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Symptoms

The symptoms of brain tumours vary widely depending on the type and location of the tumour. Some of the most common symptoms are headache, vomiting or nausea. These are often caused by increased intracranial pressure. The tumours can also encroach and compress the surrounding brain tissue giving rise to additional symptoms like drowsiness, seizures and insomnia. Abnormal behavioural changes amongst children can be associated to brain tumour.

Symptoms associated with the main parts of the brain may include one or more of the following:

Frontal lobe memory loss

Impaired sense of smell and loss of vision

Behavioural, emotional and cognitive changes

Impaired judgment

Parietal lobe impaired speech

Inability to write

Occipital lobe vision loss in one or both eyes

Temporal lobe impaired speech

Seizures

Brainstem irritability

Difficulty in swallowing

Drowsiness and headaches in the morning

Muscle weakness on one side of the face or body

Drooping eyelid or crossed eyes

Increased Intracranial Pressure (ICP)

Vomiting (usually occurs in the morning without nausea)

Uncoordinated muscle movements

Problems walking (ataxia)

Causes

The causes of brain tumours are largely unknown. However the risk of brain tumour is higher among people who have suffered from or have had exposure to:

• Genetic cell mutations
• Viruses that can affect the brain
• Injury to the head
• Exposure to harmful chemicals
• Radiation
• Hormone imbalance and/or hormone based therapy
• Environmental factors
• Occupational factors

Brain tumours are not contagious. It is however clear that a large portion of brain tumours are caused by other cancers. Patients who have had any history of cancer in their childhood are prone to getting brain tumours. Such tumours are called secondary brain tumours.

Diagnosis

Neurological examination: This helps to establish the Increased Intracranial Pressure and the focal deficit would help us localise the probable site of tumour.

Magnetic Resonance Imaging (MRI): MRI is perhaps the most valuable test used to diagnose brain tumours because it provides an accurate anatomical location of the tumour along with proximity to important areas (DTI and functional MRI) and probable pathology of the tumour (with the help of spectroscopy / perfusion studies).

Computed Tomography (CT): The CT is an affordable method for effective detection of tumour. It is most effective while detecting lesions with calcification or blood in the lesion.

Benign tumours are often extra-axial in location. Surgery is the only treatment for benign tumours and the duration depends on the complexity of the tumour.

There are times when the surgeon may not be able to treat the tumour effectively due to its complexity and location. In such cases additional radiotherapy or radiosurgery may have to be considered as adjuvant therapy. In certain instances where tumour has formed in the membranes that cover the brain (Meningioma), then surgery is advised.

Malignant brain tumours can be slow or fast-growing and is usually life threatening due to their ability to invade and destroy surrounding normal brain tissue. There are two types of malignant brain tumours known as primary and metastatic. Primary brain tumours originate from the cells in the brain and they include various sub-types. The most common type of malignant primary brain tumour is Glioblastoma Multiforme (grade IV astrocytoma), which make up approximately 20% of all primary brain tumours. Glioblastoma is quite common amongst elderly patients. Metastatic brain tumours are cancers that have spread from other areas of the body to the brain. There are cases where brain tumour is common in patients with metastatic melanoma (cancer which develops in the pigment containing cell called melanocytes). These tumours are the most common, occurring as much as four times more frequently than primary brain tumours. Cancers that commonly spread to the brain include breast and lung cancers. The prognosis depends on the grade of the malignant tumour.

Generally grade 1 or pilocytic tumours (common amongst children) behave like a benign tumour which need long-term follow up. In the present era the outlook of the disease has improved with the use of immune histology, tumour marker, modern radiotherapy technique and less toxic chemotherapy.

Treatment

Brain tumours are typically treated with surgery, radiation therapy and chemotherapy. Sometime a combination of all three options is exercised as part of the standard procedure.

Surgery is the primary treatment for brain tumours that can be removed without causing severe damage. Many benign tumours are treated only by surgery but most malignant tumours require treatment along with surgery, such as radiation therapy and/or chemotherapy.

The goals of surgical treatment for brain tumours are multiple and may include one or more of the following:

Remove all or as much of the tumour as possible

Reduce symptoms and improve quality of life by relieving intracranial pressure caused by the tumour

Provide access for implantation of internal chemotherapy or radiation

A stereotactic or navigation guided biopsy is used to access the tumour in deep seated areas where surgery is hazardous. This technique utilises a computer and a three-dimensional scan to direct the placement of the needle. Radiation Therapy (RT) may be used alone or in combination with surgery and/or chemotherapy while treating primary or metastatic brain tumours. External Beam RT is the conventional technique for administering radiation therapy for brain tumours. Another treatment method includes using the CyberKnife System which involves a frameless robotic radiosurgery system for treating benign tumours, malignant tumours and other medical conditions.

The CyberKnife system is a method of delivering radiotherapy with the intention of targeting treatment more accurately than standard radiotherapy. This system improves on other radiosurgery techniques by eliminating the need for stereotactic frames. As a result, this methodology enables doctors to achieve a high level of accuracy in a non-invasive manner and allows patients to be treated on an outpatient basis. The CyberKnife system can pinpoint a tumours’ exact location in real time using X-ray images to capture the unique bony structures of a patient’s head. It has a strong record of proven clinical effectiveness. It is used either on a stand-alone basis or in combination with chemotherapy, surgery or whole brain radiation therapy.

