Category: types of cancer

Symptoms

Most of the sarcomas begin in an arm or a leg. The common symptoms noticed at first is a lump that usually grows over a period of time. This lump is generally not painful, but in some cases it could be. There are times when the lumps may not be noticeable until they’re big enough to press on nearby muscles or nerves. About one in five soft tissue sarcomas happen in the belly. People usually don’t learn that they have one until they cause other problems, such as stomach ache, bleeding, or a blocked intestine. A doctor might find a sarcoma in your lungs or chest only after you have chest pain or trouble breathing.

About 10% of the time, a sarcoma will start in the head and neck region. The most common type of soft tissue sarcoma in children, called rhabdomyosarcoma, happens mostly in those areas.

One should consult the doctor if:

They notice a growing lump somewhere on your body.

They have stomach pain that’s getting worse.

The stool appears black or bloody.

They are vomiting blood.

Most visible lumps aren’t sarcoma. They’re usually a harmless cluster of fat cells called a lipoma. But if there is one that’s bigger than 2 inches and growing or causing pain, a doctor needs to be consulted.

Causes

Though most cancers are caused due to mutations in the DNA, Doctors aren’t sure why these types of cancers happen. However, some things may raise the chances of having soft tissue sarcoma:

A family history of certain diseases that you can inherit from your parents. These include neurofibromatosis and Gardner syndrome, which are disorders that make tumours grow in parts of your body.

Certain chemicals like arsenic, vinyl chloride, or dioxin.

Radiation, including ones taken during the treatment of other types of cancer

Diagnosis

Since there are different types of soft tissue sarcoma, it is crucial to determine the exact type so that effective treatment can be administered. The multiple ways, the combination of which can be used for accurate diagnosis are:

Imaging tests

X-rays

Computerized tomography scans

Magnetic resonance imaging

Positron emission tomography

Biopsy: Biopsy is the process where a part of the affected tissue is extracted and examined under a microscope. Experienced doctors will select the best biopsy technique to ensure proper surgical treatment and planning such as:

• Core needle biopsy. Tiny tubes of tumour material can be obtained by this method. Doctors typically try to take samples from several sections of the tumour.
• Surgical biopsy. In some cases, your doctor might suggest surgery to obtain a larger sample of tissue or to simply remove a small tumour entirely.

Treatment

Surgery is often the main treatment for soft tissue sarcoma. Surgery involves removing the cancer and some surrounding healthy tissue along with it. Radiation and chemotherapy is also administered in combination depending on the treatment plan.

Radiation Therapy: Radiation therapy involves treating cancer with high-powered beams of energy. Radiation therapy can be administered:

• Before surgery: Also called neo-adjuvant radiation therapy, it can help shrink the tumour so that it’s easier to remove.
• During surgery: Intraoperative radiation allows a higher dose of radiation to be delivered directly to the target area, while sparing surrounding tissues.
• After surgery: Also called adjuvant radiation therapy, it helps kill any remaining cancer cells.

Chemotherapy: Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy can be administered by pill or through a vein (intravenously). Some forms of soft tissue sarcoma respond better to chemotherapy than do others. For instance, chemotherapy is often used to treat rhabdomyosarcoma.

Targeted drug treatment: Certain types of soft tissue sarcoma have specific characteristics in their cells that can be attacked via targeted drug treatments. These medicines work better than chemotherapy and aren’t nearly as toxic. Targeted treatments have been particularly helpful in gastrointestinal stromal tumours (GISTs).

Symptoms

There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, ulcering in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole and enlargement of the mole.

Causes

Ultraviolet radiation from exposure to sunlight is the primary cause of skin cancer. Other factors that play a role include:

Smoking tobacco.

HPV infections increase the risk of squamous cell carcinoma.

Some genetic syndromes, including congenital melanocytic nevi syndrome, which is characterised by the presence of nevi (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20 mm (3/4″) in size are at higher risk of becoming cancerous.

Chronic non-healing wounds. These are called Marjolin’s ulcers based on their appearance, and can develop into squamous cell carcinoma.

Ionising radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin colour. It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous cell carcinomas. The World Health Organisation now places people who use artificial tanning beds in its highest risk category for skin cancer.

The use of many immunosuppressive medication increases the risk of skin cancer. Cyclosporin A, a calcineurin inhibitor, for example, increases the risk by approximately 200 times, and azathioprine about 60 times.

Diagnosis

A physical exam of the skin is used to evaluate the skin for melanoma. If melanoma is suspected, a skin biopsy will be done. For this, your doctor will remove a sample of skin tissue and send it to a pathologist to be looked at under a microscope. If the biopsy shows melanoma, the pathologist will measure the thickness of the melanoma to find out how advanced the cancer is. Other techniques may include total-body photography to monitor for changes in any mole and to watch for new moles appearing in normal skin. A series of photos of the suspicious lesions may be taken. Then the photos can be used as a baseline to compare with follow-up photos. EVALUATION OF LYMPH NODES Your doctor will do a physical exam that includes checking the lymph nodes to see whether they are larger than normal. This may be followed by a sentinel lymph node biopsy to see whether the melanoma has spread to the lymph system. EVALUATION FOR POSSIBLE METASTASES (SPREAD OF CANCER) A complete medical history and a physical exam are needed to find out whether the cancer has spread (metastasized) to other parts of the body. Imaging tests, including Positron Emission Tomography (PET scan), Computed Tomography (CT scan) or Magnetic Resonance Imaging (MRI), may be used to identify metastases in other parts of the body, such as the lungs, the brain, the liver, or other organs. EARLY DETECTION Skin self-exam is a good way to detect early skin changes that may point to melanoma. A skin self-exam is used to find suspicious growths that may be cancer or growths that may develop into skin cancer (precancers). Adults should examine their skin once every month. Look for any abnormal skin growth or any change in the colour, shape, size, or appearance of a skin growth. Check for any area of injured skin (lesion) that does not heal. Have your spouse or someone such as a close friend help you monitor your skin, especially places that are hard to see such as the scalp and the back. There are other steps one can take, to prevent skin cancer or detect it at an early stage.

