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Symptoms

Blood in the urine, painful or burning sensation during urination and needing to urinate frequently, particularly during the night, are all symptoms common to bladder, kidney and prostate cancers. Kidney cancer may also result in symptoms of fever, unexplained weight loss, fatigue and a pain in the side that does not subside. Prostate cancer will affect the flow of urine; patients may experience difficulty starting or stopping urination; as well as difficulty in achieving an erection. Testicular cancer often presents as an enlargement or swelling of the testicle, pain in the scrotum and/or pain in the groin, back or lower abdomen.

Causes

Smoking, certain bacterial infections and occupational chemical exposure are among the risk factors for bladder cancer. For kidney cancer, the risk factors include smoking, obesity, high blood pressure and heavy metal exposure. The odds of developing prostate cancer are raised by age and family history, while testicular cancer risk factors include family history and congenital abnormalities or birth defects of the testes, kidneys and penis.

Diagnosis

Prostate Cancer This is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing, however, there are cases of aggressive prostate cancers. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, problems during sexual intercourse or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.Prostate cancer tends to develop in men over the age of fifty. Globally it is the sixth leading cause of cancer-related death in men. Prostate cancer is most common in the developed world with increasing rates in the developing world. However, many men with prostate cancer never have symptoms, undergo no therapy and eventually die of other unrelated causes. Many factors, including genetics and diet, have been implicated in the development of prostate cancer.The presence of prostate cancer may be indicated by symptoms, physical examination, Prostate-Specific Antigen (PSA) or biopsy. Prostate-specific antigen testing increases cancer detection but does not decrease mortality.Management strategies for prostate cancer should be guided by the severity of the disease. Many low-risk tumours can be safely followed with active surveillance. Curative treatment generally involves surgery, various forms of radiation therapy or less commonly, cryosurgery; hormonal therapy and chemotherapy are generally reserved for cases of advanced disease (although hormonal therapy may be given with radiation in some cases).The age and underlying health of the man, the extent of metastasis, appearance under the microscope and response of the cancer to initial treatment are important in determining the outcome of the disease. The decision whether or not to treat localised prostate cancer (a tumour that is contained within the prostate) with curative intent is a patient trade-off between the expected beneficial and harmful effects in terms of patient survival and quality of life. Kidney Cancer It is a type of cancer that starts in the cells in the kidney.The two most common types of kidney cancer are Renal Cell Carcinoma (RCC) and Urothelial Cell Carcinoma (UCC) of the renal pelvis. These names reflect the type of cell from which the cancer developed.The different types of kidney cancer (such as RCC and UCC) develop in different ways, meaning that the diseases have different outlooks (or prognosis), and need to be staged and treated in different ways. RCC is responsible for approximately 80% of primary renal cancers, and UCC accounts the majority of the remainder. Bladder Cancer This includes any of the several types of malignancy arising from the epithelial lining (i.e. the urothelium) of the urinary bladder. Rarely the bladder is involved by non-epithelial cancers, such as lymphoma or sarcoma, but these are not ordinarily included in the colloquial term ‘bladder cancer’. It is a disease in which abnormal cells multiply without control in the bladder. The bladder is a hollow, muscular organ that stores urine and is located in the pelvis. The most common type of bladder cancer recapitulates the normal histology of the urothelium and is known as transitional cell carcinoma or more properly urothelial cell carcinoma.

Treatment

There are three main categories of urologic cancer treatments: surgery, radiation and chemotherapy. A fourth option sometimes applied in the treatment of prostate cancer is termed active surveillance or watchful waiting. In this case, a prostate tumour that is determined to be of very small size and slow growth is not actively treated until such a time that it is determined to be of greater risk to the patient.

