Category: types of cancer

Symptoms

Some of the common symptoms of lung cancers are:

Chronic cough for more than a month

Coughing up blood (Haemoptysis)

Shortness of breath

Wheezing

Chest pain

Fatigue

Difficulty in swallowing

Progressive weight loss

Loss of appetite

Joint problems

Swelling of the arms and face

Causes

SMOKING AND LUNG CANCER:

Cigarette smoke contains over 60 known carcinogens, including radioisotopes from the radon decay sequence, nitrosamine, and benzopyrene. Additionally, nicotine appears to depress the immune response to cancerous growths in exposed tissue. It is not surprising then that smoking accounts for 80–90% of lung cancer cases.

Passive smoking – it is the inhalation of smoke resulting from another person smoking nearby. It is a known cause of lung cancer in non-smokers. A passive smoker can be classified as someone living or working with a smoker.

Those who live with smokers have a 20-30% higher risk while those in second hand smoke environment have 16-19% higher risk compared to non-smokers who are away from such environments.

RADON GAS AND LUNG CANCER:

Radon is a colourless and odourless gas generated by the breakdown of radioactive radium. The radiation decay products ionise genetic material, causing mutations that sometimes turn cancerous.

For every increase of radon concentration by 100 Becquerel per atomic mass, the risk increases 8-16%. Becquerel is a derived unit for measuring radioactivity.

ASBESTOS AND LUNG CANCER:

Asbestos can cause a variety of lung diseases, including lung cancer. Tobacco smoking and asbestos have a synergistic effect on the formation of lung cancer.

Asbestos can also cause cancer of the pleura (a thin lining between the lung and the chest wall). An aggressive cancer of the pleura is called mesothelioma which affects the lungs, heart or abdomen.

AIR POLLUTION AND LUNG CANCER:

Outdoor air pollution has a small effect on increasing the risk of lung cancer. Fine particulates (PM2.5) and Sulphate aerosols, which are released in traffic exhaust fumes, increase the risk of lung cancer.

An increment of 10 parts per billion of Nitrogen Dioxide increases the risk of lung cancer by 14%. Outdoor air pollution is estimated to account for 1–2% of lung cancers.

There is evidence to prove that an increased risk of lung cancer is attributed to air pollution such as burning of wood, charcoal, dung or crop residue for cooking and heating. Women who are exposed to indoor coal smoke have about twice the risk. Also, a number of by-products of burning biomass are known for suspected carcinogens.

GENETICS AND LUNG CANCER:

It is estimated that 8-14% of lung cancer is due to inherited factors. In relatives of people with lung cancer, the risk is increased 2.4 times. This is likely due to a combination of genes.

OTHER CAUSES:

Numerous other substances, occupations and environmental exposures have been linked to lung cancer which are:

Production and mining of some metals and arsenic compounds

By-products of combustion such as Carbon Monoxide, Sulphur Dioxide, Nitrogen Oxides & Lead.

Ionising Radiation

Toxic gases

Rubber production and crystalline silica dust

TYPES OF LUNG CANCERS:

denocarcinoma -This type of cancer develops in the bronchioles and is usually located in the outer layers of the lungs. This type of lung cancer has a slow rate of growth and women tend to be at a higher risk of getting adenocarcinoma. It typically begins in the glandular cell and some internal organs with a possibility of treatment.

Adenocarcinoma is a type under NSCLC (Non-small cell lung cancer) which accounts for 80-85% of all lung cancers. In cases where adenocarcinoma has spread to a larger extent then it is known as advanced non-small cell lung cancer. Adenocarcinoma lung cancer treatment is subject to severity and the modalities may vary as per the prognosis.

During the advanced stage or 4th stage of lung cancer it turns into large cell lung carcinoma where the cancerous cells have spread widely within in the lungs from the point of origin. In such cases the course of lung cancer treatment varies.

Small Cell Lung Cancer – One of the common culprits to cause this cancer is smoking and its symptoms include coughing, shortness of breath & acute chest pain.

Usually in small cell lung cancer, there is uncontrolled growth of cells which form a tumour in the lungs. About 10-15% is small cell lung cancer and SCLC in short is also known as oat cell cancer. When oat cell cancer has spread extensively then it is known as advanced small cell lung cancer.

Diagnosis

Performing a chest radiograph is one of the first investigative steps when a person reports symptoms that may suggest lung cancer. This may reveal an obvious mass, widening of the mediastinum (suggestive of spread to lymph nodes there), atelectasis (collapse), consolidation (pneumonia), or pleural effusion. CT imaging is used to provide more information about the type and extent of disease. Bronchoscopy or CT-guided biopsy is often used to sample the tumour for histopathology.

Lung cancer often appears as a solitary pulmonary nodule on a chest radiograph. However, the differential diagnosis is wide. Many other diseases can also give this appearance, including tuberculosis, fungal infections and pneumonia. Less common causes of a solitary pulmonary nodule include hamartomas, bronchogenic cysts, adenomas, arteriovenous malformation, pulmonary sequestration, rheumatoid nodules, Wegener’s, or lymphoma and the treatment could vary. Lung cancer can also be an incidental finding, as a solitary pulmonary nodule on a chest radiograph or CT scan done for an unrelated reason. The definitive diagnosis of lung cancer is based on histological examination of the suspicious tissue in the context of the clinical and radiological features. It is important to note that detailed diagnosis is necessary for increasing the effectiveness lung cancer treatment.

Treatment

When it comes to treating lung cancer, one has to understand the cancer’s specific cell type, how far it has spread and the person’s overall health. In cases where the cancer has spread to other organs, it is termed as metastatic lung cancer. Common lung cancer treatments include palliative care, surgery, chemotherapy, and radiation therapy. The treatment is entirely dependent on the stage of lung cancer.

SURGERY FOR LUNG CANCER:

If investigations confirm NSCLC (non-small-cell lung carcinoma), the stage is assessed to determine whether the disease is localised and can be treated by surgery or if it has spread to the point where it cannot be addressed surgically which is commonly known as metastatic non-small cell lung cancer.

To determine the stage of lung cancer, CT scan and Positron Emission Tomography are commonly used. If mediastinal lymph node involvement is suspected, mediastinoscopy may be used to sample the nodes and assist staging for lung cancer treatment. Blood tests and pulmonary function testing are used to assess whether a person is well enough for surgery during the lung cancer treatment. If pulmonary function tests reveal poor respiratory reserve, surgery may not be a possibility. In most cases of early-stage NSCLC, removal of a lobe of the lung (lobectomy) is the surgical treatment of choice and is part of stage 1. In people who are unfit for a full lobectomy, a smaller sub-lobar excision may be performed. However, wedge resection has a higher risk of recurrence than lobectomy. Rarely, removal of a whole lung (pneumonectomy) is performed. Video-assisted thoracoscopic surgery and VATS lobectomy use a minimally invasive approach to lung cancer surgery. VATS lobectomy is equally effective, as compared to conventional open lobectomy, with less postoperative illness.

In SCLC (small-cell lung carcinoma), chemotherapy and/or radiotherapy is used. However, the role of surgery in SCLC is being reconsidered. Surgery might improve outcomes when added to chemotherapy and radiation in early stage SCLC. In cases where the small-cell lung carcinoma has become metastatic, the treatment options include chemotherapy & radiation therapy.