Treating brain tumours with chemotherapy is more complicated than treating tumours elsewhere in the body because of a natural defence system called the blood-brain barrier that protects the brain from foreign substances. Furthermore, not all brain tumours are sensitive to or respond to chemotherapy, even if the drug does penetrate the blood brain barrier. Actively dividing cells are the most vulnerable to chemotherapy. Most tumour cells and some normal cells fall into that category. In cases where lymphoma has started in the brain (cerebral lymphoma), chemotherapy becomes a possible option. The side effects of chemotherapy can include nausea, vomiting, mouth sores, loss of appetite and loss of hair.

Some of the latest methods for treating brain tumours include:

Chemotherapy wafers – the wafers contain cancer killing substances which is inserted directly into the area of the brain tumour during surgery. The wafers are effective in reaching out to remote regions of the brain.

Immunotherapy is a breakthrough innovation in cancer care where the immune system is strengthened to fight against cancer.

Symptoms

Symptoms of brain cancer usually develop over time and their characteristics depend on the location and size of the tumour. Brain cancer symptoms include:

• Behavioural and emotional changes
• Impaired judgment
• Impaired sense of smell
• Memory loss
• Paralysis on one side of the body
• Reduced mental capacity
• Inflammation of the optic nerve
• Impaired speech
• Inability to write
• Lack of recognition
• Seizures
• Spatial disorders
• Difficulty in speaking and swallowing
• Drowsiness
• Headache, especially in the morning
• Loss of hearing
• Muscle weakness on one side of the face
• Uncoordinated gait
• Vomiting
• Mental and emotional changes
• Prolonged drowsiness (somnolence)
• Seizures
• Loss of vision

Causes

Primary brain tumours may develop in different parts of the brain. The common types of primary brain tumours are Gliomas, Meningiomas, Pituitary Adenomas, Vestibular Schwannomas, and Primitive Neuroectodermal Tumours also called Medulloblastoma. Glioma also includes Glioblastoma, Astrocytoma, Oligodendroglioma, as well as Ependymoma. Metastatic brain cancer is caused by the spread of cancer cells from a body organ to the brain. However, the causes for the alteration of normal cells to cancer cells in both metastatic and primary brain tumours are not yet fully understood. Research show that people with certain risk factors are more likely to develop brain cancer. Individuals with risk factors, such as having a job in an oil refinery, handlers of jet fuel or chemicals like benzene, chemists, embalmers & rubber-industry workers, show higher rates of brain cancer than the general population. Some families have several members with brain cancer, however heredity/genetics as a cause for brain tumours has not been proven. Other risk factors such as smoking, radiation exposure and viral infections like HIV have been suggested but not proven to cause brain cancer. There is no evidence that brain cancer is contagious, caused by head trauma or caused by cell phone use.

Diagnosis

The initial test is a medical interview and a physical examination of the person by the doctor. The findings of this will indicate whether there is a problem in the brain or the brain stem. The most commonly used test for brain cancer detection is a CT scan. This diagnostic test resembles a series of X-rays and is not painful, although sometimes a dye needs to be injected into a vein for better images of some internal brain structures. Another test that is gaining popularity because of its high sensitivity for detecting anatomic changes in the brain is MRI (Magnetic Resonance Imaging). This test also resembles a series of X-rays and shows the brain structures in detail better than a CT scan. MRI is not as widely available as a CT scan. People with brain cancer usually also have other medical problems; hence, routine lab tests may be done. These include blood tests, electrolytes and liver function. If the tests show evidence (tumours or abnormalities in the brain tissue) of brain cancer, other doctors such as Neurosurgeons and Neurologists that specializes in treating brain ailments will be consulted to help determine how to treat the patient. Occasionally, a tissue sample (biopsy) may be obtained by surgery or insertion of a needle to help determine the diagnosis. Other tests may be suggested by the health-care practitioner to help determine the patient’s state of health or to detect other health problems.

