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Breast Cancer

Sep12
2009 Leave a Comment Written by admin

Causes | Symptoms | Diagnosis | Stages | Treatment
Causes and Risk factors

A person’s age, genetic factors, personal health history and diet all contribute to breast cancer. History of previous cancer in one breast, especially if it occurred before menopause increases a woman’s risk of developing a new breast cancer unrelated to the first one. About 5% to 10% of all breast cancers may be related to genes that are passed  through close relatives such as mother or sister, who developed breast cancer before menopause. Other factors include

First child over age of 30, hormonal changes during the time of pregnancy may influence a woman’s chances of developing breast cancer.

  • Not having children
  • Early menarchy (before age 12)
  • Late menopause
  • Over weight especially in the upper body
  • Use of alcohol
  • Excessive radiation
  • Hormonal contraceptives.
  • Hormone replacement therapy for more than five years.
  • Usage of diethylstilbestrol to prevent miscarriage.

Signs and Symptoms of cancer.

Early breast cancer usually does not cause pain and may cause no symptoms at all. It is normally found when a suspicious  lump  is detected. It must be about the size of a finger tip before it can be felt. Other signs of cancer  include

  • Breast or nipple skin that is warm, red, swollen, or scaly
  • Change in the shape or size of the breast

A lump or thickening near the breast, or in the underarm

  • Nipple discharge that is not breast milk
  • Nipple tenderness
  • A nipple that is turned inward, or inverted
  • A rash around the nipple that may bleed, itch, or cause skin breakdown
  • Ridges or pits in the breast
  • Skin that is dimpled like an orange.

Diagnosis

To find out the cause of any of these signs or symptoms, a woman’s doctor does a careful physical exam and asks about her personal and family medical history. The most reliable method of detecting breast cancer is the clinical breast examination, followed by immediate evaluation of any abnormality.One can detect breast cancer at its earlier stage by performing breast self examination (BSE) on a monthly basis. Other diagnostic measures include mammography, Sonography,  Thermography and biopsy.

Sonography is a technique that produces an image of the breast using sound waves rather than radiation. Ultrasound allows significant freedom in obtaining images of the breast from almost any orientation. This procedure is used more clearly define suspicious area on the mammogram rather than a screening test.   Sonography’s main value is in distinguishing fluid filled cysts, which are usually benign, from solid growth, which sometimes represent cancer. Thus, a questionable area that turns out to be a cysts can often seen, while a solid mass may need a biopsy.  However, ultrasound does not have good spatial resolution like mammography, and therefore cannot provide as much detail as a mammogram image.

Thermography takes advantage of the fact that some breast cancer cause an increase in the breast skin temperature. Thermography provides a photographic image of the heat patterns on the breast surface. A heat detecting device maps and  records hot spots or areas of increased blood distribution.  While it avoids the risks of X-rays, thermography has very limited usefulness because it does not distinguish well between cancer and other breast diseases.  The result is a high percentage of ‘false positive’ thermograms.

Biopsy : Although a doctor may suspect a diagnosis of breast cancer after examination or mammography, it is ultimately diagnosed  by a breast biopsy.  In biopsy, a sample of breast tissue is removed by a radiologist or surgeon and sent to the laboratory for microscopic examination by a pathologist. If cancer is found to be present after biopsy, it is critical that the type and stages of the cancer be identified as soon as possible. Generally, the earlier breast cancer is diagnosed, the greater a patient’s chances of survival.

There are several different methods of biopsy. They include Fine needle aspiration, biopsy, Core needle biopsy, Vaccum- assisted biopsy, Large core surgical and Open surgical. The most common method is surgical biopsy and fine needle biopsy.  In fine needle aspiration biopsy, a fine guage needle and syringe to take sample fluid from a breast cyst.