To avoid complications, it is advised that you visit the doctor. Cancer treatment becomes easy during the early stages of detection.

RADIOTHERAPY FOR LUNG CANCER:

Radiotherapy is often given together with chemo treatment in lung cancer and may be used with curative intent in people with NSCLC who are not eligible for surgery. This form of high-intensity radiotherapy is called radical radiotherapy. A refinement of this technique is Continuous Hyperfractionated Accelerated Radiotherapy (CHART), in which a high dose of radiotherapy is given in a short time period.

If cancer growth blocks a small section of bronchus, brachytherapy (localised radiotherapy) may be given directly inside the airway to open the passage. Compared to external beam radiotherapy, brachytherapy allows a reduction in treatment time and reduced radiation exposure to healthcare staff.

Some of the advances in lung cancer treatments include recent improvements in targeting and imaging which have led to the development of stereotactic radiation in the treatment of early-stage lung cancer. In this form of radiotherapy, high doses are delivered in a small number of sessions using stereotactic targeting techniques. Its use is primarily in patients who are not surgical candidates due to medical comorbidities.

CYBERKNIFE TREATMENT FOR LUNG CANCER:

Other advancements include CyberKnife treatment which is designed to streamline and optimize SBRT (stereotactic body radiation therapy). SBRT is a method of delivering targeted radiation therapy for treating lung cancer tumours effectively.

This latest lung cancer treatment is capable of adjusting the beams based on the minor movements made by the patients and also the movement of the tumor caused by breathing during treatment. This precise delivery method quickly allows the tumor to receive the full dose of radiation.

For both NSCLC and SCLC patients, smaller doses of radiation to the chest may be used for symptom control (palliative radiotherapy).

CHEMOTHERAPY FOR LUNG CANCER:

The chemotherapy regimen depends on the tumour type. Both Small-cell lung carcinoma (SCLC) & Non-small cell lung carcinoma can be treated with chemotherapy and radiation. In advanced non-small cell lung carcinoma (NSCLC), chemotherapy treatment improves the survival rate and is used as the first-line treatment versus radiation.

While treating metastatic small cell lung cancer, a check is run to see whether the patient is fit enough to be treated. Fitness is an important factor to determine the survival of patient.

Adjuvant chemotherapy refers to the use of chemotherapy, after the curative surgery, to improve the outcome. Typically, the chemotherapy is provided as the next step of lung cancer treatment after surgery. In NSCLC, samples are taken from nearby lymph nodes, during surgery, to assist staging. If stage II or III disease is confirmed, adjuvant chemotherapy improves survival by 5% at five years. Adjuvant chemotherapy as a lung cancer treatment option during stage IV cancer is debatable, as clinical trials have not clearly demonstrated a survival benefit or a standard success rate. Trials of pre-operative chemotherapy (neo-adjuvant chemotherapy) have been inconclusive.

Patients subject to chemotherapy may experience side effects during this type of lung cancer treatment like Hair Loss, Mouth Sore, Loss of Appetite, Nausea and even Vomiting to name a few.

Symptoms

The following are the symptoms that manifest when a person suffers from liver cancer:

A swollen abdomen: Swelling of the abdomen can show in liver cancer for two reasons. The liver itself can get bigger from the growing cancer. This can cause swelling over the right side of the abdomen. There could also be generalised swelling of the abdomen, caused by a buildup of fluid. This is called ascites. The fluid builds up because the liver is congested. This squeezes the blood vessels inside the liver and the blood that normally flows through it gets backed up into the veins. The pressure in these veins increases and forces fluid to leak from the veins, into the abdomen. The veins may grow in size, so much that they can be seen underneath the surface of the skin. If the liver is not able to make blood proteins as it should, fluid also tends to leak out of the veins, into the abdominal cavity.

Yellowish skin, dark coloured urine and pale coloured stools: Primary liver cancer develops from the cells that constitute the liver. Liver cancer can grow and spread outside the liver. It may grow into the bile duct. If this happens, bile cannot be drained out of the liver, causing the bile’s yellow pigment to be excreted through the kidneys. This makes the urine dark and the faeces pale. The build-up of bile in the bloodstream causes jaundice. Jaundice is a yellowing of the skin and whites of the eyes. It may make the skin itch.

Weight loss: Unexplained weight loss is another classic symptom of liver cancer. Therefore, if there is no obvious reason for one’s weight loss, it should not be ignored.

Other symptoms associated with liver cancer may include:

Loss of appetite over a period of few weeks

General feeling of sickness

Feeling full or bloated after eating, even after a small meal

Itching

A sudden worsening of health in somebody with known chronic hepatitis or cirrhosis

High temperature and sweating

Jaundice (yellowing of the skin and whites of the eyes)

Fever

Fatigue

Weakness

Nausea

Causes

Although the exact cause of liver cancer is unknown, it has been linked to damage and scarring of the liver. Below are some of the risk factors that result in the occurrence of liver cancer among individual:

Anabolic steroids: These are the steroids which are used by athletes and weightlifters. These male hormones, if used regularly and for long enough can raise the risk of developing liver cancer, as well as some other cancers.

Aflatoxins: This is a substance that is made by a fungus and may be found in mouldy wheat, groundnuts, corn, nuts, soybeans and peanuts. For liver cancer risk to increase there needs to be long-term exposure. This is more of a problem in some poor countries than in industrialised nations.

Liver disease and inherited liver disease: People with cirrhosis and hepatitis B or C have a significantly higher risk of developing liver cancer, as compared to other healthy individuals.

Diabetes: Patients with diabetes, especially if they also have hepatitis or regularly consume a lot of alcohol, are more likely to develop liver cancer.

Family History: People whose mother, father, brother or sister suffers from liver cancer, have a higher risk of developing it themselves, as compared to others.

Low Immunity: People with weakened immune systems, such as those with HIV/AIDS, have a risk of liver cancer that is five times greater than other healthy individuals.

Obesity: Obesity raises the risk of developing many cancers, including liver cancer.

Gender: A higher percentage of males get liver cancer, as compared to females. Some experts believe this is not due to gender, but due to lifestyle problems – on an average, males tend to smoke and consume alcohol more than females.

Smoking: Individuals with Hepatitis B or C have a higher risk of liver cancer if they smoke. Water wells with arsenic: People who rely on water wells that have arsenic may have a significantly high risk of developing several conditions or diseases, including liver cancer.

Diagnosis

High-risk individuals for HCC (hepatocellular carcinoma) should have regular screenings for liver cancer. Liver cancer, if not diagnosed early, is much more difficult to get rid of.

The only way to know whether a patient has liver cancer, early on, is through screening because one will present no symptoms. High-risk people include those with hepatitis C and B, patients with alcohol-related cirrhosis, other alcohol abusers, and those that have cirrhosis as a result of Hemochromatosis.

Diagnostic tests may include:

Blood test: Liver cancers secrete a substance, called Alpha-Fetoprotein (AFP) that is normally present in foetuses but goes away at birth. An elevated AFP in adults may indicate liver cancer as it is produced in 70% of all liver cancers. Elevated levels of iron may also indicate the presence of a tumour.

Imaging scans: Imaging with ultrasound is the initial diagnostic test as it can detect tumours as small as one centimetre. High-resolution CT scans and contrast MRI scans are used to diagnose and stage these tumours.

