Category: types of cancer

Symptoms

Presently, no screening tests have been shown to be helpful in finding acute myeloid leukaemia (AML) early. AML often develops and causes symptoms to surface fairly quickly. Therefore, the best way to find AML early is to report any possible symptoms of AML right away.

Certain groups of people are known to be at high risk of AML because they have certain blood disorders, such as a myelodysplastic syndrome or inherited disorders such as Down syndrome, or because they were treated with certain chemotherapy drugs or radiation.

AML can show up in the form of one or more of these symptoms:

• Fever
• Easy bruising or bleeding
• Flat pinpoint red spots under the skin caused by bleeding
• Weakness or feeling tired
• Shortness of breath
• Weight loss
• Loss of appetite
• Night sweats

Many of these symptoms may occur simply because of a reduction in normal blood cells. So it is important to see a doctor for a conclusive diagnosis.

Causes

Most AML cases can’t be pinned down to exact causes. However, the following risk factors are usually associated with the disease:

• Smoking, especially after the age of 60
• Past history of chemotherapy or radiation therapy
• Having had treatment for childhood Acute Lymphoblastic Leukaemia or ALL
• Being exposed to radiation
• Exposure to benzene
• Having a myelodysplastic syndrome or a bone marrow failure disease
• Congenital syndromes like Down’s Syndrome
• Gender (more AML patients are male)

Diagnosis

AML is diagnosed by a simple peripheral smear which requires a drop of blood and examination under microscope. A bone marrow aspiration or trephine biopsy follows. The aspirate helps in identifying blasts and special stains that differentiate other forms of acute leukaemia or from ALL.

A flow cytometry assessment and cytogenetics assessment for karyotype (chromosome arrangement patterns) using peripheral or bone marrow aspirate (preferable) will identify the immunophenotype of the AML and help in ascertaining prognosis.

The patient may need a lumbar puncture to assess spread to brain, if indicated.

Treatment

For AML cases, the treatment must begin as soon as the diagnosis is confirmed, due to the aggressiveness of the condition. Chemotherapy and stem cell transplantation are found to be the promising treatment options for AML patients.

Chemotherapy: Chemotherapy is the main treatment for most people with acute myeloid leukaemia (AML). Chemo is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemo. It is usually divided into three phases: Induction: Soon after diagnosis an intensive course of treatment begins to bring about, or induce, a remission. The goal is to clear the blood of leukaemia cells (blasts) and to reduce the number of blasts in the bone marrow to normal.

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

Maintenance phase (or post-consolidation) This involves giving a low dose of chemo for months or years after the consolidation is finished. This is often used to treat acute promyelocytic leukaemia (APL), but it is rarely used for other types of AML.

Allogeneic Transplant: Further, in consolidation therapy, once the patient is in complete remission, an allogeneic transplant may be offered to patients upfront if they have poor cytogenetics, and after the first relapse in standard-risk patients. Haematopoietic stem cell transplant is a therapy form, wherein an HLA matched donor’s stem cells are removed by peripheral vein puncture, using an apheresis machine and given to the patient after conditioning therapy. It is superior to autologous transplant, where the patient’s own stem cells are used. In poor risk patients (those with unfavourable cytogenetics), allogeneic transplant confers better survival after inducing first clinical remission than otherwise.

AML is a difficult disease to treat as it is very aggressive, and needs continuous monitoring and follow up. The single most important prognostic factor in AML is the cytogenetics or the chromosomal structure of the leukaemic cell. Certain cytogenetic abnormalities are associated with very good outcomes. About half of AML patients have ‘normal’ cytogenetics. They fall into an intermediate-risk group. A number of other cytogenetics abnormalities are known with a poor prognosis and a high risk of relapse after treatment.

Favourable outcome rates in clinical trials have ranged from 20 to 45%. However, it should be noted that clinical trials often include only younger patients and those able to tolerate aggressive therapies. The overall favourable outcome rate for all patients with AML (including the elderly and those unable to tolerate aggressive therapies) is likely lower. Favourable outcome rates for promyelocytic leukaemia can be as high as 80% – 90%.

Symptoms

Back pain, especially in the lower and middle back, is the most common symptom both in benign and malignant tumours. This pain spreads beyond the back to the hips, lower limbs and arms and gradually aggravates. Some of the key symptoms associated with the vertebral tumours include:

• Loss of sensation or muscle weakness in the legs, arms or chest
• Stiff neck or back
• Pain and/or neurologic symptoms (such as tingling)
• Difficulty walking, which may cause falls
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis, which occurs varying degrees and in different parts of the body, depending on which nerves are compressed
• Scoliosis or other spinal deformity caused due to a large and/or destructive tumour

Causes

The exact cause for primary spinal tumours is not known. A few experts believe it to be a genetic defect. However, it is not known whether such genetic defects are inherited or simply develop over time. Or, they might be caused by something in the environment, such as exposure to certain chemicals.

Most vertebral tumours are metastatic, which means they have spread from tumours in organs elsewhere in the body.