Treatment

A brain cancer treatment plan is customised for each patient. The treatment plan is constructed by the doctors who specialise in brain cancer, and treatments vary widely depending on the cancer type, tumour location, tumour size, patient age and patient’s general health status. A major part of the plan is also determined by the patient’s wishes. Patients should discuss treatment options with their healthcare providers. Most treatment plans for brain cancer are complex and can involve several consulting doctors. Surgery, Radiation Therapy and Chemotherapy are the major treatment categories for most brain cancers. Individual treatment plans often include a combination of these treatments. Surgery: Surgery attempts to remove all of the tumour cells by cutting the tumour away from normal brain tissue. This surgery is often termed invasive surgery to distinguish it from non-invasive radiosurgery or radiation therapy described below. Radiation Therapy: Radiation Therapy attempts to destroy tumour cells in the brain by using high-energy radiation focused onto the tumour to destroy the tumour cells’ ability to function and replicate. Radiosurgery is a nonsurgical procedure that delivers a single high dose of precisely targeted radiation using highly focused gamma-ray or x-ray beams that converge on the specific area or areas of the brain where the tumour or other abnormality is located. This minimises the amount of radiation to healthy brain tissue. Equipment used to do radiosurgery varies in its radiation source; a gamma knife uses focused gamma rays whereas a linear accelerator uses photons and heavy-charged particle radiosurgery uses a proton beam. Chemotherapy: Chemotherapy attempts to destroy tumour cells using chemicals (drugs) that are designed to destroy specific types of cancer cells. There are many chemical agents used. Specific drug therapies are numerous and each regimen is usually designed for the specific type of brain cancer and individualised for each patient. Chemotherapy can be administered intrathecally, by IV administration, and biodegradable chemically impregnated polymers. All treatments attempt to spare normal brain cells. Other treatment options may include Hyperthermia (heat treatments), Immunotherapy (immune cells directed to kill certain cancer cell types) or steroids to reduce inflammation and brain swelling. These may be added to other treatment plans.

Symptoms

The most common symptom of cancerous tumours in bone is pain, which gradually increases over time with the creation of bone lesions. Other key symptoms include:

Fatigue

Fever

Anaemia

Bone fractures

Many patients will not experience any symptoms making the prognosis difficult. The only giveaway would be a painless mass which, upon further tests could confirm bone cancer. Some bone tumours may weaken the structure of the bone causing pathologic fractures.

Causes

Although bone cancer does not have a clearly defined cause, researchers have identified several factors that increase the likelihood of developing these tumours.

Myeloma, a type of white blood cell which produces antibodies, has a probability of multiplying unusually or releases too much protein (immunoglobulin) into the bones and blood, giving rise to bone cancer.

Osteosarcoma occurs more frequently in people who have had high-dose external radiation therapy or treatment with certain anticancer drugs.

A small number of bone cancers are due to heredity. For example, children who have had hereditary retinoblastoma (an uncommon cancer of the eye inherited by a faulty gene) are at a higher risk of developing osteosarcoma.

It is also observed individuals who have hereditary defects of bones or metal implant to correct fractures, are more likely to develop osteosarcoma.

The following groups have a higher chance of developing bone cancer:

Children & Adults below the age of 20 are more likely to get bone cancer. Bone cancer below 20 is largely unknown. In some cases it is attributed to hereditary factors.

Patients with a history of radiation therapy

People with a history of Paget’s disease ( which interferes with the bone’s natural recycling process)

People with a close relative (parent or sibling) who has/had bone cancer.

People with Li-Fraumeni syndrome (a mutation of the tumour suppressing gene TP53)

Babies born with an umbilical hernia

Diagnosis

The doctor may order a blood test to identify the cause of the cancer. The patient will then be referred to a bone specialist (orthopaedic surgeon) to examine the bone tumour.

The following diagnostic tests may be ordered:

Bone scan: a liquid which contains radioactive material is injected into a vein. This material collects in the bone, especially in abnormal areas, and is detected by a scanner. The image is captured on a special film.

Computerized Tomography (CT): the CT scanner uses digital geometry processing to generate a 3-dimensional (3-D) image of the inside of an object. The 3-D image is made up of many 2-dimensional (2-D) X-ray images, taken around a single axis of rotation – in other words, many pictures of the same area are taken from different angles and then placed together to produce a 3-D image. It is a painless procedure. CT scans are commonly used to see whether the bone cancer has spread and where it has spread to.

Magnetic Resonance Imaging (MRI): the device uses a magnetic field and radio waves to create detailed images of the body. An MRI scan helps in determining the tumour size and checking whether or not the cancer has spread to the surrounding tissues.

Positron emission tomography (PET): A PET scan uses radiation or nuclear medicine imaging, to produce 3-dimensional, colour images of the functional processes within the human body. The machine detects pairs of gamma rays which are emitted indirectly by a tracer (positron-emitting radionuclide) which is placed in the body on a biologically active molecule. The images are reconstructed by computer analysis.

X-ray: An X-ray scan can detect damages caused by the cancer. It may also detect the new bone cells that have started to form around the tumour.Although, an X-ray does not provide sufficient data for definitive diagnosis, it can help the surgeon with the prognosis and also determine the suitable treatment plan for that particular bone cancer case.

Bone biopsy: A sample of bone tissue is extracted and examined for cancer cells. This is the most reliable way to diagnose bone cancer. The standard process involves inserting a long, thin needle into the bone and removing a sample, while an open biopsy involves making an incision in the target bone area and surgically removing a sample of the tissue.

Treatment

The options on treatment for bone cancer depends on several factors, such as what type of bone cancer it is, where it is located, how aggressive it is, and whether it is localized or spread. There are typically 4 stages of bone cancer and based on the staging made by the specialists, various treatment plans are devised.