Be aware of the risk of skin cancer and the steps you can take to prevent it, including staying out of the midday sun, wearing protective clothing, and using sunscreen on exposed skin.

• Have the doctor examine any suspicious skin changes. He or she may choose to check the skin once a year, or may suggest a skin exam more often, especially if there is:
• Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to develop melanoma. Examine your skin every month and be examined by a doctor every 4 to 6 months, preferably by the same doctor each time.
• Increased exposure to ultraviolet (UV) radiation, because of job, hobbies or outdoor activities.
• Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous, but their presence is a warning of an inherited tendency to develop melanoma.

Treatment

Treatment is dependent on type of cancer, location of the cancer, age of the patient, and whether the cancer is primary or a recurrence. Treatment is also determined by the specific type of cancer. For a small basal cell cancer in a young person, the treatment with the best cure rate (Mohs surgery or CCPDMA) might be indicated. In case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all. Topical chemotherapy might be indicated for large superficial basal cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular basal cell carcinoma or invasive squamous cell carcinoma. In general, melanoma is poorly responsive to radiation or chemotherapy. For low-risk disease, radiation therapy (external beam radiotherapy), topical chemotherapy (imiquimod or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; both, however, may have lower overall cure rates than certain type of surgery. Other modalities of treatment such as photodynamic therapy, topical chemotherapy, electrodesiccation and curettage can be found in the discussions of basal cell carcinoma and squamous cell carcinoma. In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required. Currently, surgical excision is the most common form of treatment for skin cancers. The goal of reconstructive surgery is restoration of normal appearance and function. The choice of technique in reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers is generally more challenging due to the presence of highly visible and functional anatomical structures in the face. When skin defects are small in size, most can be corrected with simple repair, where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are, by far, more common than the other listed choices. Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster dressing is placed atop the graft for seven to ten days, to immobilise the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site, regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed. Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable, cosmetically. However, full thickness grafts can only be used for small or moderate sized defects. Local skin flaps are a method of closing defects with tissue that closely matches the defect in colour and quality. Skin from the periphery of the defect site is mobilised and repositioned to fill the deficit. Various forms of local flaps can be designed to minimise disruption to surrounding tissues and maximise cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.

Symptoms

Retinoblastoma is a very rare condition. It is always recommended to talk to your doctor to rule out the chances in case you experience any of the below:

Problems with eye movement, such as crossed eyes (strabismus)

Decreased vision in one eye

Eye pain

A larger-than-normal eyeball

Lazy eye

Redness in the eye

Causes

Retinoblastoma is a type of cancer which starts in the retina of the eye and is the most common eye cancer amongst children. It is usually caused due to mutation of certain genes, occurring in children in the two to five age group. 25% to 40% of all retinoblastomas are hereditary. Although usually inherited from a parent, it can also be a new mutation that started with the said patient. In both cases, this form of the disease can be passed down to the next generation.

Diagnosis

Funduscopic eye exam: The patient is anesthetized and the pupils dilated, so that the retina can be examined.

Ultrasound of the eye

Magnetic resonance imaging (MRI) scan

Blood tests

DNA and/or genetic testing

If there is family history of retinoblastoma, regular exams should be conducted for young children to see if any tumors have formed. It is also possible to arrive at a diagnosis before any symptoms begin to appear. The earlier the diagnosis, the better the chances of success of treatment are.

Treatment

The common treatments for Retinoblastoma include chemotherapy, radiation, and surgery.

Symptoms

Abdominal pain and swelling

Back pain

Blood in the urine

Swelling of the veins around a testicle (varicocele)

Flank pain

Weight loss

Other symptoms that can occur with this disease:

Excessive hair growth in females

Pale skin

Vision problems

Causes

Lifestyle The greatest risk factors for RCC are lifestyle related – smoking, obesity and hypertension have been estimated to account to 50% of cases. Occupational exposure to some chemicals, such as asbestos, cadmium, lead, chlorinated solvents, petrochemicals and PAH (polycyclic aromatic hydrocarbon), has been examined by multiple studies with inconclusive results. Another suspected risk factor is the long term use of non-steroidal anti-inflammatory drugs (NSAIDS). Finally, studies have found that women who have had a hysterectomy are at more than double the risk of developing RCC than those who have not. Genetics Hereditary factors have a minor impact on individual susceptibility with immediate relatives of people with RCC having a two to fourfold increased risk of developing the condition. Age Diagnosis of RCC usually occurs in people aged 40 years or older, with a peak between 50 to 80 years of age. Gender The likelyhood of developing Renal Cancer is higher among males, in comparision to women. Other factors that attribute to the cause of Renal Cancer: The following may increase the risk of kidney cancer:

