the tumor. It is categorized as:
    • TX: The primary tumor cannot be evaluated.
    • T0: There is no evidence of cancer in the colon or rectum.
    • Tis: Refers to carcinoma in situ.
    • T1: The tumor has grown into the submucosa.
    • T2: The tumor has grown into the muscularis propria, a thick layer of muscle.
    • T3: The tumor has grown into the subserosa, a thin layer of connective tissue or it has grown into tissues surrounding the colon or rectum.
    • T4a: The tumor has grown into the surface of the visceral peritoneum, which means it has grown through all layers of the colon.
    • T4b: The tumor has grown into or has attached to other organs or structures.
  • Node (N): Node is used to define the spread of the tumor.
    • NX: The regional lymph nodes cannot be evaluated.
    • N0: There is no spread to regional lymph nodes.
    • N1a: There are tumor cells found in 1 regional lymph node.
    • N1b: There are tumor cells found in 2 to 3 regional lymph nodes.
    • N1c: There are nodules made up of tumor cells found in the structures near the colon that do not appear to be lymph nodes.
    • N2a: There are tumor cells found in 4 to 6 regional lymph nodes.
    • N2b: There are tumor cells found in 7 or more regional lymph nodes.
  • Metastasis(M): It tells us if cancer has spread to other organs of the body.
    • MX: Distant metastasis cannot be evaluated.
    • M0: The disease has not spread to a distant part of the body.
    • M1a: The cancer has spread to 1 other part of the body beyond the colon or rectum.
    • M1b: The cancer has spread to more than 1 part of the body other than the colon or rectum.

Based on the analysis of several factors colorectal cancer is staged in categories from 0 till 4. Needless to say, the severity of the disease increases with each passing stage.

  • Stage 0 (Carcinoma in Situ): This is a very early stage of the cancer. In this stage, abnormal cells are found in the mucosa (innermost layer) of the colon or rectum. These abnormal cells may later become cancerous and spread to other parts.
    Colorectal stage0
  • Stage I: (T1 or T2, N0, M0) In this stage, cancer that had formed in the mucosa of the colon wall has now invaded the submucosa, the muscular layer of the colon or the rectum, but has not yet spread beyond the wall of the rectum or colon.
    Colorectal stage1
  • Stage II: At this stage, cancer has spread through the muscle layer of the colon wall to the serosa which is the outermost layer. However, it has not reached the nearby lymph nodes yet. This stage is further divided into stage IIA, stage IIB, and stage IIC.
    • Stage IIA (T3, N0, M0): Cancer has spread to the serosa or visceral peritoneum of the colon wall.
    • Stage IIB(T4a, N0, M0): Cancer has spread to the serosa or visceral peritoneum of the colon wall but has not spread to nearby lymph nodes or organs.
    • Stage IIC(T4b, N0, M0): Cancer has spread through the serosa of the colon wall to nearby organs.
      Colorectal stage2
  • Stage III: Cancer at this stage has spread from the mucosa to the submucosa and may have spread to the muscle layer, and has spread to one to three nearby lymph nodes or tissues near the lymph nodes.
    • Stage IIIA(T1 or T2, N1 or N1c, M0; or T1, N2a, M0): Cancer has spread through the mucosa of the colon wall to the submucosa. Anyone of the following conditions might hold true:
      • It may have spread to the muscle layer of the colon wall.
      • It has spread to at least one but not more than 3 nearby lymph nodes
      • Cancer cells have formed in tissues near the lymph nodes
      • Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.
    • Stage IIIB(T3 or T4a, N1 or N1c, M0; T2 or T3, N2a, M0; or T1 or T2, N2b, M0): For stage IIIB cancer any of the following conditions might hold true:
      • Cancer has spread to the serosa but not to nearby organs.
      • Cancer has spread to one to three nearby lymph nodes or tissues near the lymph nodes.
      • Cancer has spread to the muscle layer or to the serosa, and to four to six nearby lymph nodes.
      • Cancer has spread through the mucosa to the submucosa and may have spread to the muscle layer.
      • Cancer has spread to seven or more nearby lymph nodes.
    • Stage IIIC(T4a, N2a, M0; T3 or T4a, N2b, M0; or T4b, N1 or N2, M0):
      • Cancer has spread through the serosa of the colon wall but has not spread to nearby organs. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.
      • Cancer has spread through the muscle layer of the colon wall to the serosa of the colon wall or has spread through the serosa but has not spread to nearby organs. Cancer has spread to 7 or more nearby lymph nodes.
      • Cancer has spread through the serosa of the colon wall and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes.

