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Types OF Cancer

  1. Bladder Cancer
  2. Bone Cancer
  3. Breast Cancer
  4. Cervical Cancer
  5. Colorectal Cancer
  6. Gastric (Stomach) Cancer
  7. Head & Neck Cancer
  8. Leukemia
  9. Liver Cancer
  10. Lung Cancer
  11. Skin Cancer

Bladder Cancer

Of the three main types of bladder cancers, the most common is transitional cell carcinoma. Less common bladder cancers include squamous cell carcinomas and adenocarcinomas.

A patient's treatment and survival rate depend on how deeply the cancer has invaded the bladder, and if it has spread to surrounding or distant sites.

Symptoms

The most common symptom of bladder cancer is blood in the urine. This symptom is usually painless, and is not always visible to the naked eye. Often, the diagnosis of bladder cancer is delayed because bleeding is intermittent. Other symptoms include an increased frequency of urination, an increased urgency to urinate, feeling the need to urinate but not being able to, and painful urination.

If you have one or more of these symptoms, it does not mean that you have bladder cancer. However, it is important to see a doctor so that any illness can be diagnosed and treated as early as possible

Diagnosis

Bladder cancer is most often diagnosed by examining cells in the urine under a microscope and by inspecting the bladder with a cystoscope a slender tube fitted with a lens and a light that is inserted into the bladder through the urethra

If cancer is suspected, a tissue sample is removed during the cystoscopic procedure and examined under a microscope. If cancer is confirmed, computed topography (CT) may also be needed to determine the stage of the cancer -- whether the cancer is confined to the bladder or whether it has spread to other parts of the body, such as the lymph nodes, lungs, bones, or liver. Research is under way at Tata Memorial Centre to determine if magnetic resonance imaging (MRI) and positron emission tomography (PET) can more accurately diagnose and stage bladder cancer.

Treatment

Treatment for bladder cancer varies greatly depending on the stage of disease at the time of diagnosis.

Superficial Bladder Cancer

The majority of bladder cancers are transitional cell carcinomas (TCC) that are confined to the lining of the bladder. The standard treatment for superficial bladder cancer is minimally invasive surgery using a cystoscope to remove the tumor.

Invasive Bladder Cancer

Surgery to remove the bladder is the most common treatment for invasive bladder cancer -- cancer that has spread into or beyond the muscle layer of the bladder wall -- and provides the best opportunity for a long-term cure for most patients.

For patients whose tumors require surgery to remove the entire bladder, it is also necessary to remove the surrounding lymph nodes to help prevent cancer recurrence or metastasis. In women, this procedure also involves the removal of the lower portion of the ureters, the uterus, fallopian tubes, the ovaries, and sometimes part of the vaginal wall and the urethra. In men, the prostate gland, the lower portion of the ureters, and sometimes the urethra are removed. After removing the bladder, surgeons must create a new way for the body to store and eliminate urine. The historical approach, called an ileal conduit, required a patient to wear a bag on the outside of the body to collect urine. During this procedure, a conduit for the urine was created using a segment of the small intestine. It transferred urine directly from the kidneys and ureters, and required a stoma on the skin to funnel the urine into the collection bag.

For people whose urethra has been removed, an internal bladder is created and then attached directly to the abdominal wall. A stoma is attached to the internal bladder, and the patient inserts a catheter into the stoma to eliminate the stored urine. It takes about three to five minutes to empty the bladder this way.

Many patients with muscle-invasive bladder cancer are treated with chemotherapy before or after surgery, using M-VAC or other regimens that have fewer side effects, to help prevent the recurrence of cancer.

Bone Cancer

Primary bone cancer -- cancer that actually starts in bone tissue -- is relatively rare. Bone cancer can occur in any of the bones of the body, but it occurs most often in the long bones of the arms and legs.

While it can occur at any age, the most common types occur in children and young adults.