Dialysis treatment

High blood pressure

Horseshoe kidney

Polycystic kidney disease

Von Hippel-Lindau disease (a hereditary disease that affects blood vessels in the brain, eyes, and other body parts)

Diagnosis

An accurate diagnosis may be difficult to establish given that the early stages of renal cancer are asymptomatic. Renal tumours are often discovered incidentally on radiologic imaging performed for an unrelated reason. The prevalence of various radiological imaging procedures such as intravenous pyelography (IVP), ultrasonography, or computed tomography (CT) scanning have revolutionised the way abnormal renal masses are detected for early stage renal cancer in patients who are asymptomatic. The first steps taken in order to diagnose this condition are observing any of the signs and symptoms, and an anamnesis to evaluate any risk factors. Upon physical examination, palpation of the abdomen may reveal the presence of a mass or an organ enlargement. Although this disease lacks characterisation in the early stages of tumour development, considerations based on diverse clinical manifestations, as well as resistance to radiation and chemotherapy are important. The main diagnostic tools for detecting renal cell carcinoma are:

Ultrasound

Computed tomography (CT) scanning (CT Scan)

Some carcinoid lung tumours that are small or in locations where they are covered by other organs in the chest may not be seen on a chest X-ray. If a patient’s health care practitioner is in doubt or there is a vague abnormality on the chest X-ray, the patient may be advised to get a CT scan done. CT scan can demonstrate more details about the nodules, masses, or suspicious changes found on chest X-ray. It is useful for characterizing and staging of the tumours.

Magnetic resonance imaging (MRI) of the kidneys

Magnetic resonance imaging is a medical imaging technique used in radiology to investigate the anatomy and function of the body in both health and disease. MRI scanners use strong magnetic fields and radio waves to form images of the body. The technique is widely used in hospitals for medical diagnosis, staging of disease and for follow-up without exposure to ionizing radiation.

Treatment

The type of treatment depends on multiple factors and the individual, some of which include:

Which stage the renal cell carcinoma is in

Which organs and parts of the body are affected or unaffected

What type of Renal cell carcinoma (RCC)

Any pre-existing or comorbid conditions the person has

Overall health and Age of the person

Every form of treatment has both risks and benefits involved, a health care professional will provide the best options that suit the individual circumstances. Active surveillance Active surveillance or “Watchful waiting” is becoming more common as small renal masses or tumours are being detected and also in the older generation surgery is not always suitable. Active surveillance involves completing various diagnostic procedures, tests and imaging to monitor the progression of the RCC before embarking on a more high risk treatment option like surgery. In the elderly, patients with co-morbidities and in poor surgical candidates, this is especially useful. Surgery Different procedures may be most appropriate, depending on circumstances. Radical nephrectomy is the removal of the entire affected kidney including Gerota’s fascia, the adrenal gland which is on the same side as the affected kidney, and the regional lymph nodes all at the same time. This method although severe is effective. But it is not always appropriate, as it is a major surgery that contains the risk of complication both during and after the surgery and can have a longer recovery time. It is important to note that the other kidney must be fully functional, and this technique is most often used when there is a large tumour present in only one kidney. Nephron-sparing partial nephrectomy is used when the tumor is small (less than 4 cm in diameter) or when the patient has other medical concerns such as diabetes or hypertension. Partial nephrectomy involves the removal of the affected tissue only, sparing the rest of the kidney, Gerota’s fascia and the regional lymph nodes. This allows for more renal preservation as compared to the radical nephrectomy, and this can have positive long term health benefits. Larger and more complex tumors can also be treated with partial nephrectomy by surgeons with a lot of kidney surgery experience. Laparoscopic nephrectomy uses laparoscopic surgery, with minimally invasive surgical techniques. Commonly referred to as key hole surgery, this surgery does not have the large incisions seen in a classically performed radical or partial nephrectomy, but still successfully removes either all or part of the kidney. Laparoscopic surgery is associated with shorter stays in hospital and quicker recovery time but there are still risks associated with the surgical procedure. Surgery for metastatic disease: If metastatic disease is present surgical treatment may still a viable option. Radical and partial nephrectomy can still occur, and in some cases if the metastasis is small this can also be surgically removed. This depends on what stage of growth and how far the disease has spread. Targeted ablative therapies Targeted ablative therapies are also known as percutaneous ablative therapies. Although the development of laparoscopic surgical techniques that are used to complete nephrectomies has reduced some of the risks associated with surgery, surgery of any sort in some cases will still not be feasible. For example, the elderly, people already suffering from severe renal dysfunction or people who have several comorbidities surgery of any sort is not warranted. Instead there are targeted therapies which do not involve the removal of any organs or serious surgery. Rather, these therapies involve the ablation of the tumor or the affected area. Ablative treatments use imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) to identify the location of the tumors, which ideally are smaller than 3.5 cm in size and to guide the treatment. However there are some cases where ablation can be used on tumors that are larger. The two main types of ablation techniques that are used for renal cell carcinoma are radio frequency ablation and cryoablation. Radio frequency ablation uses an electrode probe which is inserted into the affected tissue, to send radio frequencies to the tissue to generate heat through the friction of water molecules. The heat destroys the tumor tissue. Cell death will generally occur within minutes of being exposed to temperatures of or above 50°C. Cryoablation also involves the insertion of a probe in to the affected area. However, in this case, instead of heat being used to kill the tumor, cold is. The probe is cooled with chemical fluids which are very cold. The freezing temperatures cause the tumor cells to die by causing osmotic dehydration, which pulls the water out of the cells, destroying the enzyme, organelles, cell membrane and freezing the cytoplasm. Chemotherapy Chemotherapy and radiotherapy are not as successful in the case of RCC. RCC is resistant in most cases but there is about a 4-5% success rate sometimes, but this is often short lived with more tumours and growths developing later. Vaccine Cancer vaccines are being developed, but so far have been found to be effective for only certain forms of the RCC. The vaccines are being designed to “prime” the immune system to provide tumour specific immunity. They are still being developed and present another treatment possibility.