Diagnosis

Vertebral tumours sometimes may be overlooked because their symptoms resemble those of more common conditions. For that reason, it’s especially important for the doctor to know the complete medical history of the patient and perform both general physical and neurological exams. Vertebral tumours sometimes may be overlooked because their symptoms resemble those of more common conditions. For that reason, it’s especially important for the doctor to know the complete medical history of the patient and perform both general physical and neurological exams.

If the presence of a vertebral tumour is suspected, one or more of the following tests can help confirm the diagnosis and pinpoint the tumour’s location:

Spinal Magnetic Resonance Imaging (MRI): MRI is usually the preferred test method to diagnose vertebral tumours. A contrast agent that helps to highlight certain tissues and structures may be injected into a vein in the patient’s hand or forearm during the test. Some people may feel claustrophobic inside the MRI scanner or find the loud thumping sound inside to be disturbing. Earplugs, televisions or headphones can be used to help minimise the noise. Mild sedatives are frequently used to relieve the anxiety of claustrophobia.

Computerised Tomography (CT) Scan: This test uses a narrow beam of radiation to produce detailed images of the spine. Sometimes, it may be combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see. CT scan may be used in combination with MRI.

Biopsy: Often, the only way to determine the type of tumour is to examine a small tissue sample (biopsy) under a microscope. The biopsy results will help determine treatment options. The method used to obtain the biopsy sample can be critical to the success of the overall treatment plan. In most cases, a radiologist will conduct a fine-needle biopsy to extract a small amount of tissue, usually under the guidance of X-ray or CT imaging.

Bone Scan: Bone scan is a diagnostic test that uses Technetium-99. This scan is helpful as an adjunct for identification of bone tumours (such as primary bone tumours of the spine), infection, and diseases involving abnormal bone metabolism.

If the presence of a vertebral tumour is suspected, one or more of the following tests can help confirm the diagnosis and pinpoint the tumour’s location:

Spinal Magnetic Resonance Imaging (MRI): MRI is usually the preferred test method to diagnose vertebral tumours. A contrast agent that helps to highlight certain tissues and structures may be injected into a vein in the patient’s hand or forearm during the test. Some people may feel claustrophobic inside the MRI scanner or find the loud thumping sound inside to be disturbing. Earplugs, televisions or headphones can be used to help minimise the noise. Mild sedatives are frequently used to relieve the anxiety of claustrophobia.

Computerised Tomography (CT) Scan: This test uses a narrow beam of radiation to produce detailed images of the spine. Sometimes, it may be combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see. CT scan may be used in combination with MRI.

Biopsy: Often, the only way to determine the type of tumour is to examine a small tissue sample (biopsy) under a microscope. The biopsy results will help determine treatment options. The method used to obtain the biopsy sample can be critical to the success of the overall treatment plan. In most cases, a radiologist will conduct a fine-needle biopsy to extract a small amount of tissue, usually under the guidance of X-ray or CT imaging.

Bone Scan: Bone scan is a diagnostic test that uses Technetium-99. This scan is helpful as an adjunct for identification of bone tumours (such as primary bone tumours of the spine), infection, and diseases involving abnormal bone metabolism.

Treatment

Early detection is the key to treat vertebral tumours successfully without any serious complications. Therefore, it is important for the patients not to ignore any symptoms associated with the spinal tumours. Treatment options for vertebral tumours include surgery, radiation therapy, chemotherapy, medications or sometimes just monitoring.

Ideally, the goal of vertebral tumour treatment is to completely get rid of the tumour. But, this might be complicated by the risk of permanent damage to the spinal cord or surrounding nerves. Doctors also must consider the patient’s age, overall health, the type of tumour, and whether it is primary or has spread or metastasised to the spine from elsewhere in the body. Treatment options for most vertebral tumours include:

Monitoring: Some tumours may be discovered before they cause symptoms — often when a patient is being evaluated for another condition. If small tumours are noncancerous and aren’t growing or pressing on surrounding tissues, watching them carefully may be all that’s needed. This is especially true in older adults for whom surgery or radiation therapy may pose special risks. During the observation, the doctor will likely recommend periodic CT or MRI scans at an appropriate interval to monitor the tumour.

Surgery: Surgery is often the treatment of choice for tumours that can be removed with an acceptable risk of spinal cord or nerve injury. Newer techniques and instruments allow neurosurgeons to reach tumours that were once considered inaccessible. Sometimes, surgeons may use a high-powered microscope in microsurgery to make it easier to distinguish a tumour from healthy tissue. Doctors can also monitor the function of the spinal cord and other important nerves during surgery, thus minimising the chance of them being injured. In some instances, an ultrasound might be used during surgery to break up tumours and remove the fragments. But even with advances in surgical techniques and technology, not all tumours can be totally removed. Sometimes, surgery might be followed by radiation therapy, chemotherapy or both. Recovery from spinal surgery may take weeks or longer, depending on the procedure or complications, such as bleeding and damage to nerve tissue.