      Colorectal stage3A
      Colorectal stage3B
      Colorectal stage3C
  • Stage IV: At this stage, cancer has spread through the blood and lymph nodes to other parts of the body, such as the lung, liver, abdominal wall, or ovary. It is further subdivided into stage IVA and stage IVB.
      • Stage IVA(any T, any N, M1a): Cancer has spread to one organ that is not near the colon, such as the liver, lung, or ovary, or to a distant lymph node.
      • Stage IVB(any T, any N, M1b): Cancer has spread to more than one organ that is not near the colon or into the lining of the abdominal wall.

    Colorectal stage4

Survival rates of Colorectal Cancer?

Statistics on the outlook for a certain type and stage of cancer are often given as 5-year survival rates, but many people live longer and often surpass the 5 years time bond. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer.

Stage 5 year survival rate
Stage I 92%
Stage IIA 87%
Stage IIB 63%
Stage IIIA 89%
Stage IIIB 69%
Stage IIIC 53%
Stage IV 11%

Can Colorectal Cancer be detected early?

Over the past few decades, the worldwide statistical report of colorectal cancer claims that there is a steady decline in the death rate caused by the disease. The main reason for this success in controlling death by colorectal cancer is improvements in colorectal cancer screening.

Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of the disease. This process helps in detecting colorectal cancer early, even before symptoms develop. Screening can also sometimes find growths called polyps so they can be removed before they turn into cancer. Several screening tests have been developed to help find colorectal cancer early. Some tests that detect adenomas and polyps help diagnose the development of cancer earlier making way for effective action. Some of the tests to detect colon cancer are described below:

  • Physical examination and history : A physical examination of the body is conducted to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The doctor also inquires about the history of the patient’s health habits and past illnesses along with family history of any major disease.
  • Flexible sigmoidoscopy: A sigmoidoscope i.e. a flexible, slender and lighted tube, is used to examine part of the rectum and sigmoid (the last part of the colon). If a polyps or colon cancer is detected then a colonoscopy is advised.
  • Colonoscopy: During colonoscopy, a tube like instrument called Colonoscope is used to look inside the rectum and colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding.
  • Digital rectal examination (DRE): The average finger can reach approximately 8 cm above the dentate line; rectal tumors can be assessed for size, ulceration, and presence of any pararectal lymph nodes.
  • Rigid proctoscopy: This examination helps to identify the exact location of the tumor in relation to the sphincter mechanism
  • Chest x-ray: An x-ray uses radiations to get a clear picture of the structures inside of the body. An x-ray of the chest can help doctors find out if the cancer has spread to the lungs.
  • High-sensitivity fecal occult blood tests (FOBT): Bleeding is a common phenomenon experienced in both polyps and colorectal cancers. FOBT checks for tiny amounts of blood in feces (stool) that cannot be seen visually. However, these tests are not 100% accurate, as it fails to detect cancers that do not bleed. Furthermore, a positive result of the test also does not ascertain the presence of cancer cells as bleeding may be attributed to some other illness or conditions as well.
    FOBT may be done by:
    • Guaiac FOBT: It uses a chemical to detect heme, a component of the blood protein hemoglobin. For this test certain dietary restrictions are adviced.
    • FIT: It uses antibodies to detect human hemoglobin protein specifically (4, 5).
  • Biopsy: Biopsy is the procedure of removal of a small amount of suspected tissue for examination under a microscope. A biopsy can make a definite diagnosis of colorectal cancer.
  • Molecular testing of the tumor: Molecular testing is also called biomarker testing or genetic testing. As the root of cancer is an abnormal change in the genes, molecular testing helps in checking structural changes within the gene, abnormal features of gene products, or biochemical effects of the tumor.
    Gene tests assess either one gene or a short piece of DNA. These tests look for extra gene copies, missing genes, or incorrectly placed genes. Also, gene tests can assess for small changes, such as an altered chemical "step" within the DNA "ladder," called gene mutations.
    In case of metastatic or recurrent colorectal cancer, a sample of tissue from the cancerous area is extracted to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests help in deciding the most suitable treatment option.
  • Computed tomography (CT) scan: In a CT scan, multiple pictures of the interior of the body is taken through X-Rays from different angles and a 3-dimensional picture is created. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan is helpful in knowing details like tumor’s size, location etc. Sometimes a special dye called a contrast medium is injected or swallowed before the scan to provide better detail on the image.
  • Magnetic resonance imaging (MRI): An MRI uses magnetic fields, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. MRI is the best imaging test to find where the colorectal cancer has grown.
  • Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs to find out if cancer has spread.
  • Positron emission tomography scan: A PET scan is a way to create pictures of internal organs and tissues. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
  • Double-contrast barium enema(DCBE): It is another method of visualizing the colon from outside the body. In DCBE, a series of x-ray images of the entire colon and rectum is taken after the patient is given an enema with a barium solution. The barium helps to outline the colon and the rectum on the images. DCBE is rarely used for screening because it is less sensitive than colonoscopy in detecting small polyps and cancers. However, it may be used for people who cannot undergo standard colonoscopy—for example, because they are at particular risk for complications.
  • Blood tests: Because colorectal cancer often bleeds into the large intestine or rectum, people with the disease may become anemic. A test of the number of red cells in the blood, which is part of a complete blood count (CBC), can indicate that bleeding may be occurring. Another blood test detects the levels of a protein called carcinoembryonic antigen (CEA). High levels of CEA may indicate that cancer has spread to other parts of the body.