Biopsy: A small sample of tumour tissue is removed and analysed. The analysis can reveal whether the tumour is cancerous (malignant) or non-cancerous (benign).
Laparoscopy: This is useful in detecting small tumours, determining the extent of cirrhosis, or obtaining a biopsy, and confirms previous tests, among other things.

Treatment

The treatment for primary liver cancer patients depends on the stage of the disease as well as the person’s age, overall health and personal preferences. Liver cancer treatment options may include:

Surgery to remove a portion of the liver: In certain situations, the doctor may recommend partial hepatectomy to remove the cancer and a small portion of healthy tissue that surrounds it, if the tumour is small and liver function is good. Liver transplant surgery is a procedure where the diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.

Freezing cancer cells: Cryoablation or freezing uses extreme cold to destroy cancer cells. During the procedure, the doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumours. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.

Heating cancer cells: It is also called radiofrequency ablation and uses electric current to heat and destroy cancer cells. Using ultrasound or CT scan as a guide, a surgeon inserts one or more thin needles into small incisions in the abdomen. When the needles reach the tumour, they’re heated using electric current and destroying the cancer cells.

Alcohol injections: The injection of pure alcohol directly into tumours, either through the skin or during an operation is also a form of treatment. Alcohol causes tumour cells to die.

Injecting chemotherapy drugs into the liver or Chemoembolisation: It is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. During the procedure, chemotherapy drugs are injected into the hepatic artery — the artery from which liver cancers derive their blood supply — and then the artery is blocked. This procedure cuts blood flow to the cancer cells and delivers chemotherapy drugs to the cancer cells.

Radiation therapy: Radiation therapy uses high-powered energy beams to destroy cancer cells and shrink tumours. During radiation therapy, the patient lies down on a table and a machine directs the high-energy radiation beams precisely towards the liver tumour. Radiation therapy for liver cancer may involve a technique called stereotactic radiosurgery that simultaneously focuses many beams of radiation towards one point in the body.

Targeted therapy: Targeted drug therapy works by interfering with a tumour’s ability to generate new blood vessels. They have been shown to slow or stop advanced hepatocellular carcinoma from progressing for a few months longer than with no treatment.

Symptoms

Like all blood cells, Leukemia cells travel through the body. The symptoms of Leukemia depend on the number of Leukemia cells and where these cells collect in the body. Patients suffering from acute leukemia may encounter symptoms such as headaches, vomiting, sickness, and loss of muscle control or seizure. Other common symptoms of leukemia include:

Poor Blood clotting: As immature white blood cells crowd out blood platelets (crucial for blood clotting), the patient may bruise or bleed easily and heal slowly. This symptom indicates that the patient is in the early stages of leukemia.

Affected immune system: The patient’s white blood cells, which are crucial for fighting off infection, may be suppressed or having difficulty in carrying out their function. The patient may experience frequent infections and in some cases his/her immune system may turn against the very healthy cells that they protect.

Anaemia: As the shortage of good red blood cells grows, the patient may suffer from Anaemia resulting in difficult or laboured respiration (dyspnea) and pallor (paleness in the skin caused by illness).

Other symptoms:

Nausea

Fever

Night sweats and tiredness

Sudden loss of weight

Headaches

Frequent infections

Fatigue

Easy bleeding and bruising

Swelling or discomfort in the abdomen (arising from a swollen spleen or liver)

Pain in the bones or joints

Stages of Leukemia

Stage 0: In the initial stages, there are too many lymphocytes in the body. The symptoms are rarely visible. Stage I: The lymph nodes start getting swollen due to too many lymphocytes being made. Stage II: The swelling spreads to the spleen and liver, again due to excessive presence of lymphocytes. Stage III: In this stage, the patient may experience anaemia since the lymphocytes are crowding out the red cells in the blood. Stage IV: In the final stage, very few platelets remain in the blood and the lymph nodes, spleen and liver continue to remain swollen.

Causes

There are various causes to the different types of leukemia. Some of the common causes associated with leukemia are:

Artificial Ionising Radiation – which can damage living tissue and cause cancer

Viruses – HTLV-1 (human T-lymphotropic virus) which are known to cause t-cell leukemia

Benzene and Petrochemicals – which contain carcinogenic chemical (cancer causing agents)

Diagnosis

If a patient suffers from symptoms that are associated with Leukemia, one of the following tests will be recommended: Physical exam: The doctor will check if the skin is pale (due to anemia) and signs of swollen lymph nodes. Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells and platelets. Leukemia causes a very high count of white blood cells. It may also cause low levels of platelets and haemoglobin, which is found inside red blood cells. Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether Leukemia cells are in the bone marrow. Before the sample is taken, local anaesthesia is used to numb the area. This helps reduce the pain. The doctor removes some bone marrow from the hipbone or another large bone. A pathologist uses a microscope to check the tissue for Leukemia cells. It involves two steps:

Bone marrow aspiration: It procedure that involves taking a sample of the liquid part of the soft tissue inside the bones

Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a piece of the bone marrow tissue.

Other tests may include:

Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow or lymph nodes. If abnormal chromosomes are found, the test can show the type of leukemia the patient is suffering from. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.

Spinal tap: The doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anaesthesia. One must lie flat for several hours afterwards to avoid getting a headache. The lab checks the fluid for Leukemia cells or other signs of problems.

Chest x-ray: An X-ray can show swollen lymph nodes or other signs of disease in the chest.

Treatment

Treatments for Leukemia include: Chemotherapy Chemotherapy is the treatment of disease with chemo-drugs, designed to kill cancerous cells. This is the main treatment for most types of Leukemia. Chemotherapy is often the primary treatment for children. In case the child suffers from high risk leukemia, then stem cell transplant is prescribed as well. The various side effects of chemotherapy include fatigue, hair loss, infection, nausea & vomiting. Radiation treatments Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink swollen lymph nodes or an enlarged spleen. It may also be used before a stem cell transplant. Stem cell transplant Stem cells can rebuild the supply of normal blood cells and boost the immune system. Before the transplant, radiation or chemotherapy may be given to destroy cells in the bone marrow and make room for new stem cells. The procedure then involves infusing fresh stem cell back into the blood.

Symptoms

Kidney cancer rarely causes signs or symptoms in its early stages. In the later stages, kidney cancer signs and symptoms may include:

Blood in the urine, which may appear pink, red or cola coloured

Lump in the side of the abdomen.

Back pain just below the ribs that doesn’t go away

Persistent pain in the abdomen

Loss of appetite

Weight loss

Extreme fatigue

Anaemia

Heavy sweating

Swelling in the ankle of legs

Fever that lasts for weeks and is not caused by cold or any infection

Kidney cancer which has spread to other parts of the body could have symptoms such as:

Shortness of breath

Coughing up blood

Pain in the bone

However, many of these symptoms can be caused by other conditions as well, and there may also be no signs or symptoms in a person with kidney cancer, especially in the early stages of the disease. It is good to consult a doctor if an individual suffers from multiple of these symptoms.