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Bladder cancer Treatment

Sep09
2009 Leave a Comment Written by admin

Treatment

Treatment for bladder cancer depends on the stage of the disease, the type of cancer, and the patient’s age and overall health. It generally begins within a few weeks after the diagnosis. The treatment options for bladder cancer are surgery, radiation therapy, chemotherapy and biological therapy. Sometimes  a combination of these therapies are used.

Surgery
It is the most common and widely used treatment for bladder cancer.  It is used for all types and stages of bladder cancer.  Depending on the stage and grade of the tumor, the surgery include :

Transurethral resection: Also called TUR, this method is used to treat superficial bladder cancer (carcinoma in situ). An instrument called resectoscope is inserted through the urethra and into the bladder. A small wire loop on the end of the instrument removes the tumor by cutting it or burning it with electrical current. This is called fulguration. After TUR, patients may also have chemotherapy or biological therapy.

Radical cystectomy :  Radical cystectomy is the removal of the entire bladder as well as its surrounding lymph nodes and other structures that may contain cancer. This major surgery is used for cancers that have invaded through the bladder wall or for superficial cancers that extend a large part of the bladder. Not only the entire bladder but also other structures are removed.

Segmental or partial cystectomy: The procedure of removing only a part of the bladder is called segmental cystectomy. It is usually performed for treating low-grade cancer that have invaded the bladder wall but are limited to a small area of the bladder.

Side Effects : After surgery, the patients may have some blood in their urine and difficulty or pain when urinating. Radical cystectomy may affect a person’s sexual function. This surgery stops the production of semen because it removes the prostate and seminal vesicles in men. And in women the womb (uterus), ovaries, and part of the vagina are removed. As a result, menopause may occur and most women are not able to get pregnant.

Bladder reconstruction
The bladder is completely removed in radical cystectomy. Removal of the bladder required an ostomy (surgical creation of an artificial opening) and an external bag to collect urine. This is called urinary diversion. The continent urinary reservoir or catheterizable stoma, the neobladder, urinary or ileal conduit are some procedure include in bladder reconstruction.

The urinary or ileal conduit is a urinary channel that is surgically created from a small piece of the patient’s bowel (small intestine). During this procedure, the ureters are attached to one end of the bowel segment and the other end is connected to an opening (stoma) in the lower abdomen through which urine drains into a small bag. An external, urine-collecting bag can worn at all times and empty three or four times a day.

In continent urinary reservoir, a piece of the colon (large intestine) is used to form an internal pouch capable of holding three or four cups of urine. The urine cane be drained from the pouch with a catheter several times a day and the stoma site is easily concealed by a band aid.

In neobladder procedure, the surgeon literally recreates a bladder. The process involves suturing a similar intestinal pouch used in a catheterizable stoma to the urethra. As a result, the urine can eliminate without having an external opening. This is a complex reconstruction procedure and may lead to various complications such as scarring, internal urine leakage and incontinence.

Radiation therapy
It is also called radiotherapy and uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. Radiation may be given for small-muscle invasive bladder cancers. Some patients may have radiation therapy before surgery to shrink the tumor and others may have it after surgery to kill cancer cells that may remain in the area. The two types of radiation therapy used to treat bladder cancer are :

External radiation : Radiation is produced by a machine outside the body. The machine targets a concentrated beam of radiation directly at the tumor area. This form of therapy is usually spread out in short treatments given 5 days a week for 5-7 weeks. Spreading it out this way helps protect the surrounding healthy tissues by lowering the dose of each treatment. Treatment may be shorter when external radiation is given along with radiation implants.

Internal radiation : A small pellet of a radioactive substance is placed inside the bladder through the urethra or by making a tiny incision in the lower abdominal wall. During the entire treatment, the patient must stay in the hospital. When the treatment is done, the pellet is removed. Once it is removed, no radioactivity is left in the body.