What are the Treatments available?

Due to the advancement in technology, today colon cancer is highly treatable and the mortality rate is steadily declining. Even when it spreads to nearby lymph nodes, surgical treatment followed by chemotherapy is highly effective. Constant research is going on to learn more and provide hope for people no matter what stage they are.

The different treatment options available to beat colorectal cancer include a combination of the any of the following:

  • Surgery: Surgery is the most common treatment for all stages of colorectal cancer. Any of the following surgery may be conducted depending on the stage of the cancer and the patient’s health:
    • Local excision: If the cancer is detected at a very early stage, then there is a possibility to remove it without cutting through the abdominal wall. Instead, a tube with a cutting tool is inserted through the rectum into the colon and the cancer cells are cut out.
    • Resection of the colon with anastomosis: If the cancer is larger, a partial colectomy may be performed, wherein the cancer and a small amount of healthy tissue around it are removed. It might be followed up by an anastomosis i.e. sewing the healthy parts of the colon together.
    • Resection of the colon with colostomy: Sometimes a stoma (opening) needs to be made on the outside of the body for waste to pass through. This procedure is called a colostomy. A bag is placed around the stoma to collect the waste.
    • Endoscopic mucosal resection: Removing larger polyps may require also taking a small amount of the lining of the colon in a procedure called endoscopic mucosal resection.
  • Radiofrequency ablation: In this process, a special probe with tiny electrodes is used to kill cancer cells.
  • Cryosurgery: In this process an instrument is used to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy
  • Chemotherapy: Chemotherapy is the use of drugs to inhibit the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be done either orally mouth or injected into a vein or muscle. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
  • Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays to kill cancer cells or keep them from growing. There are two types of radiation therapy:
    • External radiation: As the name suggests, radiation when given externally through a machine then it is said to be external radiation.
    • Internal radiation: In this therapy, a radioactive substance sealed in needles, seeds, wires, or catheters is 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. External radiation therapy is used as palliative therapy to relieve symptoms and improve quality of life. However, radiation therapy has multiple side effects so various conditions need to be checked before applying radiation therapy.
  • Targeted therapy: In targeted therapy, drugs or other substances are used to identify and attack specific cancer cells without harming normal cells. Different types of targeted therapies used in the treatment of colorectal cancer include the following:
    • Monoclonal antibodies: Monoclonal antibodies are made from a single type of immune system cell. The antibodies attach and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion.
      • Bevacizumab and ramucirumab are monoclonal antibodies that bind to a protein called vascular endothelial growth factor (VEGF). This may prevent the growth of new blood vessels that aid the growth of tumors.
      • Cetuximab and panitumumab are types of monoclonal antibodies that bind to a protein called epidermal growth factor receptor (EGFR) on the surface of some types of cancer cells. This may stop cancer cells from growing and dividing.
      • Angiogenesis inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels that aids tumor growth.
      • Ziv-aflibercept is a vascular endothelial growth factor trap that blocks an enzyme needed for the growth of new blood vessels in tumors.
    • Regorafenib is used to treat colorectal cancer that has spread to other parts of the body and has not gotten better with other treatment. It blocks the action of certain proteins, including vascular endothelial growth factor. This may help keep cancer cells from growing and may kill them. It may also prevent the growth of new blood vessels that tumors need to grow.
  • Supportive (palliative) care: Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness.