Types of Bone Cancers

Primary bone cancer, which means cancer that actually starts in bone tissue, is relatively rare. About 2,400 cases are diagnosed every year. Primary bone cancer can occur in any of the 206 bones of the adult human body, but it occurs most often in the long bones of the arms and legs. Although bone cancer can occur at any age, the most common types occur in children and young adults.

Bone cancers form in the cells that make hard bone tissue. Cancers that arise in the cells produced in the bone marrow, such as leukemia, multiple myeloma, and lymphoma, are not considered bone cancers, although they do affect the bone and may require orthopedic management

Benign (noncancerous) bone tumors are more common than malignant (cancerous) ones. Although benign tumors do not spread, and are rarely life threatening, both types may grow and compress healthy bone tissue and absorb or replace it with abnormal tissue

  • Osteosarcoma :- Osteosarcoma is the most common type of primary bone cancer, making up 35 percent of bone cancer cases. This cancer affects primarily children and young adults between the ages of 10 and 25. Osteosarcoma often starts in the ends of bones, where new tissue forms as children grow. It arises most often in the knee.

  • Chondrosarcoma :- Chondrosarcomas, one of the most common types of bone cancer in adults over age 50, form in cartilage -- usually around the pelvis, knee, shoulders, or upper part of the thighs. These cancers make up 26 percent of all bone cancer cases.

  • Ewing's Sarcoma :- Ewing's sarcoma occurs most often in the middle part of bones, arising most often in the hip, ribs, upper arm, and thighbones. Like osteosarcoma, this cancer affects primarily children and young adults between the ages of 10 and 25. Ewing's sarcoma is responsible for 16 percent of bone cancer cases.

  • Rarer Bone Cancers :- The following types of bone cancer are rare, and occur primarily in adults
  • --Fibrosarcomas usually appear in the knee or hip area. They can arise in older patients after radiation therapy for other cancers
    --Adamantinomas usually occur in the shinbone
    -- Chordomas are found most often in the sacrum -- the lower part of the spine, also known as the tailbone.

Metastatic Bone Cancer

Metastatic bone cancer -- cancer that starts somewhere else in the body and then spreads to the bone -- is much more common than primary bone cancer. Although any type of cancer can spread to the bone, the most common types are those of the breast, lung, kidney, thyroid, and prostate. Bone metastases most often arise in the hip, femur (thighbone), shoulder, and spine. Like other types of cancer, those that start in the bone can also spread to other parts of the body. The remainder of this overview focuses on the primary bone cancers osteosarcoma and Ewing's sarcoma.

Symptoms

The most common symptom of bone cancer is pain, which is caused either by the spread of the tumor or by the breaking of bone that is weakened by a tumor. Stiffness or tenderness in the bone may also occur. Sometimes there are other symptoms, such as fatigue, fever, swelling, and stumbling.

But these symptoms can also be caused by other conditions. Only a doctor can tell for sure whether or not a patient has bone cancer

Diagnosis

As with most illnesses, the first part of the diagnosis of suspected bone cancer is a discussion with the doctor about the patient's personal and family medical history. Then the doctor performs a complete medical examination and conducts various tests.

Laboratory Tests

One key test is an examination of a patient's blood for alkaline phosphatase, an enzyme that can be found at particularly high levels in the blood when bone-forming cells are very active. This kind of high activity occurs normally when a young child's bones are growing, or when a broken bone is mending. Otherwise, it might be an indication that a tumor is creating abnormal bone tissue. Since alkaline phosphatase may rise in response to other causes, high levels don't necessarily indicate whether a patient has bone cancer, but they do signal the need for further evaluation.

Imaging Tests

A physician will usually order imaging tests such as an x-ray, which will allow the doctor to see any unusual bone growths. This may be followed by a bone scan, to see if there are other abnormal areas in the skeleton. Before a bone scan, a small amount of "tracer" material is injected into a vein. After a few hours, this tracer material, which is slightly radioactive, collects in places where there is new bone growth. A CT (computed tomography) or MRI (magnetic resonance imaging) scan is often ordered to show the exact size and shape of the suspected bone tumor, and to determine if it has invaded surrounding tissue or the bone marrow space.