Causes

The exact causes of kidney cancer are unknown as of now. However, there are certain factors that appear to increase the risk. These are:

Smoking, which can double the risk of the disease

Regular use of NSAIDs such as ibuprofen and naproxen, which may increase the risk by 51%

Genetic anomaly or mutations

Obesity increases the risk of kidney cancer

A family history of kidney cancer

Having kidney disease that needs dialysis

Being infected with Hepatitis C

Previous treatment for testicular cancer or cervical cancer

Older age – Your risk of kidney cancer increases as you age.

Obesity – People who are obese have a higher risk of kidney cancer than do people who are considered average weight.

High blood pressure (hypertension) – High blood pressure increases your risk of kidney cancer.

Von Hippel-Lindau disease – People with this inherited disorder are likely to develop several kinds of tumours, including, in some cases, kidney cancer.

Exposure to certain kind of substances in the workplace such as cadmium or specific herbicides.

Hereditary papillary renal cell carcinoma – Having this inherited condition makes it more likely for an individual to develop one or more kidney cancers.

Diagnosis

Tests and procedures used to diagnose kidney cancer include:

Blood and urine tests – Tests of your blood and your urine may give your doctor clues about what’s causing your signs and symptoms.

Imaging tests – Imaging tests allow your doctor to visualise a kidney tumour or abnormality. Imaging tests might include ultrasound, computerised tomography (CT) or magnetic resonance imaging (MRI).

Removing a sample of kidney tissue (biopsy) – In certain cases, your doctor may recommend a procedure called biopsy to remove a small sample of cells from a suspicious area in the kidney. The sample is tested in a lab to look for signs of cancer.

Unlike most other cancers, the doctor could be certain about a diagnosis of kidney cancer without a biopsy. Often a biopsy will be done to confirm the diagnosis. A doctor may use a needle biopsy to remove a sample of tissue, which is then examined under a microscope for cancer cells. The biopsy may also tell the grade of the cancer and how aggressive the cancer is likely to be. Often the surgeon simply removes the entire tumour and then have a sample of tissue examined.

Once the doctor makes a diagnosis of kidney cancer, other tests maybe required to confirm if the cancer has spread within the kidney, to the other kidney, or to other parts of your body. When cancer spreads from the place where it first started, it is said to have metastasized. A CT scan or an MRI or a chest X-ray can show the extent of the spread. A bone scan can see if it has spread to the bones. These tests will help your doctor determine the stage of kidney cancer. The prognosis on the general health of the patient and the stage of kidney cancer. The higher the stage, more advanced is the cancer:

Stage I: A tumour 7 centimetres or smaller that is only in the kidney and has not spread

Stage II: A tumour larger than 7 centimetres that is only in the kidney and has not spread.

Stage III:

• A tumour that is in the kidney and in at least one nearby lymph node
• A tumour that is in the kidney’s main blood vessel and may also be in nearby lymph node
• A tumour that is in the fatty tissue around the kidney and may also involve nearby lymph nodes
• A tumour that extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia
• Stage IV:
  • Cancer has spread beyond the fatty layer of tissue around the kidney, and it may also be in nearby lymph nodes
  • Cancer may have spread to other organs, such as the bowel, pancreas, or lungs
  • Cancer has spread beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)

Treatment

The treatment suggested by your doctor depends on the stage of kidney cancer. Once the patient is examined the treatment procedure is chosen for the patient which could be any of the following methods:

Surgery: Surgery is the initial treatment for the majority of kidney cancers. The different types of surgical methods used by the doctors are as below:

Nephrectomy: Radical nephrectomy involves the removal of the kidney, a border of healthy tissue and the adjacent lymph nodes. The adrenal gland may also be removed.

Nephrectomy can be an open operation, meaning the surgeon makes one large incision to access your kidney. Or nephrectomy can be done laparoscopically, using several small incisions to insert a video camera and tiny surgical tools. The surgeon watches a video monitor to perform the nephrectomy. Nephron-sparing surgery: During this procedure, also called partial nephrectomy, the surgeon removes the tumour and a small margin of healthy tissue that surrounds it, rather than removing the entire kidney. Nephron-sparing surgery is a common treatment for small kidney cancers. It may also be an option if you have only one kidney. When nephron-sparing surgery is possible, it’s generally preferred over radical nephrectomy since retaining as much kidney tissue as possible may reduce your risk of later complications, such as kidney disease and the need for dialysis.

Kidney cancer that recurs and kidney cancer that spreads to other parts of the body may not be curable, but may be controlled with treatment. In these situations, treatments may include:

Surgery to remove as much of the kidney tumour as possible: Even when surgery cannot remove all of the cancer, it may be helpful in removing a large chunk. Surgery may also be used to remove cancer that has spread to another area of the body.

Biological therapy: Biological therapy (immunotherapy) uses the body’s immune system to fight cancer.

Targeted therapy: Targeted treatments block specific abnormal signals present in kidney cancer cells that allow them to proliferate.

Radiation therapy: Radiation therapy uses high-powered energy beams, such as x-rays, to kill cancer cells. Radiation therapy is sometimes used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones.

Symptoms

Symptoms of inflammatory breast cancer include:

Swelling (oedema) and redness (erythema) that affect a third or more of the breast. The skin of the breast may also appear pink, reddish purple, or bruised. Additionally, the skin may have ridges or appear pitted, like orange peel. These symptoms are caused by fluid build-up in the skin of the breast. This happens due to cancer cells blocking the lymph vessels in the skin thus preventing the normal flow of lymph. Sometimes the breast may contain a solid tumour that can be felt during a physical exam

Other symptoms of inflammatory breast cancers are:

A rapid increase in breast size

Sensations of heaviness, thickness, burning, or tenderness in the breast

A nipple that is flattened or inverted (facing inward).

Swollen lymph nodes may also be present under the arm, near the collarbone, or both.

Discoloration, giving the breast a red, purple, pink or bruised appearance

Unusual warmth of the affected breast

It is important to note that these symptoms may also be signs of other diseases or conditions, such as an infection, injury, or another type of breast cancer that is locally advanced. Therefore, anyone suffering with inflammatory breast cancer often have a delayed diagnosis of their disease.

Causes

The causes of inflammatory breast cancer are unclear. However, it is known that inflammatory breast cancer begins with an abnormal cell in one of the breast’s ducts. Mutations within the abnormal cell’s DNA makes it grow and divide rapidly. The abnormal cells invade and block the lymphatic vessels in the skin of the breast. This blockage causes the red veins, swollen and dimpled skin, which are classic signs of inflammatory breast cancer. The factors that increase the risk of inflammatory breast cancer are:

Being a woman: Women are more likely to be diagnosed with inflammatory breast cancer than are men.

People of darker complexion have a higher risk of inflammatory breast cancer than people with fairer complexion.

Being obese have a greater risk of inflammatory breast cancer compared with those of normal weight.

Diagnosis

Inflammatory breast cancer is often difficult to diagnose. There are usually no lumps that can be felt during a physical exam or seen in a screening mammogram. Most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram difficult. Also, inflammatory breast cancer being aggressive, can arise between scheduled screening mammograms and progress rapidly. The symptoms could also be mistaken for those of mastitis, which is an infection of the breast, or other forms of locally advanced breast cancer. To aid swift diagnosis and to choose the optimal course of treatment, there are guidelines on how doctors can diagnose and stage inflammatory breast cancer correctly:

A rapid onset of erythema (redness), oedema (swelling), and a peau d’orange appearance (ridged or pitted skin, like orange peel) and/or abnormal breast warmth, with or without a lump that can be felt.