Treating Metastatic or Stage IV cancers

Treatment of Metastatic cancer becomes very difficult as it has spread to distant organs of the body. When the cancer has spread to the other organs, the treatment depends on the location of metastasis. Colorectal cancer can spread to distant organs, such as the liver, lungs, the tissue called the peritoneum that lines the abdomen, or a woman’s ovaries.

Treatment plan for metastatic cancers may include a combination of surgery, radiation therapy, immunotherapy, and chemotherapy. Such treatment is often helpful in delaying the spread of the disease or shrinking the cancerous tumor. Palliative care will also be important to help relieve symptoms and side effects.

At this stage, surgery to remove the colon or portion of colon does not cure the cancer. However, it relieves the blockage of the colon and soothes the problems related to the cancer. Surgery may also be used to remove parts of other organs where the cancer has spread.

In case cancer has spread to liver the following procedures are usually used:

  • Surgery to remove the tumor (if possible).
  • Chemotherapy may be given before or after surgery, to shrink the tumor.
  • Cryosurgery or radiofrequency ablation.
  • Chemoembolization and/or systemic chemotherapy.
  • A clinical trial of chemoembolization combined with radiation therapy.

In the final stage of cancer, curing the cancer is often not possible. However, surgery may help in adding years to life and improving quality of life.

How frequently should one visit doctor for early diagnosis?

If one is at a higher risk to develop the disease, then it is recommended to go for regular screening at least once a year to facilitate early diagnosis. For those without any potential risk, it is advised to go for screening if they experience any of the symptom mentioned above.

How can I as a patient know it early?

Complete awareness about the disease and knowing one’s familial history related to any disease helps a person to detect the disease earlier.

Melanoma Skin Cancer

What is Melanoma Skin Cancer?

Skin

The skin in the largest organ in the human body. It is a protective shield that envelops the body and protects the delicate internal organs from the harshness of the outer world.

Layers of the Skin

Skin has three distinct layers:

Layers of the Skin

  • Epidermis:It is the outermost thin layer of skin that provides a waterproof barrier. It is mainly responsible for generating new skin cells, imparting skin colour and protecting the body. Melanin the colouring pigment is present in this layer.
  • Dermis: It is situated beneath the epidermis. This layer contains tough connective tissues, hair follicles, and sweat glands. Its primary functions are sweat secretion, imparting sensation, hair growth, secreting sebum and bringing blood to the skin.
  • Hypodermis: It is the innermost subcutaneous tissue made of fat and connective tissue. Hypodermis is responsible for attaching the dermis to muscles and bones, assisting the blood vessels and nerve cells, regulating body temperature and storing fats.

Functions

The skin is entrusted with three major functions: protection, regulation and sensation.

  • The primary duty of the skin is to provide protection and shield the body from mechanical impacts and pressure, variations in temperature, micro-organisms, radiation and chemicals.
  • Skin plays an important role in regulating body temperature. The sweat glands activate to cool the body down and blood vessels in the skin tighten to prevent heat loss.
  • Skin is one of the five sensory organs in the human body. It has an extensive network of nerve cells that detect and relay changes in the environment. It has more than five different receptors that respond to touch, and pain. Damage to these nerve cells results in a loss of sensation in the affected areas.