Symptoms

Rectal cancer can cause many symptoms that require a person to seek medical care. However, rectal cancer may also be present without any symptoms, underscoring the importance of routine health screening. Symptoms to be aware of include the following:

Bleeding: Blood mixed with stool, is a sign to seek immediate medical care

Obstruction: A rectal mass may grow so large that it prevents the normal passage of stool. This blockage may lead to the feeling of severe constipation or pain when having a bowel movement. In addition, abdominal pain or cramping may occur due to the blockage. The stool size may appear narrow so that it can be passed around the rectal mass. Therefore, pencil-thin stool may be another sign of an obstruction from rectal cancer

A person with rectal cancer may have a sensation that the stool cannot be completely evacuated after a bowel movement

Weight loss: Unexpected weight loss

Causes

Rectal cancer usually develops over several years, first growing as a precancerous growth called a polyp. Some polyps have the ability to turn into cancer and begin to grow and penetrate the wall of the rectum. The actual cause of rectal cancer is not very clear. However, the following are risk factors for developing rectal cancer:

Increasing age

Smoking

Family history of colon or rectal cancer

High-fat diet or a diet mostly from animal sources

Personal or family history of polyps or colorectal cancer

An often forgotten risk factor is the lack of screening for rectal cancer. Routine cancer screening of the colon and rectum is the best way to prevent rectal cancer.

Diagnosis

Once the patient visits the specialist with the symptoms, in order to determine if the person is suffering from rectal cancer, the following screening tests for rectal cancer are conducted:

Fecal occult blood test: Early rectal cancer may damage blood vessels of the rectal lining and cause small amounts of blood to leak into the feces. The stool appearance may not change. The fecal occult blood test requires placing a small amount of stool on a special paper that is provided by a doctor. The doctor then applies a chemical to that paper to see if blood is present in the stool sample.

Endoscopy: During endoscopy, a doctor inserts a flexible tube with a camera at the end through the anus and into the rectum and colon. During this procedure, the doctor can see and remove abnormalities on the inner lining of the colon and rectum.

If rectal cancer is suspected, the tumor can be physically detected through either digital rectal examination. A digital rectal examination is performed by a doctor using a lubricated gloved finger inserted through the anus to feel the cancer on the rectal wall. Not all rectal cancers can be felt this way, and detection is dependent on how far the tumor is from the anus. If an abnormality is detected by a digital rectal examination, then an endoscopy is performed for further evaluation of the cancer.

A colonoscopy may be performed. In this a flexible endoscope is inserted through the anus and into the rectum and colon. A colonoscopy allows a doctor to see abnormalities in the entire colon, including the rectum.

A chest x-ray and a CT scan of the abdomen and pelvis are also performed to see whether the cancer has spread further than the rectum or surrounding lymph nodes.

Routine blood studies are performed to assess how a person might tolerate the upcoming treatment.

In addition, a blood test called CEA (carcinoembryonic antigen) is obtained. The CEA is often produced by colorectal cancers and can be a useful gauge of how the treatment is working. After the treatment, the doctor may regularly check the CEA level as one indicator of whether the cancer has returned. However, checking the CEA level is not an absolute test for colorectal cancers, and other conditions may cause a rise in the CEA level. Likewise, a normal CEA level is not a guarantee that the cancer is no longer present.

Treatment

The treatment of rectal cancer depends on the stage of the cancer, which is determined by the following 3 considerations:

How deep has the tumor has invaded the wall of the rectum

Whether the lymph nodes appear to have cancer in them

Whether the cancer has spread to any other locations in the body

If the patient is diagnosed with Stage I rectal cancer then surgery is the only necessary step in treatment. The risk of the cancer coming back after surgery is low, and, therefore, chemotherapy is not usually advised. Sometimes, after the removal of a tumor, the doctor may discover that the tumor has penetrated into the mesorectum which is classified as Stage II or if the lymph nodes contain cancer cells it is considered as the stage III. In these cases, chemotherapy and radiation therapy are offered after recovery from the surgery to reduce the chance of the cancer returning. Chemotherapy and radiation therapy given after surgery is called adjuvant chemotherapy. If the initial exams and tests show a person to have Stage II or Stage III rectal cancer, then chemotherapy and radiation therapy should be considered before surgery. Chemotherapy and radiation given before surgery is called neoadjuvant chemotherapy. This therapy lasts approximately 6 weeks. Neoadjuvant therapy is performed to shrink the tumor so it can be more completely removed by surgery. In addition, a person is likely to tolerate the side effects of combined chemotherapy and radiation therapy better if this therapy is administered before surgery rather than afterward. If the rectal cancer is metastatic, then surgery and radiation therapy would only be performed if persistent bleeding or bowel obstructions from the rectal mass exist. Otherwise, chemotherapy alone is the standard treatment of metastatic rectal cancer. At this time, metastatic rectal cancer is not curable. However, average survival times for people with metastatic rectal cancer have lengthened over the past several years because of the introduction of new medications.