Biopsy

Finally, a biopsy of the suspicious bone tissue is needed to make a definite diagnosis. If the tumor is small enough, the doctor may remove the entire tumor, then analyze samples of it under a microscope to see if it is cancerous. This procedure is called an "excisional biopsy." In other cases, the doctor may make a small opening in the skin and remove just a small part of the tumor for analysis -- an "open biopsy." Or the doctor may do a needle biopsy, in which a sample of the tumor is removed through the skin using a needle. It is important that the biopsy be performed by an experienced and skilled surgeon, because an improperly performed biopsy may limit treatment options later.

A pathologist examines the biopsy samples to determine whether or not the tissue is cancerous, and if it is, to identify the exact type of cancer. Determining the exact type of cancer is critical, because not all types of bone cancer respond to the same types of treatment.

Treatment

Though surgical resection remains the mainstay of treatment in musculoskeletal tumors it is uncommon for a patient with a high grade sarcoma to be treated by surgery alone. Adjuvant modalities like chemotherapy and radiotherapy play an essential part in the integrated management of these patients. A majority of bone tumors would receive chemotherapy while some like Ewing's sarcoma would benefit from additional radiotherapy.

Surgery

Surgery is used to remove the bone cancer itself. When operating to remove bone tumors, surgeons remove some of the surrounding bone and muscle to be sure that they are removing as much cancerous tissue as possible. If the operation is on an arm or leg, the surgeon will try , as much as possible, to preserve the limb and maintain its fnctionality. Sometimes the bone that is removed will be replaced with bone from another part of the body, bone from the tissue bank or with an artificial replacement.

Radiation Therapy

Radiation therapy is sometimes given together with surgery, to destroy tumors or to reduce the size of the tumor. Radiation therapy may also be used to kill remaining cancer cells after surgery, or treat tumors that cannot be surgically removed -- sometimes in combination with chemotherapy

Chemotherapy

Chemotherapy is often used to treat primary bone cancers, in conjunction with surgery. Chemotherapy is commonly given before surgery to facilitate surgery and also after surgery to kill any cancer cells that remain in the body after the main tumor is removed surgically.

Osteosarcoma

Once tissue diagnosis is made, chemotherapy is advised. Chemotherapy is given both before and after surgery . Adriamycin, cisplatinum, ifosfamide and etoposide are the effective drugs against osteosarcoma.

Ewing's family of Tumors

Like in osteosarcoma, multiagent chemotherapy improves overall survival. Ifosfamide,etoposide, vincristine, adriamycin, cyclophosphamide and actinomycin-D are the agents used. Radiation had earlier been the preferred method of local control but the role of surgery is now being established. Recent reports indicate that surgery combined with chemotherapy and with or without radiation may have better local control rates than chemotherapy with radiation alone.

Breast Cancer

Breast cancer is the most common of all cancers and is the leading cause of cancer deaths in women worldwide, accounting for >1.6% of deaths and case fatality rates are highest in low-resource countries. A recent study of breast cancer risk in India revealed that 1 in 28 women develop breast cancer during her lifetime. This is higher in urban areas being 1 in 22 in a lifetime compared to rural areas where this risk is relatively much lower being 1 in 60 women developing breast cancer in their lifetime. In India the average age of the high risk group in India is 43-46 years unlike in the west where women aged 53-57 years are more prone to breast cancer.

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Risk Factors

The risk factors influencing breast cancer risk are broadly classified into modifiable and non –modifiable factors. The non modifiable risk factors are age, gender, number of first degree relatives suffering from breast cancer, menstrual history, age at menarche and age at menopause. While the modifiable risk factors are BMI, age at first child birth, number of children, duration of breast feeding, alcohol, diet and number of unsuccessful pregnancies ( abortions).