Some of the latest bone cancer treatment options that available are:

Surgery

Radiotherapy (Radiation Therapy)

Chemotherapy

Surgery: In this form of bone cancer treatment, the aim is to remove the tumour completely along with some of the bone tissue that surrounds it. Limb sparing surgery, also known as limb-salvage surgery means that surgical intervention occurs without having to amputate the limb. During the leg or arm treatment, the surgeon may take some bone from another part of the body to replace lost bone (bone graft), or an artificial bone may be put in. In some cases, especially with advanced and aggressive cancers, however, amputation of a limb may be necessary during treatment.

Radiation Therapy: It is also known as radiotherapy, radiation oncology and XRT. Approximately 40% of patients of all types of cancer undergo some kind of radiotherapy. It involves the use of beams of high-energy X-rays or radiation particles to destroy cancer cells for a certain duration based on treatment. Radiotherapy works by damaging the DNA inside the tumour cells, destroying their ability to reproduce. This type of treatment is recommended for Metastatic bone cancer treatment.

Radiotherapy can be used for different reasons:

To suppress the tumour

To alleviate bone cancer symptoms

Neoadjuvant radiotherapy (before surgery), is delivered to shrink the tumour and allow it to be removed surgically.

Adjuvant radiotherapy to eliminate the cancer cells that remained after the surgery.

Combination therapy (radiotherapy combined with another type of therapy) – in some cases, radiation is combined with chemotherapy. Given the benefits of radiation therapy, the patient must be wary of the side effects during the treatment which ranges from fatigue, loss of appetite & changes in the skin. Common skin changes include redness, hair loss, blistering & peeling. There are also instances of low blood counts, nausea, vomiting and diarrhoea. In special cases where the pain aggravates, it would be advisable for the patients to talk to their treating doctor.

Chemotherapy: It is the use of chemicals (medication) to treat disease, specifically for the destruction of cancer cells. During the treatment, the cytotoxic medication prevents cancer cells from dividing and growing.

In general, chemotherapy has 4 possible goals:

Total remission – to treat the cancer

Delay/Prevent recurrence – to prevent the recurrence of cancer, especially after surgery.

Slow down cancer progression – used mainly when the cancer is in its advanced stages and a positive outcome is unlikely, where it can slow down the rate of growth of cancer.

To relieve symptoms – especially for patients with advanced cancer.

Symptoms

Signs and symptoms may not be present until the later stages of bile duct cancer, but in some cases they may lead to an early diagnosis. The following are some symptoms associated with bile duct cancer:

• Jaundice
• Itching
• Light-coloured stools
• Dark urine
• Abdominal pain
• Loss of appetite
• Weight loss
• Fever
• Nausea and vomiting

Causes

Bile duct cancer is uncommon. However, certain factors and conditions may put you at greater risk of developing this type of cancer. Long-standing Inflammation Long-standing inflammation is a key risk factor in developing bile duct cancer. Conditions that are associated with this kind of inflammation include:

• Sclerosing cholangitis, which causes inflammation, scarring and sometimes destruction of the bile ducts
• Ulcerative colitis, which causes ulcers in the rectum lining and colon
• Bile duct stones
• Cirrhosis, which is progressive scarring of the liver and is most often caused by alcohol abuse and infections such as hepatitis C and B

Age Nearly 60% who develop bile duct cancer are over the age of 65. Liver Fluke Infection Flukes are parasitic worms that can enter your body if you eat undercooked freshwater fish that contains parasites. Once they have entered the body, liver flukes go and inhabit the bile ducts. The species of fluke connected to bile duct cancer is mostly found in Southeast Asia. Other Risk Factors Family history of bile duct cancer, smoking, diabetes and pancreatitis may also play a role.

Diagnosis

Bile duct cancer can be a challenging condition to diagnose. If cancer is suspected, the patient is referred to a specialist for tests. Some of the tests are described below:

Blood tests- During bile duct cancer, cancerous cells may release certain chemicals that can be detected using blood tests. These types of proteins are known as tumour markers. However, tumour markers can also be caused by other conditions. A positive blood test does not necessarily mean that the patient is suffering from bile duct cancer, and vice versa.

Scans-The scans performed to diagnose bile duct cancer include:

• Ultrasound scan – high frequency sound waves are used to build up a picture of the inside of your body
• Computer Tomography (CT) scan – a series of x-rays of the liver are taken and a computer is used to assemble them into a more detailed three-dimensional image
• Magnetic Resonance Imaging (MRI) scan – this uses a strong magnetic field and radio waves to produce a picture of the inside of your liver

Endoscopic Retrograde Cholangiopancreatography (ERCP)- During Endoscopic Retrograde Cholangiopancreatography (ERCP), the patient is injected with a special liquid that makes the bile ducts show up more clearly on an x-ray scanner. The x-ray scanner is used to guide an endoscope down the throat and into your bile duct. The endoscope can detect blockages in the bile duct, which could actually indicate bile duct cancer.

Spyglass- An advanced form of ERCP is a special test called a ‘spyglass’. This involves passing a specialised endoscope into the bile duct so that abnormalities if any, can be spotted. It also enables a biopsy to be taken at this stage.