Symptoms

There may not be any symptoms at first. Over time, you might notice may become hard to pee. There is a possibility of weak urine flow or sometimes an inability to hold it. It could also result in frequent visits to the bathroom, especially at night. Other symptoms include:

Bleeding from the urethra or blood in the urine

Weak or interrupted flow of urine

Urination occurs often

A lump or thickness in the perineum or penis

Discharge from the urethra

Enlarged lymph nodes in the groin area

Causes

Doctors have not been able to clearly identify the causes of urethral cancer however, people over age 60, are have a higher risk of getting urethral cancer. The risk might be higher, if there has been a history of bladder cancer, frequent urinary tract infections, or sexually transmitted diseases that lead to an inflammation of the urethra. Urethral cancer has been linked to human papillomavirus, especially HPV 16. The HPV vaccine protects against type 16. Doctors recommend it for girls and boys at ages 11 or 12. Females can get the vaccine through age 26 and males through age 21. Some of the other causes of Urethral Cancer are the following:

Having conditions that cause chronic, swollen, reddened part in the urethra

Being a white skinned female

Diagnosis

The following tests and procedures may be used:

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

Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose the disease, plan and check treatment, or monitor the disease over time.

Urine cytology: Examination of urine under a microscope to check for abnormal cells.

Urinalysis: A test to check the colour of urine and its contents, such as sugar, protein, blood, and white blood cells. If white blood cells (a sign of infection) are found, a urine culture is usually done to find out what type of infection it is.

Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual. This procedure may be performed while the patient is under anaesthesia.

Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. This may be done while the patient is under anaesthesia.

Cystoscopy: A procedure to look inside the urethra and bladder to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.

Biopsy: The removal of cells or tissues from the urethra, bladder, and, sometimes, the prostate gland, so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Treatment

Different types of treatments are available for patients with urethral cancer. Some treatments are standard, and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. Three types of standard treatment are used: Surgery Surgery is the most common treatment for cancer of the urethra. One of the following types of surgery may be done:

Open excision: Removal of the cancer by surgery.

Electro-resection with fulguration: Surgery to remove the cancer by electric current. A lighted tool with a small wire loop on the end is used to remove the cancer or to burn the tumour away with high-energy electricity.

Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove or destroy tissue.

Lymph node dissection: Lymph nodes in the pelvis and groin may be removed.

Cystourethrectomy: Surgery to remove the bladder and the urethra.

Cystoprostatectomy: Surgery to remove the bladder and the prostate.

Anterior exenteration: Surgery to remove the urethra, the bladder, and the vagina. Plastic surgery may be done to rebuild the vagina.

Partial penectomy: Surgery to remove the part of the penis surrounding the urethra, where cancer has spread. Plastic surgery may be done to rebuild the penis.

Radical penectomy: Surgery to remove the entire penis. Plastic surgery may be done to rebuild the penis.

If the urethra is removed, the surgeon will make a new way for the urine to pass from the body. This is called urinary diversion. If the bladder is removed, the surgeon will make a new way for urine to be stored and passed from the body. The surgeon may use part of the small intestine to make a tube that passes urine through an opening (stoma). This is called an ostomy or urostomy. If a patient has an ostomy, a disposable bag to collect urine is worn under clothing. The surgeon may also use part of the small intestine to make a new storage pouch (continent reservoir) inside the body where the urine can collect. A tube (catheter) is then used to drain the urine through a stoma. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. 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 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 the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is given directly to the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way chemotherapy is given depends on the type and stage of the cancer being treated. Follow-up tests may be needed Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Symptoms

One may feel as though the pain came out of nowhere. Some people with this condition start out thinking they have an abscessed tooth and go to a dentist. The symptoms of Trigeminal Neuralgia are:

Episodes of severe, shooting or jabbing pain that may feel like an electric shock

Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth

Bouts of pain lasting from a few seconds to several minutes

Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain

Constant aching, burning feeling that may occur before it evolves into the spasm-like pain of trigeminal neuralgia

Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead

Pain affecting one side of the face at a time, though may rarely affect both sides of the face

Pain focused in one spot or spread in a wider pattern

Attacks that become more frequent and intense over time

Doctors consider these sudden and intense bouts of pain be signs of classical case of trigeminal neuralgia (TN1). At times the pain could be less intense but constant, like an aching and burning sensation. This is referred to as “atypical” trigeminal neuralgia (TN2). Some people with this condition also have anxiety because they are uncertain when the pain will return.