The above-mentioned symptoms have been present for less than 6 months.

The erythema covers at least a third of the breast.

Initial biopsy samples from the affected breast show invasive carcinoma.

Further examination of tissue from the affected breast should include testing to see if the cancer cells have hormone receptors (oestrogen and progesterone receptors) or if they have greater than normal amounts of the HER2 gene and/or the HER2 protein (HER2-positive breast cancer).

Imaging and staging tests include the following:

A diagnostic mammogram and an ultrasound of the breast and regional (nearby) lymph nodes

A PET scan or a CT scan and a bone scan to see if the cancer has spread to other parts of the body

Proper diagnosis and staging of inflammatory breast cancer helps develop the optimal treatment plan and estimate the likely outcome of the disease.

Treatment

Inflammatory breast cancer is generally treated first with systemic chemotherapy to help reduce the size of the tumour. This is followed by surgery to remove the tumour. After the surgery, radiation follows to remove any traces. Is a multimodal approach, which studies have found to be more effective and leads to a possibility of longer survival. Multimodal treatment approach may include:

Neoadjuvant chemotherapy: This type of chemotherapy is given before surgery Usually at least 6 cycles of neoadjuvant chemotherapy is recommend over the course of 4 to 6 months before the tumour is removed surgically. If the disease continues to progress during this time, it is recommended not to delay the surgery.

Targeted therapy: Inflammatory breast cancers often produce greater than normal amounts of the HER2 protein, therefore targeted therapy against this protein may be used to treat the disease. Anti-HER2 therapy can be given both as part of neoadjuvant therapy and after surgery (adjuvant therapy).

Hormone therapy: If the cells of a woman’s inflammatory breast cancer contain hormone receptors, hormone therapy is another treatment option. Drugs which prevent oestrogen from binding to its receptor, and aromatase inhibitors which block the body’s ability to make oestrogen, can cause oestrogen-dependent cancer cells to stop growing and die.

Surgery: The standard surgery for inflammatory breast cancer is a modified radical mastectomy. This involves removal of the entire affected breast and most or all of the lymph nodes under the adjacent arm. Often, the lining over the underlying chest muscles is also removed, but the chest muscles are preserved. Sometimes, however, the smaller chest muscle (pectoralis minor) may be removed.

Radiation therapy: Post-mastectomy radiation therapy to the chest wall under the breast that was removed is a standard part of multimodal therapy. Breast reconstruction can be performed in women with inflammatory breast cancer, but, due to the importance of radiation therapy in treating this disease, experts generally recommend delayed reconstruction.

Adjuvant therapy: Adjuvant systemic therapy may be given after surgery to reduce the chance of cancer recurrence. This therapy may include additional chemotherapy, hormone therapy, targeted therapy or some combination of these treatments.

Symptoms

The various symptoms of Hodgkin’s Lymphoma are:

Swollen lymph nodes in the neck, armpits or groin

Pain in lymph nodes after drinking alcohol

Itching throughout the body (Pruritus)

Persistent fatigue

Coughing, difficulty in breathing, or chest pain arising due to the swollen lymph nodes in the chest pressing the windpipe.

Unexplained weight loss

Persistent fever

Drenching night sweats

The last three symptoms are classified as ‘B symptoms’ which requires aggressive treatment. It is important to note that patients with Hodgkin’s disease may not experience any symptoms or the symptoms may not appear until the advanced stages of cancer.

Causes

Hodgkin lymphoma is caused by a mutation in the DNA of a type of white blood cell called B lymphocytes, although the exact reason why this happens isn’t known. The mutation in the DNA causing them to multiply uncontrollably. The abnormal lymphocytes usually begin to multiply in one or more lymph nodes in a particular area of the body, such as the neck or groin. Over time however, it’s possible for the abnormal lymphocytes to spread into other parts of the body, such as the bone marrow, spleen, skin, lungs and the liver.

Some of the common risk factors identified with Hodgkin’s lymphoma are:

Males tend to be at a higher risk than females to suffer the disease. The people in the age group of 15–40 years and over 55 years have a higher chance of the cancer. A family history of Hodgkin’s Lymphoma.

Glandular fever, also known as infectious mononucleosis caused by the EBV virus which is directly associated with Hodgkin’s Lymphoma. Weakened immune system due to HIV or AIDS.

Prolonged use of human growth hormone.

Diagnosis

Physical Examination: During diagnosis, the doctor takes into account the medical history of the patient and conducts a physical examination. Here, the doctor checks for swollen lymph nodes in the neck, underarm, groin, spleen and liver. If swelling in the lymph nodes is detected, then some additional tests may be needed to confirm the presence of cancer and determine the extent to which it has spread.

Blood Tests: Blood tests are performed to check the presence of cancer cells in the blood. Another variant of the standard blood test is conducted to check the erythrocyte sedimentation rate (ESR). In this procedure, blood is collected in a test tube and observations are made to see how quickly red blood cells settle at the bottom of the test tube. Generally, red blood cells settle slowly. A faster rate may indicate the possibility of cancer.

Imaging Techniques: A chest X-rays shows the lymph nodes in the chest and neck area, which is also known as the starting point for Hodgkin’s Lymphoma. The technique is also used to detect enlarged lymph nodes.

Computer Tomography (CT): CT scans are generally more accurate than x-rays. They can detect abnormalities in the chest and neck area, as well as reveal the extent of cancer. CT scans are used to evaluate symptoms, understand the stage of cancer and consistently monitor the response to treatment. A CT scan is also often used in detecting lymphomas in the brain, abdominal and pelvic areas.

Positron Emission Tomography (PET): PET scans combined with CT scans can help doctors clarify the location of cancer. It can also provide information on whether or not an enlarged lymph node is benign or cancerous. PET scans may also help doctors determine how well a patient has responded to treatment, determining if there is any residue of cancer after treatment and if the patient has achieved remission.

Biopsy: A biopsy of the suspicious lymph node is the most definitive way to diagnose Hodgkin’s disease. A pathologist examines the lymph node sample for the presence of Reed-Sternberg cells or other abnormal features. The type of biopsy performed depends on the location of cancer and how accessible the lymph node is. The doctor may engage in surgery and remove the entire lymph node or a small part of it.

In some cases, the doctor may use fine needle aspiration to withdraw a small amount of tissue from the lymph node to check for cancer cells. Biopsies of bone marrow may also be performed in patients with existing Hodgkin’s disease specifically to determine if cancer has spread to the bone marrow. In such cases, it is termed as Advanced Hodgkin’s Lymphoma.

Stages of Hodgkin’s Lymphoma:

Hodgkin’s Lymphoma can broadly be classified into four stages.

Stage I: In this stage, cancer affects only one lymph node region. There are chances that the cancer has invaded an extra-lymphatic organ but not another lymph node region. Such cases are quite rare in Hodgkin’s Lymphoma.

Stage II: Here, cancer has spread to 2 or more lymph node regions located on the same side of the diaphragm. It is possible that another organ and its regional lymph nodes may also be affected. There are instances when a tumour mass may develop in the chest. In such cases, the size of the tumour can be larger than one-third the diameter of the chest or larger than 10 centimetres.