Biopsy- If scans and tests indicate bile duct cancer, a biopsy is carried out to confirm a diagnosis. During a biopsy, a small sample of tissue is taken from the body and checked under a microscope for the presence of cancerous cells. A biopsy is usually performed while ERCP or PTC is being carried out. As well as taking bile and tissue samples from the bile duct, samples may be taken from nearby lymph nodes. This is to check whether the cancer has spread from your bile duct into the lymphatic system.

Treatment

Most cases of bile duct cancer cannot be cured. Instead, treatment is most commonly used to relieve symptoms. The treatment plan will be determined by the stage the cancer has reached. In stage 1 and stage 2 cases of bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct, and possibly some of the liver or gallbladder. In a stage 3 case, the chances of achieving a successful cure will depend on how many lymph nodes have been affected. A cure may be possible if only a few nodes have cancerous cells in them or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes. In cases of stage 4 bile duct cancer, achieving a successful cure is highly unlikely. However, chemotherapy, radiotherapy and surgery can often be used to help relieve symptoms. Surgery: If it is possible to cure bile duct cancer, surgery will be needed to remove any cancerous tissue. Depending on the extent of the cancer, it may be necessary to remove:

the part of your bile duct that contains cancerous cells,

your gallbladder,

nearby lymph nodes, and/or

part of your liver.

Unfortunately, due to the aggressive nature of bile duct cancer, fewer than one-third of patients are suitable for surgery. After surgery, it is usually possible to reconstruct what remains of the bile duct so that bile can still flow into the intestine. Unblocking The Bile Duct: If the bile duct becomes blocked as a result of cancer, a treatment to unblock the duct is recommended. This will help resolve symptoms such as:

jaundice,

itchy skin, and

abdominal (tummy) pain,

Unblocking the bile duct is sometimes necessary if the flow of bile back into your liver starts to affect the normal functioning of your liver. The bile duct can be unblocked in several ways. The first is to use a variation of the Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure. During the procedure, a surgeon will guide a long, flexible tube with a light and video camera on the end (endoscope) into the bile duct and pass down a small metal or plastic tube called a stent. The stent is used to widen the bile duct, which should help to get the bile flowing again. Alternatively, a stent can be placed in the bile duct using a variation of the Percutaneous Transhepatic Cholangiography (PTC) procedure. This involves placing the stent in the bile duct through a small incision in the stomach. Radiotherapy: Radiotherapy cannot cure bile duct cancer but can help to relieve the symptoms, slow the spread of cancer and prolong life. Two types of radiotherapy are used to treat bile duct cancer:

External beam radiotherapy – a machine is used to target radioactive beams at your bile duct

Internal radiotherapy (brachytherapy) – a radioactive wire is placed inside your bile duct next to the tumour

Radiotherapy works by damaging cancerous cells. However, it can also damage healthy cells and cause side effects. Side effects of radiotherapy include:

nausea,

vomiting, and

fatigue.

Chemotherapy: Chemotherapy is used in a way similar to radiotherapy to relieve the symptoms of cancer, slow down the rate at which it spreads and prolong life. It is sometimes used in combination with radiotherapy. As with radiotherapy, medicines used in chemotherapy can sometimes damage healthy tissue as well as cancerous tissue, and adverse side effects are common. Side effects of chemotherapy can include:

nausea

vomiting

fatigue

hair loss

However, these side effects should stop once the course of treatment has finished. Photodynamic Therapy (PDT): Photodynamic Therapy is a new technique that can help to control – but not cure – the symptoms of bile duct cancer. A special chemical is injected into the bile duct, which makes the cancerous cells more sensitive to light. A laser is then passed through an endoscope and used to shrink the tumour.

Symptoms

The symptoms of appendix cancer may include:

• Pain in the lower right quadrant
• Feeling bloated
• Abdominal distension
• Digestive disturbances and excessive flatulence
• Loss of appetite and inability to eat a complete meal
• Constipation, diarrhoea and shortness of breath
• Appendicitis
• The appearance of a hernia

Causes

Although risk factors often influence the development of cancer most do not directly cause cancer. Causes of appendix cancer are unknown and no avoidable risk factors have been identified. Age may raise a person’s risk of developing appendix cancer. It is however rare in children and the average age at diagnosis is 40 years.

Diagnosis

In the initial stages, the doctors can conduct a physical examination by applying gentle pressure on the area. When the pain is released, the pain can feel worse. This could signal a possible abnormality in the appendix. Apart from it, the other tests to diagnose appendix cancer include: Biopsy: A biopsy is conducted through the process of removing a small amount of tissue for examination under a microscope. The sample removed during a biopsy is analysed by a pathologist. Appendix cancer is often found unexpectedly during or after abdominal surgery. If cancer is suspected at the time of surgery, the doctor will remove a portion of the colon and surrounding tissue for examination. The cancer is diagnosed after the pathologist has processed and reviewed the tissue under the microscope. Computed Tomography (CT or CAT) Scan: A CT scan creates a three-dimensional picture of the inside of the body with an X-ray machine, which a computer then combines into a detailed, cross-sectional view that shows any abnormalities or tumours. A CT scan can also be used to measure a tumour’s size. Magnetic Resonance Imaging (MRI): An MRI uses magnetic fields to produce detailed images of the body. A contrast medium may be injected into a patient’s vein or given orally to get a clearer picture. Ultrasound: An ultrasound uses sound waves to create a picture of the internal organs. It gives a clearer picture on stage of the cancer. Radionuclide scanning (OctreoScan): In this, small amount of a radioactive, hormone-like substance that is attracted to a carcinoid tumour is injected into a vein. A special camera is then used to show where the radioactive substance accumulates. This procedure is useful in detecting the spread of a carcinoid tumour, especially to the liver. After the completion of various diagnostic tests, the results are reviewed. If the diagnosis confirms a cancer, these results help in the staging of the cancer and the possible prognosis.