Causes

Primary Trigeminal Neuralgia is caused in by tiny blood vessel impinging on the trigeminal nerve, 5th nerve – Neurovascular conflict (50%) or sometimes without any causes – Idiopathic (40%). Secondary Trigeminal Neuralgia in 10% of patients is caused by herpes infection, multiple sclerosis, tumours or nerve injuries. This condition usually surfaces when there is a contact between a blood vessel and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction. Very rarely, Trigeminal Neuralgia can be caused by a tumour compressing the trigeminal nerve. While in few cases, a cause can’t be found. The triggers for Trigeminal Neuralgia could be:

Shaving

Touching your face

Eating

Drinking

Brushing your teeth

Talking

Putting on makeup

Encountering a breeze

Smiling

Washing your face

Diagnosis

The diagnosis of trigeminal neuralgia is mainly based on the description of the pain, including:

Type: Pain related to trigeminal neuralgia is sudden, shock-like and brief.

Location: The parts of your face that are affected by pain will tell your doctor if the trigeminal nerve is involved.

Triggers: Trigeminal neuralgia-related pain usually is brought on by light stimulation of your cheeks, such as from eating, talking or even encountering a cool breeze.

The doctor may recommend certain tests to diagnose trigeminal neuralgia and determine underlying causes for the condition, including:

A neurological examination: Touching and examining parts of the face can help the doctor determine exactly where the pain is occurring and, if you appear to have trigeminal neuralgia, which branches of the trigeminal nerve may be affected. Reflex tests also can help the doctor determine if the symptoms are caused by a compressed nerve or another condition.

Magnetic resonance imaging (MRI): The doctor may order an MRI scan to determine if multiple sclerosis or a tumour is causing trigeminal neuralgia. In some cases, the doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiogram).

It’s important to note that the facial pain may be caused by other conditions also, so an accurate diagnosis is essential. The specialists may suggest additional tests to rule out the possibilities of other conditions.

Treatment

The treatment for Trigeminal neuralgia usually starts with medications, and in some cases no additional treatment is required. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant/intolerable side effects. For those people, injections or surgery provide other trigeminal neuralgia treatment options. Medicinal Treatment The treatment of Trigeminal Neuralgia can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best.

Anticonvulsant medicines: Used to block nerve firing, are generally effective in treating TN1 but often less effective in TN2.

Antispasmodic agents: Muscle-relaxing agents may be used alone or in combination with anticonvulsants. Side effects may include confusion, nausea and drowsiness.

Botox Injections: Studies have shown that Botox injections may reduce pain from trigeminal neuralgia in people who are no longer helped by medications. However, more research needs to be done before this treatment is widely used for this condition.

Surgical Treatment

Non-Ablative Options:

• Open Microsurgery: This procedure is called Microvascular decompression is usually contemplated when there is abnormal vessel pressing the nerve resulting in a process called demyelination. The Surgeon would place a Teflon sponge between the vessel and the nerve and minimises the damage. The recurrence rate for the condition may be 50?ter 10 years of the procedure.
• Neurectomy: Usually involves cutting of the superficial branches of the nerves. The effect caused by this procedure is typically temporary and pain recurs in 1-2 years.

Ablative Options: Few of these procedures are usually done on an outpatient basis under local anaesthesia / General anaesthesia. The side-effects of the same may include – facial numbness

Balloon Compression: Here a hollow needle is inserted through the face and guided to a part of the trigeminal nerve that goes through the base of the skull. Then, the doctor threads a thin, flexible tube (catheter) with a balloon on the end through the needle. The balloon is inflated with enough pressure to damage the trigeminal nerve and block pain signals. This procedure is done under general anaesthesia. Usually the pain relief lasts for 1-2 years

Glycerol Injection: During this procedure, a sterile needle is inserted through the face and into an opening in the base of the skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion — where the trigeminal nerve divides into three branches — and part of its root. There a small amount of sterile glycerol is injected, which damages the trigeminal nerve and blocks pain signals

Radiofrequency lesioning: This procedure selectively destroys nerve fibres associated with pain. An electrode is used to locate the area causing the pain. Once located, the heat is applied through the electrode to damage the nerve fibres creating an area of injury (lesion). The pain recurrence usually happens at 3-4 years.