Stage III: The cancer in the lymph node areas has spread to both sides of the diaphragm.

Stage IV: Here the lymphoma is in its advanced stage where it has spread to 1 or more organs beyond the lymph nodes such as cerebrospinal fluid, liver, bone marrow or lungs.

The treatment depends on the stage of cancer and how far it has spread across the organs. However one of the common symptoms observed is acute pain in the lymph nodes.

Prognostic factors:

In addition to staging, doctors use other prognostic factors to help plan the best treatment and predict how well a treatment will work. For patients with Hodgkin’s lymphoma, several factors can predict the recurrence of cancer and what treatment works best.

The Prognostic factors include:

The sex of the patient.

Age of the patient.

A low blood albumin (a type of protein) level where it is less than 4 grams per litre.

Low haemoglobin (red blood cell count), defined as less than 10.5 grams per decilitre.

If White blood cell count is more than 15,000 per cubic millimetre.

If Lymphocyte count is less than 600 per cubic millimetre or less than 8% of the total white blood cell count.

Treatment

Treatment options depend on the:

Type of Hodgkin’s disease

Tumour stage, size, and location

Patient’s age and overall health status

Presence or absence of “B symptoms” (weight loss, persistent fever and night sweats)

Chemotherapy, Radiation, or a combination of both is the primary treatment options for Hodgkin’s disease. Stem cell transplantation may be recommended for patients who have recurring cancer. During such a stage, high-dose of chemotherapy (along with radiation) is given.

Preparing for Side Effects before Treatment

One of the common side effects is the suppression of the immune system which increases the risk of infections. It is a common practice for patients to be vaccinated against three bacteria namely pneumococci, meningococci and Haemophilus influenza before the actual treatment.

Another side effect is infertility. Patients who may wish to have children in the future should be aware of the risk of infertility after treatment. Men with Hodgkin’s disease may want to consider sperm freezing and assisted reproductive techniques. Women should ask their doctors about the possibility of preserving fertility by taking hormonal drugs called GnRH analogues (responsible for fertility and sex steroids) before undergoing chemotherapy.

Symptoms

The signs and symptoms vary with the location of the primary site and the stage of the cancer. The early warning signs of head and neck cancer could lead to an early diagnosis and a high probability of better outcome in many cases. For example, hoarseness frequently occurs in the earliest stage of voice box cancers. Persistent sore throat for longer than two weeks is a possible symptom of cancer in the voice box and/or the pharynx. Though not limited to, other symptoms often are:

Pain and changes in the fit of dentures (if the patient is using one) in case of cancer in the oral cavity

A non-healing ulcer, difficulty in swallowing or nasal blockage could also be warning signs of potential carcinomas

Although not an early sign, a neck mass may be the first presenting symptom

Nasal problems may also indicate possibility of nasopharyngeal cancer

Red or white patch in the mouth

Foul mouth odour not explained by hygiene

Hoarseness or change in voice

Difficulty in breathing

Double or weak vision

Numbness or weakness in the head and neck region

Pain or difficulty in chewing, swallowing, or moving the jaw or tongue

Jaw pain

Blood in the saliva or phlegm, discharged via the mucus into the mouth from respiratory passages

Loosening of teeth

Ear pain or infection

Causes

Oral Cancers Oral cancer is the uncontrolled multiplication of cancerous cells in the mouth and surrounding regions. They are most commonly seen in people who chew tobacco, but it is also seen in smokers. In addition to tobacco, trauma due to sharp teeth and Human Papilloma Virus are emerging as causes of these cancers. This type of cancer may affect the tongue, lips, palate, floor of the mouth, pharynx, minor salivary glands and sinuses. If not treated when the disease is at an early stage, it can potentially be life threatening. Throat Cancers Throat cancer refers to cancerous tumours that develop in the throat. Throat cancer includes cancers of the air pipe, food pipe and those arising from the glands in the neck. Throat cancer includes cancer of the nasopharynx (the upper part of the throat behind the nose), the oropharynx (the middle part of the pharynx) and the hypopharynx (the bottom part of the pharynx). Cancer of the larynx (voice box) may also be included as a type of throat cancer. Nasal Cancers Different cancers can develop from each kind of cell in the paranasal sinuses and nasal cavity. The nasal cavity and paranasal sinuses are lined by a layer of mucus-producing tissue with the following cell types: squamous epithelial cells, minor salivary gland cells, nerve cells, infection-fighting cells and blood vessel cells. Symptoms may include nasal blockage, nosebleed, swelling in the eyes and partial or complete loss of vision. Ear Cancers Cancers of the ear usually begin as skin cancers on the outer ear, ear canal or skin around the outer ear. The most common types are squamous cell carcinoma and basal cell carcinoma. If they are neglected, they may grow into the:

Ear canal

Middle ear

Deep into the temporal bone, which consists of the ear canal

Facial nerve

Organs for hearing and balance

Diagnosis

Head and neck Cancer diagnosis can be done through cancer screening exams. Some of the commonly used diagnostic tests are:

Physical Examination: During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The nose, mouth, throat, and tongue are also inspected for abnormalities. Blood and urine tests may be advised to help diagnose cancer.

Endoscopy: This allows the doctor to examine inside the body via a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is gently inserted through the nose into the throat and down the oesophagus to examine inside the head and neck.

Biopsy: A biopsy is the removal of a small amount of tissue for examination under a microscope. During this procedure, cells are withdrawn using a thin needle inserted directly into the tumour or lymph node. The cells are examined under a microscope for cancer cells, which is called a cytological examination.

Molecular testing of tumour: It may be recommended to run laboratory tests on a tumour sample to identify specific genes, proteins, and other factors unique to the tumour. This will determine if the treatment options include a type of treatment called targeted therapy.

Imaging: Ultrasound, MRI, CT scan or PET-CT scan could be recommended to get detailed images of the affected region.

Treatment

Head and neck cancer treatment is dependent on the stage of the cancer. While there is a different staging system for each type of head and neck cancer, the doctors use the diagnostic tests to answer the following aspects in the staging system:

Tumor: How large is the primary tumour and where is it located

Node: Has the tumour spread to any of the lymph nodes? If so, where and how many

Metastasis: Has the cancer metastasized to other parts of the body? If so where and how much?

The combined result of the above determines the stage of the cancer basis which a treatment plan is determined for each patient. Many cancers of the head and neck can be overcome, especially if they are detected early. Although eliminating the cancer is the primary goal, preserving the function of the nearby nerves, organs, and tissues is also equally crucial. When planning the treatment, how it might affect a person’s quality of life needs to be considered, such as how a person feels, looks, talks, eats, and breathes. Multi-disciplinary approach is known to have improved the quality of cancer care and ensure that the patient has access to the best current thinking on cancer management. Surgery or radiation therapy by themselves or a combination of these therapies may be part of the treatment plan. Surgical Oncology Here the goal is to remove the cancerous tumour and some surrounding healthy tissue. Types of surgery for head and neck cancer include:

Laser surgery: This is commonly used to treat an early-stage tumour, especially if it is found in the larynx.

Excision: This is a surgery to remove the cancerous tumour and some surrounding healthy tissue, known as a margin.

Lymph node dissection or neck dissection: If it is suspected that the cancer has spread, removal of lymph nodes in the neck maybe necessary. This could be done at the same time as an excision.

