Author: admin

Symptoms

Detection of Fallopian tube cancer is difficult in the early stages since the symptoms remain vague until the cancer has advanced. It is important to note that the symptoms are non-specific and the cause of a particular symptom may be attributed to a different medical condition altogether and not necessarily cancer.

The symptoms include:

Fatigue

Frequent urination

Pain the pelvis or abdomen

Difficulty in eating and feeling full quickly

Bloating of the Abdomen & Pelvis

An upset stomach

Indigestion & Constipation

Back pain

Pain during sexual intercourse

Menstrual irregularities

Vaginal discharge which may be transparent, white or have a tinge of blood.

Causes

Fallopian tube cancer is one of the rarest cancers amongst all gynaecological cancers. There is no certain cause that can explain its occurrence. However, some of the possible risk factors observed are:

Ageing

Hereditary (in case a close relative has a history of ovarian or breast cancer)

If the patient has never given birth

If the patient has never breastfed her child

If the patient has never used birth control pills

Infertility.

It is also observed that 10-15% of fallopian tube cancers occur due to genetic mutation. A normal woman has an average risk of 1-2% in her lifetime to get fallopian cancer whereas women who have mutation of the BRCA1 & BRCA2 genes have around 40% risk in their lifetime to get the cancer. The BRCA genes aid in the production of the BRCA proteins which help repair damaged DNA or destroy cells if DNA cannot be repaired. It is said that mutations in the BRCA are connected to the fallopian tube cancer.

Diagnosis

Because fallopian tube cancer is such a rare type of cancer, it can prove to be difficult to diagnose. Reports suggest that fallopian cancers are generally detected in their advanced stages when they have spread to nearby organs, especially the abdomen. Therefore, it is important to visit the physician in case of the any of the already-discussed symptoms are witnessed. Below are the tests and diagnostic procedures used to detect fallopian cancers:

Pelvic Exam – This involves a physical exam to find any abnormality in the pelvis.

CA125 Test – The human blood contains a protein called CA125. The protein level in the blood tends to increase during pregnancy, menstruation, gynaecological diseases and also during cancer. A test is conducted to check the CA125 protein levels in the body as part of the check-up.

Ultrasound – An ultrasound of the pelvis helps in detecting abnormalities in the fallopian tubes.

Computed Tomography (CT) Scan – The computed tomography system takes pictures of the inside of the body from different angles using X-rays. These images are then used to recreate 3-dimensional images with the help of the computer. These newly created images show if there are any abnormalities or tumours in the examined area. During the CT scan of the fallopian tube, a special dye may be injected into a vein or swallowed to get a clearer picture of the organ.

These procedures helps in confirming and staging the fallopian cancers. A Fallopian tube cancer can be divided into 4 stages.

Stage I – In the early stage, the cancer is limited to just the 2 Fallopian tubes.

Stage II – During second stage, the cancer would have spread to pelvis, uterus or ovaries.

Stage III – Here the cancer spreads to the lymph nodes, intestine, peritoneum (located outside the pelvis) or the retroperitoneal lymph nodes. There are possibilities where it could touch the outer layer of the liver or spleen. Stage IV – In the final stage (also known as end stage fallopian tube cancer), the cancer spreads to the other distant parts of the body (called distant metastasis) and beyond the abdomen and pelvis region. This includes presence of cancer cells in the fluid within the pleural cavity (known as pleural cavity). In such advanced cases, the cancer can penetrate inside the liver, lungs or lymph nodes outside the abdomen.

Treatment

The treatment options are recommended after a thorough analysis of various factors such as the stage of cancer, patient’s preference and the age of the patient. Fallopian cancers are treated using one or a combination of the following treatment modalities:

Surgery:
Operating on the tumours generally works best when combined with chemotherapy. The surgical options are:

a) A salpingo-oophorectomy: This procedure is performed in the early stages of fallopian cancers and it involves the removal of the ovary and fallopian tube either on one side (unilateral) or both sides (bilateral).

b) A total hysterectomy and bilateral salpingo-oophorectomy: This treatment plan involves the removal of the fallopian tubes, ovaries and the entire uterus including the surrounding lymph nodes and tissues that may appear abnormal at that time. This is the most commonly used surgical treatment plan for fallopian cancer.

c) Cytoreductive/debulking surgery: The procedure is performed in the advanced stages, especially when the cancer has become metastatic. It involves removing tissue from nearby organs such as liver, spleen and colon apart from the fallopian tubes (the point of origin). In this surgery, there are cases where the chemotherapy is performed to reduce the size of the tumour before the actual surgery is performed. This is known as neoadjuvant chemotherapy. Loss of ovaries eliminates the body’s tendency to produce sex hormones, resulting in early menopause.

Chemotherapy:
The procedure involves destroying cancer cells using chemo drugs in two ways namely intravenous (IV) tube (which is placed into a vein using a needle) or in a pill/capsule that is swallowed orally. The chemotherapy regimen usually consists of a set number of cycles given in a finite period of time. Patients can receive a single drug at a time or combination of multiple drugs at the same time.

During treatment of the fallopian tubes with chemotherapy, there are possibilities where the patient may lose their ability to conceive a child resulting in early menopause. Based on the complexity of the cancer, there are two other options under chemotherapy which are adjuvant & neoadjuvant chemotherapy. Adjuvant chemotherapy is prescribed after the surgery is performed.

The objective is to kill the remaining cancer cells in the fallopian tubes or nearby areas and thereby prevent any recurrence. Neoadjuvant chemotherapy is delivered before the surgery. In certain cases, it is often difficult to operate on tumours which are big in size. This type of chemotherapy helps in reducing the size of the tumour thereby facilitating relatively easier removal of the tumour during surgery.

Radiation Therapy: This therapy involves the usage of high-energy rays or particles to destroy cancer cells. Although rarely used to treat fallopian tube cancer, it is usually recommended for older patients who cannot have chemotherapy.