Radiation Therapy

Stereotactic Radiosurgery: Stereotactic radiosurgery uses advanced computer and MR imaging to direct highly focused beams of radiation at the site where the trigeminal nerve exits the brain stem. This causes the slow formation of a lesion on the nerve that disrupts the transmission of sensory signals to the brain.

Advantages of Frameless Radiosurgery:

Non-invasive treatment

Non-invasive – No need for anaesthesia, No need for Blood, No risk of infections

Day-care procedure – Uses the most advanced FFF technology which enables fastest treatment delivery from 20-30mts

Uses Robotics which gives sub mm. Precision and accuracy in targeting the nerve

Allows flexi-scheduling

Symptoms

Thyroid cancer symptoms do not usually emerge in the early stages. That’s because there are very few symptoms in the beginning. As it grows however, the following problems may show:

Neck, throat pain

Lump in your neck

Difficulty swallowing

Vocal changes, hoarseness

Pain in the ears

Trouble breathing or having constant wheezing

Frequent cough that is not related to a cold

The lymph nodes in the neck are swollen

Causes

The following can be the causes as well as the risk factors that can lead to thyroid cancer:

Radiation exposure: The exposure, especially during childhood, increases the risk of developing thyroid cancer. This could be due to an all-nuclear fallout that occurs after a nuclear explosion, or radiation treatment for medical conditions/diseases when radiation risks were not properly understood.

Gender: The gender of the patient plays a big role in thyroid cancer. Around three-quarters of all patients with thyroid cancer are female.

Some health conditions/diseases: People with the following conditions/diseases have a higher risk of developing thyroid cancer:

• Hashimoto’s thyroiditis
• Cowden’s syndrome
• Thyroid adenoma and
• Familial adenomatous polyposis.
• Genetics: Some inherited conditions increase the risk of developing medullary thyroid cancer. Approximately one quarter of individuals, who develop medullary thyroid cancer, have an abnormal gene.
• Iodine deficiency: If there is iodine deficiency in the diet, there is a higher risk for certain types of thyroid cancer.
• Family history: Individuals with a family history of goitre (thyroid gland enlargement) have a higher risk of developing thyroid cancer.

Diagnosis

Thyroid nodules, or lumps, are very common. Most aren’t cancerous. In order to diagnose thyroid cancer one or a combination of the following tests can be conducted:

Physical exam: The doctor conducts a physical examination of the thyroid for lumps (nodules). He may also check the neck and nearby lymph nodes for growths or swelling.

Blood tests: The doctor may also check for abnormal levels of Thyroid-Stimulating Hormone (TSH) in the blood. Too much or too little TSH means the thyroid is not working well.

Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside the neck. The echoes create a picture of the thyroid and nearby tissues. The picture can show thyroid nodules that are too small to be felt. Nodules that are filled with fluid are usually not cancer. Nodules that are solid may be cancer.

Thyroid scan: In a thyroid scan, the patient is made to swallow a small amount of a radioactive substance (such as radioactive iodine), and it travels through the bloodstream. Thyroid cells that absorb the radioactive substance can be seen on a scan. Nodules that take up more of the substance than the thyroid tissue around them are called ‘hot’ nodules. Hot nodules are usually not cancer. Nodules that take up less substance than the thyroid tissue around them are called ‘cold’ nodules. Cold nodules may be cancer.

Biopsy: A biopsy is the only sure way to diagnose thyroid cancer. A pathologist checks a sample of thyroid tissue for cancer cells, using a microscope.

A doctor may take tissue for a biopsy in one of the following two ways:

With a thin needle: The doctor removes a sample of tissue from a thyroid nodule with a thin needle. An ultrasound device can help your doctor see where to place the needle. Most people have this type of biopsy.