Treatment

Surgery: A tumour removal surgery is performed as part of the treatment. A surgery is performed to remove the appendix tumour and the surrounding tissues affected by it. It is the most common treatment option for appendix cancer. Most often, appendix cancer is low-grade and slow-growing. Often it can be successfully treated with surgery. Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells by killing their ability to grow and divide. It is often used soon after surgery during the advanced stages, when cancer is found outside the appendix region. Radiation Therapy: Radiation therapy is the use of high-energy X-rays or other particles to kill cancer cells. A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time. Radiation therapy is rarely used in the treatment of appendix cancer. In this procedure, an isotope is dissolved in a liquid and placed inside the body after surgery. It delivers strong radiation therapy to a specific area through a tube inserted in the abdomen. Because the radioactivity disappears quickly (within a few hours), there is no need to remove the substance from the abdomen after treatment. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.

Symptoms

The most common symptom associated with anal cancer is bleeding. Itching at the anal opening may also be a symptom, although many people, initially, attribute such bleeding and itching to haemorrhoids. This can delay the diagnosis of anal cancer. Other signs and symptoms of anal cancer may include:

• Pressure in the anal area
• Unusual discharges from the anus
• Lump near the anus
• Change in bowel habits

Causes

Anal cancer occurs when a genetic mutation turns normal, healthy cells in the anal canal into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells continue to grow and multiply and do not die. The accumulating abnormal cells form a mass (tumour). Cancer cells invade nearby tissues and can separate from an initial tumour to spread elsewhere in the body (metastasize).

Anal cancer is closely related to a sexually transmitted infection called human papillomavirus (HPV). Evidence of HPV is detected in the majority of anal cancers. HPV is thought to be the most common cause of anal cancers.

Several factors have been found to increase the risk of anal cancer, including:

• Age: Most cases of anal cancer occur in people age 50 and older.
• Multiple sexual partners: People who have many sexual partners over their lifetimes have a greater risk of anal cancer.
• Anal Intercourse: People who engage in anal intercourse have an increased risk of anal cancer.
• Smoking: Smoking cigarettes may increase your risk of anal cancer.
• History of cancer: Those who have had cervical, vulvar or vaginal cancer have an increased risk of anal cancer.
• Human papillomavirus (HPV): HPV infection increases your risk of several cancers, including anal cancer and cervical cancer. HPV infection is a sexually transmitted infection that can also cause genital warts.
• Immunosuppressor Drugs or conditions that suppress immune system: People who take drugs to suppress their immune systems (immunosuppressive drugs), including people who have received organ transplants, may have an increased risk of anal cancer. HIV — the virus that causes AIDS — suppresses the immune system and increases the risk of anal cancer.

Diagnosis

Tests and procedures used to diagnose anal cancer include:

• Anal canal and rectum examination for abnormalities: During a digital rectal exam, the doctor inserts a gloved, lubricated finger into your rectum. They feel for anything unusual, such as growths.
• Visual inspection of the anal canal and rectum: A short, lighted tube (anoscope) may be use to inspect your anal canal and rectum for anything unusual.
• Ultrasound of your anal canal: To create a picture of the anal canal, a probe, similar to a thick thermometer, may be inserted into your anal canal and rectum. The probe emits high-energy sound waves, called ultrasound waves, which bounce off tissues and organs in your body to create a picture. This picture helps evaluate anything abnormal.
• Biopsy: If any unusual areas are discovered, a small samples of affected tissue maybe taken and sent to a laboratory for analysis. By looking at the cells under a microscope, doctors can determine whether the cells are cancerous. Once it’s confirmed that you have anal cancer, the doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body. This is called staging.

Tests may include:

• Computerized tomography (CT)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)

The information from these procedures is used to assign the cancer a stage. The stages of anal cancer are indicated using Roman numerals ranging from 0 to IV, with the lowest stages indicating that the cancer is small and confined to the anus. By stage IV, the cancer has spread to distant areas of the body.

Treatment

There are different ways to treat anal cancer, depending upon which stage it is in, if the patient has HIV or if the cancer is a recurrence. Doctors usually treat anal cancer with a combination of chemotherapy and radiation. Combined, these two treatments enhance each other and improve chances for a cure.

Radiation Therapy: It 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 led directly into or near the cancer. The way radiation therapy is given depends on the type and stage of cancer.

Chemotherapy: This is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing them or by stopping them from dividing. When chemotherapy is taken orally or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The mode of administration of chemotherapy depends on the type and the stage of the cancer being treated.