Symptoms

Eye melanoma does not have symptoms unless the cancer grows in certain parts of the eye or has advanced. Other, less serious conditions can also cause many of these symptoms. For example, floaters can be a normal part of the aging process. Signs and symptoms of eye melanomas can include:

Blurry vision or sudden loss of vision

Floaters (spots or squiggles drifting in the field of vision) or flashes of light

Visual field loss (losing part of your field of sight)

A growing dark spot on the iris

Change in the size or shape of the pupil

Change in position of the eyeball within its socket

Bulging of the eye

Change in the way the eye moves within the socket

Pain is rare unless the tumour has grown extensively outside the eye

Causes

The exact cause of most eye cancers is not known. But scientists have found that the disease is linked with some other conditions, which are described in Risk Factors for Eye Cancer. A great deal of research is being done to learn more about the causes. Following are some of the causes as well as risk factors that can cause eye cancer:

Eye colour: It is considered that a person with light coloured eyes like, blue, green or grey eyes, is more likely to develop melanoma of the eye as compared to people with brown eyes

Skin colour: A light skin tone is also considered to be one of the causes of the development of eye cancer

Moles: Moles also feature in the risk factor list. A person with moles is at a greater risk of skin and eye melanoma

Sunlight: Long and continuous exposure to the sun can increase the risk of eye cancer in a person

UV radiation

Weakened immune system: People are at a higher risk level if they have been infected by viruses like AIDS or human papilloma virus or autoimmune diseases like rheumatoid arthritis

Drugs that suppress the immune system

Diagnosis

Examination of the eye by an ophthalmologist (a medical doctor specializing in eye diseases) is often the most important first step in diagnosing melanoma of the eye. While checking the eye for vision and eye movement, the doctor also enquires about the symptoms. The doctor will also look for enlarged blood vessels on the outside of the eye, which can be a sign of a tumour inside the eye. The ophthalmologist may also use special instruments to get a good look inside the eye for a tumour or other abnormality. Drops may be applied in the eye to dilate the pupil before the doctor uses these instruments:

An ophthalmoscope: A hand-held instrument consisting of a light and a small magnifying lens.

Indirect Ophthalmoscope: It sits still on a platform and provides stronger magnification to get a more detailed view.

A gonioscopy lens: It is a specially mirrored lens that is placed on the cornea (the outer part of the eye) after it is numbed. It can be used to look for tumour growth into areas of the eye that would otherwise be hard to see.

Apart from the above tests, other tests or a combination thereof may be recommended such as:

Imaging studies: Ultrasound scans, fluorescein angiography, CT scans, X-Ray, and MRI scans are used to diagnose the cancers. They show the size, location and shape of the tumours and also show any enlarged or affected lymph nodes around the eyes. These lymph nodes may carry cancer cells

Biopsy: Usually a fine needle is used to aspirate some vitreous fluid from within the eye. The sample is examined under the microscope for lymphoma cancer cells

Lumbar puncture or spinal tap: Since eye lymphomas may be an extension of Central Nervous System lymphomas, a spinal tap to examine the Cerebrospinal fluid may be needed. The CSF bathes the brain and the spine and thus may offer clues to affliction of the spine or brain with lymphoma

Bone marrow examination may be done to exclude spread or other locations of the lymphoma

Treatment

Surgery: The type of surgery depends on the location and size of the tumour, how far the tumour has spread, and the person’s overall health. All of these operations are done under general anaesthesia. The operations used to treat people with eye melanoma include:

• Iridectomy: Removal of part of the iris. This might be an option for very small iris melanomas.
• Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball. This might also be an option for small iris melanomas.
• Iridocyclectomy: Removal of a portion of the iris and the ciliary body. This operation is also used for small iris melanomas.
• Trans-scleral resection: Surgically removing just a melanoma of the ciliary body or choroid.
• Enucleation: Removal of the entire eyeball. This is used for larger melanomas, but it may also be done for some smaller melanomas if vision in the eye has already been lost or if other treatment options would destroy useful vision in the eye, anyway. During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made out of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eye, so it should move the same way as the original eye would have.
• Orbital exenteration: Removal of the eyeball and some surrounding structures such as parts of the eyelid and muscles, nerves, and other tissues inside the eye socket. This surgery is not common, but it might sometimes be used for melanomas that have metastasized.

Radiation Therapy: Radiation therapy uses high-energy x-rays to kill cancer cells. It is a common treatment for eye melanoma. Radiation therapy can often save some vision in the eye.

• Brachytherapy: In this form of radiation therapy, the doctor places small seeds of radioactive material directly into or very close to the cancer. The radiation from the seeds travels a very short distance, so most of it will be focused only on the tumour.
• External beam radiation therapy: In this approach, radiation from a source outside the body is focused on the cancer. For eye melanomas, the use of this type of radiation therapy is generally limited to newer methods that focus narrow beams of radiation on the tumour, such as proton beam radiation therapy or stereotactic radiosurgery

Laser Therapy for Eye Cancer: Laser therapy is sometimes used to treat eye melanoma, especially when surgery or radiation are not possible. Types of laser therapy used to treat eye cancer are:

• Transpupillary Thermotherapy: It uses infrared light to heat and kill the tumor.
• Laser Photocoagulation: This treatment uses highly focused, high-energy light beams to burn tissue.

Chemotherapy: Melanoma usually does not respond well to standard chemo drugs. Chemo is used only when the cancer has become widespread. If chemo is used, the treatment is generally the same as for melanoma of the skin.

Symptoms

The symptoms associated with oesophageal cancer are very much similar to that of other more-common conditions. Difficulty swallowing is one of the most common symptoms associated with oesophageal cancer.

Other symptoms include:

Persistent indigestion or heartburn

Unexplained weight loss

Pain in the throat or behind the breastbone

Feeling or being sick

A cough that does not get better

A hoarse voice

Appetite loss and weight loss

Vomiting

Backache

If anyone witnesses any of these symptoms for more than 2 weeks, it must not be ignored.