Side Effects : With external radiation, healthy tissue overlying or adjacent to the tumor can be damaged. The side effects of radiation depend on the dose and the area of the body where the radiation is targeted. Internal organs, bones, and other tissues can also be damaged. Common effects include extreme tiredness, vomiting, increased susceptibility to infections, hair loss, easy bruising or bleeding. Radiation therapy may cause decrease in the number of white blood cells. External radiation may permanently darken the skin in the treated area. Radiation to the pelvis may also cause nausea, diarrhea, urinary problems, and sexual problems such as vaginal dryness in women and erectile dysfunction in men.

Chemotherapy
Chemotherapy is a systemic treatment using anti-cancer drugs to destroy cancer cells throughout the body. It is given alone or combined with surgery, radiation therapy or both. Depending on the stage of bladder cancer, chemotherapy can be classified into intravesical (within the bladder) and intravenous (within a blood vessel).

Intravesical chemotherapy is given for patients with superficial bladder cancer. After removing the cancer, a thin, flexible tube called a catheter, is inserted into the bladder through the urethra. One or more liquid drugs are introduced into the bladder through this tube. The drugs remain in the bladder for several hours and they affect the cancer cells in the bladder. It is then drained out with urination. Usually this treatment is done once a week for several weeks.

If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the cancer-fighting drugs are injected into the bloodstream via a vein. This is called systemic or intravenous chemotherapy. The drugs given flows through the bloodstream to almost every part of the body and kill cancer cells wherever they are. The drugs are usually given in cycles so that a recovery period follows every treatment period.

Side Effects : Side effects of chemotherapy vary from patient to patient and it depends mainly on the drugs and doses received, as well as how the drugs are given. Intravesical chemotherapy can irritate the bladder or kidneys. They may cause a rash when they come into contact with the skin or genitals. Common side effects of intravenous chemotherapy include nausea, vomiting, hair loss, loss of appetite, feeling tired or lacking energy, tingling in the fingers, ringing in the ears, increased susceptibility to infection, easy bruising or bleeding and mouth sores. Most side effects disappear when treatment ends.

Biological Therapy
Biological therapy or immunotherapy uses the body’s natural ability to fight cancer and helps to prevent the cancer from coming back. One widely used type of immunotherapy is intravesical BCG treatment. It is mainly for superficial bladder cancer. BCG solution contains live, weakened bacteria that activate the immune system to kill cancer cells in the bladder. BCG solution is introduced into the bladder through a thin catheter that has been passed through the urethra. The Mycobacterium in the fluid stimulates the immune system to produce cancer-fighting substances. The solution is held in the bladder for a few hours and then drained out. This treatment is usually done once a week for 6 weeks and repeated at various times over several months or even longer in some cases.

Side Effects : BCG therapy may irritate the bladder and cause minor bleeding in the bladder. Patients may feel tired and have painful urination. Other side effects include nausea, low-grade fever, and chills.

Recently developed treatments for bladder cancer include :

Interferons
These naturally occurring compounds are directly inserted into the bladder through a catheter to slow the growth of tumors.
Side Effects include bladder infections, blood in the urine, and signs and symptoms similar to those of the flu. In some cases, interferons have developed serious lung or liver infections.

Photodynamic therapy (PDT)
PDT is a new treatment that uses special drugs and light to kill cancer cells. In this therapy, a chemical called photofrin is put into the bladder and makes cancer cells more sensitive to light. When cells are exposed to light from a laser, they are killed or damaged.
Side Effects : PDT may produce serious side effects, such as chronic bladder infections, bladder shrinkage and long-term sensitivity to sunlight.

After Treatment

Bladder cancer has an unusually high propensity for recurring after treatment, so follow-up care is very important. It may reoccur . Urine cytology and cystoscopy are performed every 3 months for 2 years, every 6 months for the next 2 years, and then yearly.

Regular follow up ensures early detection and treatment. If the bladder was not removed, the doctor will perform cystoscopy and remove any new superficial tumors that are found. Patients also may have urine tests to check for signs of cancer. Follow up care may also include blood tests, x-rays, or other tests. Drinking plenty of fluids may dilute any cancer-causing substances in the bladder and may help flush them out before they can cause damage.