Cancer

Cancer occurs when normal healthy cells undergo a genetic transformation and continue to multiply rapidly without any control. Most of the times, this result in the accumulation of unhealthy cells forming a hard mass called tumor.

This tumor may be benign (non-cancerous) or malignant (cancerous) in nature. The benign tumors are less dangerous and its spread is restricted to the site of origin only, while the malignant tumors are deadly and gradually navigates to different parts of the body.

Skin Cancer

Skin cancer is caused by DNA damage in the cells of the skin. This DNA transformation triggers mutations and results in the cells multiplying uncontrollably and forming malignant tumors. These cancer cells can invade the neighbouring cells and navigate to distant organs. Skin cancer is the most common type of cancer in US and most of the western countries.

There are three major types of skin cancers:

  • Basal cell carcinoma (BCC),
  • Squamous cell carcinoma(SCC),
  • Melanoma

Melanoma Skin Cancer

Melanoma is rare but the most dangerous form of skin cancer. In Melanoma Skin Cancer, the cancer cells originate in the pigment-producing melanocytes that are located in the epidermis.

Also known as malignant melanoma and cutaneous melanoma, some mutated melanoma cells can still make melanin, so most of the melanoma tumors are brown or black in colour and appears like a mole on the skin. In some rare cases, they do not make melanin and the tumor appears to be skin-coloured, pink, red, purple, blue or white.

Melanoma can form anywhere in the skin, they are most likely to be found on the chest, back, legs, neck and face. However, in some rare cases, they may also form in other parts of the body including the eyes, mouth, genitals, and anal area.

Types of melanoma

The main types of melanoma are as follows:

  • Superficial spreading melanoma: This is the most common type of melanoma cancer accounting for about 70% of all cases of melanoma. It mostly occurs in the legs of women and the backs of men and is more prone to people in the age range of 30-50 years. These melanomas are mostly flat and have a variety of colours. It is easy to detect at an early stage and can be removed easily in case of correct diagnosis.
    Superficial spreading melanoma
  • Nodular melanoma: It accounts for about 20% of melanomas. It begins as deeper, blue-black to purplish lumps. They are more aggressive and may evolve faster. Untreated superficial spreading melanomas may become nodular and invasive at later stages.
    Nodular melanoma
  • Lentigo maligna: It mainly occurs in places which are mostly exposed to the sun. Lentigo maligna looks like a large, irregularly shaped skin infection. It develops at a slow pace and may take many years to evolve into a more dangerous melanoma or may never turn out to be invasive. But owing to its unpredictability, it is usually recommended to remove through surgery.
    Lentigo maligna

Occurrence Rate of Melanoma Skin Cancer in India

The occurrence rate of Melanoma Skin Cancer in India is comparatively low mostly because of high melanin in the skin but it is the most lethal among all types of skin cancer. Owing to the advancement in treatment facilities and increasing awareness about cancer the annual mortality rate from malignant skin melanoma in India has seen a considerable declination. Statistically, 7.8 deaths/100,000 in men and 3.6% for women per 100000 in 2003 the overall mortality due to melanoma has decreased considerably.

Anatomy of Melanoma Skin Cancer

Melanoma Skin Cancer

What are the general symptoms of Melanoma Skin Cancer?

Melanoma skin cancer can develop anywhere in the body but are more prone in areas that are constantly exposed to the sun’s radiation. In most of the cases, the very prominent sign of melanoma skin cancer is either the development of a new mole or change in an existing mole. However, not all moles assure the presence of cancerous cells neither it is the only symptom of melanoma cancer.

Cancerous moles vary greatly in appearance. While some may appear as a normal mole some give a clear hint. Here are ABCDE signs that help in identifying a cancerous mole.

A - Asymmetry

Cancerous moles appear in irregular asymmetric shapes where the two sides look very different from each other.

A - Asymmetry

Border

A benign or normal mole has smooth, even borders, whereas in case of melanoma the moles have irregular, notched or scalloped borders.

Border

Colour

Most benign moles are either brown or black in colour. Having a variety of colors is another warning signal. A melanoma may have different shades of colours including red, pink, white or blue.