With surgery: If a diagnosis can’t be made from tissue removed with a needle, a surgeon removes a lobe, or the entire thyroid. For example, if the doctor suspects follicular thyroid cancer, the lobe that contains the nodule may be removed for diagnosis.

Treatment

There are multiple ways to treat thyroid cancer. The treatment you get will depend on the type and stage of the cancer. It also depends on the age and general health of the patient. The doctor may recommend surgery, radioactive iodine and/or radiotherapy. In most cases, especially during the early stage of the cancer, treatment is effective with a favourable outcome

Surgery: If thyroid cancer is detected at an early stage, then the doctors recommend one of the following surgical procedures:

Thyroidectomy: The surgical removal of part or all of the thyroid gland. During this operation, the surgeon may also remove the lymph nodes in the neck and the some of the tissue around the thyroid gland.

Lobectomy (hemithyroidectomy): The surgical removal of a lobe (one of the wings of the thyroid gland).

Tracheostomy: Making an incision in the front of the neck and opening a direct airway through an incision in the trachea (windpipe), allowing the patient to breathe.

After surgery the patient may experience pain when swallowing and will be on a special diet of soft foods.

Thyroid Hormone Therapy: If the thyroid gland is completely or partially removed, the patient will need to take replacement hormone tablets for the rest of his/her life. The patient will need regular blood tests to make sure hormone levels are right.

Radioactive Iodine Ablation: The thyroid gland and most thyroid cancers absorb iodine. Radioactive iodine (RAI) ablation is used to destroy any thyroid tissue that’s left after a thyroidectomy.

The iodine goes to the thyroid tissue and the radiation destroys it. It may also be used for cancer that spreads to nearby lymph nodes, spreads to other parts of the body, or returns. The level of radiation in this treatment is far higher than what is used in a radioiodine scan.

The patient usually has a special diet that is low in iodine for 1 or 2 weeks before you get the treatment. If the patient is on thyroid hormone pills, they are usually stopped during this treatment.

External Radiation Therapy: Radiotherapy is usually only used for medullary or anaplastic thyroid cancers.

Chemotherapy: Chemotherapy, typically, refers to the destruction of cancer cells. It is usually only used to treat anaplastic thyroid cancer that has metastasized. However, chemotherapy may also include the use of antibiotics or other medications to treat any illness or infection.

Symptoms

The occurrence of a few symptoms may not explain the problem. However, symptoms that are persistent or increase or gradually become severe tend to reveal the presence of throat cancer. Some of the common symptoms include:

Hoarseness: a rough quality of the voice

Throat discomfort, sensation of a foreign body in the throat, a feeling of lump in the throat

Sore throat or throat pain, aggravated by swallowing

Coughing purulent bloody sputum with smelly odour, even coughing up blood

Bad breath

Difficulty in swallowing

Cough

Weight loss for unknown reasons

A lump in the back of the mouth, throat or neck

Causes

The reasons for the mutation that leads to throat cancer are not completely clear. However, factors that can increase the risk of throat cancer include:

Tobacco use, including smoking and chewing tobacco

Excessive alcohol use, which translates to more than two drinks a day for men and more than one drink a day for women

A virus called Human Papillomavirus (HPV)

A diet lacking in fruits and vegetables

Other risk factors are:

Men are five times more likely to get throat cancer than women

Most people get diagnosed with throat cancer after the age of 65

African-American men are at the biggest risk of getting throat cancer

Exposure to chemicals such as asbestos, nickel and sulphuric acid fumes increase the chances of getting throat cancer.

Diagnosis

In order to determine if a person is suffering from throat cancer or not, the dentist advices one of the following methods for diagnosis:

Endoscopy: This test is performed to determine the extent of the tumour. During the procedure, the upper portion of the gastrointestinal tract and respiratory tract are visualised with endoscopes – long, thin and flexible tubes equipped with a tiny video camera and light on the end. Other areas which can be examined include the oesophagus, trachea and bronchi of the lungs. In many cases, endoscopy is a more precise examination than X-ray studies.