Causes

Oesophageal cancer usually occurs when cells in the oesophagus develop mutations in their DNA. These mutations make cells grow and divide out of control. These mutated cells form a tumour in the oesophagus. This tumour grows and the cancerous cells start to invade nearby tissues and structures and later spread to other parts of the body.

Although the actual cause for oesophageal cancer is unknown. Several risk factors trigger the development of oesophageal cancer.

Obesity: Being overweight or obese is associated with an increased risk of oesophageal cancer.

Gastro-Oesophageal Reflux Disease (GERD): Chronic GERD is linked with a higher risk of developing cancer in the oesophagus.

Prior Gastrectomy: Gastrectomy increases the subsequent risk of developing oesophageal cancer.

HPV infection: Infection with high-risk human papillomavirus (HPV) is one of the risk factors for the cancer of the oesophagus.

Consumption of Tobacco and Alcohol: Consumption of tobacco and alcohol increases the oesophageal cancer risk.

Red Meat: Red meat or processed meat consumption increases one’s chances to develop oesophageal cancer.

Deficiencies of Zinc and Selenium: another risk factor for the cancer of the oesophagus is the reduced serum contents of zinc and selenium.

Consumption of Areca Nut and Betel Quid: Studies have shown that consumption of areca nut is linked to diagnosis at a younger age, poor chemoradiation response and shorter overall survival rate.

Diagnosis

Endoscopy + Biopsy (90% + predictive value)

EUS – preferred method for loco regional staging

Flexible laryngoscopy- for cervical esophageal SCC

FDG PET- noninvasive staging modality, more sensitive than CECT/EUS for distant metastasis, decreases 5-20% patients undergoing needless surgeries

Treatment

The primary treatment modalities used to treat oesophageal cancer include chemotherapy, surgery and radiation therapy.

Chemotherapy: Chemotherapy uses potent drugs to destroy cancer cells. Chemotherapy is typically administered before (neoadjuvant) or after (adjuvant) surgery in people with oesophageal cancer. Chemotherapy can also be combined with radiation therapy for complicated cases. In people with advanced tumours, which may have spread to other organs beyond the oesophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by cancer.

Surgery: Surgery to remove the oesophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in the skin (laparoscopically). The surgical pathway used depends on the severity of cancer. This is the primary curative modality for both oesophageal & GE junction carcinomas that have invaded through the oesophageal wall or are node-positive. With the advent of robotic surgeries, treatments for oesophageal cancers now report:

Shorter hospital stay

Less blood loss

Less pain

Lesser incidence of complications (infection, ileus)

Faster return to normal activities

Radiation Therapy: Radiation therapy is often combined with chemotherapy oesophageal cancer cases. Radiation therapy is typically given before surgery, or occasionally after surgery; it is also used to relieve complications of advanced oesophageal cancer. Modern radiation therapy techniques (3D-CRT, IMRT) are associated with a favourable toxicity profile than those associated with lower energy units used earlier.

Symptoms

As with other cancers, the early symptoms are quite vague. However, the following signs and symptoms are quite common:

A change in your bowel habits, including diarrhoea or a change in the consistency of stool for more than a couple of weeks

Rectal bleeding or blood in stool

Persistent abdominal discomfort, such as cramps, gas or pain

Abdominal pain with bowel movement

A feeling that the bowel doesn’t empty completely

Unexplained weight loss and fatigue

Causes

The causes of colon cancer are often environmental (80%) and sometimes genetic (20%). Since malignant cells have an altered genetic constitution, it implies that in 80% of cases, the environment spontaneously induces change. For those with a genetic predisposition to colon cancer, get the cancer or need less environmental exposure to get the cancer. Carcinogenesis is the process of being exposed to the environment that causes the mutation. Though specific carcinogens (cancer causing agents) have been difficult to identify; some of the causes for Colon Cancer are:

Presence of polyps as small, non-cancerous (benign) lumps of cells in the colon

A diet rich in fat and starch without fibre

Sedentary lifestyle

Smoking and alcohol consumption

A family history of colon polyps

A history of inflammatory bowel disease (two diseases – Ulcerative Colitis and Crohn’s disease)

Diagnosis

In order to determine if a person is suffering from colon cancer, the following screening tests are conducted:

A physical examination

A blood test called ‘faecal occult’, which identifies hidden blood in the stool

This is usually followed by visualization of colon through a procedure known as colonoscopy

Other tests including biopsy, where a piece of suspected tissue is taken for examination

Treatment

Once the diagnosis has been confirmed through biopsy, we come to the clinical stage of the cancer. Considering the characteristics of the primary tumour, its penetration depth through the bowel as well as the presence/absence of regional or distant metastases, we arrive at the stage of the cancer. More often than not, the depth of penetration through the bowel or the presence of regional lymph nodes cannot be determined before surgery. There are 4 stages of colon cancer based on the below general criteria:

Stage 1: The tumour is confined to the epithelium and has not penetrated through the first layer of muscle in the bowel wall.

Stage 2: Here the tumour has penetrated through to the outer wall of the colon or has gone through it, possibly invading other local tissue.

Stage 3: Here we can detect any depth or size of tumour associated with regional lymph node.

Stage 4: Any of above criteria associated with distant metastasis.

The treatment plan is chalked out once the disease is identified and staged. The treatment plan may include options from Medical Oncology, Surgical Oncology and Radiation Oncology depending on the stage of condition and the general health of the patient. Surgical Oncology for Colon Cancer: Surgery is the primary mode of therapy for stages 1 through 3 colon cancer unless there are signs that it won’t allow for complete removal of the tumour. This may happen in advanced stage 3 tumours. However, this is rare and happens in less than 2% of all colon cancer cases. Surgical removal of the affected section of the colon along with its blood supply and regional lymph nodes is called colectomy. Whether a patient requires undergoing a surgery or not depends on multiple factors such as the type, size, location, grade and stage of the tumour, as well as other general health factors such as age, physical fitness and other medical conditions. In many cases, surgery is combined with other cancer treatments such as chemotherapy, radiation therapy Radiation Oncology for Colon Cancer: Radiation therapy for colon cancer is used as a support to surgery if there is a concern about potential for recurrence provided the area of concern will be able to tolerate the radiation dose. Radiation therapy is also used to treat patients with metastatic cancer. It is useful in shrinking metastatic colon cancer to the brain. Radiation therapy is usually completely non-invasive, and does not require a patient to be admitted for the treatment. Medical Oncology for Colon Cancer: Medical Oncology is a modality of treatment in cancer care which uses chemotherapy, immunotherapy and targeted therapy to treat cancer in an effective manner. Medical oncology is usually works in conjunction with surgical oncology or radiation oncology to give the best clinical outcomes. Chemotherapy is beneficial for patients who have had all identifiable tumours removed however could be at risk for recurrence (adjuvant chemotherapy). Chemotherapy could also be used when the colon cancer is in stage 4 and is beyond the scope of regional therapy.