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Bladder cancer

Sep09
2009 Leave a Comment Written by admin

Bladder cancer is the most common cancer of the urinary tract. Bladder cancer occurs most commonly between the ages of 50 and 70. It is twice as common in men as in women. Cancer-causing agents (carcinogens) in the urine may lead to the development of bladder cancer.bladder

The bladder is a hollow organ in the lower abdomen (pelvis). It collects and stores urine, liquid waste produced by the kidneys. Urine passes from each kidney into the bladder through a tube called ureter and leaves the bladder through the urethra. The wall of the bladder has several layers. A layer of urothelial cells (also called transitional cells) lines the inside of the the kidney, ureter, bladder, and urethra. This layer is called the urothelium or transitional epithelium. Beneath the urothelium, there is a thin zone of connective tissue called the lamina propria. The next deeper layer is a wider zone of muscle tissue called muscularis propria. Beyond this muscle, another zone of fatty connective tissue separates the bladder from other nearby organs. As the cancer penetrates through these layers into the wall of the bladder, it becomes harder to treat.

Types

Most bladder cancers starts in the layer of cells which form the lining of the bladder. These are called transitional cell  carcinoma or urothelial carcinoma. Other bladder cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma starts from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce and release fluids such as mucus. Rare types of bladder cancer include small cell carcinoma, carcinosarcoma, primary lymphoma, and sarcoma.

Tumors are categorized as low-stage (superficial) or high-stage (muscle invasive). If a bladder cancer affects only the inner lining of the bladder, it is known as non-invasive cancer or superficial cancer, or carcinoma in situ. Most bladder cancers are superficial. If the bladder cancer has grown deeper into the bladder wall and extends into the muscle layer or its surrounding tissues, it is called invasive cancer. Nearly all adenocarcinomas and squamous cell carcinomas are invasive.

Causes

The exact causes of bladder cancer are unknown . Smoking is believed to be an important cause of bladder cancer. Exposure to certain toxic chemicals and drugs may also result in cancer. The risk of cancer increases with age.

Exposure to carcinogens in the workplace and the use of cyclophosphamide or arsenic drugs increase the risk for bladder cancer. Aromatic amines, an organic chemicals used in dye industry, is linked with bladder cancer. Workers in the rubber, chemical, leather, textile, paints and printing industries are also at increased risk.

People with a family history
of bladder cancer may have an increased risk of developing the disease. Those whose diets include large amounts of fried meats and animal fats are also at higher risk of bladder cancer. Frequent bladder infections, bladder stones, and other urinary tract problems that irritate the bladder increase the risk of developing a cancer, more commonly squamous cell carcinoma.

Symptoms

Common symptoms of bladder cancer include :

* Blood in the urine (hematuria). Sometimes, blood clots can form which may cause painful muscle spasms in the bladder.
* Pain or burning during urination without evidence of urinary tract infection
* Pelvic pain
* Frequent urination, or feeling the strong urge to urinate without producing much urine
* Slowing of your urinary stream

Infections, benign tumors, bladder stones or other problems can also cause these symptoms. When any of these symptoms is noticed, consult a doctor, preferably a urologist so that he can diagnose and treat any problem as early as possible.

Diagnosis

Often, bladder cancer is asymptomatic until there is advanced disease. Therefore, in such cases, screening must be performed to detect the tumor. The most widely used screening tests are medical interview, physical examination, urinalysis, urine cytology, and cystoscopy. These tests are also used to diagnose bladder cancers symptomatic patients as well.

The doctor will review the patient’s medical condition, work history, habits and lifestyle
so that he can develop and assess the risk for bladder cancer.  A complete physical examination is performed including rectal or vaginal exam. The physician
may insert a gloved finger into the vagina, rectum or both to feel for any lumps that might indicate a tumor or another cause of bleeding.