Colour

Diameter

Benign moles are generally small. Melanomas are usually larger in diameter generally over ¼ inches. However, at the initial stages they may be smaller.

Diameter

Evolving

Normal moles neither grow nor change their shape, they appear same even after years. If a mole starts to evolve or change in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting it might be a malignant melanoma.

Evolving

Symptoms of hidden melanomas

  • Acral-lentiginous melanoma is a very rare form of melanoma that occurs under a fingernail or toenail. It can also be found on the palms of the hands or the soles of the feet.
  • Mucosal melanoma develops in the mucous membrane that lines the nose, mouth, esophagus, anus, urinary tract and vagina. Mucosal melanomas are very hard to detect as they resemble many common conditions.
  • Ocular melanoma, found in the uvea i.e. the layer beneath the white of the eye. An eye melanoma may cause vision changes and is generally diagnosed during an eye exam.

What are the general causes of Melanoma Skin Cancer?

The exact cause of all melanomas isn't known to date. Multiple studies have revealed that melanoma cancer occurs when the melanin-producing cells called melanocytes gets mutated due to damage in its DNA. However what causes this damage in the DNA is not known to precision.

A number of factors including environmental and genetic factors may contribute to forming melanoma cancer. Another potent factor that might lead to melanoma is exposure to ultraviolet radiation from the sun and from tanning lamps and beds is the leading cause of melanoma.

What are the risk factors for Melanoma Skin Cancer?

Risk factors encompass those activities or incidences which increase the chance of getting melanoma cancer. Some of the potential risk factors for melanoma cancer include:

  • Exposure to harmful rays: It is the most common risk factor for melanoma cancer. Use of tanning booths, beds or high exposure to sun’s ultraviolet radiation or even X-ray radiations is harmful for the skin.
  • Chemical Exposure: Contact with certain chemicals, such as arsenic and hydrocarbons in tar, oils, and soot possesses a threat to the skin.
  • Fair skin: Fair skin is due to the lack of melanin pigment in the skin. Melanin protects the skin from UV radiation, in absence of it the skin is prone to sunburn. However, melanoma can develop in darker complexions.
  • Multiple moles: Having many moles in the body increases the risk of Melanoma cancer. Also, having an unusual type of mole increases the risk of melanoma.
  • Familial history: Having a track record of melanoma in the immediate family member increases the risk of this cancer.
  • Age: Aging increases the risk of developing melanoma cancer, especially in women.
  • Genrtic disorder: Certain genetic disorders that deplete skin pigment, such as albinism and xeroderma pigmentosum increases the risk of Melanoma cancer

Can Melanoma Skin Cancer be prevented?

Since most of the risk factors of melanoma cancer are controllable, certain conscious decisions help in preventing the fatal disease.

  • Avoiding the sun during the middle of the day.
  • Reducing sun exposure
  • Wearing sunscreen and protective clothing all year round.
  • Avoiding tanning lamps and beds.
  • Focusing on your skin’s health
  • Keeping an eye on your moles
  • Regular screening of high risk individuals

What are the stages of Melanoma Skin cancer?

Once cancer is diagnosed, it is assigned a stage based on the spread and severity of the cancer cells. Staging is a very crucial part as it is based on the stage that the complete treatment is planned and a probable outcome is analysed. Staging also gives an idea of the survival chances and outlook of the disease.

Melanoma skin cancer is categorized into 5 stages starting from 0 to 4, 0 being the nascent stage and 4 is the final or terminal stage. Here is a detailed look at the stages of melanoma skin cancer.