Reconstructive (plastic) surgery: If cancer surgery requires major tissue removal, such as jaw, skin, pharynx, or tongue removal, reconstructive or plastic surgery may be done to replace the missing tissue. This helps restore a person’s appearance and the function of the affected area.

Depending on the cancer staging, some people may need multiple surgeries. Sometimes, it is not possible to completely remove the cancer and it may have to be followed by radiation and/or chemotherapy. Chemotherapy for Head and Neck Cancer Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is also given in combination with radiotherapy and before surgery to shrink the tumour and make it easier to remove, sometimes chemotherapy is given to relieve symptoms and improve quality of life. Radiotherapy for Head and Neck Cancer Radiation Therapy uses high-energy particles or waves (like x-rays, gamma rays, electron beams) to destroy or damage cancer cells. For advanced head and neck cancer radiation therapies are used along with chemotherapy and surgery. Radiation therapies are painless and are aimed at destroying cancer cells in a specific area. It can either come from a high energy x-ray machine or from a small source of radioactive material placed close to or on the tumour. Targeted Therapy for Head and Neck Cancer Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer’s growth and survival. This treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Recent findings show that all tumours do not have the same targets. To find the most effective treatment, tests are done to identify the genes, proteins, and other factors in the tumour. This helps identify the most effective treatment whenever possible. For head and neck cancers, treatments that target a tumour protein called epidermal growth factor receptor (EGFR) may be recommended. Researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancer. Immunotherapy for Head and Neck Cancer Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defences to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Symptoms

The symptoms of the gynaecological cancers are very vague and women often don’t take the signs seriously and only consult a doctor when it becomes too late. Some of the symptoms that manifest when a woman suffers from either one of the cancers are as follows:

Unusual vaginal bleeding or discharge

Vaginal bleeding during, after sexual intercourse or inter-menstrual bleeding

White discharge from vagina

Enlarged lymph nodes and swelling in the groin

Pain in the pelvic area

Persistent abdominal swelling or bloating

Swollen legs for no major reason

Unexplained weight loss

Loss of appetite or constantly feeling full

Constant fatigue

Persistent indigestion or nausea

Causes

Even if a woman faces risk factors that could trigger gynaecological cancers, it doesn’t necessarily mean that she would develop one. A lot of women have at least one risk factor which may never develop into a gynaecological cancer, while others with a gynaecological cancer may not have had any known risk factors. The causes and reasons behind many gynaecological cancers haven’t been fully understood yet, but there are a number of factors that can increase the risk. These include:

Increasing age

Having a strong family history of gynaecological cancer

Identified gene mutations

Reproductive history such as child-bearing

Exposure to hormones – produced by the body or taken as medication

Exposure to Diethylstilbestrol (DES) in the womb

Viral infections, such as Human Papilloma Virus (HPV)

Lifestyle factors such as smoking and drinking

Diagnosis

Diagnosis of a gynaecological cancer may involve a number of tests depending on the symptoms. The tests include:

A physical examination, with a pelvic examination

A Pap smear

Blood tests such as a CA125

Imaging tests – which may include a transvaginal ultrasound or a CT scan, Magnetic Resonance Imaging (MRI) or PET scans may also be suggested.

Taking a sample of tissue for examination under a microscope, a process called biopsy.

Treatment

Treatment for gynaecological cancers depends on which organ it has affected, as well as, the stage and type of the disease, the severity of symptoms and the woman’s general health. Treatment often involves surgery to remove as much of the tumour as possible, and to determine its stage (how far the cancer may have spread). Once the stage of cancer has been determined, one of the following methods are used to fight the cancerous cells:

Surgery: In this process, the doctors remove cancer tissue in an operation.

Chemotherapy: Chemotherapy involves the use of drugs to stop or slow the growth of cancer cells. Chemotherapy may cause side effects, but these often get better or go away when treatment is over. Chemotherapy drugs may be given in several forms, including pills or through an IV (intravenous) injection.

Radiation: Radiation uses high-energy rays (similar to X-rays) to try to kill the cancer cells and stop them from spreading. The rays are aimed at the part of the body where the cancer is.

Symptoms

Since the cancer of a number of organs of the digestive system is clubbed under Gastrointestinal Cancer, the symptoms may vary. Some of the common symptoms may include the following:

Abdominal pain, tenderness or discomfort

Change in bowel habits, such as frequency or consistency or shape

Rectal bleeding or blood in stool

Bloated feeling after eating, even when eating a small amount

Loss of appetite

Nausea/vomiting

Unintentional weight loss

Fatigue

These are common symptoms of gastrointestinal cancer, but there are more symptoms that relate specifically to each type.

Causes

The following are considered to be the causes or the risk factors that could lead to the various gastrointestinal cancers:

Smoking

Excessive alcohol consumption

Increasing age

Diet high in animal fat

Diet containing high amounts of salted, cured, or poorly preserved foods

Chronic pancreatitis

Obesity

Family history of GI cancer

Diagnosis

The detection and confirmation of gastrointestinal cancers are done through various and following are the key diagnostic modalities.

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

Blood chemistry studies: This is a procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Complete Blood Count (CBC): A procedure in which a sample of blood is drawn and checked for the following:

The number of red blood cells, white blood cells and platelets

The amount of haemoglobin (the protein that carries oxygen) in the red blood cells

The portion of the sample made up of red blood cells

CAT scan: In this procedure, a series of detailed pictures of areas inside the body are taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called Computed Tomography, Computerised Tomography or Computerised Axial Tomography.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy of the stomach is usually done during the endoscopy.

Treatment

Some gastrointestinal cancer cases are treated with a single treatment modality or with a combination of two or more. The suitable treatment option for each case is decided based on various parameters such as the type of cancer, location and size, the stage of the cancer, patient’s age and the overall condition of the patient. Below are some of the major treatment modalities:

Surgery: When used to treat cancer, surgery is a procedure in which a surgeon removes cancer from the body. It could be non-invasive, minimally-invasive or open surgery depending on the factors mentioned above. The surgery is often preceded or succeeded by chemotherapy.

Radiation therapy: Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumours. Radiation can either be delivered externally or internally. Radiation therapy is always used in combination with the surgery or chemotherapy for enhanced efficacy.

Chemotherapy: Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells. Chemotherapy is used along with radiation therapy and surgery. Chemotherapy is usually prescribed in the following cases:

Along with radiotherapy as an alternative to surgery (called chemoradiation)

After surgery to decrease the risk of the relapse

To slow the growth of a tumour and control symptoms when the cancer cannot be completely treated (palliative treatment)

Immunotherapy: Immunotherapy boosts the body’s immune system to fight against cancer. Once the immunity is boosted, the body detects and destroys the cancer cells throughout the body. Although not as popular as chemotherapy or radiotherapy, immunotherapy is used to treat a few types of cancers.

Targeted therapy: Targeted therapy is a type of cancer treatment that targets biomolecules that control how cancer cells grow, divide, and spread. By targeting these biomolecules, this treatment modality may promote stronger immunity, stop cancer cells from growing, deliver tumour-killing molecules to the cancer, cut-off nutrient supply to the tumour cells or kill the cancer cells.