Radiation Therapy: This may be used following an operation to eliminate the remnants of tumours that can’t be completely removed, treat inoperable tumours or treat those tumours where surgery is too risky. It may also be the first-line therapy for some vertebral tumours. Radiation therapy may also be used to relieve pain when surgery is too risky. Medications may help ease some of the side effects of radiation, such as nausea and vomiting. Sometimes, the radiation therapy regimen may be adjusted in such a way to help prevent damage to surrounding tissue from the radiation and improve the treatment’s effectiveness. Modifications may range from simply changing the dosage of radiation to using sophisticated techniques such as 3-D conformal radiation therapy. A specialised type of radiation therapy called proton beam therapy also may be used to treat some vertebral tumours such as chordomas, chondrosarcomas and some childhood cancers when spinal radiation is required. Proton beam therapy is better at targeting the radioactive protons to the tumour site without damaging the surrounding tissue as in traditional radiation therapy.

Chemotherapy: It is a standard treatment for many types of cancer, chemotherapy uses medications to destroy cancer cells or stop them from growing. The doctor can determine whether or not chemotherapy is beneficial for the patient, either alone or in combination with other therapies.

Symptoms

In its early stages, nasopharyngeal carcinoma may not cause any symptoms. Possible noticeable symptoms of nasopharyngeal carcinoma include:

Causes

Cancer begins when one or more genetic mutations cause normal cells to grow out of control, invade surrounding structures and eventually spread (metastasise) to other parts of the body. In nasopharyngeal carcinomas, this process begins in the squamous cells that line the surface of the nasopharynx. Exact causes for the gene mutations that lead to nasopharyngeal carcinoma are not known yet. However, factors, such as the Epstein-Barr virus, that increase the risk of this cancer have been identified. Nevertheless, it isn’t clear why some people with all the risk factors never develop cancer, while others who have no apparent risk factors do. Below are some of the crucial risk factors that are associated with the development of nasopharyngeal cancers:

Tobacco Consumption: Tobacco use, which includes cigarettes, cigars, pipes and chewing tobacco, is the single greatest risk factor for head and neck cancer including nasopharyngeal cancers.

Alcohol: Frequent and heavy consumption of alcohol is associated with an increased risk of developing nasopharyngeal cancers.

Epstein-Barr Virus Infection: Several studies have confirmed a strong association between EBV infection and the incidence of nasopharyngeal cancers.

Ethnicity: Nasopharyngeal cancers are more prevalent among Southeast Asians.

Eating Habits: Consuming salt-cured fish and meats in large quantities on a regular basis increases NPC risk.

Age: The risk of developing NPC increases with age.

Gender: Nasopharyngeal cancers are more common among men than women.

Diagnosis

Tests to diagnose nasopharyngeal carcinoma

Tests and procedures used to diagnose nasopharyngeal carcinoma include:

Treatment

Specialists carefully devise a treatment plan for nasopharyngeal cancers based on several factors, such as the stage of the cancer, the treatment goals, overall health of the patient and the side effects that the patient is willing to tolerate. Treatment for nasopharyngeal carcinoma usually begins with radiation therapy or a combination of radiation and chemotherapy.

Radiation therapy: Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy for nasopharyngeal carcinoma is usually administered through external beam radiation therapy. During this procedure, the patient is positioned on a table and a large machine is manoeuvred around him/her to deliver the radiation precisely. For small nasopharyngeal tumours, radiation therapy may be the only treatment necessary. In advanced conditions, radiation therapy may be combined with chemotherapy. Radiation therapy carries a risk of side effects, including temporary skin redness, hearing loss and dry mouth.

A type of internal radiation therapy, called (brachytherapy), is sometimes used in recurrent nasopharyngeal carcinoma. During this treatment, radioactive seeds or wires are positioned in the tumour or very close to it. Radiation therapy to the head and neck, especially when combined with chemotherapy, often causes severe sores in the throat and mouth. Sometimes these sores make it difficult to eat or drink. If this occurs, the doctor may recommend inserting a tube into the patient’s throat or stomach. Food and water are delivered through the tube until the mouth and throat heal.

Chemotherapy: Chemotherapy is a systemic therapy that uses chemicals to kill cancer cells. Chemotherapy drugs can be given in pill form, administered through a vein or both. Chemotherapy may be used to treat nasopharyngeal carcinoma in three ways:

Chemotherapy at the same time as radiation therapy: When the two treatments are combined, chemotherapy enhances the effectiveness of radiation therapy. This combined treatment is called concomitant therapy or chemoradiation. However, the side effects of chemotherapy are added to the side effects of radiation therapy, making concomitant therapy more difficult to tolerate.

Chemotherapy after radiation therapy: Doctors could recommend chemotherapy after radiation therapy or after concomitant therapy. Chemotherapy is used to attack any remaining cancer cells in the body, including those that may have broken off from the original tumour and spread elsewhere. Some controversy exists as to whether additional chemotherapy actually improves survival in people with nasopharyngeal carcinoma. Many patients who undergo chemotherapy after concomitant therapy are unable to tolerate the side effects and must discontinue treatment.

