DOC I HAVE BASAL CELL CARCINOMA
Basal cell carcinoma typically occurs on the face.
Although common for skin cancer, it is relatively rare in Singapore. The one patient that I saw was an old lady with a typical ulcerated papular skin swelling at the bridge of her nose. It was slow growing. She responded well to 5-fluorouracil cream with complete disappearance of the cancer after 1 month.
She had no recurrence since the treatment.
Basal cell carcinoma is a localized malignant tumor of the basal cells of the skin which seldom spread beyond its location.
It is the most common skin cancer.
It usually occurs in fair skinned people above the age of 50.
It is never life threatening.
Basal cell carcinoma is more common in :
People with fair skin than in those with darker skin.
People with a family history of Basal cell carcinoma.
Familial cases of Basal cell carcinoma with
1.autosomal dominant genes(basal cell nevus) and
2.xeroderma pigmentosum (autosomal recessive)
are more common especially in fair skin people.
People who spend time outdoors under the sun than those staying indoors.
Exposure to the sun is one of the most common causes of Basal cell carcinoma.
The majority of basal cell carcinomas occur on sun-exposed areas of the body.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
Environmental causes:
1.Arsenic exposure in certain occupations(preparation of arsenic products)
2.Exposure to X-ray radiation especially radiotherapy
Symptoms and Signs:
1.Nodular: flesh-colored papule with capillaries which can become ulcerated ( called rodent ulcer )
2.Cystic: less common with a central cystic cavity.
3.Pigmented: pigmented nodular form
4.Sclerosing: looks like a keloid
5.Superficial: a red scaly flat lesion.
Basal cell carcinoma can present as:
1.firm nodule which grows within the skin and below it
2.Color may be like normal skin, dark brown or black.
3.Border is characteristic rolled up edge
4. red, flat, scaling areas similar to a patch of eczema.
Diagnosis is confirmed by:
1.Skin biopsy under local anesthesia
2.small lesions can be totally removed
3.larger ones are biopsied first and surgically removed if there is confirmed malignacy.
Complications are:
1.local growth and destruction of neighbouring tissues (e.g. nose).
2.Growth into vital structures resulting in the loss of extension or function
3.rarely metastases or cause death.
Treatment of Basal Cell Carcinoma:
Surgery:
Most basal cell carcinomas are removed by surgical excision with margins of 4-6mm.
Chemotherapy:
local therapy with 5-fluorouracil(a chemotherapy agent) with 70-90% success rate
Radiation:
Radiation therapy may be used in older patients not suitable for surgery.
Cryosurgery:
Cryosurgery can be done for basal cell cancer that invades cartilage.
Mohs surgery:
Mohs micrographic surgery is an outpatient procedure in which the cancer nodule is surgically excised and then immediately examined under a microscope. The base and edges are microscopically examined to confirm no evidence of malignancy before repair is done.
Immunotherapy:
Immunotherapy research indicates that treatment with Euphorbia peplus, a common garden weed, may be effective against Basal cell carcinoma.
Prognosis of majority of cases is good if there is complete removal.
Sclerosing lesions are harder to treat because they invade deeper into the tissues.
Prevention is by:
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats). Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevant malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
Sunday, October 31, 2010
Saturday, October 30, 2010
A Family Doctor's Tale - MELANOMA
DOC I HAVE MELANOMA
Melonoma is said to be more common in people exposed to the sun but the patient that I saw was an elderly woman (my mother's good friend) who seldom goes under the sun. Luckily her melanoma was slow spreading but she had to have surgery to remove the melanoma and at least 1 inch margin of skin surrounding it.
Melanoma is a progressive neoplastic tumor of melanocytes which are found mainly in the skin and can be present in the eye and the intestine.
It is a rare but dangerous cancer because of its rapid growth.
Melonoma is more common in :
1.People with fair skin than in those with darker skin.
2.People with multiple atypical nevi(moles)
3.Persons born with giant congenital melanocytic nevi(moles)
4.People with a family history of melanoma
Familial cases of melanoma with autosomal dominant genes are more common especially in fair skin people.
4.People who spend time outdoors under the sun than those staying indoors.
Exposure to the sun is one of the most common causes of melanoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
Types of primary melanomas:
1.superficial spreading melanoma
2.nodular melanoma
3.acral lentiginous melanoma
4.lentigo maligna melanoma
Melanomas occuring in non-skin areas:
5.clear cell sarcoma (Soft Parts)
6.mucosal melanoma (Intestines)
7.uveal melanoma (Eye)
Symptoms that suggest melanoma are:
1.A skin mole with
Asymmetrical features
Border of the mole is irregular.
Color: black, blue or brown with occasional reddish and white areas
Diameter: Any mole wth a diameter of 5 mm has a higher chance to become melanomas
Elevation: The mole is usually raised above the skin.
Any change in the mole appearance may suggest malignancy
Bleeding and ulcerations are late signs.
Loss of skin markings may be present.
There is rarely pain.
2.Excision biopsy of the suspected mole.
3.Lactate dehydrogenase (LDH) tests are used to detect metastases
4.Chest X-rays - to exclude spread to lungs
5.CT, MRI, PET scans of body to exclude metastases.
Metastases or spread of the melanoma can spread through the lymphatic or blood vessels to:
1.lymph nodes - if detected early and removed, survival rate is better
2.skin and lungs - have a better survival rate
3.brain , bone and liver - have the worst survival rates
Surgery is the only treatment for localized cutaneous melanoma.
The skin lesion must be totally removed with an adequate margin of surrounding skin and tissue.
The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin,in order to determine the depth and any infltration outside the lesion.
The lymph nodes nearest to the lesion are also removed.
Disseminated melanoma (Cancer has spread to other parts of body) requires chemotherapy.
Radiation therapy is also used after surgery for patients with localmelanoma or for patients with unoperable distant metastases.
Immunotherapy with interleukin-2 or interferon has also been used with encouraging good results.
Gene therapy is a new area where the genes are manipulated to help kill the melanoma cells.
Prognosis depends on the following factors:
1.tumor thickness
2.depth related to skin
3.type of melanoma,
4.ulceration presence
5.lymphatic spread
6.tumor infiltrating lymphocytes (if present, prognosis is better),
7.location of lesion,
8.distant metastasis
Early diagnosis, biopsy and sugery usually means better prognosis.
Prognosis also depends on the depth and thickness of the melanoma.
The smaller the thickness of the melanoma the better is the prognosis.
Regional node spread and distant metastases usually suggest poor prognosis.
Prevention is by doing the following:
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats)
2.Good nutrition and healthy lifestyle boost the immune system and helps prevant malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem in June 2008 announced the development of a new vaccine which can prevent recurrences and increase survival rates for melanoma patients.
Melonoma is said to be more common in people exposed to the sun but the patient that I saw was an elderly woman (my mother's good friend) who seldom goes under the sun. Luckily her melanoma was slow spreading but she had to have surgery to remove the melanoma and at least 1 inch margin of skin surrounding it.
Melanoma is a progressive neoplastic tumor of melanocytes which are found mainly in the skin and can be present in the eye and the intestine.
It is a rare but dangerous cancer because of its rapid growth.
Melonoma is more common in :
1.People with fair skin than in those with darker skin.
2.People with multiple atypical nevi(moles)
3.Persons born with giant congenital melanocytic nevi(moles)
4.People with a family history of melanoma
Familial cases of melanoma with autosomal dominant genes are more common especially in fair skin people.
4.People who spend time outdoors under the sun than those staying indoors.
Exposure to the sun is one of the most common causes of melanoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
Types of primary melanomas:
1.superficial spreading melanoma
2.nodular melanoma
3.acral lentiginous melanoma
4.lentigo maligna melanoma
Melanomas occuring in non-skin areas:
5.clear cell sarcoma (Soft Parts)
6.mucosal melanoma (Intestines)
7.uveal melanoma (Eye)
Symptoms that suggest melanoma are:
1.A skin mole with
Asymmetrical features
Border of the mole is irregular.
Color: black, blue or brown with occasional reddish and white areas
Diameter: Any mole wth a diameter of 5 mm has a higher chance to become melanomas
Elevation: The mole is usually raised above the skin.
Any change in the mole appearance may suggest malignancy
Bleeding and ulcerations are late signs.
Loss of skin markings may be present.
There is rarely pain.
2.Excision biopsy of the suspected mole.
3.Lactate dehydrogenase (LDH) tests are used to detect metastases
4.Chest X-rays - to exclude spread to lungs
5.CT, MRI, PET scans of body to exclude metastases.
Metastases or spread of the melanoma can spread through the lymphatic or blood vessels to:
1.lymph nodes - if detected early and removed, survival rate is better
2.skin and lungs - have a better survival rate
3.brain , bone and liver - have the worst survival rates
Surgery is the only treatment for localized cutaneous melanoma.
The skin lesion must be totally removed with an adequate margin of surrounding skin and tissue.
The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin,in order to determine the depth and any infltration outside the lesion.
The lymph nodes nearest to the lesion are also removed.
Disseminated melanoma (Cancer has spread to other parts of body) requires chemotherapy.
Radiation therapy is also used after surgery for patients with localmelanoma or for patients with unoperable distant metastases.
Immunotherapy with interleukin-2 or interferon has also been used with encouraging good results.
Gene therapy is a new area where the genes are manipulated to help kill the melanoma cells.
Prognosis depends on the following factors:
1.tumor thickness
2.depth related to skin
3.type of melanoma,
4.ulceration presence
5.lymphatic spread
6.tumor infiltrating lymphocytes (if present, prognosis is better),
7.location of lesion,
8.distant metastasis
Early diagnosis, biopsy and sugery usually means better prognosis.
Prognosis also depends on the depth and thickness of the melanoma.
The smaller the thickness of the melanoma the better is the prognosis.
Regional node spread and distant metastases usually suggest poor prognosis.
Prevention is by doing the following:
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats)
2.Good nutrition and healthy lifestyle boost the immune system and helps prevant malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem in June 2008 announced the development of a new vaccine which can prevent recurrences and increase survival rates for melanoma patients.
Friday, October 29, 2010
A Family Doctor's Tale - SALIVARY GLAND CANCER
DOC I HAVE SALIVARY GLAND CANCER
Funny I thought I will never see a case of salivary gland cancer because I have never seen one in the ENT Department. Just 3 years ago I met a patient who was losing tremendous amount of weight. I refer him to the hospital for checkup. They could find any thing wrong with him. Eventually after all the MRI and Cat scans of the whole body, they finally found a small swelling in the salivary gland. It was confirmed as cancer of the salivary gland. By that time it has started to spread throughout the body. In three months he had succumbed to the cancer.
Salivary Cancer is a malignant disease of the Salivary glands.
Cancers affecting the salivary glands are rare.
They can occur at any age, but are more common in people over 50.
The cause of the cancer is unknown.
Malignant tumours of the salivary glands are rare but there are benign or non-malignant tumours of the salivary glands which are more common.
Cancer of the salivary glands cannot be transmitted to another person through the saliva.
There is no inherited gene and the cancer do not run in families.
Symptoms - non-specific and silent.
In the early stage there is no symptoms.
By the the time the symptoms appeared, the cancer may be in the advanced stage.
1.swelling on one side of the face either in front of the ear or under the jaw.
2.numbness and drooping of one side of the face (facial palsy).
3.weight loss
Signs:
palpable mass under the jaw
Definite diagnosis requre the following tests:
1.X-rays to show the size and position of the cancer and possible spread.
2.CAT (computerised tomography) scan of the skull and neck to detect the enlarged salivary tumors
3.MRI (magnetic resonance imaging) scan of the skull and neck to detect the enlarged salivary tumors
4.Biopsy of the affected salivary gland for examination under a microscope through a needle or surgical removal.
Salivary Biopsy
---------------
Biopsy of Salivary tumor may be done to determine stage of Salivary cancer:
Stage 1 :
1.Size is < 2cm
2.no spread
Stage 2
1. Size is between 2 and 4cm
2.No spread.
Stage 3
1.Size > 4cm in size
2.There may be spread into nearby soft tissue.
Stage 4a
1.Size can be any size > 4cm
2.spread to the skin, jaw-bone, ear-canal or facial nerves.
Stage 4b
1.Size can be any size > 4cm
2.spread to other nearby bones, the base of the skull or the carotid artery.
Lymph nodes spread
-------------------
Stage 0
1. None of the lymph nodes are affected.
Stage1.
1.spread to one lymph node on the same side of the neck as the tumour.
2.Size of affected node <3cm
Stage 2a
1.spread to one lymph node on the same side of the neck as the tumour.
2.Size of the node is between 3-6cm
Stage 2b
1.spread to >one lymph node on the same side of the neck as the tumour.
2.Size < 6cm in size.
Stage 2c
1.spread to one or more lymph nodes on both sides of the neck.
2.Size < 6cm in size.
Stage3
1.Size of lymph nodes > 6cm in size.
Metastases Stages
---------------------
Stage 0
No spread to other parts of the body.
Stage 1
spread to other parts of the body, such as the lungs.
Treatment of Salivary cancer can be
1.surgery
2.chemotherapy
3.radiotherapy
The type of treatment given depend on
1.the position of the cancer,
2.the exact type of cancer,
3.the general health of the patient.
Surgery
Surgery is done to remove the salivary gland tumor.
If necessary, surgery is also done to remove any affected lymph nodes in the neck.
Radiotherapy
Radiotherapy can be used to treat salivary gland cancers.
Radiotherapy can be used in conjunction with surgery especially where there is spread to lymph nodes and other parts of the body.
Chemotherapy
Chemotherapy involve the use of anti-cancer drugs to destroy the cancer cells.
It is however not very effective in treating salivary gland cancers and is used only more for the cancer which has spread to the lungs, bones and other parts of the body.
The prognosis of Salivary cancer is usually poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Survival rates are best in the slow growing tumors.
There is no way to prevent salivary gland cancer but proper mouth hygience may hlp to prevent infections and chemicals in the mouth from causing mutations in the salivary gland cells.
Smoking should be avoided if possible.
Funny I thought I will never see a case of salivary gland cancer because I have never seen one in the ENT Department. Just 3 years ago I met a patient who was losing tremendous amount of weight. I refer him to the hospital for checkup. They could find any thing wrong with him. Eventually after all the MRI and Cat scans of the whole body, they finally found a small swelling in the salivary gland. It was confirmed as cancer of the salivary gland. By that time it has started to spread throughout the body. In three months he had succumbed to the cancer.
Salivary Cancer is a malignant disease of the Salivary glands.
Cancers affecting the salivary glands are rare.
They can occur at any age, but are more common in people over 50.
The cause of the cancer is unknown.
Malignant tumours of the salivary glands are rare but there are benign or non-malignant tumours of the salivary glands which are more common.
Cancer of the salivary glands cannot be transmitted to another person through the saliva.
There is no inherited gene and the cancer do not run in families.
Symptoms - non-specific and silent.
In the early stage there is no symptoms.
By the the time the symptoms appeared, the cancer may be in the advanced stage.
1.swelling on one side of the face either in front of the ear or under the jaw.
2.numbness and drooping of one side of the face (facial palsy).
3.weight loss
Signs:
palpable mass under the jaw
Definite diagnosis requre the following tests:
1.X-rays to show the size and position of the cancer and possible spread.
2.CAT (computerised tomography) scan of the skull and neck to detect the enlarged salivary tumors
3.MRI (magnetic resonance imaging) scan of the skull and neck to detect the enlarged salivary tumors
4.Biopsy of the affected salivary gland for examination under a microscope through a needle or surgical removal.
Salivary Biopsy
---------------
Biopsy of Salivary tumor may be done to determine stage of Salivary cancer:
Stage 1 :
1.Size is < 2cm
2.no spread
Stage 2
1. Size is between 2 and 4cm
2.No spread.
Stage 3
1.Size > 4cm in size
2.There may be spread into nearby soft tissue.
Stage 4a
1.Size can be any size > 4cm
2.spread to the skin, jaw-bone, ear-canal or facial nerves.
Stage 4b
1.Size can be any size > 4cm
2.spread to other nearby bones, the base of the skull or the carotid artery.
Lymph nodes spread
-------------------
Stage 0
1. None of the lymph nodes are affected.
Stage1.
1.spread to one lymph node on the same side of the neck as the tumour.
2.Size of affected node <3cm
Stage 2a
1.spread to one lymph node on the same side of the neck as the tumour.
2.Size of the node is between 3-6cm
Stage 2b
1.spread to >one lymph node on the same side of the neck as the tumour.
2.Size < 6cm in size.
Stage 2c
1.spread to one or more lymph nodes on both sides of the neck.
2.Size < 6cm in size.
Stage3
1.Size of lymph nodes > 6cm in size.
Metastases Stages
---------------------
Stage 0
No spread to other parts of the body.
Stage 1
spread to other parts of the body, such as the lungs.
Treatment of Salivary cancer can be
1.surgery
2.chemotherapy
3.radiotherapy
The type of treatment given depend on
1.the position of the cancer,
2.the exact type of cancer,
3.the general health of the patient.
Surgery
Surgery is done to remove the salivary gland tumor.
If necessary, surgery is also done to remove any affected lymph nodes in the neck.
Radiotherapy
Radiotherapy can be used to treat salivary gland cancers.
Radiotherapy can be used in conjunction with surgery especially where there is spread to lymph nodes and other parts of the body.