Urinalysis :
It is a collection of tests for finding abnormalities in the urine such as blood, protein, sugar (glucose), and solids. Any abnormal findings should be investigated with more definitive tests.

Urine cytology (Urine tests) :
Abnormal cells or tumors in the bladder wall slough off cells that are suspended in the urine and excreted from the body during urination. In this test, a sample of the urine is examined under a powerful microscope to look for abnormal cells that might suggest cancer. A urine culture may be done to rule out an infection. The presence of certain antibodies and other markers may indicate cancer.

Cystoscopy :
It is the method of examining bladder and urethra using cystoscope, which is a thin, narrow tube with a light and a camera on the end. Cystoscope is inserted into the bladder through the urethra to examine any abnormalities such as tumors. The camera transmits pictures to a video monitor, allowing direct viewing of the inside of the bladder wall. With the cystoscope, sample tissues can be removed and it is examined under a microscope to detect cancer.

If bladder cancer is suspected, further tests are performed. These includes :

Pyelography :
It is a series of x-rays of the kidneys, ureters, and bladder. The doctor will inject a special dye into a vein (intravenous pyelography or IVP) or into the urethra (retrograde pyelography) and x-ray film of the urinary tract is taken. The dye highlights the organs of the urinary tract and makes seeing certain abnormalities easier.

CT (Computerized tomography) Scan :
Similar to an x-ray film, CT gives a 3-dimensional view of the bladder, urinary tract (especially the kidneys), and pelvis to look for masses and other abnormalities. In most cases, before the test, a contrast dye is injected into a vein to highlights the organs. The greatest risk with this procedure is a possible allergic reaction to the dye.

Biopsy :
Biopsy is the removal of tissue to look for cancer cell. It is the only sure way to tell whether cancer is present. Tiny samples of the bladder wall are removed, usually during cystoscopy. The samples are examined under a microscope. Small tumors are sometimes completely removed during the biopsy process.

If bladder cancer is identified, certain other tests may be performed to find whether it has invaded the bladder wall or spread to other parts of the body. It is called staging and the tests may include CT scan, ultrasound scan, magnetic resonance imaging (MRI), sonogram, bone scan or chest x-ray.

Ultrasound Scan :
This scan can show the size  and how far the tumor has spread to other organs. In this painless test, a handheld device run over the surface of the skin uses sound waves to examine the contours of the bladder and other structures in the pelvis.

Chest x-ray film :
A simple x-ray film of the chest is taken to check whether the bladder cancer has spread to the lungs.

Magnetic resonance imaging (MRI) :
Instead of X-rays, MRI uses a powerful magnetic field and radio waves to create the image of urinary tract.

Bone scan :
This imaging test is used to determine whether cancer has spread to your bones. In this method a tiny amount of a radioactive substance is injected into the veins. A special scanner then takes pictures of all your bones.

Stages

The chances of recovery are determined by the stage of the disease. Staging is essential for better treatment and usually it can be determined at the time of diagnosis. Staging is based on imaging studies (such as CT scans, x-ray films, or ultrasound) and biopsy results.

The main features of each stage of the bladder cancer are :

*
Stage 0 - cancer cells are found only on the surface of the inner lining of the bladder. This is called noninvasive cancer or superficial cancer or carcinoma in situ.
*
Stage 1 - cancer cells has started to grow into the connective or supporting tissue beneath the bladder lining. They have not spread to the muscular bladder wall.
*
Stage 2 - cancer cells has invaded the muscular bladder wall and spread to the muscle of the bladder.
*
Stage 3 - cancer cells have spread through the muscular bladder wall to the surrounding tissues. They may have spread to the prostate in men or to the uterus or vagina (in women).
*
Stage 4 - cancer has extend to the wall of the abdomen or to the wall of the pelvis. They may have spread to lymph nodes and other parts of the body far away from the bladder, such as the liver, lungs, or bones

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Cancer

Sep09
2009 Leave a Comment Written by admin

Some foods actually contribute to the development of cancer; other foods lessen the risk. Research has proved that about 90% of colon cancers and 35% of most of the other cancers are dependent on our diet. So diet play an important role in the prevention and control of cancers.