Symptoms

Some of the symptoms experienced are:

Frequent urination especially at night

Difficulty in urination

Weak or interrupted flow of urine

Painful or burning urination

Difficulty in having an erection

Painful ejaculation

Blood in urine or semen

Frequent pain or stiffness in the lower back, hip or upper thigh

Causes

The exact cause of prostate cancer is under investigation. However, increasing age and high testosterone are known risk factors.

Diagnosis

Since the above mentioned symptoms can potentially indicate the presence of other diseases or disorders, men who experience any of these symptoms should undergo a thorough check-up to determine the underlying cause. Some of the tests that can be done are:

A blood test for a protein known as Prostate Specific Antigen (PSA)

An ultrasound examination through the rectum is suggested, usually after the doctor has examined the prostate through the rectum (Digital Rectal Examination – DRE)

Treatment

The prostate cancer treatment options depend on several factors, such as:

How fast the cancer is growing

The stage of cancer

The overall health

The pros and cons of the treatment.

Immediate treatment may not be necessary:

For men diagnosed with a very early stage of prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance. In active surveillance, regular follow-up blood tests, rectal exams and biopsies may be performed to monitor the progression of your cancer. If tests show that cancer is progressing, then the doctor recommends surgery or radiation. Active surveillance carries a risk that the cancer may grow and spread between check-ups, making it less likely to be cured. The treatment methods may vary case-by-case. Some of them are: Radiation therapy: Radiation therapy uses high-powered energy to kill cancer cells. When it comes to Prostate cancer, radiation therapy treatment can be delivered in two ways: External beam radiation: During external beam radiation therapy (treatment without surgery), the patient lies on a table while a machine moves around the body directing high-powered energy beams to the cancer. The patient undergoes this treatment five days a week for several weeks. In this process, the patient gets exposed to x-rays or protons to deliver the radiation. Brachytherapy: It involves placing many rice-sized radioactive seeds in the prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. The doctor implants the radioactive seeds in the prostate gland using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don’t need to be removed. Hormone therapy: It is a treatment to stop the body from producing the male hormone testosterone known as ‘testosterone suppression treatment’. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:

Medications that stop the body from producing testosterone

Medications that block testosterone from reaching cancer cells

Surgery for the removal of testicles (orchiectomy) as part of prostate cancer treatment.

The objective here is to slow down the growth of tumours during the treatment. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumours before radiation therapy. Sometimes hormone therapy is used after surgery or radiation therapy to slow the growth of any cancer cells left behind. Operation to remove the prostate cancer during treatment: Surgery for prostate cancer involves removing the prostate gland, some surrounding tissue and a few lymph nodes known as Radical Prostatectomy. This includes:

Using a robot to assist with surgery

Making an incision in your abdomen

Making an incision between your anus and scrotum

Laparoscopic prostatectomy (a minimally invasive surgery with multiple incisions)

Da Vinci Surgery for Prostate treatment: Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control compared to conventional techniques. Robotic surgery is usually associated with minimally invasive surgery. It is also used in certain traditional open surgical procedures. The average time for surgery is 2 hours. Advantages: Minimal blood loss, pain, scarring and complications are some of the advantages of robotic surgery apart from shorter hospital stay and faster recovery. Freezing prostate tissue: Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and the surrounding healthy tissue. Chemotherapy: Chemo uses drugs to kill rapidly growing cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both. It is considered as a treatment option especially when the cancer has become Metastatic (spread to distant areas of their bodies). Chemotherapy may also be an option for cancers that don’t respond to hormone therapy. Multiple new chemotherapy drugs have recently been approved for treatment of progressive or metastatic prostate cancer. Immunotherapy: A form of immunotherapy has been developed to treat advanced and recurrent prostate cancer. This treatment takes some of the patient’s own immune cells, genetically engineers them to fight prostate cancer, and then injects the cells back into the patient’s body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple visits.

Symptoms

The symptoms usually occur based on the differentiation of the tumor being functional or non-functional. Functional tumors cause oversecretion of hormones, while non-functional tumors don’t secrete excess hormones. Pituitary tumors are usually large enough to press on nearby nerves or parts of the brain, leading to symptoms, such as:

Blurred or double vision

Loss of peripheral vision

Sudden blindness

Headaches

Facial numbness or pain

Dizziness

Loss of consciousness

Causes

Based on certain studies, experts say that DNA can make the cells in the pituitary gland to produce a tumor as there are no known lifestyle-related or environmental causes of pituitary tumors.

Diagnosis

These tumors sometimes don’t show any symptoms and are later found by medical tests done for other health problems. Signs and symptoms might suggest that a person could have a pituitary tumor but to confirm the same, certain tests are needed such as:

Testing for diabetes

Venous blood sampling

Imaging tests

Tests of pituitary tissue samples

Treatment

Surgery and radiation therapy are the main forms of treatment and may slow the rate of tumor growth and prevent or relieve symptoms. Chemotherapy and newer targeted therapy drugs could be recommended.