Chemotherapy
Chemotherapy involve the use of anti-cancer drugs to destroy the cancer cells.
It is however not very effective in treating salivary gland cancers and is used only more for the cancer which has spread to the lungs, bones and other parts of the body.
The prognosis of Salivary cancer is usually poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Survival rates are best in the slow growing tumors.
There is no way to prevent salivary gland cancer but proper mouth hygience may hlp to prevent infections and chemicals in the mouth from causing mutations in the salivary gland cells.
Smoking should be avoided if possible.
Thursday, October 28, 2010
A Family Doctor's Tale - LARYNGEAL CANCER
DOC I HAVE LARYNGEAL CANCER
Cancer of the larynx are not that common in a family practice however there are fairly many cases in the ENT Department.
The only patient I saw in my clinic was a elderly man with loss of voice at the age of 55. He was referred to the ENT department after medication did not improve his voice. There a biopsy of the swelling in the larynx show evidence of early cancer. He was treated by surgical removal of the swelling followed by radiotherapy. Happily he was well after the treatment except for still some hoarseness of the voice but there was no recurrence of the cancer.
The cases in the ENT department were different. Most have extensive surgery with tracheostomy. There has to be proper care of the tracheostomy. In most cases the tracheostomy can be closed after reconstructive surgery and speech therapy.
Laryngeal cancer occurs when the cells lining the larynx(the vocal box) become abnormal and proliferates giving rise to cancer cells.
It affects more men than women.
Various causes may be involved:
1.Genes. -males over the age of 55 years are at four times higher
risk than females.
2.Smoking. People who smokes have a higher risk than non smokers
3.Drinking alcohol can increase the risk of laryngeal cancer.
4.Occupation. There is evidence that workers exposed to sulfuric acid and asbestos have a higher risk of developing laryngeal cancer.
The following are symptoms of Laryngeal cancer:
1.Hoarseness or other changes in the voice
2.A painless lump in the neck-usually a lymph node
infiltrated by cancer cells
3.Cough that does not go away
4.Persistent sore throat or a feeling that there is something
stuck in the throat
5.Difficulty in breathing or speaking
6.Ear pain
7.Weight loss
Diagnosis of Laryngeal Cancer is by:
Examination of the throat, vocal cords and neck for abnormal lumps
An endoscope is inserted into the throat to look at the vocal cords and their movement.
The ENT specialist may extract issue (biopsy) which can be sent for testing, to confirm if there is a cancerous growth.
If a tumor is found, magnetic resonance imaging (MRI) can be
used to assess its size.
Treatment depends on the diagnosis of the laryngeal cancer and its spread outside of the vocal box.
Usually most laryngeal cancer are slow spreading.
A.Radiotherapy.
This is the most common treatment for small cancer of the larynx. This involves the use of radiation to attack cancer cells, stopping them from growing or multiplying.
B.Chemotherapy.
This involves the use of anti-cancer medication to treat
the cancer.
For both methods, the patient may experience side-effects such as tiredness and nausea.
Radiotherapy are often used together with chemotherapy.
C.Surgery
Surgery is used only when the cancer can not be treated by
radiotherapy or chemotherapy because the removal of the vocal
cords or the entire larynx can cause the loss of voice.
The lymph node in the neck may also be removed at the same time.
If surgery is done , usually a tracheostomy or hole in the
windpipe is done to allow air to enter or escape from the tubes in the lungs.
Some patient may also require a feeding tube after surgery because swallowing of food is affected by the surgery.
Most people will learn to swallow again so the feeding tube is
temporary.
Early treatment is recommended as it increases the patient's chances of survival.
Delayed action could result in the cancer spreading to other parts of the body, making it more difficult to treat.
Living with a Tracheostomy.
The tracheostomy in the windpipe is necessary for air to enter and leave the lungs.
However the tracheostomy must be kept clean at all time and free of infection. Suction of mucus stuck in the windpipe may be necessary.
It is also dangerous for water to enter the windpipe and the lungs through the tracheostomy opening.
The tracheostomy opening should always be protected with a a
plastic stoma shield or scarf to prevent dust, water or smoke to
enter the windpipe.
After the surgery there may be loss of voice.
A speech therapist is usually needed to teach the patient to learn to speak again.
He can teach the patient to use the oesophagus to force air
through the throat to produce new gutterial sounds.
In the meantime, communication can be done with writing pads or computer.
New electronic and mechanical devices can also produce new
sounds
No one can be fully protected from laryngeal cancer.
However, you can modify your lifestyle practices to reduce your
chances of contracting laryngeal cancer.
Don't smoke. Smoking increases the risk of laryngeal cancer by two to four times. Those who smoke, can still lower their risk by cutting down on the number of cigarettes smoked a day. Better still, quit smoking.
Cancer of the larynx are not that common in a family practice however there are fairly many cases in the ENT Department.
The only patient I saw in my clinic was a elderly man with loss of voice at the age of 55. He was referred to the ENT department after medication did not improve his voice. There a biopsy of the swelling in the larynx show evidence of early cancer. He was treated by surgical removal of the swelling followed by radiotherapy. Happily he was well after the treatment except for still some hoarseness of the voice but there was no recurrence of the cancer.
The cases in the ENT department were different. Most have extensive surgery with tracheostomy. There has to be proper care of the tracheostomy. In most cases the tracheostomy can be closed after reconstructive surgery and speech therapy.
Laryngeal cancer occurs when the cells lining the larynx(the vocal box) become abnormal and proliferates giving rise to cancer cells.
It affects more men than women.
Various causes may be involved:
1.Genes. -males over the age of 55 years are at four times higher
risk than females.
2.Smoking. People who smokes have a higher risk than non smokers
3.Drinking alcohol can increase the risk of laryngeal cancer.
4.Occupation. There is evidence that workers exposed to sulfuric acid and asbestos have a higher risk of developing laryngeal cancer.
The following are symptoms of Laryngeal cancer:
1.Hoarseness or other changes in the voice
2.A painless lump in the neck-usually a lymph node
infiltrated by cancer cells
3.Cough that does not go away
4.Persistent sore throat or a feeling that there is something
stuck in the throat
5.Difficulty in breathing or speaking
6.Ear pain
7.Weight loss
Diagnosis of Laryngeal Cancer is by:
Examination of the throat, vocal cords and neck for abnormal lumps
An endoscope is inserted into the throat to look at the vocal cords and their movement.
The ENT specialist may extract issue (biopsy) which can be sent for testing, to confirm if there is a cancerous growth.
If a tumor is found, magnetic resonance imaging (MRI) can be
used to assess its size.
Treatment depends on the diagnosis of the laryngeal cancer and its spread outside of the vocal box.
Usually most laryngeal cancer are slow spreading.
A.Radiotherapy.
This is the most common treatment for small cancer of the larynx. This involves the use of radiation to attack cancer cells, stopping them from growing or multiplying.
B.Chemotherapy.
This involves the use of anti-cancer medication to treat
the cancer.
For both methods, the patient may experience side-effects such as tiredness and nausea.
Radiotherapy are often used together with chemotherapy.
C.Surgery
Surgery is used only when the cancer can not be treated by
radiotherapy or chemotherapy because the removal of the vocal
cords or the entire larynx can cause the loss of voice.
The lymph node in the neck may also be removed at the same time.
If surgery is done , usually a tracheostomy or hole in the
windpipe is done to allow air to enter or escape from the tubes in the lungs.
Some patient may also require a feeding tube after surgery because swallowing of food is affected by the surgery.
Most people will learn to swallow again so the feeding tube is
temporary.
Early treatment is recommended as it increases the patient's chances of survival.
Delayed action could result in the cancer spreading to other parts of the body, making it more difficult to treat.
Living with a Tracheostomy.
The tracheostomy in the windpipe is necessary for air to enter and leave the lungs.
However the tracheostomy must be kept clean at all time and free of infection. Suction of mucus stuck in the windpipe may be necessary.
It is also dangerous for water to enter the windpipe and the lungs through the tracheostomy opening.
The tracheostomy opening should always be protected with a a
plastic stoma shield or scarf to prevent dust, water or smoke to
enter the windpipe.
After the surgery there may be loss of voice.
A speech therapist is usually needed to teach the patient to learn to speak again.
He can teach the patient to use the oesophagus to force air
through the throat to produce new gutterial sounds.
In the meantime, communication can be done with writing pads or computer.
New electronic and mechanical devices can also produce new
sounds
No one can be fully protected from laryngeal cancer.
However, you can modify your lifestyle practices to reduce your
chances of contracting laryngeal cancer.
Don't smoke. Smoking increases the risk of laryngeal cancer by two to four times. Those who smoke, can still lower their risk by cutting down on the number of cigarettes smoked a day. Better still, quit smoking.
Wednesday, October 27, 2010
A Family Doctor's Tale - KIDNEY CANCER
DOC I HAVE KIDNEY CANCER
Kidney cancer is very rare but so far I have seen 2 cases. Both cases are detected through bleeding in the urine and kidney biopsy.
Treatment of choice is surgical removal of the cancer portion of the kidney or immunotherapy. In both cases the treatment was successful because they were detected early.
Chemotherapy and radiotherapy has not been found to be effective in the treatment of the kidney cancer.
Kidney Cancer is a malignant disease of the kidney.
Causes may be:
1.Hereditary- hereditary kidney cancer is related to the Von Lindau syndrome.
2.Smoking. cigarettes smoke chemicals has been known to damage the Kidney cells
3.Uncontrolled hypertension-damage to kidney cells may contribute to Kidney cancer
4.Obesity has been found to have some causal effect
5.Age - more common in in 50-70 age group
6.Long term dialysis for kidney failure.
Symptoms are non-specific and silent.
In the early stage there is no symptoms.
By the the time the symptoms appeared, the cancer is usually in the advanced stage.
1.painless hematuria or blood in urine
2.pain in the renal flanks
3.Fever
4.weight loss
Signs:
1.tenderness in renal area of backs
2.palpable mass in the side of abdomen
Diagnosis can usually be made by :
1.hematuria
2.Renal flank pain
3.Weight loss
4.Liver function tests
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels) in the absence of liver disease.
5.Ultrasound or abdominal CT
may be used to identify tumors.
6.Kidney Biopsy
biopsy of kidney may be done to determine types of Kidney cancer:
Clear Cell Type: 75%
Papillary type: 20%
Chromophole type: 4%
Others: 1%
Treatment of Kidney cancer can be
Surgery
If the cancer is localised within the kidney , then it is surgically resectable and curable.
No treatment after surgery has been proven to prevent recurrence.
Depending on the size of the cancer, the recurrence rate varies from
10% in Stage I
60% in Stage III
Once recurence occur then the cancer is considered as a Stage IV cancer and therefore incurable.
The aim of treatment then is palliative with emphasis to improve overall survival rates and quality of life.
Immunotherapy
High dose immunotherapy such as interleukin may be able to cure less than 5% of the kidney cancer patients.
It is however toxic and potentially life threatening and is used for patients not suitable for surgery.
Low dose immunotherapy such as interferon is better in that it can relieve symptoms and improve quality of life for an average of 3-6 month in 15% of cases treated.
Despite its low dose the side effects can also affects the treatment of the patients such as fever, chills and loss of appetite.
Biological targeted therapy
These drugs target the growth of the cancer cells by suppressing the cellular pathways which stimulates the growth of the abnormal tumor blood vessels and the tumor cells .
These treatments have been proven to better in terms of better response and length of the disease control compared to interferon and interleukin.
There has also being an improved overall survival rate with a reduced risk of death by 28%.
Side effects are hypertension, ischemia of heart, fatigue, loss of appetite, diarrhea and loss of weight.
The approved drugs are sorafenib, sumitinib and tensirolimus.
Chemotherapy and radiotherapy
Chemotherapy and radiotherapy have been found to be ineffective for renal cancer treatment.
The prognosis of Kidney cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 1 year
3.5-year survival is lower than 5%.
4.Kidney cancer has one of the highest mortality of all the cancers.
Prevention is by doing the following:
Avoid smoking
Reduce weight in obese patients
Control high blood pressure to prevent damage to the kidney
Avoid taking toxic substances which may damage or injure the cells of the kidney.
Kidney cancer is very rare but so far I have seen 2 cases. Both cases are detected through bleeding in the urine and kidney biopsy.
Treatment of choice is surgical removal of the cancer portion of the kidney or immunotherapy. In both cases the treatment was successful because they were detected early.
Chemotherapy and radiotherapy has not been found to be effective in the treatment of the kidney cancer.
Kidney Cancer is a malignant disease of the kidney.
Causes may be:
1.Hereditary- hereditary kidney cancer is related to the Von Lindau syndrome.
2.Smoking. cigarettes smoke chemicals has been known to damage the Kidney cells
3.Uncontrolled hypertension-damage to kidney cells may contribute to Kidney cancer
4.Obesity has been found to have some causal effect
5.Age - more common in in 50-70 age group
6.Long term dialysis for kidney failure.
Symptoms are non-specific and silent.
In the early stage there is no symptoms.
By the the time the symptoms appeared, the cancer is usually in the advanced stage.
1.painless hematuria or blood in urine
2.pain in the renal flanks
3.Fever
4.weight loss
Signs:
1.tenderness in renal area of backs
2.palpable mass in the side of abdomen
Diagnosis can usually be made by :
1.hematuria
2.Renal flank pain
3.Weight loss
4.Liver function tests
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels) in the absence of liver disease.
5.Ultrasound or abdominal CT
may be used to identify tumors.
6.Kidney Biopsy
biopsy of kidney may be done to determine types of Kidney cancer:
Clear Cell Type: 75%
Papillary type: 20%
Chromophole type: 4%
Others: 1%
Treatment of Kidney cancer can be
Surgery
If the cancer is localised within the kidney , then it is surgically resectable and curable.
No treatment after surgery has been proven to prevent recurrence.
Depending on the size of the cancer, the recurrence rate varies from
10% in Stage I
60% in Stage III
Once recurence occur then the cancer is considered as a Stage IV cancer and therefore incurable.
The aim of treatment then is palliative with emphasis to improve overall survival rates and quality of life.
Immunotherapy
High dose immunotherapy such as interleukin may be able to cure less than 5% of the kidney cancer patients.
It is however toxic and potentially life threatening and is used for patients not suitable for surgery.
Low dose immunotherapy such as interferon is better in that it can relieve symptoms and improve quality of life for an average of 3-6 month in 15% of cases treated.
Despite its low dose the side effects can also affects the treatment of the patients such as fever, chills and loss of appetite.
Biological targeted therapy
These drugs target the growth of the cancer cells by suppressing the cellular pathways which stimulates the growth of the abnormal tumor blood vessels and the tumor cells .
These treatments have been proven to better in terms of better response and length of the disease control compared to interferon and interleukin.
There has also being an improved overall survival rate with a reduced risk of death by 28%.
Side effects are hypertension, ischemia of heart, fatigue, loss of appetite, diarrhea and loss of weight.
The approved drugs are sorafenib, sumitinib and tensirolimus.
Chemotherapy and radiotherapy
Chemotherapy and radiotherapy have been found to be ineffective for renal cancer treatment.
The prognosis of Kidney cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 1 year
3.5-year survival is lower than 5%.
4.Kidney cancer has one of the highest mortality of all the cancers.
Prevention is by doing the following:
Avoid smoking
Reduce weight in obese patients
Control high blood pressure to prevent damage to the kidney
Avoid taking toxic substances which may damage or injure the cells of the kidney.
Tuesday, October 26, 2010
A Family Doctor's Tale - BLADDER CANCER
DOC I HAVE BLADDER CANCER
Bladder Cancer is more common in men than in women and always presents with blood in the urine. The bladder is examined with a cystoscope and if the cancer is detected early the tumor is removed surgically. The one patient that I saw had his cancer removed and had chemotherapy irrigation into the bladder. Now 2 years after treatment there was no recurrence of the cancer but he complained of weakness of the legs and occasional body aches.
Bladder cancer is a growth of abnormal cells forming a malignant tumor in the bladder. Most bladder cancers start in the inner lining of the bladder.
There are 2 main types of Bladder Cancer:
1.superficial cancer
the cancer is contained on the inner lining of the bladder,
They may occur as a small, wart-like growths on the inside of the bladder, which can be removed in a simple operation and will never recur
2.invasive cancer
where the cancer has spread into the muscle wall of the bladder.
Examples are:
a.large growth in the muscle wall of the bladder, which requires major
surgery to remove.
b.mushroom-like growths( papillary cancers)on the inside lining of the bladder. They have a short stem attached to the lining of the bladder and can spread into the wall of the bladder.
There are a few factors which increase the risk of getting bladder cancer:
1.Smoking
chemicals in a cigarette have been found to contribute to bladder cancer. The more cigarettes smoked, the greater the risk.
2.Exposure to harmful, cancer-causing chemicals
Certain chemicals at the workplace, for example, those used in dye factories, rubber, gasworks, plastics and other chemical industries, can cause a higher risk of contracting bladder cancer in workers.
It can take about 25 years after exposure to these chemicals before bladder cancer develops.
These chemicals may have been banned in some countries.
3.Frequent bouts of cystitis
Cystitis caused by repeated bacterial infections and bladder stones can lead to the development of bladder cancer.