Surgery: Doctors typically use different procedures to remove anal cancer based on the stage of the cancer:

• Surgery to remove early-stage anal cancers: Very small anal cancers may be removed through surgery. During this procedure, the surgeon removes the tumour and a small amount of healthy tissue that surrounds it. Since the tumours are small, early-stage cancers can sometimes be removed without damaging the anal sphincter muscles that surround the anal canal. Anal sphincter muscles control bowel movements, so doctors work to keep the muscles intact. Depending on the stage of the cancer, chemotherapy and radiation after surgery may be recommended
• Surgery for late-stage anal cancers or anal cancers that haven’t responded to other treatments: If the cancer hasn’t responded to chemotherapy and radiation, or if your cancer is advanced, your doctor may recommend a more extensive operation called abdominoperineal resection, which is sometimes referred to as an AP resection. During this procedure the surgeon removes the anal canal, rectum and a portion of the colon. The surgeon then attaches the remaining portion of your colon to an opening (stoma) in your abdomen through which waste will leave your body and collect in a colostomy bag.

Symptoms

Vaginal cancer often does not cause early symptoms and may be found during a routine Pap test (a type of test where the cervix is checked to see for any abnormality in the cells). Otherwise, some of the symptoms include:

Unusual bleeding or discharge not related to menstrual periods

Watery vaginal discharge

Painful urination

Frequent urination

Constipation

Pain during sexual intercourse

Pain in the pelvic area

A lump in the vagina

Causes

The various causes of vaginal cancer are:

Age- Patient generally above the age of 60 are at a higher risk of getting the cancer

Exposure to the drug DES (diethylstilbestrol) before birth- The DES is a synthetic form of the oestrogen hormone. It was prescribed to pregnant women to prevent miscarriage, premature labour and related complications arising during pregnancy. Women who were exposed to DES before birth have an increased risk of developing vaginal cancer. Some of these women develop a rare form of cancer called clear cell adenocarcinoma

There has been a link to Human Papilloma Virus (HPV) infection and vaginal cancer

A history of abnormal cells in the cervix or cervical cancer

Diagnosis

Tests that examine the vagina and other organs in the pelvis are used to detect and diagnose vaginal cancer. The following tests and procedures may be used:

Physical exam and history: A thorough examination is done to check general signs of health including lumps or any abnormality. A history of the patient’s health habits and past illnesses and treatments is also taken into analysis.

Pelvic exam: An examination of the vagina, cervix, uterus, fallopian tubes, ovaries and rectum is performed. The doctor inserts her finger (gloved and lubricated) 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 looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is also done to check for any abnormalities. The finger may also be inserted into the rectum to feel for lumps or abnormal areas.

Pap smear: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap test.

Biopsy: This process involves the removal of cells or tissues from the vagina and cervix in order to view it under a microscope and detect signs of cancer.

Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.

Through the diagnosis, the doctor is able to the extent of the cancer and is able to assign a stage. The various stages of vaginal cancer are:

Stage I: Cancer is limited to the vaginal wall

Stage II: Cancer has spread to tissue next to your vagina

Stage III: Cancer has spread further into the pelvis

Stage IVA: Cancer has spread to nearby areas, such as your bladder or rectum

Stage IVB: Cancer has spread to areas away from your vagina, such as your liver

Treatment

Different types of treatments are available for patients with vaginal cancer. Treatment varies based on the stage of the cancer. The various types of treatment include: Surgery Surgery is the most common treatment of vaginal cancer. The following surgical procedures may be used:

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 a surface lesion such as a tumour.

Wide local excision: A surgical procedure that takes out the cancer and some of the healthy tissue around it.

Vaginectomy: Surgery to remove all or part of the vagina.

Total hysterectomy: Surgery to remove the uterus and the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

Lymphadenectomy: A surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. This procedure is also called lymph node dissection. If the cancer is in the upper vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.

Pelvic exenteration: Surgery to remove the lower colon, rectum and bladder. In women, the cervix, vagina, ovaries and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery. This is to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, 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 or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can affect cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into 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 the chemotherapy is given depends on the type and stage of the cancer being treated.

Symptoms

The symptoms of Acute Lymphoblastic Leukaemia are caused by a lack of normal circulating blood cells. ALL advances quickly, so people are usually only unwell for only a short period of time (days, or weeks) before they are diagnosed.

Common symptoms of ALL can include:

Anaemia due to a lack of red blood cells (RBCs). Anaemia could result in persistent tiredness, dizziness, paleness or shortness of breath when physically active.

Frequent and/or recurring infections and slow healing, due to a lack of normal white cells, especially neutrophils

Due to a low platelet count, there is increased or unexplained bleeding or bruising

Bone and/or joint pain due to the marrow being overcrowded with leukemic cells.

Other symptoms could include swollen lymph nodes, chest pain and abdominal discomfort due to a swollen spleen or liver.

Some of these symptoms mentioned above may also be seen in other illnesses, including viral infections, therefore it is important to see the doctor so that proper examination and treatment can happen. In some cases, there may be symptoms and ALL is diagnosed during a routine blood test.