Symptoms

In its early stage, colorectal cancer usually doesn’t have symptoms. It is therefore important to keep up with the tests the doctor recommends for an early detection and correct diagnosis. However, when symptoms do appear, the following are most likely:

A change in your bowel habits, including diarrhoea or a change in the consistency of stool for more than a couple of weeks

Rectal bleeding or blood in stool

Persistent abdominal discomfort, such as cramps, gas or pain

Abdominal pain with bowel movement

A feeling that the bowel doesn’t empty completely

Unexplained weight loss and fatigue

Causes

Anyone can get colorectal cancer, and doctors often don’t know why someone gets it. Although scientists don’t know the exact cause, they do know some of the things that make people more likely to get it. These include:

Age: The disease is most common in people over age 50, and the chance of getting colorectal cancer increases with each decade.

Gender: Colorectal cancer is more common among men. Men and women are equally at risk for colon cancer, but men are more likely to develop rectal cancer.

Polyps: These growths on the inner wall of the colon or rectum aren’t cancer, but they can be precancerous. Polyps are fairly common in people over age 50. One type of polyp, called an adenoma, makes colorectal cancer more likely. Adenomas are the first step toward colon and rectal cancer.

Personal history: If you’ve already had colorectal cancer, you could get it again, especially if you had it for the first time before age 60. Also, people who have chronic inflammatory conditions of the colon, such as ulcerative colitis or Crohn’s disease, are more likely to develop colorectal cancer

Family history: If a family member has had colorectal cancer it makes one more likely to get it, too. If that relative was diagnosed when he or she was younger than 45 years old, the risk is even higher. If conditions such as familial adenomatous polyposis, MYH-associated polyposis, or hereditary non-polyposis colorectal cancer run in the family, that raises the risk for colon cancer.

Diet: People who eat a lot of fat and cholesterol and little fibre may be more likely to develop colorectal cancer.

Lifestyle: It is more likely to get colorectal cancer if one drinks a lot of alcohol, smokes, doesn’t get enough exercise, and if they are overweight.

Diabetes: People with diabetes are more likely to develop colorectal cancer than other people.

Diagnosis

People with the following risks should begin colon screening before age 45:

Family history of inflammatory bowel disease, other colorectal diseases, polyps or familial adenomatous polyposis

People with a family history of hereditary nonpolyposis colon cancer The diagnosis of colorectal cancer is done through the below tests:

Stool Based tests:

• Faecal immunochemical test (FIT) yearly
• Guaiac faecal occult blood test yearly
• Stool DNA test every 3 years

Structural Examinations:

• Colonoscopy every 10 years
• Flexible sigmoidoscopy every 5 years
• CT colonography (virtual colonoscopy) every 5 years.

Any suspicious symptoms or abnormalities will alert your doctor to perform a colonoscopy to get a biopsy. Should a biopsy confirm cancer, imaging tests using chest X-rays and CT scans of the abdomen, pelvis, and possibly chest are performed to find out whether the cancer has spread to other sites.

Blood tests will also be ordered to find out how well the liver and kidneys are functioning, to determine if you are anaemic, and to measure the blood level of a substance called carcinoembryonic antigen (CEA), often found in higher-than-normal concentration in the presence of colorectal cancer, especially if it has spread.

Treatment

The main types of treatment for colorectal cancer are surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Depending on the cancer stage, these treatments may be combined for a better outcome.

Surgery is the most effective treatment for localised colorectal tumours. Very small tumours can be removed through a colonoscope, but even with small tumours, removing the portion of the colon containing the tumour, the surrounding fat, and nearby lymph nodes is often the best treatment. Surgery may be performed either laparoscopically or by the open method, which uses larger incisions. Usually, the healthy sections of the colon and rectum gets reconnected. In cases where this is not possible, an opening is formed, known as a stoma, in the abdomen and the severed colon is rerouted to it. Waste matter is collected in a bag worn over the stoma. This is known as a colostomy and is often only temporary. Once the bowel has had time to heal, a second operation is done to reconnect the colon and rectum. The need for permanent colostomy is more common with rectal cancer, since retaining the rectum may be difficult.

Radiation therapy is treatment with high-energy rays that destroy the cancer cells. For rectal cancer, radiation is usually given after surgery, along with chemotherapy (known as adjuvant therapy) to destroy any cancer cells left behind. It can also be used along with chemotherapy before surgery (known as neoadjuvant therapy) in order to shrink the size of the tumour, making the surgery easier. In advanced rectal cancer, radiation can be used to shrink tumours that cause symptoms of bowel obstruction, bleeding, or pain.

Chemotherapy is used to treat various stages of colorectal cancer, especially the advanced stages where metastasis has happened. If the cancer has metastasized to the liver chemotherapy can also be directly administered there.

Targeted therapy works in a completely different way in treating colorectal cancer. Through this treatment, the aim is to block the cancer’s blood supply or block a protein or genetic change made by the cancer to enhance it growth. This form of treatment is effective especially after metastasis

Immunotherapy involves drugs that stimulate the body’s own immune system to recognize and destroy cancer cells.