Chemotherapy before radiation therapy: Neoadjuvant chemotherapy is chemotherapy treatment administered before radiation therapy alone or before concomitant therapy. More research is needed to determine whether neoadjuvant chemotherapy can improve survival rates in people with nasopharyngeal carcinoma. Decisions on the chemotherapy drugs that will be administered to the patient will be made by the specialists based on the condition of the disease.

Surgery: Surgery is often used in the removal of the tumour and some surrounding healthy tissue during an operation. Although it is occasionally used in the treatment of nasopharyngeal cancers, it is not a common treatment choice. This is because the nasopharynx region is hard to reach and lies close to cranial nerves and blood vessels.

Symptoms

Symptoms of laryngeal cancer are often mistaken for other conditions. In case any of the below-mentioned symptoms are experienced, it has to be discussed with the doctor, immediately.

• Persistent sore throat or cough
• Hoarseness in the voice for more than two weeks
• Pain and swallowing difficulties
• Lump in the neck or throat
• Dysphonia (having trouble making voice sounds)
• Ear pain
• Trouble breathing (dyspnea)
• Noisy and high-pitched breathing
• A feeling of fullness in the throat
• Coughing up blood (haemoptysis)

Some may also experience breathlessness, bad breath, and unexplained weight loss.

Causes

Although the exact causes for laryngeal cancer are unknown, it has been found that certain lifestyle factors increase an individual’s risk of developing this cancer.

• Tobacco and Alcohol Consumption: Like all other head and neck cancers, the risk of developing laryngeal cancer also develops with increased tobacco (smoking and chewing) and alcohol consumption.
• Processed Foods: Consumption of processed foods in large quantities for a long time also increases the risk of laryngeal cancer development.
• Poor Diet: Not consuming enough fruits and vegetables is reported to increase the risk of this cancer.
• Exposure to Hazardous Chemicals: The chances of developing laryngeal cancer are high among those who have prolonged exposure to harmful chemical substances like asbestos and coal dust.
• Family History: Those with a family history of head and neck cancers have a higher risk of developing laryngeal cancer.

Diagnosis

The diagnostic method recommended by doctors depends on the symptoms experienced by the patients. If they are any or a few of the previously discussed symptoms, then the doctor may suggest a laryngoscopy; whereas, a biopsy is recommended if a lump is visible in the throat or neck region.

Nasendoscopy/ Laryngoscopy: It involves insertion of an endoscopy through nose or mouth. This procedure allows the larynx to be seen in greater detail. If the doctor sees anything abnormal, he/she may recommend further tests.

Biopsy: This is a procedure, wherein a small sample of the tissue is collected and examined for the signs of cancer.

Imaging Tests: Imaging tests like MRI scan, CT and PET scan are necessary to determine the exact location, size and the stage of the tumour. These imaging modalities also help in analysing the treatment response during and after the treatment.

Treatment

The main treatment modalities recommended for laryngeal cancer include radiation therapy, surgery and chemotherapy.

Radiation therapy: Radiation therapy removes the cancerous cells from the larynx by delivering radiation to it. If diagnosed early, laryngeal cancers can be treated successfully through radiation therapy and surgery.

Surgery: Surgery is recommended both in the early and advanced stages of the cancer. In the early stages, surgery is used to remove small tumours, with a radiation therapy session possibly following behind. However, if the cancer is advanced, the surgery is used to remove a part or all of the larynx and if it has spread to the lymph nodes, those lymph nodes are removed too. When the larynx is removed, the patient is no longer able to speak or breathe normally. He/she will have to breathe through a permanent hole in the neck (stoma) and the patient will need additional treatment to help restore his/her voice. It could be an implant in the throat or an electrical device that the patient has to hold against his/her throat to produce sound.

Chemotherapy: Chemotherapy uses a combination of drugs to destroy the cancer cells, and it is often used along with surgery and radiation therapy. The chemo drugs are either administered orally or intravenously, which then travel throughout the body to kill the cancer cells. Chemotherapy might also be used by the doctors to have the tumour size reduced.

Symptoms

The signs and symptoms of intestinal cancer are often vague and often resemble those of other less-serious health conditions. Therefore, intestinal cancers are often diagnosed several months after the symptoms start to appear.
Tumours growing in the lining of the small intestine tend to affect digestion by blocking the flow of food. As the cancer advances, these blockages cause pain in the stomach. In most cases, pain is the primary symptom.