4.Age and Gender
Bladder cancer occurs mostly among people aged between 50 - 70 years.
It is twice as common in men as in women.
It is rare in people below age 40.
The most common symptom is
1.blood in the urine which usually occurs suddenly and is generally not painful. The blood may not be present constantly but eventually it does recur.In some cases, blood clots can form and these may cause painful muscle spasms in the bladder.
The amount of blood present is however not related to the extent of the cancer.
2. burning feeling when they pass urine.
3. frequency of urination.
While these are also symptoms of bladder irritation, further tests would be necessary if they persist and do not clear with antibiotics.
The treatment for bladder cancer depends on the type of cancer, the stage and grade. It also depends on the health of the patient.
Superficial cancers:
Superficial cancers, which can be single or multiple, are usually removed using a cystoscope. Anti-cancer drugs (chemotherapy or immunotherapy) may be instilled into the bladder to try to prevent the cancer recurring.
Invasive cancers, the options are as follows:
Surgery
The most common treatment method is surgery to remove a part of the bladder. A new bladder is sometimes constructed if it has to be removed.
Radiotherapy
Radiotherapy may be used instead of surgery to avoid removal of the bladder. Radiotherapy may also be used before surgery in cases of large tumours to facilitate the tumour removal or if there is a high risk of cancer cells left behind after surgery.
Chemotherapy
In some cases, chemotherapy is given before surgery or radiotherapy to shrink the tumour so that it can be treated more effectively.
Chemotherapy is also applied after surgery to reduce the recurrence of the tumor.
The drug can be instilled into the bladder to maximise contact with the cancer cells.
Once the cancer has spread outside the bladder, the main treatment is chemotherapy.
Removal of bladder
In a small proportion of people with bladder cancer, the bladder may completely removed.
The surgeon will then give the patients an urostomy - an artificial opening from the urinary tract.
The opening is usually formed on the abdomen, to the right of the navel. Wrinkles, scars and prominent underlying bones must be avoided, as placing the opening near them may cause problems with leakage later on.
Ensure that the bag is emptied and changed as often as necessary. At first the opening will be slightly swollen.
It may take several weeks for it to reduce to its normal size.
There may also be mucus (a thick white substance) from the opening. The amount of mucus will gradually reduce over time but will never disappear completely.
Most people with an urostomy live a normal life. Many return to their jobs and take up their favourite pastimes again, including swimming.
Bladder Cancer is more common in men than in women and always presents with blood in the urine. The bladder is examined with a cystoscope and if the cancer is detected early the tumor is removed surgically. The one patient that I saw had his cancer removed and had chemotherapy irrigation into the bladder. Now 2 years after treatment there was no recurrence of the cancer but he complained of weakness of the legs and occasional body aches.
Bladder cancer is a growth of abnormal cells forming a malignant tumor in the bladder. Most bladder cancers start in the inner lining of the bladder.
There are 2 main types of Bladder Cancer:
1.superficial cancer
the cancer is contained on the inner lining of the bladder,
They may occur as a small, wart-like growths on the inside of the bladder, which can be removed in a simple operation and will never recur
2.invasive cancer
where the cancer has spread into the muscle wall of the bladder.
Examples are:
a.large growth in the muscle wall of the bladder, which requires major
surgery to remove.
b.mushroom-like growths( papillary cancers)on the inside lining of the bladder. They have a short stem attached to the lining of the bladder and can spread into the wall of the bladder.
There are a few factors which increase the risk of getting bladder cancer:
1.Smoking
chemicals in a cigarette have been found to contribute to bladder cancer. The more cigarettes smoked, the greater the risk.
2.Exposure to harmful, cancer-causing chemicals
Certain chemicals at the workplace, for example, those used in dye factories, rubber, gasworks, plastics and other chemical industries, can cause a higher risk of contracting bladder cancer in workers.
It can take about 25 years after exposure to these chemicals before bladder cancer develops.
These chemicals may have been banned in some countries.
3.Frequent bouts of cystitis
Cystitis caused by repeated bacterial infections and bladder stones can lead to the development of bladder cancer.
4.Age and Gender
Bladder cancer occurs mostly among people aged between 50 - 70 years.
It is twice as common in men as in women.
It is rare in people below age 40.
The most common symptom is
1.blood in the urine which usually occurs suddenly and is generally not painful. The blood may not be present constantly but eventually it does recur.In some cases, blood clots can form and these may cause painful muscle spasms in the bladder.
The amount of blood present is however not related to the extent of the cancer.
2. burning feeling when they pass urine.
3. frequency of urination.
While these are also symptoms of bladder irritation, further tests would be necessary if they persist and do not clear with antibiotics.
The treatment for bladder cancer depends on the type of cancer, the stage and grade. It also depends on the health of the patient.
Superficial cancers:
Superficial cancers, which can be single or multiple, are usually removed using a cystoscope. Anti-cancer drugs (chemotherapy or immunotherapy) may be instilled into the bladder to try to prevent the cancer recurring.
Invasive cancers, the options are as follows:
Surgery
The most common treatment method is surgery to remove a part of the bladder. A new bladder is sometimes constructed if it has to be removed.
Radiotherapy
Radiotherapy may be used instead of surgery to avoid removal of the bladder. Radiotherapy may also be used before surgery in cases of large tumours to facilitate the tumour removal or if there is a high risk of cancer cells left behind after surgery.
Chemotherapy
In some cases, chemotherapy is given before surgery or radiotherapy to shrink the tumour so that it can be treated more effectively.
Chemotherapy is also applied after surgery to reduce the recurrence of the tumor.
The drug can be instilled into the bladder to maximise contact with the cancer cells.
Once the cancer has spread outside the bladder, the main treatment is chemotherapy.
Removal of bladder
In a small proportion of people with bladder cancer, the bladder may completely removed.
The surgeon will then give the patients an urostomy - an artificial opening from the urinary tract.
The opening is usually formed on the abdomen, to the right of the navel. Wrinkles, scars and prominent underlying bones must be avoided, as placing the opening near them may cause problems with leakage later on.
Ensure that the bag is emptied and changed as often as necessary. At first the opening will be slightly swollen.
It may take several weeks for it to reduce to its normal size.
There may also be mucus (a thick white substance) from the opening. The amount of mucus will gradually reduce over time but will never disappear completely.
Most people with an urostomy live a normal life. Many return to their jobs and take up their favourite pastimes again, including swimming.
Monday, October 25, 2010
A Family Doctor's Tale - LIVER CANCER
DOC I HAVE LIVER CANCER
Liver cancer is one of most dangerous cancer
because the liver detoxify a lot of poisons in the body. Once the liver is damaged the organ can shut down together with the heart and brain. Any liver cancer is dangerous and need to be treated urgently. Liver transplant is still the best treatment for liver cancer if there is no spread. Chemotherapy may be dangerous because it may damage the liver more.
Hepatitis B and C infections are major causes of Liver Cancer.
Liver Cancer develops when the liver cells undergo abnormal changes to form cancer cells.
Most Primary cancer of the liver begins as mutated hepatocytes(liver cells).
Secondary cancer of the liver is due to spread from the stomach, colon, breast, lungs, ovaries etc
Liver cancer is one of the most common cancer.
It occurs in men more than women.
It is more common in the 40s and 50s age groups.
The main risk factor for liver cancer is
1.Hepatitis B infection.
Other important risk factors include
2.Hepatitis C infection
3.alcoholic liver disease (disease of the liver caused by heavy alcohol consumption).
4.family history of liver cancer
5.Chemicals exposures such as nitrites,solvents, hydrocarbons,viny chloride
7.poisons (e.g. aflatoxin present in some spoilt or mouldy peanuts).
8.inherited liver diseases (alpha-1 anti-trypsin deficiency)
9.Drug abuse eg heroin
10.Smoking
During the early stages, most people with liver cancer do not show any signs or symptoms. Signs and symptoms, when they do appear, include:
1.loss of appetite and weight
2.discomfort or swelling in the upper part of the abdomen on the right side
3.weakness and fatigue
4.nausea and vomiting
5.jaundice - yellowness of the skin and eyes
6.dark color urine
7.Persistent or swinging fever
Diagnosis of Liver Cancer is based on:
1.full medical history especially history of Hepatitis B and alcohol
2. full examination especially of the liver
3.an ultrasound scan of the liver and gallbladder, if possible the whole abdomen.
4.CT scan or MRI of the liver and surrounding tissues
5.blood tests (a protein present in blood called the alpha- fetoprotein or AFP may be found to be raised in liver cancer)
6.liver biopsy into the liver swelling as detected by ultrasound or MRI (to confirm the liver cancer).
With the diagnosis confirmed, the doctor will proceed with further tests to find out how advanced the liver cancer is. This will help the doctor to plan the treatment.
As in all cancers, treatment includes surgery, radiation therapy, chemotherapy.
In Liver cancer percutaneous ethanol (alcohol) injection is injected directly into the tumour, by means of a small needle, to kill the cancerous cells.
Liver transplant can also be carried out in selected cases where the size of the cancer is not too massive but surgery is not feasible due to the patient's limited liver reserve(provided a suitable liver donor can be found).
Treatment depends on the the stage of the cancer as well as health of the affected person.
The goal of treatment is complete cure.
However, where this is not possible, treatment is aimed at preventing the tumour from spreading or growing.
Helping to eliminate uncomfortable symptoms is also an important aspect of liver cancer treatment.
Prevention from getting liver cancer is by taking steps to reduce your risk factors.
1. Reduce your risk of Hepatitis B by getting vaccinated. The Hepatitis B vaccine is safe and effective.
Both Hepatitis B and C are spread through infected blood or sexual fluids as well as intravenous drug abuse. It is therefore important to avoid activities that put you at risk:
2.Avoid multiple sex partners and having sex with commercial sex workers, strangers or anyone with multiple sex partners.
3.Do not abuse drugs or share injection needles.
4.Never share personal items like razors, toothbrushes or other items that may cause breaks in the skin.
5.Visit only reliable operators for ear/body piercing, tattooing or acupuncture.
6.It is also important that you limit your consumption of alcohol as excessive drinking can give rise to liver disease and increase your risk of liver cancer.
The liver is one of the largest and most important organs in your body. It performs many essential functions including:
making and storing of essential nutrients
making important hormones and enzymes
breaking down harmful substances.
Do not abuse Your LIVER by excessive drinking or taking drugs!
Liver cancer is one of most dangerous cancer
because the liver detoxify a lot of poisons in the body. Once the liver is damaged the organ can shut down together with the heart and brain. Any liver cancer is dangerous and need to be treated urgently. Liver transplant is still the best treatment for liver cancer if there is no spread. Chemotherapy may be dangerous because it may damage the liver more.
Hepatitis B and C infections are major causes of Liver Cancer.
Liver Cancer develops when the liver cells undergo abnormal changes to form cancer cells.
Most Primary cancer of the liver begins as mutated hepatocytes(liver cells).
Secondary cancer of the liver is due to spread from the stomach, colon, breast, lungs, ovaries etc
Liver cancer is one of the most common cancer.
It occurs in men more than women.
It is more common in the 40s and 50s age groups.
The main risk factor for liver cancer is
1.Hepatitis B infection.
Other important risk factors include
2.Hepatitis C infection
3.alcoholic liver disease (disease of the liver caused by heavy alcohol consumption).
4.family history of liver cancer
5.Chemicals exposures such as nitrites,solvents, hydrocarbons,viny chloride
7.poisons (e.g. aflatoxin present in some spoilt or mouldy peanuts).
8.inherited liver diseases (alpha-1 anti-trypsin deficiency)
9.Drug abuse eg heroin
10.Smoking
During the early stages, most people with liver cancer do not show any signs or symptoms. Signs and symptoms, when they do appear, include:
1.loss of appetite and weight
2.discomfort or swelling in the upper part of the abdomen on the right side
3.weakness and fatigue
4.nausea and vomiting
5.jaundice - yellowness of the skin and eyes
6.dark color urine
7.Persistent or swinging fever
Diagnosis of Liver Cancer is based on:
1.full medical history especially history of Hepatitis B and alcohol
2. full examination especially of the liver
3.an ultrasound scan of the liver and gallbladder, if possible the whole abdomen.
4.CT scan or MRI of the liver and surrounding tissues
5.blood tests (a protein present in blood called the alpha- fetoprotein or AFP may be found to be raised in liver cancer)
6.liver biopsy into the liver swelling as detected by ultrasound or MRI (to confirm the liver cancer).
With the diagnosis confirmed, the doctor will proceed with further tests to find out how advanced the liver cancer is. This will help the doctor to plan the treatment.
As in all cancers, treatment includes surgery, radiation therapy, chemotherapy.
In Liver cancer percutaneous ethanol (alcohol) injection is injected directly into the tumour, by means of a small needle, to kill the cancerous cells.
Liver transplant can also be carried out in selected cases where the size of the cancer is not too massive but surgery is not feasible due to the patient's limited liver reserve(provided a suitable liver donor can be found).
Treatment depends on the the stage of the cancer as well as health of the affected person.
The goal of treatment is complete cure.
However, where this is not possible, treatment is aimed at preventing the tumour from spreading or growing.
Helping to eliminate uncomfortable symptoms is also an important aspect of liver cancer treatment.
Prevention from getting liver cancer is by taking steps to reduce your risk factors.
1. Reduce your risk of Hepatitis B by getting vaccinated. The Hepatitis B vaccine is safe and effective.
Both Hepatitis B and C are spread through infected blood or sexual fluids as well as intravenous drug abuse. It is therefore important to avoid activities that put you at risk:
2.Avoid multiple sex partners and having sex with commercial sex workers, strangers or anyone with multiple sex partners.
3.Do not abuse drugs or share injection needles.
4.Never share personal items like razors, toothbrushes or other items that may cause breaks in the skin.
5.Visit only reliable operators for ear/body piercing, tattooing or acupuncture.
6.It is also important that you limit your consumption of alcohol as excessive drinking can give rise to liver disease and increase your risk of liver cancer.
The liver is one of the largest and most important organs in your body. It performs many essential functions including:
making and storing of essential nutrients
making important hormones and enzymes
breaking down harmful substances.
Do not abuse Your LIVER by excessive drinking or taking drugs!
Sunday, October 24, 2010
A Family Doctor's Tale - STOMACH CANCER
DOC I HAVE STOMACH CANCER
Stomach cancer can affect young people and older people.
Men are more often affected than women. So far the patients that I have seen were mostly men. One was a 27 year patient whom I sent for gastroscopy for suspected gastric ulcer. The surgeon who did the gastroscopy did a biopsy of the ulcer region. The biopsy showed very early cancer cells. He was treated with surgery followed by chemotherapy. Now after 10 years he is in perfect health.
The patient involved a 62 year old man who is still undergoing chemotherapy but his prognosis is poor.
The incidence of stomach is apparently higher in people with Blood group A and also those with helicobacter pylori infection.
Stomach cancer (also called “gastric cancer”) is the growth of abnormal cells in the lining and wall of the stomach which mutates and proliferates giving rise to the stomach cancer growth. Stomach Cancer can spread to the surrounding organs like liver,pancreas and colon. Once in the blood stream it can spread to the brain, bones and kidneys.
1. Chronic Helicobacter pylori bacteria infection.
This bacteria is found in the stomach and has been found to cause gastric ulcers and stomach cancer.
2. family history of stomach cancer
3. frequent consumption of preserved or smoked food such as salted vegetables,fish,meat. Cancer causing nitrosamines are released when these food are cooked.
4.previous stomach surgery with partial removal of stomach (gastric ulcers or polyps)
5. Pernicious anaemia- a rare blood disorder
6. Smoking
7. Men are affected more than women
8. Age above 50 years of age
9.People with blood group A has a higher risk
In the early stages, stomach cancer may have no symptoms. As it spread it can cause the following symptoms:
1.Indigestion, stomach discomfort or heartburn
2.A fullness feeling or bloating after eating a small meal
3. loss of appetite
4.Nausea or belching
5. Feeling tired
When the cancer is larger, it can cause the following symptoms:
1.Stomach pain
2.Vomiting
3.Blood in your stool or black tarry stools
4.Unexplained weight loss
5.pallor
Many of these symptoms can be caused by other conditions besides cancer. So the earlier stomach cancer is found, the better are the chances of it being cured.
Diagnosis of stomach cancer is based on:
1.medical history and complete physical exam.
2.Abdominal X-ray for any other condition in the abdomen causing pain
3.Gastroscopy: a thin, lighted tube is put into your mouth and passed down to your stomach.
4.Biopsy: During gastrocopy, a small piece of your suspicious stomach tissue is taken to check for cancer cells. This is called a biopsy sample which is then examined under a microscope for cancer cells.
Treatment for stomach cancer may include surgery, chemotherapy or radiation therapy, or a combination of these treatments.
The choice of treatment depends on whether the cancer is just in the stomach or if it has spread to other places in the body.
A person’s age and overall health will also affect the choice of treatment.
Surgery
Surgery is still the best form of treatment for stomach cancer.
For smaller cancers -partial removal of the stomach is done. In early stages cure rate is about 90%.
For later stages of cancer, the whole stomach including the spleen and surrounding tissues may be removed.
Chemotherapy
Chemotherapy is used in conjunction with surgery in later stges of cancer.
Radiotherapy:
Radiation can help to kill the cancer cells surrounding the stomach cancer as well as to relieve pain.