Symptoms

Cancer can be hard to detect in children. Children with cancer may experience the following symptoms or signs. Sometimes, children with cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. Some of the symptoms include:

Continued, unexplained weight loss

Headaches, often with early morning vomiting

Increased swelling or persistent pain in the bones, joints, back, or legs

Lump or mass, especially in the abdomen, neck, chest, pelvis, or armpits

Development of excessive bruising, bleeding or rash

Constant, frequent or persistent infections

A whitish colour behind the pupil

Nausea that persists or vomiting without nausea

Constant tiredness or noticeable paleness

Eye or vision changes that occur suddenly and persist

Recurring or persistent fevers of unknown origin

Causes

Doctors and researchers don’t know what causes most childhood cancers. A small percentage of cancers can be linked to the genetic disorder Down’s syndrome, other inherited genetic abnormalities and previous radiation treatment. Environmental causes, such as exposure to infectious and toxic substances, are unlikely to cause childhood cancer.

Diagnosis

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body (metastasis). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy or surgery to remove as much of the tumour as possible is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. In addition to a physical examination, the following tests may be used to diagnose childhood cancer: Biopsy A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but except for certain types of brain tumours, only a biopsy can make a definite diagnosis. The type of biopsy performed depends on the location of the cancer. The sample removed during the biopsy is analysed by a pathologist. A pathologist is a doctor who specialises in interpreting laboratory tests and evaluating cells, tissues and organs to diagnose disease. Bone Marrow Aspiration and Biopsy These two procedures are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of the fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. The samples are then analysed by a pathologist. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The skin in that area is usually numbed with medication beforehand, and other types of anaesthesia may be used. Computed Tomography (CT) Scan A CT scan creates a three-dimensional picture of the insides of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumours. A CT scan can also be used to measure the tumour size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. Magnetic Resonance Imaging (MRI) An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumour 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. Positron Emission Tomography (PET) Scan A PET scan is a way to create pictures of organs and tissues inside the body. 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 cancerous cells tend to use energy actively, they absorb more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Treatment

Surgery Surgery is the removal of the tumors, either cancerous or non-cancerous, and surrounding tissue during an operation. Many children with a tumour will need surgery at some point during their treatment. A surgical oncologist is a doctor who specialises in treating a tumour using surgery. The goal of surgery is to remove the entire tumour and the margin (tissue around the tumour), leaving a negative margin (no cancer in the healthy tissue). For most childhood tumours, there is a microscopic amount of tumour left after surgery. Doctors will recommend chemotherapy, radiation therapy or other treatments for the remaining tumour. Chemotherapy Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cell’s ability to grow and divide. Chemotherapy is given by a paediatric oncologist, a doctor who specialises in treating children with cancer. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein, muscle, spinal fluid or under the skin using a needle, or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Radiation Therapy Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defences to fight cancer. It uses materials made either by the body or in a laboratory to improve, target or restore immune system function. Examples of immunotherapy include cancer vaccines, monoclonal antibodies and interferons. Radiation therapy is the use of high-energy x-rays or other particles such as photons to destroy cancer cells. A doctor who specialises in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time. Immunotherapy Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defences to fight cancer. It uses materials made either by the body or in a laboratory to improve, target or restore immune system function. Examples of immunotherapy include cancer vaccines, monoclonal antibodies and interferons. Stem Cell Transplantation/Bone Marrow Transplantation: A stem cell transplant is a medical procedure in which bone marrow that contains cancer is replaced by highly specialised cells, called hematopoietic stem cells that develop into healthy bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the stem cells in the blood that are typically being transplanted, not the actual bone marrow tissue.

Symptoms

There are chances that a patient suffering from parathyroid cancer may not experience any symptoms at all. Otherwise, the common symptoms observed are:

Acute stomach pain

Bone pain

Fatigue & Weakness

Difficulty in speaking

Kidney problems which includes excessive urination

History of gastroduodenal ulcers (found in the stomach and/or small intestine)

Vomiting

Lump in the back

Loss of sleep

Depression & Confusion

A General feeling of discomfort or illness

The symptoms mentioned are not unique to parathyroid cancer alone, therefore it is important to get a check-up done quickly to drive early detection.

Causes

It is understood that Parathyroid cancer occurs during middle-age amongst men and women. Although there are no known causes of Parathyroid cancer, the following risk factors may increase a person’s chance of developing the cancer:

Family History – An inherited condition such as multiple endocrine neoplasia (MEN1) may increase the individual’s risk of developing benign parathyroid tumours.

Another condition called Hyperparathyroidism Jaw tumour (HPT-JT) which causes increased activity in the parathyroid glands put a person at a higher risk of developing parathyroid cancer.

Radiation (treatment with X-rays or other kinds of energy) to the neck

Stages of Parathyroid cancer : A Parathyroid cancer can be classified into 3 stages specifically: Localized stage: In the 1st stage, the cancer is present only in the parathyroid gland or nearby tissues. Metastatic stage: In the 2nd stage, the cancer has spread to the other parts of the body and nearby tissues including lymph nodes, lungs or bone. Recurrent stage: In this stage, the cancer can come back after it has been treated. A recurrent parathyroid cancer is most often in the tissues or lymph nodes in the neck. It can also come back in other parts of the body.