Causes

Very little is known about the factors that cause intestinal cancers. However, certain factors might increase an individual’s risk of developing intestinal cancer.
A personal history of colorectal cancer or polyps: Polyps that are left untreated increase the risk of intestinal cancers. Benign polyps also become cancerous and pose a severe health risk, especially among those who are genetically predisposed to developing familial adenomatous polyposis.
Bowel inflammation: Chronic inflammation of the intestinal tract raises one’s risk of developing intestinal cancers. Those with conditions like Crohn’s disease and celiac disease should ensure that their condition is treated successfully with appropriate treatment.
Tobacco and alcohol consumption: Smoking and drinking are known to increase the risk of all forms of cancer, including small intestine cancer.
Family history of colon cancer: Having a family member suffering from intestinal cancer, increases the risk too.
Eating habits: Excessive consumption of foods that are smoked, cured and high in fat increase the risk of developing intestinal cancers.
Older age: The risk of developing intestinal cancer increases with age.
Gender: Men tend to be more at risk than women for developing this form of cancer.
A sedentary lifestyle: A sedentary lifestyle increases the risk of not just cancer, but various other health problems.

Diagnosis

If the signs and symptoms indicate that an individual could have intestinal cancer, the doctor may recommend one or more tests and procedures, including:
Gastroscopy: Gastroscopy uses a long, flexible and slender tube attached to a video camera and monitors to view the inner lining of the GI tract. If any suspicious areas are found, the doctor can pass surgical tools through the tube to take tissue samples (biopsies) for analysis and remove polyps.
Blood tests: Intestinal cancers often lead to the abdominal area, which eventually causes anaemia. A CBC test is carried out to check if all the blood cells are in optimum quantities. Anaemia coupled with the symptoms of cancer experienced by the patient will alert the doctor to act carefully. Blood tests also help in checking whether or not cancer has spread to other organs
Imaging tests: Imaging tests like CT, MRI and PET scans are performed to have more information about the tumour such as its size, shape and exact location. These tests also help in determining if cancer has spread to other organs, if the treatment is working or if cancer has recurred
Biopsy: Biopsy is the only way to confirm a cancer diagnosis. A small sample of the tissue from the abnormal area is collected during the endoscopy or surgery and is examined under the microscope to see if the cells show cancerous activity.

Treatment

The treatments that are most likely to help the patient depend on his/her particular situation, including the location of the cancer, its stage and other health concerns of the patient. Treatment for intestinal cancer usually involves surgery to remove the cancer. Other treatments, such as radiation therapy and chemotherapy, might also be recommended.
Surgery: There are different types of surgical approaches and the method that a doctor chooses for his/her patients depends on the stage of the cancer and the overall condition of the patient.
Removing polyps during a gastroscopy (polypectomy: If the cancer is small, localised, completely contained within a polyp and in a very early stage, the doctor may be able to remove it completely during a gastroscopy.
Small Bowel Resection: During this procedure, the surgeon removes a piece of the small intestine containing the tumour, along with a margin of healthy tissue on either side of the tumour. Nearby lymph nodes and other surrounding tissues may also be removed if they contain cancer. Later, the surgeon reconnects the ends of the remaining healthy portions of the intestines. This procedure is called a small bowel resection.
Minimally invasive surgery (laparoscopic surgery): Polyps that cannot be removed during the gastroscopy can be removed through laparoscopic surgery. Laparoscopic surgery involves several small incisions in the abdomen. Through one incision the surgeon places a laparoscope, a lighted tube with a tiny camera that creates two-dimensional images of the cancer and the surrounding organs. The doctor places small surgical tools through the remaining incisions to perform the procedure.
Open surgery: Open surgery, which requires a large abdominal incision, may be necessary for larger tumours and for those that are near critical structures, such as the pancreas and liver. People with abdominal scar tissue from previous surgeries may also need an open procedure.
Chemotherapy: Chemotherapy uses drugs to destroy cancer cells. Chemotherapy for intestinal cancer is usually given after surgery if the cancer is larger or has spread to the lymph nodes. In this way, chemotherapy may kill any cancer cells that remain in the body and help reduce the risk of cancer recurrence. Chemotherapy might also be used before an operation to shrink large cancer so that it’s easier to remove with surgery. Chemotherapy can also be used to relieve symptoms of intestinal cancer that can’t be removed with surgery or that has spread to other areas of the body. Sometimes it’s combined with radiation therapy.
Radiation therapy: Radiation therapy uses powerful energy sources, such as X-rays and protons, to kill cancer cells. It might be used to shrink large cancer before an operation so that it can be removed more easily. When surgery isn’t an option, radiation therapy might be used to relieve symptoms, such as pain. Sometimes radiation is combined with chemotherapy.

Symptoms

The symptoms may vary depending on the tumour’s location in the brain and its stage. Below are the symptoms commonly seen:

• Persistent headaches
• Double or blurred vision
• Nausea and vomiting
• Sleepiness
• Weakness on one side of the body
• Loss of appetite
• Loss of memory
• Problems with speech and language
• Changes in mood and personality
• Changes in the ability to think and learn
• New onset of seizures
• Speech difficulty of gradual onset

Causes

The causes of glioblastoma are largely unknown. However, there are a few risk factors:

Rare Genetic Conditions: People with rare genetic conditions, such as Turcot syndrome, neurofibromatosis type 1 and Li Fraumeni syndrome are more susceptible to glioblastoma.