Symptoms

A woman may have no symptoms when the cervical tumour is small. As the tumour becomes large, the first symptom to be seen is the abnormal vaginal bleeding. Other key symptoms of cervical cancer include:

Bleeding between normal periods (intermenstrual bleeding)

Bleeding after having sex (post-coital bleeding)

Any vaginal bleeding in women past menopause

An early symptom of cervical cancer in some cases is a vaginal discharge that smells unpleasant, or discomfort or pain during sex.

If the cancer has spread, the symptoms may vary basis which the doctor may ask for specific tests.

All of the above symptoms can be caused by various other common conditions. If a woman develops any of these symptoms, she should have it followed-up by a doctor to determine the possibility of cervical cancer treatment.

Causes

A cervical tumour begins with the abnormal cell growth (dysplasia) that occurs on the surface lining of the cervix or the endocervical canal commonly known as the opening between the uterus and the vagina. In cases where severe dysplasia is observed, then it is called CIN 3. Common risk factors associated with the formation of cervical tumour:

HPV Infection: The initial ‘pre-cancerous’ abnormality of cervical cells is usually caused by a prior infection with the Human papillomavirus (HPV). Of the multiple types of HPV, two types – HPV 16 and 18 are commonly associated with the formation of cervical cancer. Other strains cause genital warts. The cancer-causing HPV strains can be transmitted through sexual intercourse.
Within two years, 9 out of 10 infections with HPV will clear completely from the body. This implies that most women infected with these strains of HPV do not develop cancer. Vaccination is proven to reduce the risk of cervical cancer among women. The HPV vaccine is recommended for girls aged 11-12 years, as it is reported to act more effectively when administered at a younger age. However, even if a woman has had the HPV vaccine, she must regularly undergo cervical screening, which helps in early detection.

Age: The risk of developing cervical cancer among women increases with age.

Smoking: Smokers are more likely to develop certain cancers, including cervical cancer than non-smokers. Among those who smoke and have an HPV infection, the risk is compounded. Therefore, it is advised to avoid smoking as a mode of prevention of cervical cancer.

A poor immune system: A suppressed immunity contributes to the increased risk of cervical cancer. People with AIDS or people taking immunosuppressant medication are at a higher risk of developing cervical cancer.

Oral contraceptive pill: A possible link between the oral contraceptive pill and an increased risk of cervical cancer (if the pill is taken for more than five years) has been mooted. However, the risk of cervical cancer has been found to decline over time after women stop using oral contraceptives.

Diagnosis

To confirm the diagnosis, the specialist will usually do a vaginal examination if a woman has symptoms which may indicate cervical cancer. If the findings from the physical examination are abnormal, a colposcopy (a more detailed examination of the cervix) is advised. For this test, a speculum is gently put into the vagina, so the cervix can be seen in detail using a magnifier (Colposcope). During a colposcopy, a small piece of tissue from the cervix is taken for a biopsy, which helps in the confirmation and treatment planning for the cancer.

To assess and confirm the extent to which the cancer may have spread the specialist may advise for a few screening tests like:

CT Scan

MRI Scan

Chest X-ray

Ultrasound Scan

Blood tests

These tests help in the staging of cervical cancer. The aim of understanding cervical cancer treatment by stage is to find out:

The extent to which the tumour has grown, and if it has grown to other nearby structures such as the bladder or rectum

Whether the cancer has spread to local lymph glands (nodes)

Finding out the stage of the cancer helps the specialist to advise on treatment options and gives a reasonable indication of outlook

Cervical screening helps in the early detection of cancer and thereby facilitates effective treatment and successful outcome. Guidelines suggest starting screening tests for cervical cancers and precancerous changes from age 21. Cervical screening primarily involves Pap test, during which the physician scraps and brushes cells from the cervix of the patient. The samples are then examined for any abnormalities, which may point towards the risk of cervical cancer.

Treatment

“It is important for patients to promptly report any abnormal vaginal bleeding (bleeding between periods, heavy periods, bleeding after intercourse) or vaginal discharge to their physicians, which will help ascertain the treatment of cervical cancer.

Treatment options for cervical cancer which may be considered to include different types including surgery, chemotherapy and radiotherapy, or a combination of these treatments which is best determined by the specialists. In terms of modalities, the treatment advised for each case depends, on factors including the stage of the cancer and the general health of the patient.

Surgery: If the cancer is in its early stages, doctors may consider the removal of the cervix only without removing the entire uterus for fertility preservation, which keeps the pregnancy option open for the patient.

As part of the surgical management of cervical, a surgery is carried out to remove the cervix and uterus (radical hysterectomy) which is a common course of action.

Post hysterectomy cancer treatment, in case the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. Even if the cancer is advanced, some surgical techniques may be used to ease the symptoms.

Chemotherapy: Chemotherapy is a cervical cancer treatment modality that uses anti-cancer drugs to kill cancer cells, or stop them from multiplying. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations. Nowadays concomitant chemo-radiotherapy is the preferred method of treatment for cervical cancer.

Radiation Therapy: Radiation therapy is a treatment modality, which uses high energy beams of radiation focused on cancerous tissue, killing the cancer cells or stopping them from multiplying. Radiotherapy alone can be curative for early-stage cervical cancer treatment and may be an alternative to surgery which involves laser surgery. For more advanced cancers, radiotherapy may be advised in addition to other treatments.

Two types of radiotherapy are used for cervical cancer, external and internal. In many cases both types are used:

External Radiotherapy – This is where radiation is targeted on the cancer from a machine. (This is a common type of radiotherapy used for many types of cancer)

Internal radiotherapy (Brachytherapy) – This treatment involves placing a small radioactive implant next to the cancerous tumour for a short time. It is a safe and effective procedure. Even if the cancer is advanced and a cure is not possible, radiotherapy may still be used to ease the symptoms.

Radiotherapy has been a convenient option for outpatient treatment especially for patients who would not like to get into the complexity of hospital admission.

Even in cases of post cervical cancer treatment, patients are advised to consult their respective doctors to check for any recurrence and early prevention during diagnosis.