Diagnosis

Diagnosis of Parathyroid Cancer may require the following tests and procedures: Physical Exam & History: The doctor does a physical exam to check for any lumps around the neck which seem unusual. A detailed account of patient’s health habits and past illnesses and treatments are also carefully studied. Blood Chemistry Studies: A blood sample from the patient is extracted to check high level of calcium levels which can indicate the presence of parathyroid cancer. A secondary test is also done to check the amount of parathyroid hormone which is released into the blood by the parathyroid glands. CT-Scan: The computerized tomography test makes a series of detailed pictures of areas inside the body at different angles. A dye is injected into the vein or swallowed to the help the organs or tissues show up more clearly. The test is highly effective in detecting any abnormalities in the parathyroid gland. A SPECT scan (single photon emission computed tomography scan) is also conducted before or after the CT scan where a special camera is used to make a 3-D picture with help of a small amount of radioactive substance that gets injected into the vein. Ultrasound exam: The procedure involves high-energy sound waves (ultrasound) which bounces off internal tissues or organs and makes echoes. The echoes form a picture of the parathyroid gland and how far the tumour has spread. Angiogram: Under this a procedure is performed to check the blood vessels and the flow of blood. A dye is injected into the blood vessel. As the dye moves through the blood vessel, x-rays are taken to see the presence of tumour in the parathyroid gland. Venous Sampling: A procedure in which sample of blood is taken from specific veins and checked to measure the amount of certain substances released into the blood by nearby organs and tissues. If imaging tests don’t show which parathyroid gland is overactive, blood samples may be taken from veins near each parathyroid gland to find which one is making excessive PTH (Parathyroid Hormone).

Treatment

After conducting multiple tests and making a proper diagnosis, the consultants may decide to go with one or more possible treatment modalities. These include radiation therapy, chemotherapy, and surgery. It is understood that a parathyroid tumour can cause high level of calcium in the blood (hypercalcaemia). The medication prescribed is used to reduce the calcium levels in the blood. Most of the drugs are only used for short periods until treatment to remove the tumour can be started. Otherwise, the various types of treatment are: Surgery Under this, a surgical procedure is performed to remove the tumour in the parathyroid gland. Surgery is usually recommended when the tumour is larger than 3 centimetres. In such cases, the parathyroid gland and surrounding tissues are removed. In order to treat benign parathyroid cancers, a surgery called parathroidectomy is performed. During the procedure, if the surgeon discovers that the tumour is benign during surgery, it is common to check the patient’s level of PTH in the blood during the operation. If required, the surgeon will then put back 1 of the normal parathyroid glands that had been removed earlier in the operation. Radiation Therapy During radiation, high energy x-rays are used to destroy cancer cells. Radiation therapy is usually recommended after surgery for parathyroid cancer. It helps in reducing the risk of recurrent parathyroid cancer. It is also considered an option where surgery is not possible. The side effects of radiation therapy can include fatigue, mild skin reactions, upset stomach and loose bowel movements. Chemotherapy During this form of therapy, chemo-drugs are used to destroy the cancer cells. The drugs are injected into the body through the intravenous (IV) tube placed into a vein using a needle or in a capsule which requires to be swallowed orally. It is understood that chemotherapy rarely works at treating metastatic or recurrent parathyroid cancer. The side effects of chemotherapy include fatigue, risk of infection, nausea, vomiting, hair loss, loss of appetite and diarrhoea.

Symptoms

Early pancreatic cancer often does not cause symptoms, and the later symptoms are usually nonspecific and varied. Therefore, pancreatic cancer is often not diagnosed until it is advanced. Common symptoms include:

Pain in the upper abdomen that typically radiates to the back

Heartburn

Poor appetite or nausea and vomiting

Diarrhoea, loose stools

Significant weight loss

Painless jaundice (yellow tint to whites of eyes or yellowish skin, possibly in combination with darkened urine). The jaundice may be associated with itching as the salt from excess bile can cause skin irritation

Pulmonary embolisms due to pancreatic cancers producing blood clotting chemicals

Diabetes mellitus, or elevated blood sugar levels. Many patients with pancreatic cancer develop diabetes months to even years before they are diagnosed with pancreatic cancer, suggesting that the onset of diabetes in an elderly individual may be an early warning sign of pancreatic cancer

Signs of cancer metastasis. Typically, pancreatic cancer first metastasises to regional lymph nodes, and later to the liver or to the peritoneal cavity and rarely, to the lungs; it rarely metastasises to bone or brain.

Causes

Although pancreatic cancer is not yet fully understood, several risk factors and causes that have been identified may increase your chance of developing it:

Ageing Pancreatic cancer can affect people of any age, but it mainly affects people aged 50 to 80. Around 63% of people diagnosed with cancer of the pancreas are over 70.

Smoking Smoking is associated with almost a third of all pancreatic cancer cases. Smoking cigarettes, cigars or chewing tobacco can all increase your risk of developing cancer of the pancreas. This is because tobacco smoke contains harmful toxins and chemicals that can cause irritation and inflammation (swelling) in the tissues and organs within your body.

Chronic Pancreatitis Chronic pancreatitis (long-term inflammation of the pancreas) will increase your risk of pancreatic cancer. Although very uncommon, patients with hereditary (inherited) pancreatitis have a particularly high risk of pancreatic cancer, especially from the age of 40.

Diagnosis

It is important to note that pancreatic cancer is not just one disease. There are many types of pancreatic tumours, each with its own unique prognosis and treatment recommendations. In the diagnosis of pancreatic cancer, the doctor may conduct the following tests:

Medical History and Physical Examination: A series of tests may be necessary to make a definite diagnosis. The doctor will first start by asking about the patient’s medical history and any physical complaints or symptoms, specifically recent weight loss, pain and changes in appetite, bowel patterns or skin colour. The doctor will then complete a thorough physical exam, which will include palpation and observation of the chest and abdomen.

Lab Tests: Blood specimens may be collected and less commonly, urine or stool samples may also be asked for. Of particular interest to the doctor is the level of bilirubin and liver enzymes in a patient’s blood, which measures liver and pancreas function.