Causes

While the exact causes of ALL still remain largely unknown, it is believed to result from mutations in one or more of genes that are responsible for blood cell development resulting in abnormal growth.

Ongoing research to find possible causes of this damage have identified certain factors that could put some people at an increased risk. These include:

• Very high doses of radiation either accidentally (nuclear accident) or therapeutically (to treat other cancers)
• Industrial chemicals such as benzene, pesticides, as well as certain types of chemotherapy used to treat other forms of cancers
• Certain types of viral infections and the way in which the immune system reacts to the infection could play a role in the development of some types of ALL
• Certain genetic disorders like Down’s syndrome and Fanconi’s anaemia may have a higher than average risk of developing ALL.

Diagnosis

The World Health Organisation has classified ALL into the following types:

Pre-B-cell ALL: It accounts for approximately 75-80% of adult cases, ALL arising in the B-lymphocytes which is in the early stages of development in the bone marrow is referred to as precursor B-Cell-ALL or Pre-B-Cell-ALL.

B-cell ALL: B-cell ALL arises in more mature developing lymphocytes. This form of ALL is rarer and accounts for 3-5% of all adult cases. B-cell ALL is also referred to as Burkitt-like or Burkitt type ALL. Patients diagnosed with B-cell ALL may be treated with similar drugs to those used to treat Burkitt lymphoma.

T-cell ALL: Approximately 1/4th of ALL cases arise in developing T-cells. This can be further classified as early, mid or late, depending on the maturity of the affected cell. T-cell ALL commonly presents with a high white blood cell count and involvement of the central nervous system at diagnosis.

ALL is diagnosed by examining blood and bone marrow samples in a variety of tests.

Full blood count: Full Blood Test (FBC) or complete blood count (CBC)is the first step in the diagnosis of ALL. Blood sample will be collected from a vein in the arm and will be investigated in the laboratory. White blood cells may be abnormal leukemic blast cells and the presence of these blast cells in the test suggests ALL. The ALL diagnosis needs to be confirmed by examining the cells in the bone marrow.

Bone marrow examination: This is performed is the results of the blood tests suggests ALL. A bone marrow biopsy is done to help confirm the diagnosis. A bone marrow biopsy involves taking a sample of bone marrow, usually from the back of the hip bone and examined in the laboratory under the microscope. The sample is examined to determine the number and type of cells present and the amount of haemopoiesis (blood forming) activity taking place there. The diagnosis of ALL is confirmed by the presence of an excessive number of blast cells in the bone marrow.

Further testing: Once ALL is confirmed, blood and bone marrow cells are examined further using special laboratory tests. These include immunophenotyping, cytogenetic and molecular tests. These tests provide more information about the exact type of disease, the likely course of the disease and the best way to treat it. A small sample of the cerebrospinal fluid (CSF) that surrounds your brain and spinal cord is also collected, during a procedure called a lumbar puncture. This fluid is tested in the laboratory to check for the presence of leukemic cells within the central nervous system.

Chest x-rays and baseline blood tests may also be required, to look at kidney and liver functions.

Treatment

Since ALL progresses quickly, treatment needs to begin soon after ALL is diagnosed. The treatment plan will depend on a number of factors including the sub-type of ALL, the genetic make-up of the leukemic cells, the patient’s age and general health.

Chemotherapy: Chemotherapy is the primary form of treatment for ALL. A combination of drugs, including steroids, is usually given in several cycles with a rest period of a few weeks in between. The first priority of the treatment is to destroy leukemic cells and induce a remission. This implies that there is no evidence of leukemic cells in the blood and bone marrow and that normal blood cell production and blood counts are restored. In cases, where the risk of relapse is high, patients may be offered even more intensive therapy followed by a stem cell transplant.

Chemotherapy is administered in many different ways to treat ALL and includes intravenously (into a vein), intramuscularly (into a muscle) and in tablet form. To prevent and treat disease in the brain and spinal cord (CNS) chemotherapy is injected intrathecally, directly into the fluid that surrounds these structures. Sometimes, this area is also treated using radiotherapy. In males, radiotherapy may be given to the testes to treat relapsed disease in this area.

Treatment for ALL can be divided into three phases:

Induction therapy

Post-remission (consolidation) therapy

Maintenance therapy.

Induction therapy: Soon after diagnosis an intensive course of treatment begins to bring about, or induce, a remission. If it is resistant or refractory disease, a more intensive form of therapy to treat the disease more effectively may be recommended.

Post-remission (consolidation) therapy: After induction therapy finishes and remission is achieved, more treatment is required to help destroy any leftover disease in your body. This helps prevent a relapse and/or a spread to the central nervous system. consolidation therapy chosen will depend on the estimated risk of relapse.

Maintenance therapy: Maintenance therapy is designed to help keep your disease in remission and prevent it from reappearing (relapsing) in the future. Common maintenance protocols involve chemotherapy tablets — some taken daily and others weekly — and possibly blocks of injections of chemotherapy with courses of corticosteroids. This phase of treatment usually lasts for several months.