There is no way to prevent stomach cancer.
However, you can help reduce your risk of getting stomach cancer by:
Living a healthy lifestyle
Not drinking a lot of alcohol or smoking.
Avoid preserved food
Treat H.pyrori infections of the stomach early.
Eat a diet high in fresh fruits and vegetables, and vitamin C. Vitamin C is found in foods such as oranges, grapefruit and broccoli.
Stomach cancer can affect young people and older people.
Men are more often affected than women. So far the patients that I have seen were mostly men. One was a 27 year patient whom I sent for gastroscopy for suspected gastric ulcer. The surgeon who did the gastroscopy did a biopsy of the ulcer region. The biopsy showed very early cancer cells. He was treated with surgery followed by chemotherapy. Now after 10 years he is in perfect health.
The patient involved a 62 year old man who is still undergoing chemotherapy but his prognosis is poor.
The incidence of stomach is apparently higher in people with Blood group A and also those with helicobacter pylori infection.
Stomach cancer (also called “gastric cancer”) is the growth of abnormal cells in the lining and wall of the stomach which mutates and proliferates giving rise to the stomach cancer growth. Stomach Cancer can spread to the surrounding organs like liver,pancreas and colon. Once in the blood stream it can spread to the brain, bones and kidneys.
1. Chronic Helicobacter pylori bacteria infection.
This bacteria is found in the stomach and has been found to cause gastric ulcers and stomach cancer.
2. family history of stomach cancer
3. frequent consumption of preserved or smoked food such as salted vegetables,fish,meat. Cancer causing nitrosamines are released when these food are cooked.
4.previous stomach surgery with partial removal of stomach (gastric ulcers or polyps)
5. Pernicious anaemia- a rare blood disorder
6. Smoking
7. Men are affected more than women
8. Age above 50 years of age
9.People with blood group A has a higher risk
In the early stages, stomach cancer may have no symptoms. As it spread it can cause the following symptoms:
1.Indigestion, stomach discomfort or heartburn
2.A fullness feeling or bloating after eating a small meal
3. loss of appetite
4.Nausea or belching
5. Feeling tired
When the cancer is larger, it can cause the following symptoms:
1.Stomach pain
2.Vomiting
3.Blood in your stool or black tarry stools
4.Unexplained weight loss
5.pallor
Many of these symptoms can be caused by other conditions besides cancer. So the earlier stomach cancer is found, the better are the chances of it being cured.
Diagnosis of stomach cancer is based on:
1.medical history and complete physical exam.
2.Abdominal X-ray for any other condition in the abdomen causing pain
3.Gastroscopy: a thin, lighted tube is put into your mouth and passed down to your stomach.
4.Biopsy: During gastrocopy, a small piece of your suspicious stomach tissue is taken to check for cancer cells. This is called a biopsy sample which is then examined under a microscope for cancer cells.
Treatment for stomach cancer may include surgery, chemotherapy or radiation therapy, or a combination of these treatments.
The choice of treatment depends on whether the cancer is just in the stomach or if it has spread to other places in the body.
A person’s age and overall health will also affect the choice of treatment.
Surgery
Surgery is still the best form of treatment for stomach cancer.
For smaller cancers -partial removal of the stomach is done. In early stages cure rate is about 90%.
For later stages of cancer, the whole stomach including the spleen and surrounding tissues may be removed.
Chemotherapy
Chemotherapy is used in conjunction with surgery in later stges of cancer.
Radiotherapy:
Radiation can help to kill the cancer cells surrounding the stomach cancer as well as to relieve pain.
There is no way to prevent stomach cancer.
However, you can help reduce your risk of getting stomach cancer by:
Living a healthy lifestyle
Not drinking a lot of alcohol or smoking.
Avoid preserved food
Treat H.pyrori infections of the stomach early.
Eat a diet high in fresh fruits and vegetables, and vitamin C. Vitamin C is found in foods such as oranges, grapefruit and broccoli.
Saturday, October 23, 2010
A Family Doctor's Tale - OVARIAN CANCER
DOC I HAVE OVARIAN CANCER
Ovarian cancer can occur in relatively young girls as well in older women . The cases that I have seen involved a 12 year old girl whose enlarged lower abdomen although painless made her mother worried. I examined her and found that there was large swelling in the region of the left lower abdomen. A X-ray of the abdomen confirmed that it was an ovarian tumor.I quickly got a surgeon to see her as soon as possible. It turned out to be an ovarian cancer. Although the cancerous ovary was removed, there was spread outside of the ovary . She was put on chemotherapy and after 5 years she was well and now doing her study in the university.
The parents were so relieved that she manage to survive her ordeal.
Ovarian Cancer is a disease which cause abnormal cells in the ovary to proliferate and spread to the rest of the ovary or outside the ovary.
The most common type, the epithelial carcinoma that begins from the surface of the ovary is discussed here.
The cause of cancer of the ovary is unknown. However, studies show that certain factors may increase the chance of developing this disease.
1.family history of ovarian cancer.
2.history of cancer of the breast or colon.
3.age over 60 years.
4. Infertility or not having children. The more children you have, the lesser your risk is.
5.Early menstruation before the age of 12
6.late menopause
7.high fat diet
8.Use of fertility drugs, or Hormone Replacement Therapy (HRT).
Attempts are being made to detect early stages of ovarian cancer, especially among women who have an increased risk. A blood test is done to check for a substance called CA 125. If the sample contains raised amounts of CA 125, you may be given an ultrasound scan to see if your ovaries appear abnormal in any way.
Ovarian cancer is the most dangerous of gynaecological cancers because it is often silent and difficult to detect.
There is no early detection method, so you must be vigilant and take note of persistent warning signs seriously.
If you are having some of the following symptoms persisting for more than a week or so, see your doctor.
1.Vague gastrointestinal symptoms such as gas, indigestion, nausea and a bloated feeling
2.Swelling in the abdomen, unexplained weight gain
3.Pelvic or abdominal pain or discomfort, and/or feeling of fullness
Backache
4.Urinary symptoms e.g. frequency and/or urgency of urination in the absence of an infection
5.Unexplained or changes in bowel habits
6.Loss of appetite/loss of weight
7.backache or pain in the legs
8.Abnormal vaginal bleeding, although this is rare
If you do have any of the above symptoms you must have them checked by your doctor. Remember, they are non specific and most women with these symptoms will not have cancer.
If you are at risk of ovarian cancer, see your gynaecologist regularly.
A following may be done:
recto-vaginal bimanual pelvic exam,
Pap smear,
blood test for CA-125
transvaginal ultrasound
Treatment depends on a number of factors, including the stage of the disease (the extent of spread of the disease) and the general health of the patient.
Surgery, chemotherapy and various types of radiotherapy may be used alone, or in combination to treat ovarian cancer.
Surgery
Surgery is normally the first choice of treatment for ovarian cancer, and may sometimes also be needed to make the diagnosis.
If detected is in the early stages, surgery is all the treatment that may be required. The ovaries, fallopian tubes, uterus and cervix are usually removed. The omentum (thin tissue covering the stomach and intestines) and lymph nodes (small organs located along the channels of the lymphatic system) in the abdomen are often removed too.
If the surgeon feels the cancer may be difficult to remove, a few cycles of chemotherapy may be applied first and surgery carried out thereafter, in the hope that the tumor would have been reduced.
Chemotherapy
Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control cancer growth or to relieve symptoms of the disease. Sometimes a few cycles of chemotherapy may have to be applied before surgery is carried out.
Radiotherapy
Radiotherapy is less commonly used in this cancer but may sometimes be used to treat individual spots of cancer which have recurred after surgery and chemotherapy.
Ovarian cancer can occur in relatively young girls as well in older women . The cases that I have seen involved a 12 year old girl whose enlarged lower abdomen although painless made her mother worried. I examined her and found that there was large swelling in the region of the left lower abdomen. A X-ray of the abdomen confirmed that it was an ovarian tumor.I quickly got a surgeon to see her as soon as possible. It turned out to be an ovarian cancer. Although the cancerous ovary was removed, there was spread outside of the ovary . She was put on chemotherapy and after 5 years she was well and now doing her study in the university.
The parents were so relieved that she manage to survive her ordeal.
Ovarian Cancer is a disease which cause abnormal cells in the ovary to proliferate and spread to the rest of the ovary or outside the ovary.
The most common type, the epithelial carcinoma that begins from the surface of the ovary is discussed here.
The cause of cancer of the ovary is unknown. However, studies show that certain factors may increase the chance of developing this disease.
1.family history of ovarian cancer.
2.history of cancer of the breast or colon.
3.age over 60 years.
4. Infertility or not having children. The more children you have, the lesser your risk is.
5.Early menstruation before the age of 12
6.late menopause
7.high fat diet
8.Use of fertility drugs, or Hormone Replacement Therapy (HRT).
Attempts are being made to detect early stages of ovarian cancer, especially among women who have an increased risk. A blood test is done to check for a substance called CA 125. If the sample contains raised amounts of CA 125, you may be given an ultrasound scan to see if your ovaries appear abnormal in any way.
Ovarian cancer is the most dangerous of gynaecological cancers because it is often silent and difficult to detect.
There is no early detection method, so you must be vigilant and take note of persistent warning signs seriously.
If you are having some of the following symptoms persisting for more than a week or so, see your doctor.
1.Vague gastrointestinal symptoms such as gas, indigestion, nausea and a bloated feeling
2.Swelling in the abdomen, unexplained weight gain
3.Pelvic or abdominal pain or discomfort, and/or feeling of fullness
Backache
4.Urinary symptoms e.g. frequency and/or urgency of urination in the absence of an infection
5.Unexplained or changes in bowel habits
6.Loss of appetite/loss of weight
7.backache or pain in the legs
8.Abnormal vaginal bleeding, although this is rare
If you do have any of the above symptoms you must have them checked by your doctor. Remember, they are non specific and most women with these symptoms will not have cancer.
If you are at risk of ovarian cancer, see your gynaecologist regularly.
A following may be done:
recto-vaginal bimanual pelvic exam,
Pap smear,
blood test for CA-125
transvaginal ultrasound
Treatment depends on a number of factors, including the stage of the disease (the extent of spread of the disease) and the general health of the patient.
Surgery, chemotherapy and various types of radiotherapy may be used alone, or in combination to treat ovarian cancer.
Surgery
Surgery is normally the first choice of treatment for ovarian cancer, and may sometimes also be needed to make the diagnosis.
If detected is in the early stages, surgery is all the treatment that may be required. The ovaries, fallopian tubes, uterus and cervix are usually removed. The omentum (thin tissue covering the stomach and intestines) and lymph nodes (small organs located along the channels of the lymphatic system) in the abdomen are often removed too.
If the surgeon feels the cancer may be difficult to remove, a few cycles of chemotherapy may be applied first and surgery carried out thereafter, in the hope that the tumor would have been reduced.
Chemotherapy
Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control cancer growth or to relieve symptoms of the disease. Sometimes a few cycles of chemotherapy may have to be applied before surgery is carried out.
Radiotherapy
Radiotherapy is less commonly used in this cancer but may sometimes be used to treat individual spots of cancer which have recurred after surgery and chemotherapy.
Friday, October 22, 2010
A Family Doctor's Tale - CERVIX CANCER
DOC I HAVE CERVICAL CANCER
Cervical cancer is a fairly common cancer in Singapore. There is a relationship with sexually transmitted human papilloma virus ( or genital warts) so sexually active women should go for a Pap's smear at least once a year or once in 2 years. Treatment is effective if detected early. Unfortunately many cases may be detected late.
Now there are 2 vaccines which can be used to prevent infection by the human papilloma virus. There is wide spread vaccination of school girls and females in England.
Cervical cancer is a common cancer in women which affects the cervix (the neck of the womb).
All women aged between 25 and 69 who:
Ever had sex
Had multiple sexual partners
Had sexually transmitted infections (STI) e.g. genital warts, genital herpes and human papilloma virus infection
If you experience the following, see your doctor about it right away.
Vaginal bleeding after sexual intercourse
Irregular bleeding in between periods or after menopause
Foul-smelling vaginal discharge
As with breast cancer, the initial stages of cervical cancer are painless, so women may not know it. Regular screening detects abnormal changes in the cervical cells and prevents cancer.
To check if you may have cervical cancer, go for a Pap smear test. This is simple, quick, safe and is usually painless procedure. If you have had sex before or are sexually active, you should go for a Pap smear once every 3 years.
Pap smears are available at all hospitals, most private clinics and the local Cancer Society.
If the Pap smear is positive, a colposcopy (examination of the inner lining of the womb) followed by cone biopsy of any suspicious area may be done.
In the pre-cancer stage of of the cervix, removal of all the abnormal tissues can be done by a cone biopsy. Repeated Pap smears must be done to confirm that there is no recurrence of the cancer.
In all cases of established cancer of the cervix(stage II - IV), surgery is done with removal of the womb followed by radiotherapy( external or internal).
Reviews of the woman's condition is done regularly.
Sexual intercourse should be avoided temporarily after treatment.
Normal physical and social activities may be resumed in 2-3 month after treatment.
So take steps now to protect yourself against cancer.
Encourage your loved ones to go for screening if they have not done so.
Bear in mind that a pro-active approach with regular clinical screening is to prevent common cancers like breast and cervical cancers from affecting your lives.
Cervical cancer is a fairly common cancer in Singapore. There is a relationship with sexually transmitted human papilloma virus ( or genital warts) so sexually active women should go for a Pap's smear at least once a year or once in 2 years. Treatment is effective if detected early. Unfortunately many cases may be detected late.
Now there are 2 vaccines which can be used to prevent infection by the human papilloma virus. There is wide spread vaccination of school girls and females in England.
Cervical cancer is a common cancer in women which affects the cervix (the neck of the womb).
All women aged between 25 and 69 who:
Ever had sex
Had multiple sexual partners
Had sexually transmitted infections (STI) e.g. genital warts, genital herpes and human papilloma virus infection
If you experience the following, see your doctor about it right away.
Vaginal bleeding after sexual intercourse
Irregular bleeding in between periods or after menopause
Foul-smelling vaginal discharge
As with breast cancer, the initial stages of cervical cancer are painless, so women may not know it. Regular screening detects abnormal changes in the cervical cells and prevents cancer.
To check if you may have cervical cancer, go for a Pap smear test. This is simple, quick, safe and is usually painless procedure. If you have had sex before or are sexually active, you should go for a Pap smear once every 3 years.
Pap smears are available at all hospitals, most private clinics and the local Cancer Society.
If the Pap smear is positive, a colposcopy (examination of the inner lining of the womb) followed by cone biopsy of any suspicious area may be done.
In the pre-cancer stage of of the cervix, removal of all the abnormal tissues can be done by a cone biopsy. Repeated Pap smears must be done to confirm that there is no recurrence of the cancer.
In all cases of established cancer of the cervix(stage II - IV), surgery is done with removal of the womb followed by radiotherapy( external or internal).
Reviews of the woman's condition is done regularly.
Sexual intercourse should be avoided temporarily after treatment.
Normal physical and social activities may be resumed in 2-3 month after treatment.
So take steps now to protect yourself against cancer.
Encourage your loved ones to go for screening if they have not done so.
Bear in mind that a pro-active approach with regular clinical screening is to prevent common cancers like breast and cervical cancers from affecting your lives.
Thursday, October 21, 2010
A Family Doctor's Tale - NASOPHARYNGEAL CANCER
DOC I HAVE NASOPHARYNGEAL CANCER
Nasopharyngeal Cancer is one of the deadly cancer because of the difficulty in diagnosis and because it is close to the brain.
My father in law has NPC in the 1970. Treatment was concentrated on radiotherapy at the site of the cancer. Unlike the present gamma-ray knife treatment which can pin point the exact site of the cancer, in the past the old deep X-ray treatment could only target the area of the cancer. The side effects of burns to the skin and clotting of arteries to the brain caused a lot of discomfort to the patient. There is loss of smell and taste with loss of appetite. It is important to be aware of the disease and early detection for treatment to be effective.
Nasopharyngeal cancer, commonly referred to as NPC, occurs when the cells lining the nasopharynx (area behind the nose and above the back of the throat) become abnormal and proliferates giving rise to cancer cells.
It affects more men than women.
Various contributing factors may be involved:
1.Genes. -males between the ages of 20-50 from southern China and Southeast Asia are at higher risk.
2.Diet. such as preserved foods ( salted fish, vegetables and meat) can cause a higher risk of NPC. Cooking of such food releases toxic substances called nitrosamines into the fumes that we breathe.
Many NPC patients consumed much less fresh fruit and vegetables.
3.Virus. There is evidence that NPC patients have higher levels of the Epstein-Barr virus in their blood. The Epstein-Barr virus activating substances have been detected in a number of these preserved foods.
4.Smoking
The following are symptoms of nasopharyngeal cancer:
A painless lump in the neck-usually a lymph node infiltrated by cancer cells
Nosebleed or blood stained sputum
Blocking of one or both nostrils
Loss of hearing, or ringing in the ear
Discharge from the ear
Blurred or double vision
Difficulty in breathing or speaking
Persistant Sore throat
Paralysis of one side of the face
Headaches
Examination of the upper part of the nose for swelling or lumps.
An endoscope is inserted into the nose. The ENT specialist may extract tissue which can be sent for testing, to confirm if there is a cancerous growth.