Age: An individual’s risk of a brain tumour increases with age. Gliomas are most common among adults aged 45 to 65 years old. Certain types of gliomas, such as ependymomas and pilocytic astrocytomas, are more common in children and young adults.

Exposure to Radiation: People who have been exposed to ionising radiation have an increased risk of brain tumours. Examples of ionising radiation include the radiation that comes from radiotherapy and atomic bombs.

Family History of Glioma: Having a family history of glioma increases the risk of glioblastoma.

Diagnosis

Tests and procedures used to diagnose glioblastoma include:

Neurological exam: During a neurological exam, the patient will be questioned about his/her signs and symptoms. The doctor may also check the vision, hearing, balance, coordination, strength and other reflexes of the patient. Problems in one or more of these areas may provide clues about the part of the patient’s brain that could be affected by a brain tumour.

Imaging tests: Imaging tests can help the doctor determine the location and size of the tumour in the patient’s brain. MRI is often used to diagnose brain tumours, and it may be used along with specialised MRI imaging, such as functional MRI and magnetic resonance spectroscopy.

Other imaging tests may include CT and positron emission tomography (PET).

Biopsy: A biopsy can be done with a needle before surgery or during surgery to remove the glioblastoma, depending on the patient’s condition and the location of the tumour. The sample of the suspicious tissue is analysed in a laboratory to determine the types of cells and their level of aggressiveness.

Specialised tests of the tumour cells can tell the doctor the types of mutations the cells have acquired. Data from these tests give a better prognosis and may guide the doctor on the best treatment options.

Treatment

Glioblastoma treatment options include:

Surgery to remove the glioblastoma: The brain surgeon (neurosurgeon) will work to remove the glioblastoma. The goal is to remove as much of the tumour as possible. But because glioblastoma grows into the normal brain tissue, a complete removal isn’t possible. For this reason, most people receive additional treatments after surgery to target the remaining cells.

Radiation therapy: Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. During radiation therapy, the patient is asked to lie on a table while a machine moves around him/her, directing beams to precise points in the brain. Radiation therapy is usually recommended after surgery and may be combined with chemotherapy. For people who can’t undergo surgery, radiation therapy and chemotherapy may be used as a primary treatment.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells. In some cases, thin, circular wafers containing chemotherapy medicine is placed in the brain during surgery. The wafers dissolve slowly, releasing the medicine and killing cancer cells. After surgery, the chemotherapy drug temozolomide (Temodar) — taken as a pill — is often used during and after radiation therapy. Other types of chemotherapy may be recommended for patients if the glioblastoma recurs. These other types of chemotherapy are often administered through a vein in the arm.

Tumour treating fields (TTF) therapy: TTF uses an electrical field to disrupt the tumour cells’ ability to multiply. TTF involves applying adhesive pads to the patient’s scalp. The pads are connected to a portable device that generates the electrical field. TTF is combined with chemotherapy and may be recommended after radiation therapy.

Targeted drug therapy: Targeted drugs focus on specific abnormalities in cancer cells that allow them to grow and thrive. The drugs attack those abnormalities, causing the cancer cells to die. Bevacizumab (Avastin) targets the signals that glioblastoma cells send to the body that cause new blood vessels to form and deliver blood and nutrients to cancer cells. Bevacizumab may be an option if the glioblastoma recurs or doesn’t respond to other treatments.

Clinical trials: Clinical trials are studies of new treatments. These studies give patients with glioblastoma a chance to try the latest treatment options, but the risk of side effects may not be known. Patients can enquire with their doctors whether they might be eligible to participate in clinical trials.

Supportive (palliative) care: Palliative care is specialised medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

Symptoms

Causes

Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:

Diagnosis

In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:

Treatment

For people who are healthy enough, treatment for these cancers is most often chemoradiation followed by surgery. Patients with adenocarcinoma at the place where the stomach and esophagus meet (the gastroesophageal junction) are sometimes treated with chemo (without radiation) followed by surgery.Jun 24, 2

Symptoms

Unusual vaginal bleeding is the first sign of endometrial cancer. Extra attention should be given to the bleeding that is not associated with the menstrual period. Following are the key signs and symptoms of endometrial cancer that women need to look for:

Causes

Several risk factors increase the risk of endometrial cancer. Obesity is considered the biggest risk factor. Below are the key risk factors that might increase a woman’s risk of developing endometrial cancer.

Obesity: Fatty tissue in women who are overweight produces additional oestrogen, a sex hormone that can increase the risk of uterine cancer.

Age: The risk of developing endometrial cancer increases with age. Uterine cancer most often occurs in women over 50. The average age at diagnosis is 60.

Genetics: Those with a family history of endometrial cancer are at a higher risk of developing the disease.

Diabetes: Women may have an increased risk of endometrial cancer if they have diabetes, which is often associated with obesity.

Other cancers: Women who have had breast cancer, colon cancer, or ovarian cancer may have an increased risk of endometrial cancer.