Symptoms

Carcinoid tumours often don’t cause signs and symptoms until late in the disease. It can produce and release hormones into the body that cause signs and symptoms such as diarrhoea or skin flushing. When symptoms do occur, they are usually vague and depend on the location of the tumour.

If the tumours develop in the GI tract, the following are the symptoms:

Pain in belly

Diarrhoea

Nausea and vomiting and inability to pass stool due to intestinal blockage

Rectal pain and bleeding

Flushed Skin

Breath loss

Blood in stool

Loss of weight

In lung carcinoid tumour, the person may present symptoms like coughing up bloody mucus, followed by wheezing. Carcinoid syndrome starts when the tumours start releasing hormones into the bloodstream.

The common symptoms are:

• Chest pain
• Wheezing
• Shortness of breath
• Diarrhoea
• Increased Heartbeat,
• Weight gain, particularly around the mid-section and upper back
• Flushed skin
• Pink or purple marks on the skin that look like stretch marks

Causes

It is unclear as to what causes carcinoid tumours. Usually cancer occurs when a cell develops mutations in its DNA. These mutations allow the cell to continue growing and dividing when healthy cells would normally die. The resulting mass of cells form a tumour. Cancer cells can invade nearby healthy tissue and spread to other parts of the body as well.

What causes the mutations that can lead to carcinoid tumours have not been determined as yet. However, it is now known that carcinoid tumours develop in neuroendocrine cells. Neuroendocrine cells are found in various organs throughout the body. They perform some nerve cell functions and some hormone-producing endocrine cell functions. Some hormones that are produced by neuroendocrine cells are cortisol, histamine, insulin and serotonin.

Carcinoid tumours can develop for one or more of these reasons:

Genetics: Carcinoid tumours may occur if a person is suffering from Multiple Endocrine Neoplasia Type 1 (MEN1). It is a hereditary disease and about 10% of carcinoid tumours are due to MEN1

Another condition that can raise your risk for them is Neurofibromatosis Type 1.

Race: Carcinoid Tumour in the GI is more commonly seen amongst the population from the African region.

Gender: Women are slightly more likely than men to have this type of cancer.

Age: Most people are diagnosed with carcinoid tumours in their 40s or 50s.

Other Conditions: One is more likely to get a carcinoid tumour in the stomach if they have a disease like Pernicious Anaemia or Zollinger-Ellison syndrome, which changes the amount of acid the stomach makes.

The is important to note that carcinoid tumour cells can secrete hormones and other chemicals, causing a range of complications, including:

• Carcinoid syndrome: Carcinoid syndrome causes redness or a feeling of warmth in your face and neck (skin flushing), chronic diarrhoea, and difficulty in breathing, among other signs and symptoms.
• Carcinoid heart disease: Carcinoid tumours may secrete hormones that can cause thickening of the lining of heart chambers, valves and blood vessels. This can lead to leaky heart valves and heart failure that may require valve-replacement surgery. Carcinoid heart disease can usually be controlled with medications.
• Cushing syndrome: A lung carcinoid tumour can produce an excess of a hormone that can cause your body to produce too much of the hormone called cortisol.

Diagnosis

Carcinoid tumour diagnosis can be done using the following procedures. However, definitive diagnosis is made using multiple diagnostic tests.

• Blood tests: Carcinoid tumour patients are likely to have high levels of hormones in their blood. These are secreted by a carcinoid tumour or by-products created when those hormones are broken down by the body.
• Urine Tests: People with carcinoid tumours have excess levels of a chemical in their urine that’s produced when the body breaks down hormones secreted by carcinoid tumours.
• Imaging Tests: Imaging tests, including a computerized tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET), octreotide scan and X-ray, may help your doctor pinpoint the carcinoid tumour’s location.
• Endoscopy: The doctor may use a long, thin tube equipped with a lens or camera to examine areas inside your body. An endoscopy, which involves passing a scope down the throat, may help the doctor see inside the gastrointestinal tract. A bronchoscopy, using a scope passed down your throat and into your lungs, can help find lung carcinoid tumours. Passing a scope through the rectum (colonoscopy) can help diagnose rectal carcinoid tumours. To see inside the small intestine, it may be recommended to test using a pill-sized camera that you swallow (capsule endoscopy).
• Radionuclide scanning: Before this test, the patient takes in a small amount of a radioactive substance through one of the veins. This substance is attracted to carcinoid tumours. The test can show where in the body the tumour has spread.
• Biopsy: During a biopsy, a sample of tissue from the tumour may be collected to confirm the diagnosis. What type of biopsy the patient undergoes depends on where the tumour is located. In certain cases, a surgeon may use a needle to draw cells out of the tumour. In other cases, a biopsy may be collected during surgery. The tissue is sent to a laboratory for testing to determine the types of cells in the tumour and how aggressive those cells appear under the microscope.

Treatment

The treatment for options for carcinoid tumours could be one or a combination of the below. It is administered based on the type of carcinoid tumour and its location.

Surgery:

1. GI Carcinoid Tumours:

A cut in the skin is made to remove the tumour, along with some of the tissue around it. If the tumour is in the rectum, the method that uses an electric current to heat and destroy it may be applied. This is called fulguration. Some small carcinoid tumours of the stomach, duodenum, and rectum can be removed with an endoscope. For larger tumours, the doctor may also remove some of the stomach, colon, or rectum, along with nearby lymph nodes.

2. Lung Carcinoid Tumours: While removing the tumour, parts of the airway above and below it may also be removed. This is called a sleeve resection. The airway is reconnected after the surgery. For a larger tumour, the surgeon may remove a piece of the lung or all of it. They may also take out some lymph nodes to stop the tumour from spreading.

Radiation: It uses high-energy X-rays to kill cancer cells. Usually, the radiation is from a machine outside the body. Sometimes radioactive seeds are implanted inside the body, near the tumour. Side effects can include fatigue and redness in the treated area. If radiation is given to the neck or throat, one may have sore throat, cough, shortness of breath.