If a tumor is found, magnetic resonance imaging (MRI) can be used to assess its size.
Patients may also be tested for the presence of the Epstein-Barr virus in their systems. This is used to indicate the likelihood of contracting NPC.
No one can be fully protected from NPC.
However, you can modify your lifestyle practices to reduce your chances of contracting NPC.
Avoid preserved foods at an early age.
Eat fresh fruit and vegetables. Studies ave found that citrus fruits (rich in Vitamin C) and orange-coloured vegetables (eg, carrots and sweet potatoes), tomatoes, and dark green vegetables (all rich in carotenoids) also help lower the chances of contracting NPC.
Don't smoke. Smoking increases the risk of NPC by two to four times. Those who smoke, can still lower their risk by cutting down on the number of cigarettes smoked a day. Better still, quit smoking.
Treatment
Radiotherapy. This is the most common treatment. This involves the use of radiation to attack cancer cells, stopping them from growing or multiplying.
Chemotherapy. This involves the use of medication to treat the cancer.
For both methods, the patient may experience side-effects such as tiredness and nausea.
Surgery is seldom because of the danger of cutting tissues too close to the brain.
Early treatment is recommended as it increases the patient's chances of survival. Delayed action could result in the cancer spreading to other parts of the body, making it more difficult to treat.
Nasopharyngeal Cancer is one of the deadly cancer because of the difficulty in diagnosis and because it is close to the brain.
My father in law has NPC in the 1970. Treatment was concentrated on radiotherapy at the site of the cancer. Unlike the present gamma-ray knife treatment which can pin point the exact site of the cancer, in the past the old deep X-ray treatment could only target the area of the cancer. The side effects of burns to the skin and clotting of arteries to the brain caused a lot of discomfort to the patient. There is loss of smell and taste with loss of appetite. It is important to be aware of the disease and early detection for treatment to be effective.
Nasopharyngeal cancer, commonly referred to as NPC, occurs when the cells lining the nasopharynx (area behind the nose and above the back of the throat) become abnormal and proliferates giving rise to cancer cells.
It affects more men than women.
Various contributing factors may be involved:
1.Genes. -males between the ages of 20-50 from southern China and Southeast Asia are at higher risk.
2.Diet. such as preserved foods ( salted fish, vegetables and meat) can cause a higher risk of NPC. Cooking of such food releases toxic substances called nitrosamines into the fumes that we breathe.
Many NPC patients consumed much less fresh fruit and vegetables.
3.Virus. There is evidence that NPC patients have higher levels of the Epstein-Barr virus in their blood. The Epstein-Barr virus activating substances have been detected in a number of these preserved foods.
4.Smoking
The following are symptoms of nasopharyngeal cancer:
A painless lump in the neck-usually a lymph node infiltrated by cancer cells
Nosebleed or blood stained sputum
Blocking of one or both nostrils
Loss of hearing, or ringing in the ear
Discharge from the ear
Blurred or double vision
Difficulty in breathing or speaking
Persistant Sore throat
Paralysis of one side of the face
Headaches
Examination of the upper part of the nose for swelling or lumps.
An endoscope is inserted into the nose. The ENT specialist may extract tissue which can be sent for testing, to confirm if there is a cancerous growth.
If a tumor is found, magnetic resonance imaging (MRI) can be used to assess its size.
Patients may also be tested for the presence of the Epstein-Barr virus in their systems. This is used to indicate the likelihood of contracting NPC.
No one can be fully protected from NPC.
However, you can modify your lifestyle practices to reduce your chances of contracting NPC.
Avoid preserved foods at an early age.
Eat fresh fruit and vegetables. Studies ave found that citrus fruits (rich in Vitamin C) and orange-coloured vegetables (eg, carrots and sweet potatoes), tomatoes, and dark green vegetables (all rich in carotenoids) also help lower the chances of contracting NPC.
Don't smoke. Smoking increases the risk of NPC by two to four times. Those who smoke, can still lower their risk by cutting down on the number of cigarettes smoked a day. Better still, quit smoking.
Treatment
Radiotherapy. This is the most common treatment. This involves the use of radiation to attack cancer cells, stopping them from growing or multiplying.
Chemotherapy. This involves the use of medication to treat the cancer.
For both methods, the patient may experience side-effects such as tiredness and nausea.
Surgery is seldom because of the danger of cutting tissues too close to the brain.
Early treatment is recommended as it increases the patient's chances of survival. Delayed action could result in the cancer spreading to other parts of the body, making it more difficult to treat.
Wednesday, October 20, 2010
A Family Doctor's Tale - MYELOMA
DOC I HAVE MYELOMA
Multiple myeloma is a cancer affecting patients 50 years and above. It is sad because patients who have been working so hard and on the way to enjoying their retirement are striked down by the disease. One notable case was a good friend of mine who was so fit and healthy.
He suddenly had breathing problem and went for a complete checkup only to be diagnosed as a multiple myeloma patient. He fought the illness for four years before finally succumbing to it.
Multiple myeloma is cancer of the bone marrow which occurs from the uncontrolled growth of plasma cells, a form of immune-protective white blood cells.Normally plasma cells make antibodies to fight infections.
The disease is called multiple myeloma because myeloma cells can occur in multiple bone marrow sites in your body.
Common multiple myeloma symptoms include:
1.Bone pain.
2.Presence of abnormal proteins — which can be produced by myeloma cells — in your blood or urine. These proteins — which are antibodies or parts of antibodies — are called monoclonal, or M, proteins. Often discovered during a routine exam, monoclonal proteins may indicate multiple myeloma, but also can indicate other conditions.
3.High level of calcium in your blood. This can occur when calcium from affected bones dissolves into your blood.
If you have a high calcium level in your blood, you may experience signs and symptoms such as:
2.Excessive thirst and urination
3.Constipation
4.Nausea
5.Loss of appetite
6.Mental confusion
7.Anemia can occur as myeloma cells replace oxygen-carrying red blood cells in your bone marrow, which may lead to another 8.fatigue.
Although the exact cause isn't known, doctors do know that multiple myeloma begins with one abnormal plasma cell in your bone marrow . This abnormal cell then starts to multiply.
Because abnormal cells don't mature and then die as normal cells do, they accumulate slowly reducing the number of healthy cells.
Because myeloma cells may circulate in low numbers in your blood, they can populate other bone marrow sites in your body, even far from where they began. Uncontrolled plasma cell growth can damage bones and surrounding tissue.
Factors that may increase your risk of multiple myeloma include:
1Age. The majority of people who develop multiple myeloma are older than 50, with most diagnosed around age 70. Few cases occur in people younger than 40.
2.Sex. Men are more likely to develop the disease than are women.
Race. Blacks are about twice as likely to develop multiple myeloma as are whites.
3.History of a monoclonal gammopathy of undetermined significance. Every year 1 percent of the people with MGUS in the United States develop multiple myeloma.
4.Obesity. Your risk of multiple myeloma is increased if you're overweight or obese.
5.exposure to radiation and working in petroleum-related industries.
Multiple myeloma can be diagnosed before you ever have symptoms — through blood and urine tests.
Blood and urine tests
A blood test called serum protein electrophoresis separates your blood proteins and can detect the presence of M proteins, called an "M spike," in your blood. Parts of M proteins may also be detected in a test of your urine — when found in urine, they're referred to as Bence Jones proteins.
Your doctor may also conduct other blood tests to check for beta2-microglobulin — another protein produced by myeloma cells — or to measure the percent of plasma cells in your bone marrow.
Other tests include:
Imaging. X-rays of your skeleton can show whether your bones have any thinned-out areas, common in multiple myeloma. If a closer view of your bones is necessary, your doctor may use magnetic resonance imaging (MRI) or computerized tomography (CT) scanning.
Bone marrow examination. Your doctor may also conduct a bone marrow examination by using a needle to remove a small sample of bone marrow tissue. The sample is then examined under a microscope to check for myeloma cells.
Staging and classification These tests can help confirm whether you have multiple myeloma or another condition. If tests indicate you have multiple myeloma, the results from these tests allow your doctor to classify your disease as stage 1, stage 2 or stage 3. People with stage 3 myeloma are more likely to have one or more signs of advanced disease, including greater numbers of myeloma cells and kidney failure. Screening and diagnosis
Multiple myeloma can result in several complications:
Impaired immunity. Myeloma cells inhibit the production of antibodies needed for normal immunity. Having multiple myeloma may make you more likely to develop infections, such as pneumonia, sinusitis, bladder or kidney infection, skin infections and shingles.
Bone problems. Multiple myeloma also can affect your bones, leading to erosion of bone mass and fractures. The condition may cause compression of your spinal cord. Signs of this medical emergency include weakness, or even paralysis, in your legs.
Impaired kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure. Higher calcium levels in the blood related to eroding bones can interfere with your kidneys' ability to filter your blood's waste. The proteins produced by the myeloma cells can cause similar problems, especially if you become dehydrated.
Anemia. As cancerous cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.
Standard treatments for myeloma Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity. The appropriate multiple myeloma treatment depends on your needs, medical status and general health. You may also wish to consider approved clinical trials as an option.
Standard treatment options include:
1.Chemotherapy. Chemotherapy involves using medicines — taken orally as a pill or given through an intravenous (IV) injection — to kill myeloma cells. Chemotherapy is often given in cycles over a period of months, followed by a rest period. Often chemotherapy is discontinued during what is called a plateau phase or remission, during which your M protein level remains stable. You may need chemotherapy again if your M protein level begins to rise. Common chemotherapy drugs used to treat myeloma are melphalan (Alkeran), cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil).
2.Corticosteroids. Corticosteroids such as prednisone and dexamethasone (Decadron) have been used for decades to treat multiple myeloma. They are typically given as pills. Some research suggests that high doses of steroids may not be needed, and that lower doses may be safer and more effective.
3.Stem cell transplantation. This treatment involves using high-dose chemotherapy — usually high doses of melphalan — along with transfusion of previously collected immature blood cells (stem cells) to replace diseased or damaged marrow. The stem cells can come from you or from a donor, and they may be from either blood or bone marrow.
4.Thalidomide (Thalomid). Thalidomide, a drug originally used as a sedative and to treat morning sickness in the 1950s, was removed from the market after it was found to cause severe birth defects. However, the drug received approval from the Food and Drug Administration (FDA) again in 1998, first as a treatment for skin lesions caused by leprosy. Thalidomide is currently FDA-approved in conjunction with the corticosteroid called dexamethasone for the treatment of newly diagnosed cases of multiple myeloma. This drug is given orally.
5.Bortezomib (Velcade). Velcade was the first approved drug in a new class of medications called proteasome inhibitors. It is administered intravenously. It works by blocking the action of proteasomes, which causes cancer cells to die. One study showed that bortezomib had more than twice the response rate of a commonly used drug, dexamethasone. Bortezomib is approved by the FDA for use in a treatment for people with multiple myeloma who have received at least one prior therapy.
6.Lenalidomide (Revlimid). Lenalidomide is chemically similar to thalidomide, but appears to be more potent and cause fewer side effects. It is given orally. Lenalidomide is FDA-approved for use in combination with dexamethasone as a treatment for people who have received at least one prior therapy for multiple myeloma.
Radiation therapy. This treatment uses high-energy penetrating waves to damage myeloma cells and stop their growth. Radiation therapy may be used to target myeloma cells in a specific area — for instance, to more quickly shrink a tumor that's causing pain or destroying a bone.
Initial therapy for myeloma The initial chemotherapy used to treat multiple myeloma depends on whether you're considered a candidate for stem cell transplantation. Factors such as the risk of your disease progressing, your age and your general health play a part in determining whether stem cell transplantation may be right for you.
If you're considered a candidate for stem cell transplantation: Your initial therapy will likely exclude melphalan because this drug can have a toxic effect on stem cells, making it impossible to collect enough of them. You may begin treatment with the most common initial myeloma therapy in the United States, thalidomide plus dexamethasone. Or your doctor may instead recommend a newer regimen, lenalidomide plus low-dose dexamethasone.
Your stem cells will likely be collected after you've undergone three to four months of treatment with these initial agents. Your doctor may recommend undergoing the stem cell transplant soon after your cells are collected or delaying the transplant until after a relapse, if it occurs. Your age and your personal preference are important factors that will help your doctor make his or her recommendation.
If you're not considered a candidate for stem cell transplantation: Your initial therapy is likely to be a combination of melphalan, prednisone and thalidomide (MPT). If the side effects are intolerable, melphalan plus prednisone is another option (MP). This type of therapy is typically given for about 12 to 18 months.
Treatments for relapsed or treatment-resistant multiple myeloma Most people who are treated for multiple myeloma eventually experience a relapse of the disease. And in some cases, none of the currently available, first-line therapies slow the cancer cells from multiplying. If you experience a relapse of multiple myeloma, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first-line therapy, either alone or in combination.
Research on a number of promising new treatment options is ongoing, and these drugs offer important options for those with multiple myeloma. Talk to your doctor about what clinical trials may be available to you.
Treating complications Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:
Back pain. Taking pain medication or wearing a back brace can help relieve the back pain you might experience with multiple myeloma.
1.Kidney complications. People with severe kidney damage may need dialysis.
Infections. Antibiotics may be necessary to help treat infections or to help reduce your risk of them.
2.Bone loss. You may take medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), which bind to the surface of your bones and help prevent bone loss. Treatment with these drugs is associated with the risk of harm to the jawbone. If you're taking these medications, don't have dental procedures done without consulting your doctor first.
3.Anemia. If you have persistent anemia, your doctor may prescribe erythropoietin injections. Erythropoietin is a naturally occurring hormone made in the kidneys that stimulates the production of red blood cells. Research suggests that the use of erythropoietin may increase the risk of blood clots in some people with myeloma.
Multiple myeloma is a cancer affecting patients 50 years and above. It is sad because patients who have been working so hard and on the way to enjoying their retirement are striked down by the disease. One notable case was a good friend of mine who was so fit and healthy.
He suddenly had breathing problem and went for a complete checkup only to be diagnosed as a multiple myeloma patient. He fought the illness for four years before finally succumbing to it.
Multiple myeloma is cancer of the bone marrow which occurs from the uncontrolled growth of plasma cells, a form of immune-protective white blood cells.Normally plasma cells make antibodies to fight infections.
The disease is called multiple myeloma because myeloma cells can occur in multiple bone marrow sites in your body.
Common multiple myeloma symptoms include:
1.Bone pain.
2.Presence of abnormal proteins — which can be produced by myeloma cells — in your blood or urine. These proteins — which are antibodies or parts of antibodies — are called monoclonal, or M, proteins. Often discovered during a routine exam, monoclonal proteins may indicate multiple myeloma, but also can indicate other conditions.
3.High level of calcium in your blood. This can occur when calcium from affected bones dissolves into your blood.
If you have a high calcium level in your blood, you may experience signs and symptoms such as:
2.Excessive thirst and urination
3.Constipation
4.Nausea
5.Loss of appetite
6.Mental confusion
7.Anemia can occur as myeloma cells replace oxygen-carrying red blood cells in your bone marrow, which may lead to another 8.fatigue.
Although the exact cause isn't known, doctors do know that multiple myeloma begins with one abnormal plasma cell in your bone marrow . This abnormal cell then starts to multiply.
Because abnormal cells don't mature and then die as normal cells do, they accumulate slowly reducing the number of healthy cells.
Because myeloma cells may circulate in low numbers in your blood, they can populate other bone marrow sites in your body, even far from where they began. Uncontrolled plasma cell growth can damage bones and surrounding tissue.
Factors that may increase your risk of multiple myeloma include:
1Age. The majority of people who develop multiple myeloma are older than 50, with most diagnosed around age 70. Few cases occur in people younger than 40.
2.Sex. Men are more likely to develop the disease than are women.
Race. Blacks are about twice as likely to develop multiple myeloma as are whites.
3.History of a monoclonal gammopathy of undetermined significance. Every year 1 percent of the people with MGUS in the United States develop multiple myeloma.
4.Obesity. Your risk of multiple myeloma is increased if you're overweight or obese.
5.exposure to radiation and working in petroleum-related industries.
Multiple myeloma can be diagnosed before you ever have symptoms — through blood and urine tests.
Blood and urine tests
A blood test called serum protein electrophoresis separates your blood proteins and can detect the presence of M proteins, called an "M spike," in your blood. Parts of M proteins may also be detected in a test of your urine — when found in urine, they're referred to as Bence Jones proteins.
Your doctor may also conduct other blood tests to check for beta2-microglobulin — another protein produced by myeloma cells — or to measure the percent of plasma cells in your bone marrow.
Other tests include:
Imaging. X-rays of your skeleton can show whether your bones have any thinned-out areas, common in multiple myeloma. If a closer view of your bones is necessary, your doctor may use magnetic resonance imaging (MRI) or computerized tomography (CT) scanning.
Bone marrow examination. Your doctor may also conduct a bone marrow examination by using a needle to remove a small sample of bone marrow tissue. The sample is then examined under a microscope to check for myeloma cells.