Symptoms

Some of the symptoms that manifest in a patient suffering from gallbladder cancer are:

Steady pain in the upper right abdomen

Weakness

Loss of appetite

Weight loss

Jaundice and vomiting due to obstruction

A swollen abdomen (tummy)

Gallbladder enlargement

Early symptoms mimic gallbladder inflammation due to gallstones. Later, the symptoms may be that of biliary and stomach obstruction.

Causes

The exact causes of gallbladder cancer are as yet unclear. What we do know is that most gallbladder cancer begins in the glandular cells that line the inner surface of the gallbladder. Gallbladder cancer that begins in this type of cell is called adenocarcinoma. Some of the risk factors that increase the probability of getting gallbladder cancer are:

Gender of the patient: Gallbladder disease as such is more common in women. Similarly, gallbladder cancer affects women more commonly than men.

Cholecystitis: Gallstones and inflammation of the gallbladder is also known as cholecystitis. This is by far the most common risk factor that predisposes one to gallbladder cancer. Gallstones are hard stones that are formed within the gallbladder due to deposition of cholesterol and minerals from bile. About eight out of ten people with gallbladder cancer (80%) have gallstones or an inflamed gallbladder at diagnosis. However, most people with an inflamed gallbladder or gallstones do not get gallbladder cancer.

Family history of gallstones and gallbladder cancer: Those with a family history of gallstones have double the chance of gallbladder cancer. In addition, those with a family history of gallstones who also have gallstones themselves have almost 60 times the normal risk of gallbladder cancer. Those with a first degree relative with gallbladder cancer are five times more likely to develop gallbladder cancer than people who do not have a relative with it. The risk, however, still remains very small as the cancer is rare.

Genetics: Some races and ethnicities are more at risk of gall bladder cancer than others. The basis could be a family history of gallstones and gallbladder cancer: genetics. For example, north India has the highest rate of gallbladder cancer in the world.

Smoking and exposure to chemicals: Cigarettes and some industrial chemicals containing nitrosamines can damage the DNA and lead to genetic mutations and raise the risk of gallbladder and other cancers. Workers in the metal or rubber industry are more likely to develop gallbladder cancer

Porcelain gallbladder: This is a condition where calcium deposits build up on the inside wall of the gallbladder hardening the walls. This is usually seen in individuals who have repeated cholecystitis or inflammation of the gallbladder.

Defects of the pancreas and bile ducts: Defects of the pancreas and bile ducts raise gallbladder cancer risk. Abnormalities in the connection between the bile duct and the pancreas and outgrowths in the bile duct (choledochal cysts) may also be risk factors for gall bladder cancer. These conditions may affect a baby since birth but symptoms may appear much later.

Obesity: Being obese or overweight raises the risk of gallstones and cholecystitis. This is mainly because they change the hormonal balances of the body, particularly in women. Studies show that more than one in ten cases of gallbladder cancer in men and almost a third of cases in women are due to being overweight.

Diet: Diet high in carbohydrates and low in fibre may increase the risk of gallbladder cancer. A diet rich in fresh fruit and vegetables seems to reduce the risk of many cancers, including gallbladder cancer. Inclusion of vitamins A, C, E and antioxidant chemicals in diet is also important for cancer prevention.

Diabetes: Diabetes may also raise the risk of gallbladder cancer

Exposure to female hormones in hormone replacement therapy: Women who have increased exposure to the hormone oestrogen may have an increased risk of gallbladder cancer. With longer use of hormone replacement therapy, the risk of gallbladder cancer seems to rise

Diagnosis

In order to treat gallbladder cancer, it is necessary to diagnose the stage of the cancer. In order to do that, the doctor adopts any one of the following procedures:

Physical examination: During the exam, signs of gallbladder cancer and other health problems are looked for. The exam will focus mostly on the abdomen (belly) to check for any lumps, tenderness, or fluid build-up. The skin and the white part of the eyes will be checked for jaundice (a yellowish colour). Sometimes, cancer of the gallbladder spreads to lymph nodes, causing a lump that can be felt beneath the skin. Lymph nodes above the collarbone and in several other locations may be checked.

If symptoms and/or the physical exam suggest you might have gallbladder cancer, tests will be done. These might include lab tests, imaging tests, and other procedures.

Blood Tests: Lab tests might be done to find out how much bilirubin is in the blood. Bilirubin is the chemical that causes jaundice. Problems in the gallbladder, bile ducts, or liver can raise the blood level of bilirubin. Tests for albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT), and certain other substances in your blood may also be done. These tests are often called liver function tests. They help diagnose liver, bile duct, or gallbladder diseases.

Tumour Markers: Tumour markers are substances made by cancer cells that can sometimes be found in the blood. People with gallbladder cancer may have high blood levels of the markers called CEA and CA 19-9. Usually the blood levels of these markers are high only when the cancer is in an advanced stage. While these markers are not specific for gallbladder cancer these tests can sometimes be useful after a person is diagnosed with gallbladder cancer. If the levels of these markers are found to be high, they can be followed over time to help tell how well treatment is working.

Imaging Tests:

• Ultrasound exam: This is a procedure in which high energy sound waves are bounced off internal tissues or organs to produce echoes. The echoes form a picture of body tissues called a sonogram. An abdominal ultrasound or endoscopic/laparoscopic ultrasound is done to diagnose gallbladder cancer.
• CT scan: It is a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called Computed Tomography, Computerised Tomography, or Computerized Axial Tomography.
• Chest x-ray: This involves an x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, creating an image of areas inside the body.
• MRI: MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called Nuclear Magnetic Resonance Imaging (NMRI). A dye may be injected into the gallbladder area so the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine will show up better in the image.
• Cholangiography: A cholangiogram is an imaging test that looks at the bile ducts to see if they are blocked, narrowed, or dilated (widened). This can help show if someone might have a tumour that’s blocking a duct. It can also be used to help plan surgery. There are several types of cholangiograms, each of which has different pros and cons:
• Magnetic resonance cholangiopancreatography (MRCP):
• Endoscopic retrograde cholangiopancreatography (ERCP):
• Percutaneous transhepatic cholangiography (PTC):

Biopsy: Biopsy involves the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumour. If the tumour clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumour. The tests help diagnose the cancer and also ascertain its stage. The earliest stage gallbladder cancers (called carcinoma in situ) are stage 0. Stages then range from stages I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage.

Treatment

There are different types of treatment for patients with gallbladder cancer. Three types of standard treatment that are used are: Surgery Gallbladder cancer may be treated with a cholecystectomy, a surgery performed to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. A laparoscope is sometimes used to guide gallbladder surgery. The laparoscope is attached to a video camera and inserted through an incision (port) in the abdomen. Surgical instruments are inserted through other ports to perform the surgery. Because there is a risk that gallbladder cancer cells may spread to these ports, tissue surrounding the port sites may also be removed. If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:

Surgical biliary bypass: If the tumour is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area

Endoscopic stent placement: If the tumour is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The stent may be placed through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine

Percutaneous transhepatic biliary drainage: A procedure done to drain bile when there is a blockage and endoscopic stent placement is not possible. An x-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be done to relieve jaundice before surgery

Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation towards 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 the cells from dividing. When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Chemotherapy is typically administered after (adjuvant) surgery to people with gall bladder cancer. For people with advanced cancers which may have spread to other organs beyond the Gall bladder, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer; and to improve survival to some extent.