Another blood test commonly performed is CA19-9 (carbohydrate antigen 19-9). CA19-9 is referred to as a ‘tumour marker’ which is a chemical substance in the body that may be found at higher levels if cancer is present. An elevated CA19-9 test by itself is not used to make the diagnosis of pancreatic cancer, as it can be elevated in a variety of other conditions, such as pancreatitis or cirrhosis of the liver, and some people with pancreatic cancer do not show this marker at all. CA 19-9 however can be used as a tool to help evaluate the effectiveness of a cancer therapy by comparing the levels before and during treatment.

Ultrasound: Ultrasound uses a machine that emits high-frequency sound waves to create images of the organs inside the body. An abdominal ultrasound examines the liver, gallbladder, spleen, pancreas and kidneys, and can help identify abnormal structures or tissue.

Computed Tomography (CT) Scan: This is a non-invasive method of examining internal organs that captures a series of thin x-ray images of the inside of the body. CT scans can help detect tumours and determine whether it has spread to other parts of the body, such as the liver.

There are different types of CT scans and special techniques that can be done to create more detailed images of the pancreas. Some places offer a three-dimensional CT scan, often referred to as a ‘spiral’ or ‘helical’ scan, which creates extremely detailed images of the pancreas and nearby blood vessels and structures to help determine treatment decisions.

Endoscopic Ultrasound (EUS): This is a procedure that allows a specially trained doctor, typically a gastroenterologist, to view the oesophagus, stomach and the first portion of the small intestine, as well as adjacent organs including the liver and pancreas. While the patient sleeps, a thin flexible tube called an endoscope is passed through the mouth into the stomach and small intestine. At the end of the tube is an ultrasound probe that emits sound waves that create images of the abdominal organs.

If unusual masses are detected, the doctor may collect a specimen of tissue at the time of the procedure during a biopsy. The use of EUS can decrease the likelihood that a patient will need to go to the operating room for surgery.

Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure uses an endoscope – a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the patient’s stomach and into the small intestine. ERCP combines two imaging techniques: ‘endoscopy’ the direct visualisation of internal structures and ‘fluoroscopy’ a live action x-ray method. These two techniques allow the doctor to view images of the liver, gall bladder and pancreas ducts, which can help detect a narrowed or blocked duct.

Further tests, such as a biopsy, can pinpoint the cause of a narrowed or blocked duct. If a duct is narrowed or blocked by a tumour, a plastic or metallic stent can be placed across the blockage. The stent is designed to expand and reopen the duct to allow bile juices to flow freely.

Magnetic Resonance Cholangiopancreatography (MRCP): MRCP uses radio waves and a powerful magnet linked to a computer to visualise the biliary and pancreatic ducts in a non-invasive manner. These pictures can show the difference between normal and diseased tissue and can also detect bile duct obstruction.

MRCP may be performed in patients who cannot have an Endoscopic Retrograde Cholangiopancreatography (ERCP) or may also prevent unnecessary invasive procedures.

Biopsy: A biopsy allows a doctor to collect a small amount of tissue. A pathologist then uses a microscope to examine the tissue and identify the types of cells collected.

Tissue can be collected at the time of an endoscopic ultrasound or endoscopic retrograde cholangiopancreatography. A biopsy can also be performed under the guidance of a CT scan. If necessary, a biopsy can be performed at the time of abdominal open surgery.

There are two methods frequently used to collect tissue for a biopsy. A Fine Needle Aspiration (FNA) utilises a very narrow needle. A core needle biopsy uses a larger needle. Both methods have advantages and risks.

If cancer is suspected to have spread, or metastasised, it is preferable to biopsy the tumour than the pancreas itself. A specially trained doctor can then determine the best method to use. It is also important to note that if all of your other test results suggest cancer, you may not need a biopsy before you have treatment.

Treatment

Treatment for pancreatic cancer depends on the stage and location of the cancer. Following are the treatments that a doctor will recommend depending on the stage of cancer.

SURGERY Surgery may be an option if the cancer is confined only to the pancreas. Operations used in people with pancreatic cancer include:

• Surgery for tumours in the pancreatic head: If the cancer is located in the head of the pancreas, whipple procedure is used by the doctor. It involves removing the head of the pancreas, as well as a portion of the small intestine (duodenum), the gallbladder and part of the bile duct. Part of the stomach may also be removed. Finally, the surgeon reconnects the remaining parts of the pancreas, stomach and intestines to allow the patient to digest food.
• Surgery for tumours in the pancreatic tail and body: Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. The surgeon may also remove the spleen. Surgery carries a risk of bleeding and infection.

RADIATION THERAPY Radiation therapy uses high-energy beams, such as x-rays and protons, to destroy cancer cells. The patient may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, the doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can’t be treated surgically.

Radiation therapy usually comes from a machine that moves around you, directing radiation to specific points on the body (external beam radiation).

CHEMOTHERAPY

Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. Depending on the extent of cancer, the patient may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.

Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs. This combination may also be used after surgery to reduce the risk that pancreatic cancer may recur.

In people with advanced pancreatic cancer, chemotherapy may be used alone or it may be combined with targeted drug therapy.

TARGETED THERAPY Targeted therapy uses drugs that attack specific abnormalities within cancer cells. There are targeted drugs which blocks chemicals that signal cancer cells to grow and divide. Such drugs are usually combined with chemotherapy for use in people with advanced pancreatic cancer.