stages of Melanoma skin cancer

  • Stage 0: Also known as melanoma in situ, the cancerous cells at this stage are found only in the epidermis. It has not spread to nearby lymph nodes or distant sites. This stage is.
  • Stage I: The cancerous cells are still restricted to the skin and their size is no more than 2 mm thick. Depending on the thickness, the mitotic rate, and state of ulceration this stage is further categorized into two subgroups.
  • Stage II: At this stage the melanoma has grown thicker and has penetrated through the epidermis into the dermis. The thickness ranges between 1.01mm to 4.0 mm. Depending on the thickness and state of ulceration this stage can be further divided into 3 subgroups.
  • Stage III: At this stage, melanoma has spread through the lymphatic system, either to a regional lymph node or to a skin site on the way to a lymph node, called “in-transit metastasis.” Depending on the size and number of lymph node involved and the state of ulceration this stage is further categorized into three subgroups.
    • Stage IIIA: The cancer size is less than 2.0 mm thick and has spread to 3 or less lymph nodes. It has not spread to distant sites and the cancer may or may not be ulcerated.
    • Stage IIIB: The cancer size is less than 4.0 mm thick and has spread to one or more lymph node(s) and has spread to nearby skin or to skin lymphatic channels around the tumor. It has not spread to distant sites and the cancer may or may not be ulcerated.
    • Stage IIIC: The cancer size is less than 4.0 mm thick and the cancerous cells have spread to one or more lymph nodes or to very small areas of nearby skin or to skin lymphatic channels around the tumor. It has not spread to distant sites.
    • Stage IIID: The cancer size is thicker than 4.0 mm and is ulcerated. The cancerous cells have spread to 4 or more lymph nodes or have spread to very small areas of nearby skin or to skin lymphatic channels around the tumor. It has not spread to distant sites.
  • Stage IV: At this stage, melanoma has spread to other parts of the body, such as distant locations on the skin or soft tissue, distant lymph nodes, or other organs like the lung, liver, brain, bone, or gastrointestinal tract. The cancer can be any thickness and might or might not be ulcerated.
  • Recurrent: Recurrent melanoma is melanoma that has come back after treatment. It might be the recurrence of new tumor at the site of a previous tumor or in other body sites. Recurrence is most likely to occur within the first five years, but new tumors felt to be recurrences may show up decades later.

Survival rates of Melanoma Skin cancer?

Malignant melanoma is a highly aggressive cancer that tends to spread to other parts of the body and may be fatal if not treated early. Apart from the stage, there are a number of other factors like the patient's age, overall health, location of the tumor, results of biopsy, and the depth of the tumor that plays an important role in determining the survival rates for melanoma.

Survival statistics are generalized numbers that has been accumulated based on five-year survival rate of many patients with the same condition in the past.

Stage 5 year survival Rate
Stage 1 (thin melanoma, Localized) 100%
Stage 2 (thicker melanoma, local only) 80-90%
Stage 3 (local and nodal metastasis) 50%
Stage 4 (distant metastasis) 10-25%

Survival rates give a generalized view but the outlook for cancer treatment depends on various factors that are unique to each individual. Hence, the survival rates cannot be used to precisely predict the outcome of a particular patient.

Can Melanoma Skin Cancer be detected early?

If melanoma skin cancer originates in the visible part of the body then being aware about the condition helps in early diagnosis. However, melanoma cancer can also occur in areas less visible or not accessible to us, in those cases regular health check-ups and tests can aid in detecting the hideous disease.

Here are some of the recommended tests and procedures to detect melanoma skin cancer.

  • Physical Examination: Regular self exams may help to learn about the developments in moles, freckles and other skin marks that might be an indication of cancer. Check the areas more prone to skin cancer very minutely. During regular health check-ups, the physician would inspect your skin from head to toe and if anything suspicious is detected then other tests are suggested to confirm the abnormality.
  • Biopsy: Biopsy is a procedure in which a small part of the skin would be taken out for investigation under a strong microscope. Biopsy procedures that are usually adopted to diagnose melanoma include:
    • Punch biopsy: In this procedure, a tool with a circular blade is used to remove a round piece of skin around a suspicious mole.
      Punch biopsy
    • Excisional biopsy: In this procedure, the entire mole is removed along with a small border of normal skin.
      Excisional biopsy
    • Incisional biopsy: In incisional biopsy, only the irregular part of a mole or growth is taken for laboratory analysis.
      Incisional biopsy
    • Shave (tangential) biopsy: In this procedure, the top layer of the skin is shaved with a small surgical blade. An ointment is applied to the site to stop bleeding and soothe pain.
      Shave (tangential) biopsy
      Here are a few more biopsies that may be recommended once cancer is diagnosed.
  • Fine needle aspiration biopsy: In this procedure a thin, hollow needle is used to remove very small pieces of a lymph node or tumor. FNA biopsies are not invasive and do not causes much discomfort nor they leave any scar.
  • Surgical (excisional) lymph node biopsy: In this procedure an enlarged lymph node is removed through a small incision in the skin. This type of biopsy is helpful when the size of the lymph node suggests the melanoma has spread there.
  • Sentinel lymph node biopsy: A sentinel lymph node biopsy is done to confirm if the cancer has spread to nearby lymph nodes. In this procedure a small amount of a radioactive substance is injected into the area of the melanoma and after some time a special camera is used to see if it collects in one or more sentinel lymph nodes.
    Once the radioactive area has been marked, the patient is taken for surgery, and a blue dye is injected in the same place as the radioactive substance. A small incision is then made in the marked area, and the lymph nodes are then checked and if any malicious node is detected then it is removed and looked at under a microscope.