Imaging Tests: Another method that is generally used by the doctors are imaging tests, such as a Computed Tomography (CT) scan, Positron Emission Tomography (PET) scan or Magnetic Resonance Imaging (MRI), which provide additional information regarding the stage of the tumour and whether the cancer has spread to surrounding lymph nodes in the neck or elsewhere in the body.

A Biopsy: It is done to collect tissue samples that get examined under a microscope. It is the only way to know for sure if the tumour is cancerous or not. A biopsy procedure can be done with a surgery or a fine needle or through the endoscope.

Treatment

Multi-disciplinary approach is known to have improved the quality of cancer care and ensures that the patient has access to the best current thinking on cancer management. Surgery or radiation therapy by themselves or a combination of these therapies may be part of the treatment plan. The treatment plan is based on the staging, location and other health factors of the patient. The stages of throat cancer are: Stage 1 and 2: The cancer is this stage is smaller and remains in one location Stage 3: The cancer may have spread to the lymph nodes and/or other parts of the throat Stage 4: Here the cancer may have spread to lymph nodes and different parts of the throat, head, neck, or chest. The most serious stage 4 throat cancer is when it has metastasised to distant parts of the body like the lungs or liver. Medical Oncology for Throat Cancer: Chemotherapy is a process where medical drugs are used to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. For advanced stage tumours, chemotherapy is often given in combination with radiation therapy, typically in the setting of a therapeutic clinical trial. Surgical Oncology for Throat Cancer: Surgery can be performed by an incision with a scalpel, by an endoscope, through laser or robotic surgery. Very early stage throat cancer is usually taken out by endoscopic or laser surgery. However, if the tumour is advanced and has spread to surrounding areas, surgery will be more extensive and may involve the removal of parts of the throat, mouth, jaw or voice box. In these cases, the ability to speak, chew, swallow and breathe may be affected. Reconstructive surgery in throat cancer treatment can help in restoring the appearance of the organ and rehabilitate the ability to speak and swallow. In more advanced cases, the patient may need to use tubes for feeding and breathing and an artificial voice aid for speaking. In addition, one may have to work with a dietician who will help in developing a nutrition plan that includes healthy foods that are easy to swallow and chew. With the advancements in the technology, robotic surgery in treatment of throat cancers is now used to deliver best possible outcome in a minimally invasive way. Radiation Oncology for Throat Cancer: Sometimes radiation is the only treatment needed for early stage throat cancer. Radiation Therapy uses high-energy particles or waves (like x-rays, gamma rays, electron beams) to destroy or damage cancer cells. Radiation therapies could be used with chemotherapy and surgery, in the treatment of stage 3 and 4 throat cancer. Radiation therapies are painless, do not require surgery and are aimed at destroying cancer cells in a specific area. It can either come from a high energy x-ray machine or from a small source of radioactive material placed close to or on the tumour.

Symptoms

Most common symptoms are:

Lump or swelling in the testicle

Heaviness or aching in the lower belly or testicles

Voice changes and facial and body hair growth in a very young boy (early puberty)

In some cases, there may be fluid collection in the scrotum which can be identified in children easily. The lump can be painless, and any painless lump should be seen by a doctor.

Causes

Anything that can increase the risk of getting a disease is called a risk factor. Different cancers have different risk factors.­ Having one or more of these risk factors doesn’t necessarily mean one will get that cancer. As testicular cancer is rare, the risk of developing it is small even if one has any risk factors.

Undescended testicles

Abnormal cells in testicle

Fertility problems

Previous testicular cancer

Family history

Hypospadias

Inguinal hernia

Diagnosis

Ultrasound scan of the scrotum/inguinal area/abdomen: Often the first test to be performed, an ultrasound can detect the size and nature (fluid filled/cystic or solid) of the swelling, its position in case of undescended testis, and a hydrocoele.