Chemotherapy: It uses drugs to stop cancer cells from growing. These might be in the form of pills or through IV. This treatment is mostly used if the disease has metastasized to other parts of the body. Side effects of chemo include nausea, vomiting, hair loss, loss of appetite, and a higher risk for infections.

Hormone therapy: It stops the tumour from making extra hormones. The drugs are administered through an injection shot.

Immunotherapy: It helps to boost body’s immune system, helping it fight the cancer better.

Targeted therapy: It uses drugs that aim for genes, proteins, or other substances that are unique to your cancer and that help it grow. Some medications stop the growth of new blood vessels that help carcinoid tumours survive.

Treatment for Carcinoid Tumours that have spread to the liver:

• Liver surgery. Surgery to remove part of the liver (hepatic resection) may control signs and symptoms caused by liver tumours.
• Stopping blood supply to liver tumours. In a procedure called hepatic artery embolization, a doctor clogs the liver’s main artery (hepatic artery), cutting off the blood supply to cancer cells that have spread to the liver. Healthy liver cells survive by relying on blood from other blood vessels.
• Killing cancer cells with heat or cold. Radiofrequency ablation delivers heat treatments that cause carcinoid tumour cells in the liver to die. Cryoablation uses cycles of freezing and thawing to kill cancer cells.
• Chemoembolization: It’s a treatment used to treat a carcinoid tumour that has spread to the liver. Chemo drugs are delivered straight to the liver through a tube called a catheter that a doctor inserts into an artery. The drug stops blood flow to the tumour.
• Radioembolization: Tiny radioactive beads are injected into the blood near the liver. They’ll get stuck in the vessels around the tumour and give off radiation for several days, which can kill cancer cells.

Symptoms

Bronchial tumours are detected purely by accident especially when routine chest x-rays are done for unrelated medical problems. When symptoms do appear, they usually include:

Persistent coughing

Blood in cough

Chest pain

Difficulty in breathing

Wheezing

Fever

Facial flushing (redness and warmness that may last hours to days)

Sweating

Diarrhoea

Fast heartbeat

Weight loss and weakness

Increased facial and body hair

Increased skin pigmentation

Causes

Bronchial tumours can be caused by a variety of factors including: Cigarette smoking – Cigarette smokers form the highest number of bronchial tumour cases by far. Cigarette smoke contains over 60 known cancer causing chemical substances. Researchers have found that nicotine reduces immunity to cancerous growths in exposed tissue. Passive smoking – A passive smoker is someone who inhales smoke exhaled by another smoker. This causes bronchial tumours in non-smokers. Passive smokers are said to be at a higher risk since they are likely to inhale side-stream smoke (smoke that burns off the end of the cigarette). Radon gas – Radon is a colourless and odourless gas generated by the breakdown of radioactive radium. This causes bronchial tumours in non-smokers. The radiation present in this gas causes cancers by affecting the genetic make-up. Asbestos – Asbestos can cause a variety of lung diseases, including bronchial tumours. Tobacco smoking and asbestos both facilitate the formation of lung cancer. Air pollution – Fine particulates and sulphate aerosols, which may be released in traffic exhaust fumes, can slightly increase the risk of bronchial tumours. Women who are exposed to indoor coal smoke have about twice the risk as people who are not. Genetics – It is estimated that 8-14% of bronchial tumours are inherited genetically. If a person has a relative who suffers from lung cancer, the risk of contracting the disease increases by 2.4 times.

Diagnosis

There are multiple ways through which bronchial tumours can be diagnosed: Blood tests: If a patient is suspected of having the tumour, he or she may be advised to undergo some blood and urine tests to understand the concentration of cancer cells. Chest x-ray: 75% of patients with bronchial tumours show signs of it on their chest x-ray. The signs can either be in the form of the tumour itself or reveal an indirect evidence of its presence CT scan: Some carcinoid lung tumours are too minute to be detected or are located behind organs that obstruct the chest x-ray. In some of these cases, the specialists ask patients to undergo a CT scan. CT scans help highlight nodules, masses, or suspicious changes found on a chest x-ray. Magnetic Resonance Imaging (MRI): MRI generally provides information similar to that of CT scans, while also helping to differentiate small tumours from adjacent blood vessels Biopsy: While x-rays and scans can determine the presence of a tumour, it is necessary to conduct a biopsy to understand the nature of the tumour. The various ways of doing biopsy includes:

Bronchoscopy: A procedure which involves inserting a fibre optic viewing tube called a bronchoscope into the windpipe and the airways of the lungs through the throat.

Trans-bronchial fine-needle biopsy: If the tumour is small, a fine-needle biopsy of the tumour may be performed through the bronchoscope.

Transthoracic needle biopsy: If a tumour is inaccessible, or is located in the periphery of the lung, it is accessed using a long needle inserted between the ribs.

Thoracotomy (surgically opening the chest cavity): In the rare event that neither a bronchoscopic biopsy nor a transthoracic needle biopsy can provide enough tissue to identify the type of tumour, a thoracotomy may be necessary to obtain a biopsy and determine subsequent treatment

Treatment

One of the effective ways to treat bronchial tumour is the resection of the primary tumour via surgery. Most tumours end up being classified as benign (which requires only a surgery). There are various surgical options available to the specialists for bronchial tumours:

Sleeve resection: a procedure where a section of the airway containing the tumour is removed.

Segmental resection: a procedure where the segment of the lung containing the tumour is removed.

Wedge resection: a procedure where a small wedge of the lung containing the tumour is removed.

Lobectomy: a procedure where a lobe of the lung containing the tumour is removed

Endoscopic tumour ablation using laser: This is a surgical technique that involves a removal of the tumour through the bronchoscope using laser technology.

Chemotherapy and Radiation therapy are used when the tumours spread to other parts of the body. If this is a solitary mass, it may be treated with chemotherapy directed at the hepatic artery connected to the location of the tumour.