Staging and classification These tests can help confirm whether you have multiple myeloma or another condition. If tests indicate you have multiple myeloma, the results from these tests allow your doctor to classify your disease as stage 1, stage 2 or stage 3. People with stage 3 myeloma are more likely to have one or more signs of advanced disease, including greater numbers of myeloma cells and kidney failure. Screening and diagnosis
Multiple myeloma can result in several complications:
Impaired immunity. Myeloma cells inhibit the production of antibodies needed for normal immunity. Having multiple myeloma may make you more likely to develop infections, such as pneumonia, sinusitis, bladder or kidney infection, skin infections and shingles.
Bone problems. Multiple myeloma also can affect your bones, leading to erosion of bone mass and fractures. The condition may cause compression of your spinal cord. Signs of this medical emergency include weakness, or even paralysis, in your legs.
Impaired kidney function. Multiple myeloma may cause problems with kidney function, including kidney failure. Higher calcium levels in the blood related to eroding bones can interfere with your kidneys' ability to filter your blood's waste. The proteins produced by the myeloma cells can cause similar problems, especially if you become dehydrated.
Anemia. As cancerous cells crowd out normal blood cells, multiple myeloma can also cause anemia and other blood problems.
Standard treatments for myeloma Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity. The appropriate multiple myeloma treatment depends on your needs, medical status and general health. You may also wish to consider approved clinical trials as an option.
Standard treatment options include:
1.Chemotherapy. Chemotherapy involves using medicines — taken orally as a pill or given through an intravenous (IV) injection — to kill myeloma cells. Chemotherapy is often given in cycles over a period of months, followed by a rest period. Often chemotherapy is discontinued during what is called a plateau phase or remission, during which your M protein level remains stable. You may need chemotherapy again if your M protein level begins to rise. Common chemotherapy drugs used to treat myeloma are melphalan (Alkeran), cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil).
2.Corticosteroids. Corticosteroids such as prednisone and dexamethasone (Decadron) have been used for decades to treat multiple myeloma. They are typically given as pills. Some research suggests that high doses of steroids may not be needed, and that lower doses may be safer and more effective.
3.Stem cell transplantation. This treatment involves using high-dose chemotherapy — usually high doses of melphalan — along with transfusion of previously collected immature blood cells (stem cells) to replace diseased or damaged marrow. The stem cells can come from you or from a donor, and they may be from either blood or bone marrow.
4.Thalidomide (Thalomid). Thalidomide, a drug originally used as a sedative and to treat morning sickness in the 1950s, was removed from the market after it was found to cause severe birth defects. However, the drug received approval from the Food and Drug Administration (FDA) again in 1998, first as a treatment for skin lesions caused by leprosy. Thalidomide is currently FDA-approved in conjunction with the corticosteroid called dexamethasone for the treatment of newly diagnosed cases of multiple myeloma. This drug is given orally.
5.Bortezomib (Velcade). Velcade was the first approved drug in a new class of medications called proteasome inhibitors. It is administered intravenously. It works by blocking the action of proteasomes, which causes cancer cells to die. One study showed that bortezomib had more than twice the response rate of a commonly used drug, dexamethasone. Bortezomib is approved by the FDA for use in a treatment for people with multiple myeloma who have received at least one prior therapy.
6.Lenalidomide (Revlimid). Lenalidomide is chemically similar to thalidomide, but appears to be more potent and cause fewer side effects. It is given orally. Lenalidomide is FDA-approved for use in combination with dexamethasone as a treatment for people who have received at least one prior therapy for multiple myeloma.
Radiation therapy. This treatment uses high-energy penetrating waves to damage myeloma cells and stop their growth. Radiation therapy may be used to target myeloma cells in a specific area — for instance, to more quickly shrink a tumor that's causing pain or destroying a bone.
Initial therapy for myeloma The initial chemotherapy used to treat multiple myeloma depends on whether you're considered a candidate for stem cell transplantation. Factors such as the risk of your disease progressing, your age and your general health play a part in determining whether stem cell transplantation may be right for you.
If you're considered a candidate for stem cell transplantation: Your initial therapy will likely exclude melphalan because this drug can have a toxic effect on stem cells, making it impossible to collect enough of them. You may begin treatment with the most common initial myeloma therapy in the United States, thalidomide plus dexamethasone. Or your doctor may instead recommend a newer regimen, lenalidomide plus low-dose dexamethasone.
Your stem cells will likely be collected after you've undergone three to four months of treatment with these initial agents. Your doctor may recommend undergoing the stem cell transplant soon after your cells are collected or delaying the transplant until after a relapse, if it occurs. Your age and your personal preference are important factors that will help your doctor make his or her recommendation.
If you're not considered a candidate for stem cell transplantation: Your initial therapy is likely to be a combination of melphalan, prednisone and thalidomide (MPT). If the side effects are intolerable, melphalan plus prednisone is another option (MP). This type of therapy is typically given for about 12 to 18 months.
Treatments for relapsed or treatment-resistant multiple myeloma Most people who are treated for multiple myeloma eventually experience a relapse of the disease. And in some cases, none of the currently available, first-line therapies slow the cancer cells from multiplying. If you experience a relapse of multiple myeloma, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first-line therapy, either alone or in combination.
Research on a number of promising new treatment options is ongoing, and these drugs offer important options for those with multiple myeloma. Talk to your doctor about what clinical trials may be available to you.
Treating complications Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:
Back pain. Taking pain medication or wearing a back brace can help relieve the back pain you might experience with multiple myeloma.
1.Kidney complications. People with severe kidney damage may need dialysis.
Infections. Antibiotics may be necessary to help treat infections or to help reduce your risk of them.
2.Bone loss. You may take medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), which bind to the surface of your bones and help prevent bone loss. Treatment with these drugs is associated with the risk of harm to the jawbone. If you're taking these medications, don't have dental procedures done without consulting your doctor first.
3.Anemia. If you have persistent anemia, your doctor may prescribe erythropoietin injections. Erythropoietin is a naturally occurring hormone made in the kidneys that stimulates the production of red blood cells. Research suggests that the use of erythropoietin may increase the risk of blood clots in some people with myeloma.
Tuesday, October 19, 2010
A Family Doctor's Tale - BLOOD CANCER
DOC I HAVE BLOOD CANCER
One of the more common cancer in children is leukemia a blood cancer. The chances of a cure in 1970 is about 10% but now the chances of success in acute leukemia is almost 90% due to improvement in chemotherapy and marrow transplant.
One of my patients who was treated for leukemia came to my clinic for weekly injection of steroid and vitamin B12 in 1990 after his chemotherapy and is presently free of cancer and a father of a one year old child.
Blood cancer consists of mainly lymphoma, leukaemia and multiple myeloma. These cancers developed either in the bone marrow or the lymphatic tissues of the body. These three types of blood cancers all involve an uncontrolled growth of abnormal cells within the blood and bone marrow.
The risk of developing blood cancers increases with age.
Adults therefore are more prone to blood cancer than children.
The acute leukemia tends to affect children.
The chronic leukemia is more common in adults.
However children and adults can develop any kind of leukaemia.
In Multiple myeloma, the average onset is at age 60.
Leukaemia
Leukaemia is a cancer that affects the blood-forming system of the body which include the bone marrow and the lymphatic system.
Leukaemia can be classified as either acute or chronic.
The acute leukemia tends to affect children while the chronic leukemia is more common in adults.
However children and adults can develop any kind of leukaemia.
Acute leukaemia
In acute leukaemia, immature blood cells reproduce quickly in the bone marrow, slowly killing the normal cells.
These abnormal cells can also spread to other organs, ultimately leading to disruption and distortion of organ functions.
Acute leukaemia can be further divided into two types according to the predominant type of cells affected:
1.Lymphoblasts are immature cells that normally develop into lymphocytes
2.myeloblasts are immature cells that normally develop into other cells such as neutrophils.
1. Acute lymphoid leukaemia (ALL) -
here the lymphoblasts, which normally mature to form lymphocytes, reproduce without developing into normal blood cells. These immature lymphoblasts block out the healthy blood cells and frequently congregate in the lymph nodes, causing a swelling in that area.
(b) Acute myeloid leukaemia (AML) -
here the myeloblasts reproduce without developing into normal blood cells. The immature blast cells gather in the bone marrow and upset the production of healthy normal cells.
Anaemia results due to lack of sufficient red blood cells.
Frequent infections occurs due to the low levels of white blood cells which fight infections.
Chronic leukaemia
Chronic leukaemia occurs when there is over-production of blood cells that appear to be mature.
Unfortunately these cells actually lack the normal functions of mature blood cells.
Chronic leukaemia usually has a slower, less dramatic course than acute leukaemia. Chronic leukaemia can also be broken into two groups:
(a) Chronic lymphoid leukaemia (CLL) -
Here there is production of too many apparently mature lymphocytes in the bone marrow. The abnormal cells appear to be fully developed ymphocytes, but cannot fight infections as well as normal lymphocytes.
(b) Chronic myeloid leukaemia (CML) -
here the over-production of apparently mature but defective myeloid cells, reach a point where almost no healthy cells remain.
Lymphoma (A Simple Guide to Lymphoma)
Lymphoma is a cancer of the lymphoid tissues which are composed of several types of immune-system cells that work together to fight infections. Lymphoma usually begins in a lymph node as a primary cancer. It can also begin in the stomach, intestines, skin or any other organ that contains lymphoid tissue
Multiple Myeloma (A Simple Guide To Myeloma)
Multiple myeloma is cancer of the bone marrow which occurs from the uncontrolled growth of plasma cells, a form of immune-protective white blood cells.Normally plasma cells make antibodies to fight infections.
In multiple myeloma, there is a malignant proliferation of plasma cells.
All three blood cancers have similar symptoms.
Among the common warning signs are:
1.weight loss,
2.constant infections such as flu and diarrhoea,
3.bleeding of gums or nose and slow healing cuts or frequent bruises
In addition to the above,
4.severe kidney problems,
5.pain in the bones
6.general numbness of the skin
may indicate the existence of multiple myeloma and leukemia as the disease progresses.
The pain can radiate to the back, ribs and arms of the victims.
The pain is a result of an increase in the number of myeloma cells where the bone marrow is being destroyed.
7.swelling of lymph nodes in the neck, the armpits or in the groin may indicate more likely a diagnosis of lymphoma
8.Persistent fever
9.loss of appetite
10.generalised weakness and pallour
Cause may be related to:
1.Exposure to excessive radiation
2.hazardous chemicals like benzene, asbestos, herbicides and pesticides are known to be the primary causes of blood cancer.
Avoid these harmful materials as much as possible.
3.certain genetic abnormalities, such as Down Syndrome and the inheritance of a particular chromosome called the Philadelphia chromosome, have also been linked to the development of specific forms of leukaemia. This is still controversial.
Besides a medical history and full examination especially for signs of:
anaemia,
enlarged liver and spleen,
bleeding tendencies in the skin such as petechie and ecchymoses
enlarged lymph nodes
a full blood test should be done to examine the blood cells under the microscope for cancer cells as well as to assess the patient's kidney, liver functions and the severity of anaemia.
A bone marrow aspirate using a syringe and needle can be examined for further evidence of blood and bone marrow cell abnormailties.
The presence of the Philadelphia chromosome may suggest evidence of Blood Cancer.
Before any cancer treatment is done, because of the patient's anaemia and bleeding tendency, blood transfusions are usually given to improve the general health and resistance of the patient.
Chemotherapy and radiation therapy have always been used to treat blood cancer effectively. Besides these treatments, stem cells infusion and bone-marrow transplants also give patients and their families another source for a cure.
Unlike chemotherapy and radiation therapy that are used to treat all the three kinds of blood cancer, bone-marrow transplants are more frequently used to cure lymphoma and leukaemia only .
It is also more successful for younger patients and when the disease is in the early stage.
Patients should know that dangers and side effects of bone-marrow transplants exist. In extreme cases when the transplant fail, death may occur.
When exposed to dangerous chemicals and radiation, take extra precautions by wearing protective and appropriate clothing.
The threat of contracting lymphoma can be reduced by avoiding the risk of HIV. Patients infected with HIV are known to have a higher rate of lymphoma because of their low immune-system cells to fight infections.
Any family member of a leukemia patient should go for genetic testing and regular check-ups to spot the symptoms early.
One of the more common cancer in children is leukemia a blood cancer. The chances of a cure in 1970 is about 10% but now the chances of success in acute leukemia is almost 90% due to improvement in chemotherapy and marrow transplant.
One of my patients who was treated for leukemia came to my clinic for weekly injection of steroid and vitamin B12 in 1990 after his chemotherapy and is presently free of cancer and a father of a one year old child.
Blood cancer consists of mainly lymphoma, leukaemia and multiple myeloma. These cancers developed either in the bone marrow or the lymphatic tissues of the body. These three types of blood cancers all involve an uncontrolled growth of abnormal cells within the blood and bone marrow.
The risk of developing blood cancers increases with age.
Adults therefore are more prone to blood cancer than children.
The acute leukemia tends to affect children.
The chronic leukemia is more common in adults.
However children and adults can develop any kind of leukaemia.
In Multiple myeloma, the average onset is at age 60.
Leukaemia
Leukaemia is a cancer that affects the blood-forming system of the body which include the bone marrow and the lymphatic system.
Leukaemia can be classified as either acute or chronic.
The acute leukemia tends to affect children while the chronic leukemia is more common in adults.
However children and adults can develop any kind of leukaemia.
Acute leukaemia
In acute leukaemia, immature blood cells reproduce quickly in the bone marrow, slowly killing the normal cells.
These abnormal cells can also spread to other organs, ultimately leading to disruption and distortion of organ functions.
Acute leukaemia can be further divided into two types according to the predominant type of cells affected:
1.Lymphoblasts are immature cells that normally develop into lymphocytes
2.myeloblasts are immature cells that normally develop into other cells such as neutrophils.
1. Acute lymphoid leukaemia (ALL) -
here the lymphoblasts, which normally mature to form lymphocytes, reproduce without developing into normal blood cells. These immature lymphoblasts block out the healthy blood cells and frequently congregate in the lymph nodes, causing a swelling in that area.
(b) Acute myeloid leukaemia (AML) -
here the myeloblasts reproduce without developing into normal blood cells. The immature blast cells gather in the bone marrow and upset the production of healthy normal cells.
Anaemia results due to lack of sufficient red blood cells.
Frequent infections occurs due to the low levels of white blood cells which fight infections.
Chronic leukaemia
Chronic leukaemia occurs when there is over-production of blood cells that appear to be mature.
Unfortunately these cells actually lack the normal functions of mature blood cells.
Chronic leukaemia usually has a slower, less dramatic course than acute leukaemia. Chronic leukaemia can also be broken into two groups:
(a) Chronic lymphoid leukaemia (CLL) -
Here there is production of too many apparently mature lymphocytes in the bone marrow. The abnormal cells appear to be fully developed ymphocytes, but cannot fight infections as well as normal lymphocytes.
(b) Chronic myeloid leukaemia (CML) -
here the over-production of apparently mature but defective myeloid cells, reach a point where almost no healthy cells remain.
Lymphoma (A Simple Guide to Lymphoma)
Lymphoma is a cancer of the lymphoid tissues which are composed of several types of immune-system cells that work together to fight infections. Lymphoma usually begins in a lymph node as a primary cancer. It can also begin in the stomach, intestines, skin or any other organ that contains lymphoid tissue
Multiple Myeloma (A Simple Guide To Myeloma)
Multiple myeloma is cancer of the bone marrow which occurs from the uncontrolled growth of plasma cells, a form of immune-protective white blood cells.Normally plasma cells make antibodies to fight infections.
In multiple myeloma, there is a malignant proliferation of plasma cells.
All three blood cancers have similar symptoms.
Among the common warning signs are:
1.weight loss,
2.constant infections such as flu and diarrhoea,
3.bleeding of gums or nose and slow healing cuts or frequent bruises
In addition to the above,
4.severe kidney problems,
5.pain in the bones
6.general numbness of the skin
may indicate the existence of multiple myeloma and leukemia as the disease progresses.
The pain can radiate to the back, ribs and arms of the victims.
The pain is a result of an increase in the number of myeloma cells where the bone marrow is being destroyed.
7.swelling of lymph nodes in the neck, the armpits or in the groin may indicate more likely a diagnosis of lymphoma
8.Persistent fever
9.loss of appetite
10.generalised weakness and pallour
Cause may be related to:
1.Exposure to excessive radiation
2.hazardous chemicals like benzene, asbestos, herbicides and pesticides are known to be the primary causes of blood cancer.
Avoid these harmful materials as much as possible.
3.certain genetic abnormalities, such as Down Syndrome and the inheritance of a particular chromosome called the Philadelphia chromosome, have also been linked to the development of specific forms of leukaemia. This is still controversial.
Besides a medical history and full examination especially for signs of:
anaemia,
enlarged liver and spleen,
bleeding tendencies in the skin such as petechie and ecchymoses
enlarged lymph nodes
a full blood test should be done to examine the blood cells under the microscope for cancer cells as well as to assess the patient's kidney, liver functions and the severity of anaemia.
A bone marrow aspirate using a syringe and needle can be examined for further evidence of blood and bone marrow cell abnormailties.
The presence of the Philadelphia chromosome may suggest evidence of Blood Cancer.
Before any cancer treatment is done, because of the patient's anaemia and bleeding tendency, blood transfusions are usually given to improve the general health and resistance of the patient.
Chemotherapy and radiation therapy have always been used to treat blood cancer effectively. Besides these treatments, stem cells infusion and bone-marrow transplants also give patients and their families another source for a cure.