What are the Treatments available?

Melanoma skin cancer is highly curable when it is detected at an early stage before the cancer cells has metastasized and spread to other parts of the body. The treatment opted for melanoma skin cancer depends on a number of factors including the stage of the cancer, patient’s health, age, past records and preference. Here we have discussed the treatment options according to the stage of the cancer.

Treating early-stage melanomas

Early stage melanomas are generally restricted to the site of origin only and the cancerous cells can be easily removed through a surgery.

Treating melanomas that have spread beyond the skin

If melanoma has spread beyond the skin, treatment options may include:

  • Surgery: Surgery is the most preferred and effective line of treatment. The layer of skin along with the affected lymph nodes is removed through surgery.
  • Chemotherapy: Chemotherapy is the process of using drugs to kill the cancer cells or inhibit the growth of such cells. Chemotherapy can be given intravenously or orally to the patient. Utmost care is to be taken while administering chemotherapy treatment as these are very strong drugs and may lead to a number of adverse effects.
  • Radiation therapy: This treatment involves the use of high-powered energy beams to kill the cancer cells. Radiation therapy may be recommended after surgery to remove the lymph nodes. Care should be taken during radiation therapy as it increases the risk of several other cancer types.
  • Biological therapy: Biological therapy boosts the immune system to fight cancer. These treatments are made of substances produced by the body or similar substances produced in a laboratory. Biological therapies used to treat melanoma include interferon and interleukin-2, ipilimumab, nivolumab, and pembrolizumab.
  • Targeted therapy: Targeted therapy uses medications designed to target specific vulnerabilities in cancer cells. Some of the drugs used for targeted therapy to treat advanced melanoma are Vemurafenib, dabrafenib and trametinib. These drugs are only effective if your cancer cells have a certain genetic mutation.

What are the side effects of treatment?

Cancer treatment is a complex process and may involve high risk and toxic drugs that can trigger a cluster of other problems in the body. However, side effects of a particular drug or therapy varies from person to person as it depends on the body’s response, patient’s age and health as well as the immune system of the patient.

  • Side effects of Biological therapies may include chills, fatigue, fever, headache and muscle aches.
  • Side effects of targeted therapies vary, but tend to include skin problems, fever, chills and dehydration.
  • Side effects of chemotherapy include damaging of nerves and pain, burning, tingling, or weakness or increased sensitiveness to heat or cold. Other side effects include hair loss, mouth sores, infection, bruising or bleeding.
  • Radiation therapy may increase the risk of several other cancer. It also causes fatigue and weakness in the body.

In case the patient experiences any side effect of the treatment, he/she must report to the doctor immediately without any delay. Proper medications can be given to control these side effects and in case of more severe actions the treatment plan might also be changed.

Is there a curative treatment for Melanoma Skin Cancer?

Melanoma skin cancer is highly curable when it is recognized and treated early. But a delay in the treatment deems the chances of cure. As the cancer advances and spreads to other parts of the body, it becomes hard to treat and may result in fatal conditions. Though it is not the most common of the skin cancers, it causes the most deaths.

How frequently should one visit doctor for early diagnosis?

Regular health check-ups have shown phenomenal results in detecting cancer at an early stage. Apart from meticulous self examination, it is recommended to go for a complete health check up at least once a year. In case of high risk individuals the check up should be done in every six months.

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