Radiation therapy in the past: Women who have undergone radiation therapy for another cancer in the pelvic area have an increased risk of endometrial cancer.

Diet/nutrition: Women who eat foods high in animal fat may have an increased risk of uterine cancer.

Hormone-related risks: Extended exposure to oestrogen and/or an imbalance of oestrogen increases the risk of endometrial cancer:

Diagnosis

Diagnostic tests used to detect and confirm endometrial cancers:

Pelvic examination: The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done for cervical cancer screening, is performed to check if there are any abnormal glandular cells, which are caused by endometrial cancer.

Endometrial biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. Endometrial biopsy is often a very accurate way to diagnose uterine cancer.

Dilation and curettage (D&C): A D&C is a procedure to remove tissue samples from the uterus. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure.

Imaging tests: Transvaginal ultrasound, CT scan and MRI scan are some of the imaging tests used to capture detailed images of the insides of the uterus. These images help in treatment planning, studying the treatment response and to check if cancer has recurred.

Treatment

Treatment for endometrial cancer is usually with surgery to remove the uterus, fallopian tubes and ovaries. Another option is radiation therapy with powerful energy. Drug treatments for endometrial cancer include chemotherapy with powerful drugs and hormone therapy to block hormones that cancer cells rely on. Other options might be targeted therapy with drugs that attack specific weaknesses in the cancer cells and immunotherapy to help your immune system fight cancer.

Surgery

Treatment for endometrial cancer usually involves an operation to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy). A hysterectomy makes it impossible for you to become pregnant in the future. Also, once your ovaries are removed, you’ll experience menopause, if you haven’t already. During surgery, your surgeon will also inspect the areas around your uterus to look for signs that cancer has spread. Your surgeon may also remove lymph nodes for testing. This helps determine your cancer’s stage.

Radiation therapy

Radiation therapy uses powerful energy beams, such as X-rays and protons, to kill cancer cells. In some instances, your doctor may recommend radiation to reduce your risk of a cancer recurrence after surgery. In certain situations, radiation therapy may also be recommended before surgery, to shrink a tumor and make it easier to remove.

If you aren’t healthy enough to undergo surgery, you may opt for radiation therapy only. Radiation therapy can involve:

• Radiation from a machine outside your body. During external beam radiation, you lie on a table while a machine directs radiation to specific points on your body.
• Radiation placed inside your body. Internal radiation (brachytherapy) involves placing a radiation-filled device, such as small seeds, wires or a cylinder, inside your vagina for a short period of time.

Chemotherapy

Chemotherapy uses chemicals to kill cancer cells. You may receive one chemotherapy drug, or two or more drugs can be used in combination. You may receive chemotherapy drugs by pill (orally) or through your veins (intravenously). These drugs enter your bloodstream and then travel through your body, killing cancer cells. Chemotherapy is sometimes recommended after surgery if there’s an increased risk that the cancer might return. It can also be used before surgery to shrink the cancer so that it’s more likely to be removed completely during surgery. Chemotherapy may be recommended for treating advanced or recurrent endometrial cancer that has spread beyond the uterus.

Hormone therapy

Hormone therapy involves taking medications to lower the hormone levels in the body. In response, cancer cells that rely on hormones to help them grow might die. Hormone therapy may be an option if you have advanced endometrial cancer that has spread beyond the uterus.

Targeted drug therapy

Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy for treating advanced endometrial cancer.

Immunotherapy

Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body’s disease-fighting immune system might not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. For endometrial cancer, immunotherapy might be considered if the cancer is advanced and other treatments haven’t helped.

Symptoms

Bleeding in the urine is the classic symptom of bladder cancer. Apart from bleeding, there are several other signs and symptoms that point towards bladder cancer:

Causes

Following are some of the risk factors associated with the development of breast cancer:

Cigarette smoking: Cigarette smoking alone is reported to cause about 50% of all bladder cancers. The longer and heavier the exposure, greater are the chances of developing bladder cancer.

Age: The risk of developing bladder cancer develops with age. About 90% of people with bladder cancer are over age 55.

Gender: Men are more prone to developing bladder cancer, and this probably due to a higher incidence of smoking and exposure to toxic chemicals

Family history: A close relative with a history of bladder cancer may increase the predisposition for the development of this disease.

Toxic chemicals: Exposure to toxic chemicals such as arsenic, phenols, aniline dyes, and arylamines increase the risk of bladder cancer. Dye workers, rubber workers, aluminium workers, leather workers, truck drivers, and pesticide applicators are at the highest risk.

Previous cancer treatments: Radiation therapy (given for prostate or cervical cancer) and chemotherapy with certain drugs increases the risk for development of bladder cancer.

Chronic infections: Long-term chronic infections of the bladder and irritation due to stones or foreign bodies also predispose to bladder cancer.

Diagnosis

Following are some of the major diagnostic methods used in diagnosing bladder cancer:

Urinalysis: A simple urine test that can confirm that there is bleeding in the urine and this can alert the doctor to conduct further tests. It is usually one of the first tests that a physician suggests.