Unlike chemotherapy and radiation therapy that are used to treat all the three kinds of blood cancer, bone-marrow transplants are more frequently used to cure lymphoma and leukaemia only .
It is also more successful for younger patients and when the disease is in the early stage.
Patients should know that dangers and side effects of bone-marrow transplants exist. In extreme cases when the transplant fail, death may occur.
When exposed to dangerous chemicals and radiation, take extra precautions by wearing protective and appropriate clothing.
The threat of contracting lymphoma can be reduced by avoiding the risk of HIV. Patients infected with HIV are known to have a higher rate of lymphoma because of their low immune-system cells to fight infections.
Any family member of a leukemia patient should go for genetic testing and regular check-ups to spot the symptoms early.
Monday, October 18, 2010
A Family Doctor's Tale - LYMPHOMA
DOC I HAVE LYMPHOMA
Lymphoma is a blood cancer which causes the presence of large number of abnormal lymphocytes which is a type of white blood cell. It can cause the lymph nodes along the path of lymphatic vessels to enlarge appearing as lumps on the skin or inside the lung cavity or abdominal cavity.
In most cases the patient is detected through enlargement of lymph nodes on the body or inside the body (through CT Scan). There is corresponding loss of weight and large amounts of lymphocytes in the blood. Once detected treatment must instituted quickly as the abnormal cells can spread very quickly. Chemotherapy is the treatment of choice.
Bone marrow transplants can also help in fighting the cancer.
Lymphoma is a cancer of the of the tissue of the lymphatic system where there is a large number of abnormal white blood cells called lymphocytes causing swelling of lymph nodes or involvement of the other organs. This can disrupt the immune-system cells and reduce a person's ability to resist infections and diseases. The lymph nodes become swollen forming painless lumps or tumors.
Although lymphomas usually begin in a lymph node, it also can originate in the stomach, intestines, skin or any other organ that contains lymphoid tissue. Lymph nodes are found anywhere in the body, particularly in the neck, armpits, groin, above the heart and around the big blood vessels inside the abdomen.
1.Men are at a higher risk of getting lymphomas.
The disease is uncommon among younger men.
It often develops after the age of 50.
2. past history of severe viral infections which lowers your immune system
eg. HIV virus
3.history of organ transplants and on immuno suppressive drugs
4.history of cancer and previous treatment with chemotherapy or radiation therapy
5. frequent exposure to chemicals, solvents,pesticides
6.family history of lymphoma
There are two main types of lymphoma.
They are:
1.Hodgkin's Disease
Hodgkin's disease is characterized by the presence of a specific type of abnormal cell called the Reed-Sternberg cell. This cancer can spread throughout the lymphatic system, affecting any organ or lymph tissue in the body.
Hodgkin's disease usually attack people in their late 20s or older than 50.
2.Non-Hodgkin's Lymphoma
Most lymph cancers are non-Hodgkin's lymphomas. There are many types of non-Hodgkin's lymphomas.
Non-Hodgkin's lymphomas develops in the age group of 60 - 70.
Different types of lymphoma occur in different age groups.
1.Adult non-Hodgkin's lymphoma is classified by the size, shape and arrangement of the cancer cells in the lymph node. The appearance will determine the type of non-Hodgkin's lymphoma. The degree or seriousness of the disease is broken into three types (grades) -
1.low-grade (slower-growing),
2.intermediate grade and
3.high-grade (aggressive).
These grades are crucial in determining the treatment options to treat the cancer.
In childhood - Childhood non-Hodgkin's lymphomas include lymphoblastic lymphoma, large cell lymphoma and small non-cleaved cell lymphoma (including Burkitt's and non-Burkitt's lymphomas).
The most common symptom associated with lymphoma is
1.lymph node swelling. A painless swelling initially surfaces in the early stages of the cancer. This swelling may persist or increase in size. The most common affected areas would be the neck, armpits or groin.
Other symptoms are:
2.unexplained constant fever,
3.sudden weight loss,
4. itchy skin or rashes,
5. night sweats and
6. abdominal pain
There is no known cause for lymphomas.
However, it has been closely linked to several factors -
1) environmental influences,
Environmental influences may take the form of extreme
exposure to certain chemicals like herbicides and insecticides.
2) genetic factors
There are inherited immune-deficiency disorders from birth such as Wiskott-Aldrich syndrome which have been blamed for the cause of genetic factors that result in lymphomas.
3) viral infections.
Viral infections such as the Epstein-Barr virus (EBV) and human immunodeficiency virus (HIV) have been associated with lymphomas.
Hodgkin's Disease can only be treated with radiation therapy using high-energy X-rays to kill lymphoma cells in the affected area(s). This procedure may also be combined with chemotherapy.
Treatment for non-Hodgkin's lymphoma, can vary. The treatment is based on the degree of grade of the disease.
1.Early stage and low-grade (slow-growing) lymphoma can be treated with radiation therapy and sometimes just simple observation is enough.
2. intermediate-grade lymphoma may be treated with chemotherapy. The drugs are either injected directly into the bloodstream or swallowed as pills. Each course of treatment is given at regulated intervals to kill cancer cells and allow the body to recover. The drugs circulate throughout the body and will reach cancer cells even when they are widespread.
Patients who are suffering from the more advanced stages and high-grade (aggressive) lymphomas will require a higher dosage of chemotherapy. However, the high dosage has its own side effects. Too much of it may kill healthy bone marrow that produces white and red blood cells and platelets (cells that prevent bleeding).
Therefore, to assist patients tolerate the high dosage of chemotherapy treatment, stem cells or bone marrow from the patient or donor are collected beforehand. After a patient has received the chemotherapy, the stem cells or bone marrow are returned to the patient through a drip in a vein.
In addition to the above treatment methods, another option for treating lymphomas would be biological therapy. This procedure uses products such as immunoglobulin that boost the body's own immune system to fight cancer. This therapy may be used alone or combined with chemotherapy.
In conclusion, the type of treatment sought or used depends very much on the stage, and grade of the lymphoma when diagnosed and the age and health of the patient. Usually, doctors will advise their patients on the various treatment options that are the most beneficial and appropriate whilst considering the factors mentioned above.
1.Where exposure to some toxins and chemicals which are known to cause lymphomas are possible, one should be properly attired and guarded from these chemicals, so as to decrease the risk of developing the disease.
2.Since HIV / AIDS carriers are also related to lymphomas, one should be aware of the importance of safe sex and should stay away from drugs, as far as possible.
3.regular visits to the family doctor helps in detecting any sign or symptom that may eventually lead to the cancer.
4.healthy lifestyle
Lymphoma is a blood cancer which causes the presence of large number of abnormal lymphocytes which is a type of white blood cell. It can cause the lymph nodes along the path of lymphatic vessels to enlarge appearing as lumps on the skin or inside the lung cavity or abdominal cavity.
In most cases the patient is detected through enlargement of lymph nodes on the body or inside the body (through CT Scan). There is corresponding loss of weight and large amounts of lymphocytes in the blood. Once detected treatment must instituted quickly as the abnormal cells can spread very quickly. Chemotherapy is the treatment of choice.
Bone marrow transplants can also help in fighting the cancer.
Lymphoma is a cancer of the of the tissue of the lymphatic system where there is a large number of abnormal white blood cells called lymphocytes causing swelling of lymph nodes or involvement of the other organs. This can disrupt the immune-system cells and reduce a person's ability to resist infections and diseases. The lymph nodes become swollen forming painless lumps or tumors.
Although lymphomas usually begin in a lymph node, it also can originate in the stomach, intestines, skin or any other organ that contains lymphoid tissue. Lymph nodes are found anywhere in the body, particularly in the neck, armpits, groin, above the heart and around the big blood vessels inside the abdomen.
1.Men are at a higher risk of getting lymphomas.
The disease is uncommon among younger men.
It often develops after the age of 50.
2. past history of severe viral infections which lowers your immune system
eg. HIV virus
3.history of organ transplants and on immuno suppressive drugs
4.history of cancer and previous treatment with chemotherapy or radiation therapy
5. frequent exposure to chemicals, solvents,pesticides
6.family history of lymphoma
There are two main types of lymphoma.
They are:
1.Hodgkin's Disease
Hodgkin's disease is characterized by the presence of a specific type of abnormal cell called the Reed-Sternberg cell. This cancer can spread throughout the lymphatic system, affecting any organ or lymph tissue in the body.
Hodgkin's disease usually attack people in their late 20s or older than 50.
2.Non-Hodgkin's Lymphoma
Most lymph cancers are non-Hodgkin's lymphomas. There are many types of non-Hodgkin's lymphomas.
Non-Hodgkin's lymphomas develops in the age group of 60 - 70.
Different types of lymphoma occur in different age groups.
1.Adult non-Hodgkin's lymphoma is classified by the size, shape and arrangement of the cancer cells in the lymph node. The appearance will determine the type of non-Hodgkin's lymphoma. The degree or seriousness of the disease is broken into three types (grades) -
1.low-grade (slower-growing),
2.intermediate grade and
3.high-grade (aggressive).
These grades are crucial in determining the treatment options to treat the cancer.
In childhood - Childhood non-Hodgkin's lymphomas include lymphoblastic lymphoma, large cell lymphoma and small non-cleaved cell lymphoma (including Burkitt's and non-Burkitt's lymphomas).
The most common symptom associated with lymphoma is
1.lymph node swelling. A painless swelling initially surfaces in the early stages of the cancer. This swelling may persist or increase in size. The most common affected areas would be the neck, armpits or groin.
Other symptoms are:
2.unexplained constant fever,
3.sudden weight loss,
4. itchy skin or rashes,
5. night sweats and
6. abdominal pain
There is no known cause for lymphomas.
However, it has been closely linked to several factors -
1) environmental influences,
Environmental influences may take the form of extreme
exposure to certain chemicals like herbicides and insecticides.
2) genetic factors
There are inherited immune-deficiency disorders from birth such as Wiskott-Aldrich syndrome which have been blamed for the cause of genetic factors that result in lymphomas.
3) viral infections.
Viral infections such as the Epstein-Barr virus (EBV) and human immunodeficiency virus (HIV) have been associated with lymphomas.
Hodgkin's Disease can only be treated with radiation therapy using high-energy X-rays to kill lymphoma cells in the affected area(s). This procedure may also be combined with chemotherapy.
Treatment for non-Hodgkin's lymphoma, can vary. The treatment is based on the degree of grade of the disease.
1.Early stage and low-grade (slow-growing) lymphoma can be treated with radiation therapy and sometimes just simple observation is enough.
2. intermediate-grade lymphoma may be treated with chemotherapy. The drugs are either injected directly into the bloodstream or swallowed as pills. Each course of treatment is given at regulated intervals to kill cancer cells and allow the body to recover. The drugs circulate throughout the body and will reach cancer cells even when they are widespread.
Patients who are suffering from the more advanced stages and high-grade (aggressive) lymphomas will require a higher dosage of chemotherapy. However, the high dosage has its own side effects. Too much of it may kill healthy bone marrow that produces white and red blood cells and platelets (cells that prevent bleeding).
Therefore, to assist patients tolerate the high dosage of chemotherapy treatment, stem cells or bone marrow from the patient or donor are collected beforehand. After a patient has received the chemotherapy, the stem cells or bone marrow are returned to the patient through a drip in a vein.
In addition to the above treatment methods, another option for treating lymphomas would be biological therapy. This procedure uses products such as immunoglobulin that boost the body's own immune system to fight cancer. This therapy may be used alone or combined with chemotherapy.
In conclusion, the type of treatment sought or used depends very much on the stage, and grade of the lymphoma when diagnosed and the age and health of the patient. Usually, doctors will advise their patients on the various treatment options that are the most beneficial and appropriate whilst considering the factors mentioned above.
1.Where exposure to some toxins and chemicals which are known to cause lymphomas are possible, one should be properly attired and guarded from these chemicals, so as to decrease the risk of developing the disease.
2.Since HIV / AIDS carriers are also related to lymphomas, one should be aware of the importance of safe sex and should stay away from drugs, as far as possible.
3.regular visits to the family doctor helps in detecting any sign or symptom that may eventually lead to the cancer.
4.healthy lifestyle
Sunday, October 17, 2010
A Family Doctor's Tale - BREAST CANCER
DOC I HAVE BREAST CANCER
Breast cancer is the second most common cancer in Singapore women. Fortunately with early detection and diagnosis, treatment for breast cancer has been very successful as compared to twenty years ago. I have a patient who has seven lumps in both breasts one of which turned up to be cancerous. the surgeon at that time 15 years ago suggested mastectomy (total removal) of the affected breast. She turned to me for advice. I suggest lumpectomy because that was the latest treatment successfully done in USA at that time.However the surgeon was adamant about removal of the breast.So unfortunately for my patient that was done and the pathological examination of the removed breast showed no evidence of cancer. Nowadays breast lumpectomy has become the main treatment for breast cancer followed by chemotherapy. Rarely is mastectomy done unless there is extensive spread.
Another patient also had her left breast removed but bled heavily on the 4th day and I had to stop the bleeding, bandaged the wound and sent her back to hospital for treatment. 7 years later she had difficulty in swallowing was discovered to have a spread to the lung at the back of the gullet blocking her swallowing.
Chest X-ray could not detect the spread to the lung. Only a CAT scan of the lung a few moths later found the lump in the lung. Because of the late detection of the spread, she eventually succumbed to her illness.
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
It is the most common type of cancer among women.
Breast Cancer occurs as uncontrolled growth of mutated (abnormal) cells from the breast tissues.
It occurs as in 2 main forms:
1.preinvasive cancer:
Preinvasive breast cancer is confined to the breast ducts or lobules and the cancer cells do not have the abilty to spread. It is classified as Stage 0 Breast Cancer (carcinoma-in-situ).
2.invasive cancer:
Invasive Breast Cancer occurs when the cancer cells spread to the surrounding tissues of the breasts and then to the lymph nodes under the armpits. These cancer cells can also spread to other parts of the body like the lungs, liver and bones.
Invasive breast cancer is classified into 4 stages from Stage 1 to 4 according to severity, stage 4 being the most severe.
All women are at risk of breast cancer and the risk increases with age.
Main risk factors are:
1.family history of breast cancer,
2.a past medical history of breast cancer and ovarian cancer,
3.Menstruating at an early age.
4.late menopause or
5.having your first child after age 30 or never having given birth.
6.Taking hormones such as estrogen and progesterone.
Signs, which may indicate Breast Cancer, are:
1.a painless lump in the breast or armpit
2.abnormal discharge from the nipple
3.changes in the skin over the breast or nipple
4.new retraction (pulling in) of the nipple
5.persistant rash around the nipple
Breast Self Examination (BSE)
---------------------------------
It is very important for every woman above aged 30 years old to learn, and practise BSE regularly once a month, about a week after each menstrual period. Women who no longer have periods should practise BSE on a fixed date each month.
Mammography
-----------------
1.Women aged 40 - 49 years are encouraged to go for regular mammography every year
2.Women 50 years and above should go every two years.
3.Women who are at higher risk of developing breast cancer should see a doctor for advice. You may need to go for screening earlier and more frequently.
Mammography is a low-dose X-ray of the breast using specially designed X-ray machine. It is the most effective method to detect very small lumps in the breast even before the hand can feel them. It also helps to monitor any recurrence of previously treated breast cancer.
Most lumps detected by mammography are usually not cancerous.
Ultrasound of the Breasts
----------------------------
Ultrasound of the Breasts is used together with mammography in cases where the diagnosis of possible cancer of the breast is not confirmed. Here the ultrasound may be able to pick up small lumps, which are not detected by mammogram.
MRI (magnetic resonance imaging) of the Breasts
------------------------------------------------
MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas in the body.
With advancement of technology, a MRI of the breasts can detect even more clearly any abnormal lumps or tissues in the breasts.
Estrogen and progesterone receptor test:
-----------------------------------------------
A test to measure the amount of estrogen and progesterone (female hormones) receptors in cancer tissue. The test results show whether hormone therapy may stop the cancer from growing.
Biopsy:
------
The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump.
Four types of biopsies are as follows:
Excisional biopsy: The removal of an entire lump or suspicious tissue.
Incisional biopsy: The removal of part of a lump or suspicious tissue.
Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle.
This procedure is also called a fine-needle biopsy.
There are different types of treatment for patients with breast cancer.
Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Lumpectomy: Breast-conserving surgery to remove a tumor (lump) and a small amount of normal tissue around it.
Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time.
Radiation therapy
-----------------
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Chemotherapy
------------
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Hormone therapy
---------------
Hormone therapy is a cancer treatment that removes female hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream.
Examples are tamoxifen and aromaase inhibitors.
Sentinel lymph node biopsy followed by surgery
-----------------------------------------------
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
Monoclonal antibodies as adjuvant therapy
-----------------------------------------
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. The antibodies attach to the cancer cells, block their growth, or keep them from spreading.
Examples are Trastuzumab (Herceptin) which blocks the effects of the growth factor protein HER2, Tyrosine kinase inhibitors which block signals needed for tumors to grow, Lapatinib which blocks the effects of the HER2 protein and other proteins inside tumor cells.
Treatment of Preinvasive Breast Cancer
--------------------------------------------
Surgery is the main form of treatment for this stage of Cancer.