Blood tests: This includes routine blood tests as well as ‘tumor markers’ which are certain proteins/hormones which get elevated in certain cancers, depending upon the cancer site. In testicular cancers, important ones are Alpha Feto Protein (AFP), beta – Human Chorionic Gonadotropin (beta HCG), and Lactate Dehydrogenase (LDH). The elevated levels are not specific or confirmatory but can still help doctors to arrive at a diagnosis and to assess post treatment status.

Other scans: Once the doctor sees that the swelling is suspicious, body scans should be performed, to assess the extent of local and distant spread, which include CT abdomen and chest, X-ray of the lungs which are the most common site of distant spread, or a PET-CT scan, if whole body imaging is required.

Biopsy and pathological examination: This is the confirmatory and mandatory test. Biopsy is done by unilateral or bilateral orchidectomy (removal of the testis through surgery), after which a pathologist checks under the microscope to find out the types of cells that are out of control. The treatment modalities are entirely dependent on this.

Types, Grades and Stages of Testicular cancer The cancer can be classified into-

Seminomas -Tumors that grow and spread slower than most other testicular cancers.

Non-seminomas – Tumors that are often found in younger men, who are in their late teens and early 30s.

Grading This helps doctors to predict how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. Usually grades 1, 2, and 3 are given, based on how different the cells look from normal cells. Cells that look very different from normal cells are given a higher grade (3) and tend to grow the fastest. Staging It depicts the status of spread. Testicular cancers can be staged into 0-III stages and subsets A-C, depending upon the size of testicular cancer, number and site of lymph nodes involved. As the stage increases, disease severity also increases, with stage III being the most advanced form of this disease.

Treatment

Fortunately testicular cancer patients respond well to both chemotherapy (medicines) and radiation. Treatment modalities are decided based on the stage of the disease and other risk factors. Stage 1:

Surgery (orchidectomy) – Followed by surveillance.

Chemotherapy – Indicated in certain patients, if the possibility of recurrence of the disease is high due to cryptorchidism and/or family history.

Stage 2: Seminoma – Surgery and radiotherapy, or chemotherapy may be required in later stages. Non-seminomas (teratomas) – Surgery (orchidectomy) and chemotherapy may be required. Stage 3: After orchidectomy- Chemotherapy. If seminoma – After chemotherapy, only follow ups are required. If non-seminoma – The patient might need surgurical removal of lymph nodes and lung lesions. Recurrent Tumor – Chemotherapy or High dose chemotherapy with stem cell transplant – A stem cell transplant lets doctors use higher doses of chemo. The cells that make blood (called stem cells), are taken out of the blood using a special machine. Then very strong chemo is given, which can lead to side effects like severe reduction in blood counts. So, the stem cells are given back to the person, after chemo, to aid his system. Clinical trials- Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better. These mostly have to be given to people in whom the disease has relapsed.

Symptoms

In the early stages of stomach cancer, the symptoms are not very clear. But in the later stages the following symptoms manifest themselves:

Indigestion and stomach discomfort

A bloated feeling after eating

Mild nausea

Loss of appetite

Heartburn

These symptoms are similar to those caused by a peptic ulcer. If you are experiencing any of these symptoms, you should see your health care provider so that a proper diagnosis can be made and timely treatment given. A stomach cancer can grow very large before it causes other symptoms.

In more advanced cancer, you may have:

Discomfort in the upper or middle part of the abdomen.

Blood in the stool (which appears as black, tarry stools).

Vomiting or vomiting blood.

Weight loss.

Pain or bloating in the stomach after eating.

Weakness or fatigue associated with mild anaemia (a deficiency in red blood cells).

Causes

The exact cause of stomach cancer is unknown, but a number of factors can increase the risk and causes of the disease, including:

Gender: According to studies, men have more than double the risk of getting stomach cancer in comparison to their female counterpart.

Race: The occurrence of stomach cancer is on the higher side among African-American or Asian.

Genetics: Genetic abnormalities and some inherited cancer syndromes may increase an individual’s risk towards developing stomach cancer.

Blood type: Individuals with blood group A may be at increased risk.

Advanced age: Stomach cancer occurs more often around ages 70 and 74 in men and women, respectively.