Urine cytology: A health care professional performs the test on a urine sample to detect malformed cancerous cells that may pass into the urine from cancer. Many early bladder cancers may be missed by this test so a negative or inconclusive test does not effectively rule out the presence of bladder cancer.

Ultrasound: An ultrasound examination of the bladder can detect bladder tumours. It also helps in detecting other causes of bleeding, such as stones in the urinary system or prostate enlargement, which may be the cause of the symptoms or may coexist with a bladder tumour. An X-ray examination helps in ruling out other causes of symptoms.

CT scan/MRI: A CT scan or MRI provides better details than an ultrasound exam and may detect smaller tumours in the bladder than cannot be detected by an ultrasound.

Cystoscopy and biopsy: This is probably the single most important investigation for bladder cancer. In some cases, the bladder tumours are missed on imaging investigations (ultrasound/CT/MRI) and urine cytology. Therefore, it is recommended that all patients with bleeding in the urine, without an obvious cause, should have a cystoscopy performed by a urologist as a part of the initial evaluation.

During a cystoscopy, a health care provider passes a thin tube-like optical instrument with a camera and a light source through the urethra into the bladder and the inner surface of the bladder is visualized on a video monitor. Small or flat tumours that may not be visible on other investigations are visible by this method.

The biopsy is collected during the cystoscopy, which is later sent to a laboratory to be examined under a microscope. The tumour cells look different under the microscope than normal cells. This method effectively diagnoses the presence and type of bladder cancer.

Treatment

There are several treatment options for bladder cancer. However, the treatment planning is made based on several factors, including the type of cancer, the grade of the cancer and stage of the cancer.

Surgery: Surgery is performed to remove the cancer cells and there are different types of surgery for bladder cancer surgery.

1. Transurethral resection of bladder tumour (TURBT): During the procedure, a surgeon passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away the cancer. Alternatively, a high-energy laser may be used. There are no incisions or cuts. This procedure is usually followed by a one-time injection of cancer-killing medication into the bladder to destroy the remaining cancer cells.

2. Cystectomy: It is a surgical procedure that removes all (radical cystectomy) or a part (partial cystectomy) of the bladder. In men, radical cystectomy involves the removal of the bladder, prostate and seminal vesicles and in women, radical cystectomy involves the removal of the bladder, uterus, ovaries and a part of the vagina.

When the bladder is removed completely, there needs to be urine diversion or in other words, a new way created for the urine to leave the body. This is when neobladder reconstruction is considered. Neobladder is a reservoir built from a part of the patient’s intestine and attached to the urethra. This neobladder functions almost like the original bladder.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells. Two or more drugs are used in combination to treat bladder cancer. Chemotherapy is either delivered intravenously to kill the remaining cancer cells or directly into the bladder to treat the superficial bladder cancer, where the cancer cells would have affected the bladder lining only.

Radiation therapy: Radiation therapy uses powerful energy beams of powerful energy, such as X-rays and protons, to kill the cancer cells. Radiation therapy is delivered in combination with chemotherapy or surgery for better outcomes.

Symptoms

Base of tongue cancer shows very few signs and symptoms in its early stages. It is for this reason that this cancer is usually diagnosed at an advanced stage when the tumour is larger and the cancer has spread into the lymph nodes in the neck.

A few patients show symptoms, while a few do not show any symptoms. It is important to see a doctor if any of the below symptoms are experienced persistently:

Causes

The exact causes of the base of tongue cancers are not fully known. However, certain risk factors can increase the chances of developing this cancer. It is also important to note that not everyone with the risk factors will develop tongue cancer, and people who don’t have risk factors can develop the disease.

Diagnosis

To confirm the diagnosis of the base of tongue cancer, the patient might be asked to undergo one or more tests discussed below:

Treatment

The treatment plan for the base of tongue cancer is made considering various factors like the stage of the cancer, the location, its aggressiveness, patient’s age and the overall condition of the patient. Following are key treatment modalities used in treating tongue cancer.

Surgery: Surgery involves the removal of the tumours and surrounding lymph nodes if the cancer is in its advanced stages. In the case of early-stage cancers or small cancers, the surgery leaves little cosmetic or functional changes in the mouth region. However, in the case of larger tumours, the surgery may affect the patient’s speech and swallowing abilities. In these situations, the cancer surgery is often followed by a reconstruction surgery, which helps in restoring speech and swallowing problems.

Radiation Therapy: Radiation therapy is a treatment modality that stops cancer cells from dividing and slows the growth of the tumour. It also destroys cancer cells and shrinks tumours. Through advanced technology, the dose of radiation can be carefully adjusted such that the radiation is delivered to the target area precisely with least damage to the surrounding healthy tissues.

Chemotherapy: During chemotherapy, specific chemicals are administered into the body, and these chemicals destroy the cancer cells throughout the body. Chemotherapy is usually prescribed in the following cases: