I was treated very professionally by Dr. Vijay Kumar Malladi at the practice and was pleased with the outcome of the service. My first choice for cancer treatment every time. Thank you Dr Vijay!
Head & Neck Cancers
Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon.
Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. These areas are described below.
Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.
Pharynx: The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); the hypopharynx (the lower part of the pharynx).
Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.
Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.
Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.
Alcohol and tobacco use (including smokeless tobacco, sometimes called “chewing tobacco” or “snuff”) are the two most important risk factors for head and neck cancers, especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx. At least 75% of head and neck cancers are caused by tobacco and alcohol use. People who use both tobacco and alcohol are at greater risk of developing these cancers than people who use either tobacco or alcohol alone. Tobacco and alcohol use are not risk factors for salivary gland cancers.
Infection with cancer-causing types of human papillomavirus (HPV), especially HPV type 16, is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers that involve the tonsils or the base of the tongue.
Other risk factors for cancers of the head and neck include the following:
Paan (betel quid). Immigrants from Southeast Asia who use paan (betel quid) in the mouth should be aware that this habit has been strongly associated with an increased risk of oral cancer.
Preserved or salted foods. Consumption of certain preserved or salted foods during childhood is a risk factor for nasopharyngeal cancer.
Oral health. Poor oral hygiene and missing teeth may be weak risk factors for cancers of the oral cavity. Use of mouthwash that has a high alcohol content is a possible, but not proven, risk factor for cancers of the oral cavity.
Occupational exposure. Occupational exposure to wood dust is a risk factor for nasopharyngeal cancer. Certain industrial exposures, including exposures to asbestos and synthetic fibers, have been associated with cancer of the larynx, but the increase in risk remains controversial. People working in certain jobs in the construction, metal, textile, ceramic, logging, and food industries may have an increased risk of cancer of the larynx. Industrial exposure to wood or nickel dust or formaldehyde is a risk factor for cancers of the paranasal sinuses and nasal cavity.
Radiation exposure. Radiation to the head and neck, for noncancerous conditions or cancer, is a risk factor for cancer of the salivary glands.
Epstein-Barr virus infection. Infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.
Ancestry. Asian ancestry, particularly Chinese ancestry, is a risk factor for nasopharyngeal cancer.
SYMPTOMS & SIGNS:
The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms. Symptoms that may affect specific areas of the head and neck include the following:
Oral cavity. A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.
Pharynx. Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.
Larynx. Pain when swallowing or ear pain.
Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.
Salivary glands. Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away.
To find the cause of the signs or symptoms of a problem in the head and neck area, a doctor evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. The exams and tests may vary depending on the symptoms. Examination of a sample of tissue under a microscope is always necessary to confirm a diagnosis of cancer.
If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve an examination under anesthesia (in an operating room), x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.
The treatment plan for an individual patient depends on a number of factors, including the exact location of the tumor, the stage of the cancer, and the person’s age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.
People who are diagnosed with HPV-positive oropharyngeal cancer may be treated differently than people with oropharyngeal cancers that are HPV-negative. Recent research has shown that patients with HPV-positive oropharyngeal tumors have a better prognosis and may do just as well on less intense treatment.
Regular follow-up care is very important after treatment for head and neck cancer to make sure that the cancer has not returned, or that a second primary (new) cancer has not developed. Depending on the type of cancer, medical checkups could include exams of the stoma, if one has been created, and of the mouth, neck, and throat. Regular dental exams may also be necessary.
From time to time, complete physical exam, blood tests, x-rays, and computed tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI) scans may be needed. The doctor may monitor thyroid and pituitary gland function, especially if the head or neck was treated with radiation. Also, the doctor is likely to counsel patients to stop smoking.
Retinoblastoma is a cancer that starts in the retina, the very back part of the eye. It is the most common type of eye cancer in children.
ABOUT THE EYE:
The main part of the eye is the eyeball (also known as the globe), which is filled with a jelly-like material called vitreous humor. The front of the eyeball has a clear lens with an iris (the colored part of the eye that acts like a camera shutter), which allows light to enter the eye and focuses it on the retina.
The retina is the inner layer of cells in the back of the eye. It is made up of special nerve cells that are sensitive to light. These light-sensing cells are connected to the brain by the optic nerve, which runs out the back of the eyeball. The pattern of light (image) that reaches the retina is sent through the optic nerve to an area of the brain called the visual cortex, allowing us to see.
Development of Retinoblastoma:
The eyes develop very early as babies grow in the womb. During the early stages of development, the eyes have cells called retinoblasts that divide into new cells and fill the retina. At a certain point, these cells stop dividing and develop into mature retinal cells.
Rarely, something goes wrong with this process. Instead of maturing into special cells that detect light, some retinoblasts continue to divide and grow out of control, forming a cancer known as retinoblastoma.
The chain of events inside cells that leads to retinoblastoma is complex, but it almost always starts with a change (mutation) in a gene called the retinoblastoma (RB1) gene. The normal RB1 gene helps keep cells from growing out of control, but the change in the gene stops it from working like it should. Depending on when and where the change in the RB1 gene occurs, 2 different types of retinoblastoma can result.
Congenital (hereditary) retinoblastoma
In about 1 out of 3 children with retinoblastoma, the abnormality in the RB1 gene is congenital (present at birth) and is in all the cells of the body, including all of the cells of both retinas. This is known as a germline mutation.
In most of these children, there is no family history of this cancer. Only about 25% of the children born with this gene change inherit it from a parent. In about 75% of children the gene change first occurs during early development in the womb. The reasons for this are not clear.
Children born with a mutation in the RB1 gene usually develop retinoblastoma in both eyes (known as bilateral retinoblastoma), and there are often several tumors within the eye (known as multifocal retinoblastoma).
Because all of the cells in the body have the changed RB1 gene, these children also have a higher risk of developing cancers in other areas as well.
- A small number of children with this form of retinoblastoma will develop another tumor in the brain, usually in the pineal gland at the base of the brain (a pineoblastoma). This is also known as trilateral retinoblastoma.
- For survivors of hereditary retinoblastoma, the risk of developing other cancers later in life is also higher than average.
Sporadic (non-hereditary) retinoblastoma
In about 2 out of 3 children with retinoblastoma, the abnormality in the RB1 gene develops on its own in only one cell in one eye. It is not known what causes this change. A child who has sporadic (non-hereditary) retinoblastoma develops only one tumor in one eye. This type of retinoblastoma is often found at a later age than the hereditary form.
Children with this type of retinoblastoma do not have the same increased risk of other cancers as children with congenital retinoblastoma.
Spread of Retinoblastoma:
If retinoblastoma tumors are not treated, they can grow and fill much of the eyeball. Cells might break away from the main tumor on the retina and float through the vitreous to reach other parts of the eye, where they can form more tumors. If these tumors block the channels that let fluid circulate within the eye, the pressure inside the eye can rise. This can cause glaucoma, which can lead to pain and loss of vision in the affected eye.
Most retinoblastomas are found and treated before they have spread outside the eyeball. But retinoblastoma cells can occasionally spread to other parts of the body. The cells sometimes grow along the optic nerve and reach the brain. Retinoblastoma cells can also grow through the covering layers of the eyeball and into the eye socket, eyelids, and nearby tissues. Once the cancer reaches tissues outside the eyeball, it can then spread to lymph nodes (small bean-shaped collections of immune system cells) and to other organs such as the liver, bones, and bone marrow (the soft, inner part of many bones).
Signs and Symptoms of Retinoblastoma:
Retinoblastomas nearly always occur in young children. They are often found when a parent or doctor notices a child’s eye looks unusual.
White pupillary reflex
This is the most common early sign of retinoblastoma. Normally when you shine a light in the eye, the pupil (the dark spot in the center of the eye) looks red because of the blood vessels in the back of the eye. In an eye with retinoblastoma, the pupil often appears white or pink instead, which is known as a white pupillary reflex (or leukocoria).
This white glare of the eye may be noticed by a parent after a flash photograph is taken, especially if the pupils are different colors. It also might be noted by the child’s doctor during a routine eye exam.
Sometimes the eyes don’t appear to look in the same direction, a condition often called lazy eye. (Doctors call this strabismus.) There are many possible causes of this in children. Most of the time lazy eye is caused by a mild weakness of the muscles that control the eyes, but it can also be caused by retinoblastoma.
Other possible signs and symptoms
Less common signs and symptoms of retinoblastoma include:
- Vision problems
- Eye pain
- Redness of the white part of the eye
- Bleeding in the front part of the eye
- Bulging of the eye
- A pupil that doesn’t get smaller when exposed to bright light
- A different color in each iris (the colored part of the eye)
Many of these signs and symptoms are more likely to be caused by something other than retinoblastoma.
Diagnosis of Retinoblastoma:
Ultrasound uses sound waves to create images of tissues inside the body, such as the inner parts of the eye. For this test, a small ultrasound probe is placed up against the eyelid or eyeball. The probe gives off sound waves and detects the echoes that bounce off the tissues inside and around the eye. The echoes are converted by a computer into an image on a computer screen.
Ultrasound is one of the most common imaging tests for confirming the diagnosis of retinoblastoma. It is painless and does not expose the child to radiation, but the child may need to be given medicine to help keep them calm or even asleep so the doctor can get a good look at the eye. This test can be very useful when tumors in the eye are so large they prevent doctors from seeing inside the whole eye.
Optical coherence tomography (OCT) is a similar type of test that uses light waves instead of sound waves to create very detailed images of the back of the eye.
Magnetic resonance imaging (MRI) scan
MRI scans are often used for retinoblastomas because they provide very detailed images of the eye and surrounding structures without using radiation. This test is especially good at looking at the brain and spinal cord. For children with bilateral retinoblastomas (tumors in both eyes), many doctors continue to do MRI scans of the brain for several years after treatment to look for tumors of the pineal gland (sometimes called trilateral retinoblastoma).
Computed tomography (CT) scan
CT scans use x-rays to make detailed images of parts of the body. CT scans can help determine the size of a retinoblastoma tumor and how much it has spread within the eye and to nearby areas.
Normally, either a CT or an MRI scan is needed, but usually not both. Because CT scans give off radiation, which might raise a child’s risk for other cancers in the future, most doctors prefer to use MRI. However, a CT scan can show deposits of calcium in the tumor much better than an MRI, which can be very helpful when the diagnosis of retinoblastoma is not clear.
A bone scan can help show if the retinoblastoma has spread to the skull or other bones. Most children with retinoblastoma don’t need to have a bone scan. It is normally used only when there is a strong reason to think retinoblastoma might have spread beyond the eye.
For most cancers, a biopsy (removing a tissue sample from the tumor and looking at it under a microscope) is needed to make a diagnosis. Trying to biopsy a tumor at the back of the eye can often damage the eye and may spread tumor cells, so this is almost never done to diagnose retinoblastoma. Instead, doctors make the diagnosis based on eye exams and on imaging tests such as those listed above.
Lumbar puncture (spinal tap)
Retinoblastomas can sometimes grow along the optic nerve, which connects the eye to the brain. If the cancer has spread to the surface of the brain, this test can often find cancer cells in samples of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord). Most children with retinoblastoma don’t need to have a lumbar puncture. It is used mainly when there is a reason to think retinoblastoma might have spread into the brain.
Bone marrow aspiration and biopsy
These 2 tests may be done to see if the cancer has spread to the bone marrow, the soft, inner part of certain bones. These tests are usually not needed unless the retinoblastoma has grown outside the eye and doctors suspect that the cancer may have also spread through the bloodstream to the bone marrow.
The tests are typically done at the same time. The samples are usually taken from the back of the pelvic (hip) bone, but in some cases they may be taken from other bones.
The Reese-Ellsworth staging system
The Reese-Ellsworth system was developed in the 1960s, when most children were being treated with external beam radiation therapy (EBRT). While this is no longer a common treatment, some doctors may still use this system to classify retinoblastomas that have not spread beyond the eye. This system can help determine the likelihood of preserving vision while still treating the tumor.
Group 1 (very favorable for saving [or preserving] the eye)
- 1A: one tumor, smaller than 4 disc diameters (DD), at or behind the equator
- 1B: multiple tumors smaller than 4 DD, all at or behind the equator
Group 2 (favorable for saving [or preserving] the eye)
- 2A: one tumor, 4 to 10 DD, at or behind the equator
- 2B: multiple tumors, with at least one 4 to 10 DD, and all at or behind the equator
Group 3 (doubtful for saving [or preserving] the eye)
- 3A: any tumor in front of the equator
- 3B: one tumor, larger than 10 DD, behind the equator
Group 4 (unfavorable for saving [or preserving] the eye)
- 4A: multiple tumors, some larger than 10 DD
- 4B: any tumor extending toward the front of the eye to the ora serrata (front edge of the retina)
Group 5 (very unfavorable for saving [or preserving] the eye)
- 5A: tumors involving more than half of the retina
- 5B: vitreous seeding (spread of tumors into the jelly-like material that fills the eye)
TREATMENT OF RETINOBLASTOMA:
Surgery (Enucleation) for Retinoblastoma
Surgery is not needed for all retinoblastomas, especially for smaller tumors. But if a tumor gets quite large before it is found, vision in the eye has often already been destroyed, with no hope of getting it back. The usual treatment in this case is enucleation, an operation to remove the whole eye, plus part of the optic nerve attached to it. This is done while the child is under general anesthesia.
During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made out of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eye, so it should move the same way as the eye would have.
Radiation Therapy for Retinoblastoma
This treatment uses high energy x-rays or particles to kill cancer cells. Radiation therapy is an effective treatment for some children with retinoblastoma. Compared with surgery, it has the advantage of possibly saving vision in the eye.
External beam radiation therapy
External beam radiation therapy (EBRT) focuses radiation beams from a source outside the body on the cancer. This was once a common treatment for retinoblastoma. But because of the side effects it can cause, it is now most often used only for cancers that are not well-controlled with other treatments.
Radiation is usually given 5 days a week for several weeks. Before treatments start, the radiation team takes careful measurements with imaging tests such as MRI scans to determine the correct angles for aiming the radiation beams and the proper dose of radiation.
Each treatment is much like getting an x-ray, but the dose of radiation is much higher. For each session, your child will lie on a special table while a machine delivers the radiation from precise angles.
The actual treatment each day lasts only a few minutes, but the setup time – getting your child into place for treatment – usually takes longer. The child’s head is positioned in a custom-fitted mold that is similar to a cast used to treat broken bones. The treatment is not painful, but young children may be given medicine to make them sleep so they will stay still during treatment.
Intensity modulated radiation therapy (IMRT): IMRT lets doctors shape the radiation beams and aim them at the tumor from several angles, as well as adjust the intensity (strength) of the beams to limit the dose reaching the nearby normal tissues. This may let the doctor deliver a higher dose to the tumor, while reducing side effects. Many major hospitals and cancer centers now use IMRT.
Proton beam therapy: Protons are positive parts of atoms. Unlike the x-rays used in standard radiation, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and then release their energy after traveling a certain distance. Proton beam radiation may be able to deliver the same level of radiation to the tumor while causing much less damage to nearby normal tissues.
Brachytherapy (plaque radiotherapy)
The use of brachytherapy, also known as internal radiation therapy or episcleral plaque radiotherapy, is limited to small tumors. During brachytherapy, a small amount of radioactive material is placed on the outside of the part of the eyeball where the tumor is for several days. The radioactive material is put in a small carrier (known as a plaque), which is shaped like a very small bottle cap. The plaque is made of gold or lead to shield nearby tissues from the radiation. The radiation travels a very short distance, so most of it will be focused only on the tumor.
The plaque is sewn in place on the eyeball with tiny stitches during a short operation. It is then removed during a second operation several days later. Both operations are done while the child is under general anesthesia. The child typically stays in the hospital while the plaque is in place.
Chemotherapy for Retinoblastoma
Systemic chemotherapy: In most cases, chemo drugs are injected into a vein (IV) or given by mouth. These drugs enter the bloodstream and reach throughout the body. This is known as systemic chemotherapy.
Periocular (subtenon) chemotherapy: For some advanced intraocular cancers, higher doses of chemo are needed inside the eye. Along with systemic chemotherapy, one of the drugs (carboplatin) may be injected in the tissues around the eye, where it slowly diffuses into the eyeball. This is called periocular or subtenon chemotherapy.
Intra-arterial chemotherapy: A newer approach sometimes used instead of systemic chemotherapy is to inject chemo directly into the ophthalmic artery, the main artery that supplies blood to the eye. In this technique, a very thin catheter (a long, hollow, flexible tube) is inserted into a large artery on the inner thigh and slowly threaded through the blood vessels all the way up into the ophthalmic artery. The chemo is then infused into the artery. The drug used most often is melphalan, but other drugs such as carboplatin and topotecan can also be used.
Intravitreal chemotherapy: In this newer approach, chemotherapy is given directly into the vitreous humor, the jelly-like substance inside the eye.
Follow-up exams and tests
Once treatment is finished, your health care team will discuss a follow-up schedule with you, including which tests should be done and how often. It’s very important to go to all follow-up appointments. Follow-up is needed to check for cancer recurrence, as well as possible side effects of certain treatments. Doctor visits and tests are done more often at first. If nothing abnormal is found, the time between tests can then be extended.
Lung cancer has emerged as the leading killer of men and women stricken with invasive cancer, affecting husbands and wives, friends and neighbors, and causing suffering for many families.
This disease is difficult to detect in its early stages, and treatments for lung cancer in its later stages provide a poor prognosis: Those with stage IV non-small cell lung cancer—the most common type—have an estimated 1 percent survival rate five years after diagnosis.
The major cause of lung cancer in men and women is mainly due to cigarette smoking. Currently about 90% of all lung cancers are related to smoking. Radon gas, pollution, toxins, and other factors contribute to the remaining 10%.
Signs and Symptoms:
Unfortunately, lung cancers often have either no early symptoms or nonspecific early symptoms that people often dismiss.
List of Lung Cancer Symptoms
- Cough (chronic, recurrent)
- Weight loss
- Shortness of breath or wheezing
- Coughing up phlegm that contains blood
- Chest pain
- Paraneoplastic symptoms: Lung cancers frequently are accompanied by symptoms that result from production of hormone-like substances by the tumor cells. These paraneoplastic syndromes occur most commonly with SCLC but may be seen with any tumor type. A common paraneoplastic syndrome associated with SCLC is the production of a hormone called adrenocorticotrophic hormone (ACTH) by the cancer cells, leading to oversecretion of the hormone cortisol by the adrenal glands (Cushing’s syndrome). The most frequent paraneoplastic syndrome seen with NSCLC is the production of a substance similar to parathyroid hormone, resulting in elevated levels of calcium in the bloodstream.
Screening for lung cancer is usually accomplished using three methods.
A physical exam will look for signs of wheezing, shortness of breath, cough, pain and other possible signs of lung cancer. Depending on the advancement of the cancer, other early signs of lung cancer symptoms may include a lack of sweating, dilated neck veins, face swelling, excessively constricted pupils, and other signs. The physical exam will also include the patient’s history of smoking and a chest X-ray.
Sputum Cytology Exam
A sputum cytology exam involves a microscopic examination of a patient’s mucus (sputum).
Spiral CT Exam
This method of CT scanning builds a detailed image of the body’s internal workings. Inside a spiral CT machine, detailed images are taken of the relevant parts of the patient’s body. Those images are then linked to an X-ray machine to create 3D images of the patient’s internal organs. These images may reveal potentially cancerous tumors.
At best, the screening methods find about 30% of lung cancers leaving the bulk (about 70%) cancers of lung undetected.
Types of LUNG Cancer:
There are only two major types of lung cancers: small cell lung cancer and non-small cell lung cancers. Less than 5% of lung cancer tumors will take the form of a carcinoid tumor, while other cancerous tumors are even more rare, including adenoid cystic carcinomas, lymphomas, and sarcomas. Although cancer from another part of the body may spread to the lungs, these are not categorized as lung cancer.
- Adenocarcinomas are the most commonly seen type of NSCLC in the U.S. and comprise up to 50% of NSCLC. While adenocarcinomas are associated with smoking like other lung cancers, this type is observed as well in nonsmokers who develop lung cancer. Most adenocarcinomas arise in the outer, or peripheral, areas of the lungs.
- Bronchioloalveolar carcinoma is a subtype of adenocarcinoma that frequently develops at multiple sites in the lungs and spreads along the preexisting alveolar walls.
- Squamous cell carcinomas were formerly more common than adenocarcinomas; at present, they account for about 30% of NSCLC. Also known as epidermoid carcinomas, squamous cell cancers arise most frequently in the central chest area in the bronchi.
- Large cell carcinomas, sometimes referred to as undifferentiated carcinomas, are the least common type of NSCLC.
- Mixtures of different types of NSCLC also are seen.
Diagnosis & Staging Procedures:.
- Bone scans are used to create images of bones on a computer screen or on film. Doctors may order a bone scan to determine whether a lung cancer has metastasized to the bones. In a bone scan, a small amount of radioactive material is injected into the bloodstream and collects in the bones, especially in abnormal areas such as those involved by metastatic tumors. The radioactive material is detected by a scanner, and the image of the bones is recorded on a special film for permanent viewing.
- Sputum cytology: The diagnosis of lung cancer always requires confirmation of malignant cells by a pathologist, even when symptoms and X-ray studies are suspicious for lung cancer. The simplest method to establish the diagnosis is the examination of sputum under a microscope. If a tumor is centrally located and has invaded the airways, this procedure, known as a sputum cytology examination, may allow visualization of tumor cells for diagnosis. This is the most risk-free and inexpensive tissue diagnostic procedure, but its value is limited since tumor cells will not always be present in sputum even if a cancer is present. Also, noncancerous cells may occasionally undergo changes in reaction to inflammation or injury that makes them look like cancer cells.
Bronchoscopy: Examination of the airways by bronchoscopy (visualizing the airways through a thin, fiberoptic probe inserted through the nose or mouth) may reveal areas of tumor that can be sampled (biopsied) for diagnosis by a pathologist.
Needle biopsy: Fine-needle aspiration (FNA) through the skin, most commonly performed with radiological imaging for guidance, may be useful in retrieving cells for diagnosis from tumor nodules in the lungs. Needle biopsies are particularly useful when the lung tumor is peripherally located in the lung and not accessible to sampling by bronchoscopy.
Blood tests: While routine blood tests alone cannot diagnose lung cancer, they may reveal biochemical or metabolic abnormalities in the body that accompany cancer. For example, elevated levels of calcium or of the enzyme alkaline phosphatase may accompany cancer that is metastatic to the bones. Likewise, elevated levels of certain enzymes normally present within liver cells, including aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT), signal liver damage, possibly through the presence of tumor metastatic to the liver.
Molecular Testing: testing may be done to look for mutations or abnormalities in the epithelial growth factor receptor (EGFR) and the anaplastic lymphoma kinase (ALK) genes. Other genes that may be mutated include MAPK and PIK3. Specific therapies are available that may be administered to patients whose tumors have these alterations in their genes.
Early stage (stage 0 or even some stage I) cancer treatment of non-small cell lung cancer may benefit from surgery. Part or all of a lung segment that contains the cancer may be removed; in some individuals, this may result in a cure. However, many patients still undergo chemotherapy, radiation therapy or both to kill any cancer cells not removed by surgery. Because small cell lung cancers are almost never diagnosed early, surgery (and other treatments) may prolong life but rarely, if ever, result in a cure.
After a diagnosis of lung cancer, it is not unusual to feel depressed and upset. However, research is ongoing and it is possible to survive and extend your life with treatment. Even with the diagnosis, there is evidence that people who develop a healthy lifestyle and stop smoking do better than those who do not change.
Radiation: Radiation therapy may be employed as a treatment for both NSCLC and SCLC. Radiation therapy uses high-energy X-rays or other types of radiation to kill dividing cancer cells. Radiation therapy may be given as curative therapy, palliative therapy (using lower doses of radiation than with curative therapy), or as adjuvant therapy in combination with surgery or chemotherapy. The radiation is either delivered externally, by using a machine that directs radiation toward the cancer, or internally through placement of radioactive substances in sealed containers within the area of the body where the tumor is localized. Brachytherapy is a term used to describe the use of a small pellet of radioactive material placed directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope. Radiation therapy can be given if a person refuses surgery, if a tumor has spread to areas such as the lymph nodes or trachea making surgical removal impossible, or if a person has other conditions that make them too ill to undergo major surgery. Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10%-15% of people it leads to long-term remission and palliation of the cancer.
Chemotherapy: Both NSCLC and SCLC may be treated with chemotherapy. Chemotherapy refers to the administration of drugs that stop the growth of cancer cells by killing them or preventing them from dividing. Chemotherapy may be given alone, as an adjuvant to surgical therapy, or in combination with radiotherapy. While a number of chemotherapeutic drugs have been developed, the class of drugs known as the platinum-based drugs have been the most effective in treatment of lung cancers.
Chemotherapy is the treatment of choice for most SCLC, since these tumors are generally widespread in the body when they are diagnosed. Only half of people who have SCLC survive for four months without chemotherapy. With chemotherapy, their survival time is increased up to four- to fivefold. Chemotherapy alone is not particularly effective in treating NSCLC, but when NSCLC has metastasized, it can prolong survival in many cases.
The uterine cervix is the lowest portion of a woman’s uterus (womb), connecting the uterus with the vagina. Cervical cancer occurs when the cells of the cervix grow abnormally and invade other tissues and organs of the body. When it is invasive, this cancer affects the deeper tissues of the cervix and may have spread to other parts of the body (metastasis), most notably the lungs, liver, bladder, vagina, and rectum. However, cervical cancer is slow-growing, so its progression through precancerous changes provides opportunities for prevention, early detection, and treatment.
Causes of Cervical Cancer
Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes is associated with infection with human papillomavirus (HPV). In addition, early sexual contact, multiple sexual partners, and taking oral contraceptives (birth control pills) increase the risk of cervical cancer because they lead to greater exposure to HPV.
Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer. Certain types of HPV have also been linked to cancers involving the vulva, vagina, penis, anus, tongue, and tonsils. Genetic material that comes from certain forms of HPV (high-risk subtypes) has been found in cervical tissues that show cancerous or precancerous changes.
In addition, women who have been diagnosed with HPV are more likely to develop a cervical cancer. Girls who begin sexual activity before age 16 or within a year of starting their menstrual periods are at high risk of developing cervical cancer.
Cigarette smoking is another risk factor for the development of cervical cancer. The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer. The risk of cervical cancer in cigarette smokers is two to five times that of the general population
Symptoms of Cervical Cancer
As in many cancers, you may have no signs or symptoms of cervical cancer until it has progressed to a dangerous stage. They may include:
- Pain, when the cancer is advanced
- Abnormal vaginal bleeding (other than during menstruation)
- Abnormal vaginal discharge
- Pelvic pain
- Kidney failure due to a urinary tract or bowel obstruction, when the cancer is advanced
Diagnosing Cervical Cancer
As with all cancers, an early diagnosis of cervical cancer is key to successful treatment and cure. Treating precancerous changes that affect only the surface of a small part of the cervix is much more likely to be successful than treating invasive cancer that affects a large portion of the cervix and has spread to other tissues.
There are various diagnostic tools that can be used to identify changes in the cervix. They include:
Colposcopy is a procedure similar to a pelvic exam. It is usually used for a patient who had an abnormal Pap smear result but a normal physical exam. The examination uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye or acetic acid to make abnormal cells easier to see. These areas are then biopsied. The colposcope magnifies the cervix by eight to 15 (depends on the colposcope) times, allowing easier identification of any abnormal-appearing tissue that may need biopsy. This procedure can usually be done in your gynecologist’s office. If a biopsy under colposcopy suggests an invasive cancer, a larger biopsy is needed to fully evaluate your condition. Treatment will depend on stage of the cancer.
The loop electrosurgical excision procedure (LEEP) technique uses an electrified loop of wire to take a sample of tissue from the cervix. This procedure can often be performed in your gynecologist’s office.
A conization (removal of a portion of the cervix) is performed in the operating room while you are under anesthesia. It can performed with a LEEP, with a scalpel (cold knife conization) or a laser. In this procedure, a small cone-shaped portion of your cervix is removed for examination.
If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, invasive cervical cancer, or metastatic cancer. Cervical cancer occurs most often in women aged 40 years or older.
If the biopsy results show invasive cancer, a series of tests may be performed, all designed to see whether the cancer has spread and, if so, how far. They include:
- A chest X-ray to see if the cancer has spread to the lungs
- Blood tests can indicate whether the liver is involved; a CT scan may be necessary if results are not definitive.
- Special X-rays known as an IVP or a CT scan can be used to look at the urinary tract; the bladder and urethra are evaluated by cystoscopy.
- The vagina is examined by colposcopy; the rectum is evaluated by a procto signoidoscopy and barium enema.
- Lymph nodes are evaluated by CT scans, MRI scans, or PET scans; the MRI is superior to the CT scan and the PET scan is superior to both.
The most widely used treatments for invasive cervical cancer are surgery and radiation therapy. Chemotherapy or biological therapy also is sometimes used.
If a biopsy shows that cancerous cells have invaded through a layer called the basement membrane, which separates the surface layers of the cervix from other underlying layers, surgery is usually required. The extent of the surgery varies, depending on the stage of the cancer.
If the cancer is only on the surface of the cervix, the cancerous cells may be removed or destroyed by using methods similar to those used to treat precancerous lesions, such as the LEEP or a cold knife conization.
If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix, an operation may remove the tumor but leave the uterus and the ovaries.
If the disease has spread into the uterus, hysterectomy — removal of the uterus and cervix — is usually necessary. Sometimes, the ovaries and fallopian tubes also are removed. In addition, lymph nodes near the uterus may be removed to check for spread of the cancer. Hysterectomy is also sometimes done to prevent spread of the cancer.
Radiation therapy (or radiotherapy) is also used to treat cervical cancer at some stages. Radiation therapy uses high-energy rays to damage cancer cells and stop their growth. Like surgery, radiation therapy is local therapy; the radiation affects cancer cells only in the treated area. Radiation may be applied externally or internally. Some women receive both kinds.
External radiation comes from a large machine, which aims a beam of radiation at your pelvis. Treatments, which take only a few minutes, usually are given five days a week for five to six weeks. At the end of that time, an extra dose of radiation called a “boost” may be applied to the tumor site.
Because of safety concerns and expense of equipment, radiation therapy generally is offered only at certain large medical centers or hospitals.
Internal or implant radiation comes from a capsule containing radioactive material which is placed directly in the cervix. The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it.
There are two types of implant radiation, also called brachytherapy. With low dose rate brachytherapy the implant is usually left in place for one to three days. The treatment may be repeated several times over the course of 1-2 weeks. You stay in the hospital while the implants are in place.
Another type is high dose rate brachytherapy. This form may be performed as an outpatient. During this treatment the implant is inserted for several minutes then removed. The therapy is performed several times over a series of weeks, each treatment usually at least a week apart.
Chemotherapy is the use of powerful drugs to kill cancer cells. In cervical cancer, it is used most often when the cancer is locally advanced or has spread to other parts of the body. Just one drug or a combination of drugs may be given. Anticancer drugs used to treat cervical cancer may be given via an IV line or by mouth. Either way, chemotherapy is systemic treatment, meaning that the drugs flow through the body in the bloodstream. They can kill cancer cells anywhere in the body.
Follow-Up After Cervical Cancer Treatment
Regular pelvic exams and Pap smears are important for every woman. These tests are no less important for a woman who has been treated for precancerous changes or for cancer of the cervix.
Follow-up care should include a full pelvic exam, Pap smear, and other tests as indicated on a regular schedule recommended by your gynecologist. These precautions are necessary to allow early detection should the cancer return.
Cervical cancer treatment may cause side effects many years later. For this reason, you should continue to have regular checkups and should report any health problems that appear.
Colorectal cancer, also known as bowel cancer, colon cancer, or rectal cancer, is any cancer that affects the colon and the rectum.
The possible risk factors include:
- older age
- a diet that is high in animal protein, saturated fats, and calories
- a diet that is low in fiber
- high alcohol consumption
- having had breast, ovary, or uterine cancer
- a family history of colorectal cancer
- having ulcerative colitis, Crohn’s disease, or irritable bowel disease (IBD)
- overweight and obesity
- a lack of physical activity
- the presence of polyps in the colon or rectum, as these may eventually become cancerous.
Most colon cancers develop within polyps (adenoma). These are often found inside the bowel wall.
Eating red or processed meats may increase the risk
People who have a tumor suppressor gene known as Sprouty2 may have a higher risk of some colorectal cancers.
According to WHO (World Health Organization) colorectal cancer is the second most common tumor among both men and women, after lung tumors.
Around 2 percent of people aged over 50 years will eventually develop colorectal cancer in Western Europe.
Colorectal cancer tends to affect men and women equally. However, men tend to develop it at a younger age.
Diagnosis of Colorectal Cancer:
The following are the most common screening and diagnostic procedures for colorectal cancer.
Fecal occult blood test (blood stool test)
This checks a sample of the patient’s stool (feces) for the presence of blood. This can be done at the doctor’s office or with a kit at home. The sample is returned to the doctor’s office, and it is sent to a laboratory.A blood stool test is not 100-percent accurate, because not all cancers cause a loss of blood, or they may not bleed all the time. Therefore, this test can give a false negative result.
Stool DNA test
This test analyzes several DNA markers that colon cancers or precancerous polyps cells shed into the stool. Patients may be given a kit with instructions on how to collect a stool sample at home. It is then sent to a laboratory.This test is more accurate for detecting colon cancer than polyps, but it cannot detect all DNA mutations that indicate that a tumor is present.
The doctor uses a sigmoidoscope, a flexible, slender and lighted tube, to examine the patient’s rectum and sigmoid. The sigmoid colon is the last part of the colon, before the rectum.
The test takes a few minutes and is not painful, but it might be uncomfortable. There is a small risk of perforation of the colon wall.
If the doctor detects polyps or colon cancer, a colonoscopy can then be used to examine the entire colon and take out any polyps that are present. These will be examined under a microscope.
A sigmoidoscopy will only detect polyps or cancer in the end third of the colon and the rectum. It will not detect a problem in any other part of the digestive tract.
Barium enema X-ray
Barium is a contrast dye that is placed into the patient’s bowel in an enema form, and it shows up on an X-ray. In a double-contrast barium enema, air is added as well.
The barium fills and coats the lining of the bowel, creating a clear image of the rectum, colon, and occasionally of a small part of the patient’s small intestine.
A flexible sigmoidoscopy may be done to detect any small polyps the barium enema X-ray may miss. If the barium enema X-ray detects anything abnormal, the doctor may recommend a colonoscopy.
A colonoscope is longer than a sigmoidoscope. It is a long, flexible, slender tube, attached to a video camera and monitor. The doctor can see the whole of the colon and rectum. Any polyps discovered during this exam can be removed during the procedure, and sometimes tissue samples, or biopsies, are taken instead.
A colonoscopy is painless, but some patients are given a mild sedative to calm them down. Before the exam, they may be given laxative fluid to clean out the colon. An enema is rarely used. Bleeding and perforation of the colon wall are possible complications, but extremely rare.
A CT machine takes images of the colon, after clearing the colon. If anything abnormal is detected, conventional colonoscopy may be necessary. This procedure may offer patients at increased risk of colorectal cancer an alternative to colonoscopy that is less-invasive, better-tolerated, and with good diagnostic accuracy.
Ultrasound or MRI scans can help show if the cancer has spread to another part of the body.
The Centers for Disease Control and Prevention (CDC) recommend regular screening for those aged 50 to 75 years. The frequency depends on the type of test.
A commonly used system gives the stages a number from 0 to 4. The stages of colon cancer are:
- Stage 0: This is the earliest stage, when the cancer is still within the mucosa, or inner layer, of the colon or rectum. It is also called carcinoma in situ.
- Stage 1: The cancer has grown through the inner layer of the colon or rectum but has not yet spread beyond the wall of the rectum or colon.
- Stage 2: The cancer has grown through or into the wall of the colon or rectum, but it has not yet reached the nearby lymph nodes.
- Stage 3: The cancer has invaded the nearby lymph nodes, but it has not yet affected other parts of the body.
- Stage 4: The cancer has spread to other parts of the body, including other organs, such as the liver, the membrane lining the abdominal cavity, the lung, or the ovaries.
- Recurrent: The cancer has returned after treatment. It may come back and affect the rectum, colon, or another part of the body.
Treatment will depend on several factors, including the size, location, and stage of the cancer, whether or not it is recurrent, and the current overall state of health of the patient.
Treatment options include chemotherapy, radiotherapy, and surgery.
Surgery for colorectal cancer
This is the most common treatment. The affected malignant tumors and any nearby lymph nodes will be removed, to reduce the risk of the cancer spreading.
The bowel is usually sewn back together, but sometimes the rectum is removed completely and a colostomy bag is attached for drainage. The colostomy bag collects stools. This is usually a temporary measure, but it may be permanent if it is not possible to join up the ends of the bowel.
If the cancer is diagnosed early enough, surgery may successfully remove it. If surgery does not stop the cancer, it will ease the symptoms.
Chemotherapy involves using a medicine or chemical to destroy the cancerous cells. It is commonly used for colon cancer treatment. Before surgery, it may help shrink the tumor.
Targeted therapy is a kind of chemotherapy that specifically targets the proteins that encourage the development of some cancers. They may have fewer side effects than other types of chemotherapy. Drugs that may be used for colorectal cancer include bevacizumab (Avastin) and ramucirumab (Cyramza).
A study has found that patients with advanced colon cancer who receive chemotherapy and who have a family history of colorectal cancer have a significantly lower likelihood of cancer recurrence and death.
Radiation therapy uses high energy radiation beams to destroy the cancer cells and to prevent them from multiplying. This is more commonly used for rectal cancer treatment. It may be used before surgery in an attempt to shrink the tumor.
Both radiation therapy and chemotherapy may be given after surgery to help lower the chances of recurrence
Dr. Vijay Kumar Malladi Honored with Vaidya Siromani Awards 2016
Dr. Vijay Kumar Malladi honored with Vaidya Siromani awards 2016 by Mothers Foundation.
Honored with Vaidya Siromani
Dr. Vijay Kumar Malladi pursued his MBBS at Osmania Medical College, February 1982. And he did his M.D. (Radio Therapy) also in Osmania Medical College.
The bladder is a hollow organ that collects urine from the kidneys through the ureters for storage and eventual removal from the body through the urethra. Bladder cancer is an uncontrolled abnormal growth and multiplication of cells in the urinary bladder, which have broken free from the normal mechanisms that keep uncontrolled cell growth in check. Invasive bladder cancer (like cancers of other organs) has the ability to spread (metastasize) to other body parts, including the lungs, bones, and liver. Bladder cancer is a common cancer; men have a higher risk of getting bladder cancer than women. Cigarette smoking is the most significant risk factor for bladder cancer, with smokers three to four times more likely to get the disease than nonsmokers. There are two subdivisions of bladder cancer: noninvasive, or superficial, and invasive, with the former having much better treatment outcomes than the latter.
What are the types of Bladder Cancer?
- Urothelial carcinoma (previously known as “transitional cell carcinoma”) is the most common type and comprises 90%-95% of all bladder cancers. This type of cancer has two subtypes: papillary carcinoma (growing finger-like projections into the bladder lumen) and flat carcinomas that do not produce fingerlike projections. Urothelial carcinoma (transitional cell carcinoma) is strongly associated with cigarette smoking.
- Adenocarcinoma of the bladder comprises about 1%-2% of all bladder cancers and is associated with prolonged inflammation and irritation. Most adenocarcinomas of the bladder are invasive.
- Squamous cell carcinoma comprises 1%-2% of bladder cancers and is also associated with prolonged infection, inflammation, and irritation such as that associated with longstanding stones in the bladder. In certain parts of the Middle East and Africa (for example, Egypt), this is the predominant form of bladder cancer and is associated with chronic infection caused by Schistosoma worm (a blood fluke, that causes schistosomiasis, also termed bilharzia or snail fever).
- Other rare forms of cancer found in the bladder include small cell cancer (arising in neuroendocrine cells), pheochromocytoma (rare), and sarcoma (in muscle tissue).
Signs & Symptoms of bladder cancer:
The most common symptom of bladder cancer is bleeding in the urine (hematuria). Most often the bleeding is “gross” (visible to the naked eye), episodic (occurs in episodes), and is not associated with pain (painless hematuria). However, sometimes the bleeding may only be visible under a microscope (microscopic hematuria) or may be associated with pain due to the blockage of urine by formation of blood clots. There may be no symptoms or bleeding for prolonged periods. Some types of bladder cancer may cause irritative symptoms of the bladder with little or no bleeding. The patients may have the desire to urinate small amounts in short intervals (increased urinary frequency), an inability to hold the urine for any length of time after the initial desire to void (urgency), or a burning sensation while passing urine (dysuria).
Diagnosis of Bladder Cancer:
Bladder cancer is most frequently diagnosed by investigating the cause of bleeding in the urine that a patient has noticed. The following are investigations or tests that come in handy in such circumstances:
- Urinalysis: A simple urine test that can confirm that there is bleeding in the urine and can provide an idea about whether an infection is present or not. It is usually one of the first tests that a physician requests. It does not confirm that a person has bladder cancer but can help the physician in short-listing the potential causes of bleeding.
- Urine cytology: A health care professional performs the test on a urine sample that is centrifuged. Then a pathologist examines the sediment under a microscope. The idea is to detect malformed cancerous cells that may pass into the urine from a cancer. A positive test is quite specific for cancer (for example, it provides a high degree of certainty that cancer is present in the urinary system). However, many early bladder cancers may be missed by this test so a negative or inconclusive test does not effectively rule out the presence of bladder cancer.
- Ultrasound: An ultrasound examination of the bladder can detect bladder tumors. It can also detect the presence of swelling in the kidneys in case the bladder tumor is located at a spot where it can potentially block the flow of urine from the kidneys to the bladder. It can also detect other causes of bleeding, such as stones in the urinary system or prostate enlargement, which may be the cause of the symptoms or may coexist with a bladder tumor. An X-ray examination may rule out other causes of symptoms.
- CT scan/MRI: A CT scan or MRI provides greater visual detail than an ultrasound exam and may detect smaller tumors in the kidneys or bladder than can be detected by an ultrasound. It can also detect other causes of bleeding more effectively than ultrasound, especially when intravenous contrast is used.
- Cystoscopy and biopsy: This is probably the single most important investigation for bladder cancer. Since there is always a chance to miss bladder tumors on imaging investigations (ultrasound/CT/MRI) and urine cytology, it is recommended that all patients with bleeding in the urine, without an obvious cause, should have a cystoscopy performed by a urologist as a part of the initial evaluation. This entails the use of a thin tube-like optical instrument connected to a camera and a light source (cystoscope). A health care provider passes it through the urethra into the bladder and the inner surface of the bladder is visualized on a video monitor. Small or flat tumors that may not be visible on other investigations are visible by this method, and a piece of this tissue can be taken as a biopsy for examination under the microscope. This method effectively diagnoses the presence and type of bladder cancer. In addition, health care professionals may perform fluorescence cystoscopy at the same time; fluorescent dyes are placed in the bladder and are taken up by cancer cells. These cancer cells are visible (fluoresce) when a blue light is shined on them through the cystoscope and thus become visible, thereby making identification of cancer cells easier with this technique.
- Newer biomarkers like NMP 22 and fluorescent in-situ hybridization (FISH) are currently in use to detect bladder cancer cells by a simple urine test. UroVysion, BTA, and the ImmunoCyt test are newer diagnostic tests. However, they have not yet achieved the level of accuracy to replace cystoscopy and cytology in the diagnosis and follow-up of bladder cancer.
Staging & Grading:
The proper staging of bladder cancer is an essential step that has significant bearings on the management of this condition. A pathologist examines the tumor specimen under a microscope to determine the grading of the bladder cancer. It is a measure of the extent by which the tumor cells differ in their appearance from normal bladder cells. The greater the distortion of appearance, the higher the grade assigned. High-grade cancers are more aggressive than low-grade ones and have a greater propensity to invade into the bladder wall and spread to other parts of the body. The grades are-
- Grade 1 cancers (or low grade or well differentiated cancers) have cells that look very much like normal cells. They tend to grow slowly and are not likely to spread.
- Grade 2 cancers have cells that look more abnormal. They are called medium grade or moderately differentiated and may grow or spread more quickly than low grade.
- Grade 3 cancers have cells that look very abnormal. They are called high grade or poorly differentiated and are more quickly growing and more likely to spread.
- Grade 4 cancers are so abnormal that they have no distinguishing features to say that they even started as bladder cells. They are undifferentiated.
The initial surgical procedure that a patient undergoes after the diagnosis of bladder cancer is established is usually a transurethral resection of bladder tumor or “TURBT.” This does not involve an external cut on the body. For Superficial Bladder Cancer, after an initial TURBT, patient may be put on follow up with repeated cystoscopic examinations. For high grade superficial cancers, Intravesicular instillation of BCG vaccine and for recurrent tumors intravesicular instillation of Mitomycin-C or Adriamycin are used.
For Invasive bladder cancer, the preferred treatment is surgical approach. But an organ preservative Radical Chemo Radiotherapy is also used.
The prostate is a gland that is a part of the male reproductive system that wraps around the male urethra at its exit from the bladder. A malignant tumor of the prostate, the gland that produces some of the components of semen. It is often first detected as a hard nodule found during a routine rectal examination. The PSA blood test is a screening test for prostate cancer. Diagnosis of prostate cancer is established when cancer cells are identified in prostate tissue obtained via biopsy. In some patients, prostate cancer is life threatening. In many others, prostate cancer can exist for years without causing any health problems.
Symptoms of prostate problems (and prostate cancer) include urinary problems such as: Decreased force of urine stream; difficulty starting (hesitancy); the need to strain to urinate; stopping/starting of the urine stream (intermittency); frequent urination; dribbling; pain or burning during urination, erectile dysfunction; painful ejaculation; blood in urine or semen and/or deep back, hip, pelvic or abdominal pain; other symptoms may include weight loss, bone pain and lower extremity swelling.
The exact causes of prostate cancer are not known.
Diagnosis of Prostate Cancer is made by Digital rectal examination (DRE), Prostate specific antigen (PSA) blood test, Prostate biopsy.
The Gleason score and the extent of involvement of the biopsy core expressed as a percentage, as well as the PSA level as well as your general state of health and otherwise estimated life expectancy, all help to allow doctors to make their best recommendations for you regarding how your cancer should be treated.
The NCCN treatment recommendations based on risk stratification are as follows:
Very low risk
- Life expectancy < 10 years — observation
- Life expectancy 10-20 years — active surveillance
- Life expectancy > 20 years — active surveillance, EBRT, brachytherapy, or RRPX
- Life expectancy < 10 years — observation
- Life expectancy > 10 years — active surveillance, EBRT, brachytherapy, or RRPX
- Life expectancy < 10 years — observation; EBRT +/- ADT (four to six months), +/- brachytherapy; brachytherapy
- Life expectancy > 10 years — RRPX +/- lymph node dissection EBRT +/- ADT (four to six months) +/- brachytherapy; brachytherapy
- EBRT + ADT (two to three years); EBRT + brachytherapy +/- ADT; RRPX in select individuals
Very high risk
- EBRT + long-term ADT; EBRT + brachytherapy +/- long-term ADT; RRPX + lymph node dissection ADT or observation in select patients