Fat

Limit your daily intake of all kinds of fat especially saturated fats to not more 20% of the total food calorie intake. Fats contained in food can be either saturated or unsaturated fats .  Unsaturated fat don’t contribute to cancer and may in fact have some anticancer properties while saturated fats may promote cancer and raise cholesterol levels. So limiting your diet to unsaturated fats, found in plant foods, such as legumes; vegetable oils that are high in monounsaturated fats, such as olive, peanut and canola oil and seafood, such as salmon and tuna, that is high in omega 3 fatty acids can be of great benefit. Avoid oils high in saturated fats such as palm, coconut, cotton seed oil; red meat like beef, pork, lamb etc. Instead of frying, try to use low fat cooking methods such as steaming, baking etc as far as possible.

Vegetables and fruits

Eat more vegetables and fruits. Having five servings of fruits and vegetables particularly dark green and dark yellow vegetables like spinach, broccoli,  beans, carrots and other vegetables like cabbage, soybeans, cauliflower, brinjal, onions (red), peppers, garlic, sweet potatoes, tomatoes etc. and fruits like grapefruit, grapes, lemons, mangoes, oranges and papayas are beneficial for preventing cancer. Eat fruits with out peeling the skin if possible and make sure the fruits and vegetables are fresh.

Green tea :  Green tea has been shown to inhibit the growth of cancer cells, possibly because of a phytochemical it contains called catechins.

Fibre

A high fibre diet protects against cancer. Increase your fibre intake to at least 25grams a day. Fiber moves potential carcinogens through the intestines faster, decreasing the contact time between carcinogens and the intestinal wall.  High fiber food include wheat bran, kidney beans, potatoes, whole wheat, whole grains, legumes, whole grain bread, prunes etc. Eating beans regularly and brown rice, brown bread etc. instead of white bread and rice can meet the fibre requirements you need. Insufficient consumption of fibre may lead to the development of Colon cancer and increase levels blood cholesterol.

Antioxidants

Eat a diet high in antioxidants. Fruits and vegetables are the main sources of these naturally occurring antioxidants. Antioxidants prevent free radicals reactions and faulty metabolism in the cell which makes the cell becoming carcinogenic. They also protect the membrane of intestinal cells. Vitamin A, Betacarotine, Riboflavin, Selenium, Zinc, Foliate, Vitamin E etc. have antioxidant properties. Cancers of the mouth can be avoided by having the food which contain antioxidants.

Vitamin Supplements

Vitamin C:  Daily intake of 1000 to 2000 milligrams of vitamin C may have anticancer benefits. Vitamin C improves the immune system and blocks the formation of carcinogens made from nitrates and nitrites found in foods like processed meat. Main sources of vitamin c are citrus fruits and fresh vegetables.

Vitamin D: Vitamin D suppresses the formation of new blood vessels that promote the growth of tumors.  It is of great benefit for the cancers of the breast, prostate and colon. The dietary sources are fish, oil, egg yolks and dairy products. 10-15 minutes a day of exposure to sunshine also is an essential source of vitamin D. Vitamin E also has anticancer properties.

Salt

Cut down the overall salt intake. Most foods are salted during cooking and manufactured foods like pickles contain a lot of added salt. You must try to reduce the amount of salt while cooking. Cut down on snacks with a high salt content like crisps or salted nuts.

Alcohol

Limit alcohol consumption. Intake of alcohol may lead to several cancers like mouth, throat, larynx, esophagus, pharynx, stomach, rectum, breast, liver cancer etc. One drink a day for women and two for men or lesser should be the limit to reduce cancer risks. Alcohol may contain carcinogens that can damage the DNA of cells. For example Beer  and red wine contains carcinogens like nitrosamines and tannins respectively.

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