Symptoms

Generally, lumps in the breasts warrant a medical opinion/treatment by breast oncology specialists. Most breast lumps aren’t cancerous. The most common symptoms in women are:

A painless lump or thickening in the breast

A spontaneous discharge of blood from the nipple

Retraction or indentation of nipple

A change in the size or contours of the breast

Redness or pitting of the skin over the breast

Mass below the arms

Changes in the size or shape of a breast

Dimpling or thickening of the skin on a part of a breast

However, it is important to note that:

Most breast lumps are not cancerous.

Most breast lumps are fluid-filled cysts or fibroadenomas which are benign.

The first place that breast cancer usually spreads to is the lymph nodes (glands) in the armpit. Invasive cancer that spreads to the lymph nodes comes under Stage 2 Metastatic breast cancer. If this occurs, one may develop a swelling or lump in an armpit. In case, the cancer spreads to other parts of the body then it is classified as ‘Stage 4 breast cancer’. A Cancerous tumour in the breast which has spread to other parts of the body can also be termed as ‘Malignant Neoplasm’.

Causes

Includes menarche(the 1st occurrence of menstruation), late age at menopause and first childbirth at late stage

Shorter duration of breastfeeding

A family history of breast cancer increases the risk. If a woman has a mother who has suffered from breast cancer, her risk increases by three times. If a woman has a sister with breast cancer, the risk increases by 2-3 times.

Obesity( which contain fat cells called adipocyte, that are susceptible to cancer)

A cancerous tumour starts from one abnormal cell and multiple to many.

RISK FACTORS:

Even when breast cancer can develop for no apparent reason, there are certain ‘risk factors’ that increase the chances of developing it. These are:

Ageing: The risk of developing breast cancer roughly doubles every 10 years.

Location: The rate of breast cancer varies between countries, due to environmental factors.

HRT (Hormone Replacement Therapy): Taking Hormone Replacement Therapy for several years increases risk of breast cancer.

Dense breast tissue: A highly dense tissue can increase the risk too.

History of benign diseases: If the person has a history of benign breast diseases, the risk of getting breast cancer increases.

Lifestyle factors: Signs such as lack of exercise, obesity after menopause and excess intake of alcohol can also add to the chances of getting breast cancer.

Diagnosis

The first test after physical evaluation may include an X-ray of the breast known as mammography. This could be followed by biopsy and other imaging tests.

INITIAL ASSESSMENT :

If you develop a lump or detect a possible symptom, a doctor will usually examine your breasts and armpits to look for any lump or abnormalities. The various tests can include:

• Digital mammogram: A Special X-ray which can detect changes in the density of breast tissue indicating tumours
• Ultrasound scan of the breasts
• MRI scan of the breasts, more commonly performed on younger women, especially those with a strong family history of breast cancer.

BIOPSY – TO CONFIRM THE DIAGNOSIS:

A biopsy is a small sample of the tissue that is removed from a part of the body, in this case a breast tissue. The sample is then examined under the microscope to look for abnormal cells. A specialist may take a biopsy with a needle inserted into the lump and extract some cells commonly known as FNAC procedure (Fine Needle Aspiration Cytology). Sometimes a mammogram or ultrasound scan guides the doctor in locating the spot for needle insertion. There are cases where a small operation is needed to obtain a biopsy sample. As part of the diagnosis, the cells from a tumor can be assessed and tested to determine their progression levels.

ASSESSING THE EXTENT AND SPREAD (STAGING) :

The aim of staging is to find out:

The extent of growth of the tumor (if the cancer has spread to the local lymph nodes in the armpit or other areas of the body).

Assessing the grade of the cells and the receptor status of the cancer. This information helps doctors recommend the best surgery for breast cancer and examine any non-surgery options that are available.

Treatment

The treatment can include surgery, radiation therapy, chemotherapy and hormone therapy depending on the stage of the disease. The treatment depends on:

• The size and shape of the tumour
• The grade of the cancer cells in the tumour
• Age of the patient
• If the patient has reached menopause or not.
• General health and personal preferences for treatment.

SURGERY FOR BREAST CANCER:

The different types of surgeries that can be considered are:

Breast organ preservation surgery is often suggested if the tumour is not too big

‘Lumpectomy‘ (or wide local excision) is a type of surgery where just the tumour and some surrounding tissues of the breast are removed. It is usually followed up with radiotherapy and surgery (to kill any cancer cells that may have been left in the breast tissue).

Removal of the affected breast

• This may be necessary if there is a large tumour or if the tumour is located in the middle of the breast. Surgical removal of the breast (mastectomy) is recommended when the cancer has spread aggressively.
• The Breast reconstruction surgery can be done immediately after the removal of the cancerous breast also.

After the surgery is completed, it is common to remove one or more lymph nodes in the armpit where the cancer originated. The lymph nodes which are removed are examined to see if they contain any cancerous cell and determine the next course of treatment after surgery.

• Alternatively, a sentinel lymph node biopsy may be performed. This is to assess if the main lymph nodes contain any cancer at all. If they are clear, then the remaining lymph nodes in the armpit need not be removed.

RADIOTHERAPY:

The breast radiation therapy is a treatment which uses high energy beams to kill the cancerous cells or stop them from multiplying. In the case of breast cancer, radiotherapy is mainly used in conjunction to surgery.

CHEMOTHERAPY FOR BREAST CANCER:

Chemotherapy otherwise known as ‘chemo treatment’ is a procedure to where anti-cancer drugs are used against cancer cells to stop them from multiplying. ‘Adjuvant Chemotherapy’ is the treatment recommended after surgery. Chemo may sometimes be given before surgery to shrink the tumour in case it has grown to an abnormal size. There are also new gene tests being developed to help doctors decide ascertain which women will benefit the most from chemotherapy.

Chemotherapy is often a recommended option for metastatic cancers and while treating older patients.

HORMONAL THERAPY FOR BREAST CANCER:

Female hormones such as oestrogen and progesterone stimulate the cancer cells to divide and multiply. The treatments involves thee suppression of these hormones, thereby stopping the growth of cancer cells. Hormonal therapy provides better response amongst patients who have good oestrogen and progesterone receptors.

However, it would be important that the patients must monitor and have constant checks done for effective treatment at an early stage.