Family history of gastric cancer can double or triple the risk of stomach cancer.

Lifestyle factors such as smoking, drinking alcohol and eating a diet devoid of fruits and vegetables or high in salted, smoked or nitrate-preserved foods may increase risk.

Helicobacter pylori (H. pylori) infection of the stomach: H. pylori is a bacterium that infects the lining of the stomach and causes chronic inflammation and ulcers.

Certain health conditions, including chronic gastritis, pernicious anaemia, gastric polyps, intestinal metaplasia and prior stomach surgery.

Work-related exposure due to coal mining, nickel refining and rubber and timber processing and asbestos exposure.

Diagnosis

If anyone of the following symptoms occurs, such as indigestion, weight loss, nausea and loss of appetite, screening tests may be recommended. These tests may include:

Upper GI series: These are X-rays of the oesophagus, stomach and first part of the intestine taken after you drink a barium solution. The barium outlines the stomach on the X-ray, which helps the doctor, using special imaging equipment, to find tumours or other abnormal areas.

Gastroscopy and biopsy: This test examines the oesophagus and stomach using a thin, lighted tube called a gastroscope, which is passed through the mouth to the stomach. Through the gastroscope, the doctor can look directly at the inside of the stomach. If an abnormal area is found, the doctor will remove some tissue (biopsy) to be examined under a microscope. A biopsy is the only sure way to diagnose cancer. Gastroscopy and biopsy are the best methods of identifying stomach cancer.

Once stomach cancer is diagnosed, more tests may be performed to determine whether the cancer has spread. These tests may include CT scans, PET scans, bone scans, laparoscopy and endoscopic ultrasound.

Other tests undertaken:

Physical exam: The doctor feels the abdomen for fluid, swelling or other changes. The doctor will also check for swollen lymph nodes.

Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look into the stomach. He first numbs the patient’s throat with an anaesthetic spray. The tube is then passed through the mouth and oesophagus to the stomach.

Biopsy: An endoscope has a tool for removing tissue. The doctor uses the endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

Treatment

Cancer of the stomach is difficult to cure unless it is found in an early stage. Unfortunately, because early stomach cancer causes few symptoms, the disease is usually advanced when the diagnosis is made. Treatment for stomach cancer may include surgery, chemotherapy and/or radiation therapy. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials.

SURGERY

Surgery is the most common treatment. The surgeon removes part or all of the stomach, as well as the surrounding lymph nodes, with the basic goal of removing all of the cancer tissue and a margin of normal tissue. Depending on the extent of invasion and the location of the tumour, surgery may also include removal of part of the intestine or pancreas. Tumours in the lower part of the stomach may call for a Billroth I or Billroth II procedure.

Endoscopic Mucosal Resection (EMR) is a treatment for early gastric cancer (tumour only involves the mucosa) that has been pioneered in Japan, but is also available in the United States at some centres. In this procedure, the tumour, together with the inner lining of stomach (mucosa), is removed from the wall of the stomach using an electrical wire loop through the endoscope. The advantage is that it is a much smaller operation than removing the stomach. Endoscopic Submucosal Dissection (ESD) is a similar technique pioneered in Japan, used to resect a large area of mucosa in one piece. If the pathologic examination of the resected specimen shows incomplete resection or deep invasion by tumour, the patient would need a formal stomach resection.

Surgical interventions are currently curative in less than 40% of all cases, and in cases of metastasis may only be palliative.

CHEMOTHERAPY

The use of chemotherapy to treat stomach cancer has no firmly established standard of care. Unfortunately, stomach cancer has not been particularly sensitive to these drugs and chemotherapy, if used, palliatively reduces the size of the tumour, relieves symptoms of the disease and increases survival time.

RADIATION

Radiation therapy is the use of high-energy rays to damage cancer cells and stop them from growing. When used, it is generally in combination with surgery and chemotherapy, or used only with chemotherapy in cases where the individual is unable to undergo surgery. Radiation therapy may be used to relieve pain or blockage by shrinking the tumour for palliation of incurable disease.