Either a lumpectomy or a mastectomy can be done.
Women who choose lumpectomy usually have to undergo radiation treatment or radiotherapy.
The type of surgical treatment depends on
1. The size and extent of cancer within the breast
2.the patient's suitability or desire to undergo radiotherapy.
Chemotherapy is not required for cancer detected at such an early stage.
Treatment of Invasive Breast Cancer
----------------------------------------
Surgery is the main treatment as well in this case. It involves the removal of the cancer with or without preserving the breast. In the lste stages where the cancer has spread to the other parts of the body, surgical removal of the cancer may be
done to reduce the pain.
Chemotherapy is given to treat the cancer that has spread beyond the breast and armpit. It can be given orally or by injection.
The decision to use chemotherapy depends on:
1. The stage of the cancer
2. Type of cancer cells
3. Whether the woman has reached menopause
Chemotherapy may be used before surgery in large cancers to reduce cancer recurrence or to increase the chance of safe breasr preservation surgery.
Hormonal therapy is usedfor hormone responsive cancers to deprive the cancer cells of oestrogen, which is required for such cancers to grow. It is given in place of chemotherapy or following it.
Radiotherapy uses high-energy rays to kill cancer cells or stop them from growing further. It may be given for a peroid of time after a lumpectomy or after a mastectomy. It is also given for inoperable cancers.
How is Breast Cancer Recurrence detected?
------------------------------------------------
After cancer treatment, patients are required to follow up with their doctors at regular intervals especially in the first 5 years after treatment when the risk of recurrence is highest.
This include:
Physical examination of the breasts, underarm, neck.
Peroidic mammograms
Blood tests
Chest x-rays and bone scan.
Any complaints of change in surgical areas or other parts of the breasts, swollen lymph glands or bone pains may suggest a recurrence.
The prognosis (chance of recovery) and treatment options depend on the following:
The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
The type of breast cancer.
Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
A woman's age, general health, and menopausal status (whether a woman is still having menstrual periods).
Whether the cancer has just been diagnosed or has recurred (come back).
Breast cancer is the second most common cancer in Singapore women. Fortunately with early detection and diagnosis, treatment for breast cancer has been very successful as compared to twenty years ago. I have a patient who has seven lumps in both breasts one of which turned up to be cancerous. the surgeon at that time 15 years ago suggested mastectomy (total removal) of the affected breast. She turned to me for advice. I suggest lumpectomy because that was the latest treatment successfully done in USA at that time.However the surgeon was adamant about removal of the breast.So unfortunately for my patient that was done and the pathological examination of the removed breast showed no evidence of cancer. Nowadays breast lumpectomy has become the main treatment for breast cancer followed by chemotherapy. Rarely is mastectomy done unless there is extensive spread.
Another patient also had her left breast removed but bled heavily on the 4th day and I had to stop the bleeding, bandaged the wound and sent her back to hospital for treatment. 7 years later she had difficulty in swallowing was discovered to have a spread to the lung at the back of the gullet blocking her swallowing.
Chest X-ray could not detect the spread to the lung. Only a CAT scan of the lung a few moths later found the lump in the lung. Because of the late detection of the spread, she eventually succumbed to her illness.
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
It is the most common type of cancer among women.
Breast Cancer occurs as uncontrolled growth of mutated (abnormal) cells from the breast tissues.
It occurs as in 2 main forms:
1.preinvasive cancer:
Preinvasive breast cancer is confined to the breast ducts or lobules and the cancer cells do not have the abilty to spread. It is classified as Stage 0 Breast Cancer (carcinoma-in-situ).
2.invasive cancer:
Invasive Breast Cancer occurs when the cancer cells spread to the surrounding tissues of the breasts and then to the lymph nodes under the armpits. These cancer cells can also spread to other parts of the body like the lungs, liver and bones.
Invasive breast cancer is classified into 4 stages from Stage 1 to 4 according to severity, stage 4 being the most severe.
All women are at risk of breast cancer and the risk increases with age.
Main risk factors are:
1.family history of breast cancer,
2.a past medical history of breast cancer and ovarian cancer,
3.Menstruating at an early age.
4.late menopause or
5.having your first child after age 30 or never having given birth.
6.Taking hormones such as estrogen and progesterone.
Signs, which may indicate Breast Cancer, are:
1.a painless lump in the breast or armpit
2.abnormal discharge from the nipple
3.changes in the skin over the breast or nipple
4.new retraction (pulling in) of the nipple
5.persistant rash around the nipple
Breast Self Examination (BSE)
---------------------------------
It is very important for every woman above aged 30 years old to learn, and practise BSE regularly once a month, about a week after each menstrual period. Women who no longer have periods should practise BSE on a fixed date each month.
Mammography
-----------------
1.Women aged 40 - 49 years are encouraged to go for regular mammography every year
2.Women 50 years and above should go every two years.
3.Women who are at higher risk of developing breast cancer should see a doctor for advice. You may need to go for screening earlier and more frequently.
Mammography is a low-dose X-ray of the breast using specially designed X-ray machine. It is the most effective method to detect very small lumps in the breast even before the hand can feel them. It also helps to monitor any recurrence of previously treated breast cancer.
Most lumps detected by mammography are usually not cancerous.
Ultrasound of the Breasts
----------------------------
Ultrasound of the Breasts is used together with mammography in cases where the diagnosis of possible cancer of the breast is not confirmed. Here the ultrasound may be able to pick up small lumps, which are not detected by mammogram.
MRI (magnetic resonance imaging) of the Breasts
------------------------------------------------
MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas in the body.
With advancement of technology, a MRI of the breasts can detect even more clearly any abnormal lumps or tissues in the breasts.
Estrogen and progesterone receptor test:
-----------------------------------------------
A test to measure the amount of estrogen and progesterone (female hormones) receptors in cancer tissue. The test results show whether hormone therapy may stop the cancer from growing.
Biopsy:
------
The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump.
Four types of biopsies are as follows:
Excisional biopsy: The removal of an entire lump or suspicious tissue.
Incisional biopsy: The removal of part of a lump or suspicious tissue.
Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle.
This procedure is also called a fine-needle biopsy.
There are different types of treatment for patients with breast cancer.
Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Lumpectomy: Breast-conserving surgery to remove a tumor (lump) and a small amount of normal tissue around it.
Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time.
Radiation therapy
-----------------
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Chemotherapy
------------
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Hormone therapy
---------------
Hormone therapy is a cancer treatment that removes female hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream.
Examples are tamoxifen and aromaase inhibitors.
Sentinel lymph node biopsy followed by surgery
-----------------------------------------------
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
Monoclonal antibodies as adjuvant therapy
-----------------------------------------
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. The antibodies attach to the cancer cells, block their growth, or keep them from spreading.
Examples are Trastuzumab (Herceptin) which blocks the effects of the growth factor protein HER2, Tyrosine kinase inhibitors which block signals needed for tumors to grow, Lapatinib which blocks the effects of the HER2 protein and other proteins inside tumor cells.
Treatment of Preinvasive Breast Cancer
--------------------------------------------
Surgery is the main form of treatment for this stage of Cancer.
Either a lumpectomy or a mastectomy can be done.
Women who choose lumpectomy usually have to undergo radiation treatment or radiotherapy.
The type of surgical treatment depends on
1. The size and extent of cancer within the breast
2.the patient's suitability or desire to undergo radiotherapy.
Chemotherapy is not required for cancer detected at such an early stage.
Treatment of Invasive Breast Cancer
----------------------------------------
Surgery is the main treatment as well in this case. It involves the removal of the cancer with or without preserving the breast. In the lste stages where the cancer has spread to the other parts of the body, surgical removal of the cancer may be
done to reduce the pain.
Chemotherapy is given to treat the cancer that has spread beyond the breast and armpit. It can be given orally or by injection.
The decision to use chemotherapy depends on:
1. The stage of the cancer
2. Type of cancer cells
3. Whether the woman has reached menopause
Chemotherapy may be used before surgery in large cancers to reduce cancer recurrence or to increase the chance of safe breasr preservation surgery.
Hormonal therapy is usedfor hormone responsive cancers to deprive the cancer cells of oestrogen, which is required for such cancers to grow. It is given in place of chemotherapy or following it.
Radiotherapy uses high-energy rays to kill cancer cells or stop them from growing further. It may be given for a peroid of time after a lumpectomy or after a mastectomy. It is also given for inoperable cancers.
How is Breast Cancer Recurrence detected?
------------------------------------------------
After cancer treatment, patients are required to follow up with their doctors at regular intervals especially in the first 5 years after treatment when the risk of recurrence is highest.
This include:
Physical examination of the breasts, underarm, neck.
Peroidic mammograms
Blood tests
Chest x-rays and bone scan.
Any complaints of change in surgical areas or other parts of the breasts, swollen lymph glands or bone pains may suggest a recurrence.
The prognosis (chance of recovery) and treatment options depend on the following:
The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
The type of breast cancer.
Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
A woman's age, general health, and menopausal status (whether a woman is still having menstrual periods).
Whether the cancer has just been diagnosed or has recurred (come back).
Saturday, October 16, 2010
A Family Doctor's Tale - LUNG CANCER
DOC I HAVE LUNG CANCER
Lung cancer is the most common cancer in Singapore men. Smoking (active and passive) contributes to this cancer as does inhalation of asbestos and other toxic chemicals. While the incidence of men smoking has decreased there is alarmingly more women who are smoking.
A lung cancer patient of mine recounts his regret in long term smoking which led to his condition with the breathlessness, loss of weight, heart failure and weakness. Lung cancer can be hard to treat especially if they are fast spreading. He eventually succumbed to his illness.
Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs. The cells lining air passages grow and divide until an abnormal mass or tumor is formed. The cells then grow and spread to the rest of the body.
There are 2 main types of Lung Cancer:
1. small cell lung cancer (SCLC) has the most aggressive clinical course of any type of pulmonary tumor, with median survival from diagnosis of only 2 to 4 months.
2. non-small cell lung cancer.
a.Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
b.Large cell carcinoma: Cancer that may begin in several types of large cells.
Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
c.Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.
These types are diagnosed based on how the cells look under a microscope.
The Non-small cell Lung cancer may take up to 10-30 years to develop. Thus it is often seen in middle aged and elderly persons. Once developed Lung cancers tend to spread quickly because the lungs are richly supplied by blood and lymph
vessels. In the travel through the lymph vessels, it can cause enlarged lymph nodes. If it enter the blood , the cancer cells can spread to the liver, bone, brain or other parts of the body.
Causes are related to:
1. Cigarette smoking is the main cause of lung cancer.
2. Cigar and pipe smoking is also a source of lung cancer though less than those who smoke cigarettes.
3. Passive smoking in a family where one member smokes has been to increase the risk of lung cancer by 35%
4. Industrial hazards such as chemicals and smoke emitted at workplace also increase the risk of lung cancer. Examples are asbestos, coal gas, chromates, uranium.
5.Being treated with radiation therapy to the breast or chest.
Symptoms:
1. Persistent cough which does not improve
2. shortness of breath and wheezing due to the pressure of the tumor pressing on the airways.
3.Production of blood stained sputum
4. chest pain especially together with a chronic cough
5.Sudden unexplained loss of weight
6. Loss of appetite
7. General weakness and tiredness
8.Recurrent chest infections and fever
9. hoarseness of voice
1. History and Medical examination especially history of smoking and exposure to chemicals
2. Chest X-ray to check for lung shadows
3. Sputum cytology- sometimes the cancer cells may be detected in the sputum
4. Bronchoscopy- a bronchoscope is passed into bronchi to study the airway while the patient is under general anesthesia. Suspicious growth can be taken for biopsy(examination under microscope for cancer cells)
5.CT Scan and MRI produce 3D images of the lung
6.Ultrasound or another imaging procedure is used to locate the abnormal tissue or fluid in the lung.
7.Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. This procedure may be used to remove parts of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
AS usual the treatment consists of Surgery, Radiotherapy and chemotherapy.The choice of treatment depends on the size, extent and the type lung cancer and the general health of the patient.
Part or whole of the lung can be removed in the treatment of lung cancer. After surgery the patient may required assisted ventilation for a short period. Physical activity may be limited for a while. If the remaining lung is in good condition, the patient may be able to live a normal life.
Chemotherapy:
Certain type of lung cancer are sensitive to chemotherapy. It is used in combination with surgery and radiotherapy.
Radiotherapy:
Radiation may be used in conjunction with surgery or to relieve pressure symptoms or pain caused by the lung cancer.
The prognosis (chance of recovery) depend on the following:
The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
The type of lung cancer.
Whether there are symptoms such as coughing or trouble breathing.
The patient’s general health.
For most patients with non-small cell lung cancer, current treatments do not cure the cancer.
Compared with other cell types of lung cancer, SCLC has a greater tendency to be widely disseminated by the time of diagnosis but is much more responsive to chemotherapy and radiation therapy.
Because patients with small cell lung cancer tend to develop distant metastases, localized forms of treatment, such as surgical resection or radiation therapy, rarely produce long-term survival. With incorporation of current chemotherapy regimens into the treatment program, however, survival is unequivocally prolonged.
Lung cancer is the most common cancer in Singapore men. Smoking (active and passive) contributes to this cancer as does inhalation of asbestos and other toxic chemicals. While the incidence of men smoking has decreased there is alarmingly more women who are smoking.
A lung cancer patient of mine recounts his regret in long term smoking which led to his condition with the breathlessness, loss of weight, heart failure and weakness. Lung cancer can be hard to treat especially if they are fast spreading. He eventually succumbed to his illness.
Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs. The cells lining air passages grow and divide until an abnormal mass or tumor is formed. The cells then grow and spread to the rest of the body.
There are 2 main types of Lung Cancer:
1. small cell lung cancer (SCLC) has the most aggressive clinical course of any type of pulmonary tumor, with median survival from diagnosis of only 2 to 4 months.
2. non-small cell lung cancer.
a.Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This is also called epidermoid carcinoma.
b.Large cell carcinoma: Cancer that may begin in several types of large cells.
Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
c.Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.
These types are diagnosed based on how the cells look under a microscope.
The Non-small cell Lung cancer may take up to 10-30 years to develop. Thus it is often seen in middle aged and elderly persons. Once developed Lung cancers tend to spread quickly because the lungs are richly supplied by blood and lymph
vessels. In the travel through the lymph vessels, it can cause enlarged lymph nodes. If it enter the blood , the cancer cells can spread to the liver, bone, brain or other parts of the body.
Causes are related to:
1. Cigarette smoking is the main cause of lung cancer.
2. Cigar and pipe smoking is also a source of lung cancer though less than those who smoke cigarettes.
3. Passive smoking in a family where one member smokes has been to increase the risk of lung cancer by 35%
4. Industrial hazards such as chemicals and smoke emitted at workplace also increase the risk of lung cancer. Examples are asbestos, coal gas, chromates, uranium.
5.Being treated with radiation therapy to the breast or chest.
Symptoms:
1. Persistent cough which does not improve
2. shortness of breath and wheezing due to the pressure of the tumor pressing on the airways.
3.Production of blood stained sputum
4. chest pain especially together with a chronic cough
5.Sudden unexplained loss of weight
6. Loss of appetite
7. General weakness and tiredness
8.Recurrent chest infections and fever
9. hoarseness of voice
1. History and Medical examination especially history of smoking and exposure to chemicals
2. Chest X-ray to check for lung shadows
3. Sputum cytology- sometimes the cancer cells may be detected in the sputum
4. Bronchoscopy- a bronchoscope is passed into bronchi to study the airway while the patient is under general anesthesia. Suspicious growth can be taken for biopsy(examination under microscope for cancer cells)
5.CT Scan and MRI produce 3D images of the lung
6.Ultrasound or another imaging procedure is used to locate the abnormal tissue or fluid in the lung.
7.Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. This procedure may be used to remove parts of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
AS usual the treatment consists of Surgery, Radiotherapy and chemotherapy.The choice of treatment depends on the size, extent and the type lung cancer and the general health of the patient.
Part or whole of the lung can be removed in the treatment of lung cancer. After surgery the patient may required assisted ventilation for a short period. Physical activity may be limited for a while. If the remaining lung is in good condition, the patient may be able to live a normal life.
Chemotherapy:
Certain type of lung cancer are sensitive to chemotherapy. It is used in combination with surgery and radiotherapy.
Radiotherapy:
Radiation may be used in conjunction with surgery or to relieve pressure symptoms or pain caused by the lung cancer.
The prognosis (chance of recovery) depend on the following:
The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
The type of lung cancer.
Whether there are symptoms such as coughing or trouble breathing.
The patient’s general health.
For most patients with non-small cell lung cancer, current treatments do not cure the cancer.
Compared with other cell types of lung cancer, SCLC has a greater tendency to be widely disseminated by the time of diagnosis but is much more responsive to chemotherapy and radiation therapy.
Because patients with small cell lung cancer tend to develop distant metastases, localized forms of treatment, such as surgical resection or radiation therapy, rarely produce long-term survival. With incorporation of current chemotherapy regimens into the treatment program, however, survival is unequivocally prolonged.
Subscribe to:
Posts (Atom)
Subscribe to my RSS:
Subscribe in a reader
Share and Enjoy: These icons link to social bookmarking sites where readers can share and discover new web pages.
Click on:
Search Engine Optimization and SEO Tools
Submit URL Free to Search Engines