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Screening

Women with a higher than average risk of developing breast cancer may be offered screening and genetic testing for the condition. NHS Breast Screening Programme recommends that women between 50-70 years of age of should be screened once every three years. Screening is especially recommended for women with risk factors, a significant one being family history. Having a 1st-degree relative (mother, sister, and daughter) with breast cancer doubles or triples the risk of developing the cancer. About 5% of women with breast cancer carry a mutation in one of the 2 known breast cancer genes, BRCA1 or BRCA2. If relatives of such a woman also carry the gene, they have a 50 to 85% lifetime risk of developing breast cancer. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and an improvement in survival rates. Approximately 20% of the cancers detected in a given year will be missed at the screening, but will become clinically evident in the period before the next screen (interval cancers).

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Pathology

The various abnormalities of the breast include nipple discharge, inflammations, ANDI , benign disorders, phyllodes / sarcomas  and carcinoma Most breast cancers are epithelial tumors that develop from cells lining ducts or lobules; less common are nonepithelial cancers of the supporting stroma (eg, angiosarcoma, primary stromal sarcomas, phyllodes tumor). Cancers are divided into carcinoma in situ and invasive cancer. Paget's disease of the nipple is a form of ductal carcinoma in situ that extends into the overlying skin of the nipple and areola, manifesting with an inflammatory skin lesion and may become invasive.
The pathological variations of breast cancer influence the prognosis.  In situ cancers (DCIS/LCIS) are slow growing, indolent tumors. Autopsy studies have indicated that the incidence of DCIS in asymptomatic women ranges from .02% to 18.2% indicating that some DCIS do not become evident during a women’s lifetime. Invasive carcinoma is primarily adenocarcinoma. About 80% is the infiltrating ductal type; most of the remainder is infiltrating lobular. The pathological variants with a favorable prognosis are tubular, cribriform, mucinous and adenoid cystic variants, while intermediate prognosis is seen with medullary, secretory and invasive lobular cancers. The most unfavorable pathology is high grade metaplastic, micropalliary, signet ring cell morphology, inflammatory cancer.

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Pathophysiology

Breast cancer invades locally and spreads initially through the regional lymph nodes, bloodstream, or both. Metastatic breast cancer may affect almost any organ in the body—most commonly, lungs, liver, bone, brain, and skin.

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Symptoms and Signs

Most breast cancers present as

  • a lump felt by the patient or during routine physical examination or mammography.

  • Less commonly, the presenting symptom is thickening in the breast. Paget's disease of the nipple presents with skin changes, including erythema, crusting, scaling, and discharge.

  • A few patients with breast cancer present with signs of metastatic disease (eg, pathologic fracture, pulmonary dysfunction).

During a physical examination a lump is felt distinctly different from the surrounding breast tissue. More advanced breast cancers are characterized by fixation of the lump to the chest wall or to overlying skin, by satellite nodules or ulcers in the skin. Matted or fixed axillary lymph nodes suggest tumor spread. Inflammatory breast cancer is characterized by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive course.

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Diagnosis

The triple assessment includes: clinical examination, radiological investigation and pathological correlation.

Radiololgy

Mammogram, ultrasound
Diagnostic mammography is a standard procedure done as part of the triple test for diagnosing breast cancer. However the efficacy of diagnostic mammography is anecdotal.

Often, the lump is not even visible on the mammogram or a lump is visible on mammogram but the appearance may be indeterminate. If the lesion is clinically suspicious and is not a cyst by ultrasonography or aspiration, then a biopsy is indicated despite the mammographic results. In this case, the mammogram adds little to the diagnosis. Its main use is for screening the rest of the breast and the contralateral breast for unsuspected cancer.

The lump may have a classic appearance of a benign calcifying fibroadenoma, mixed radiographic density hamartoma, or fat lesion such as fat necrosis or a lipoma. The appearance of these lesions can be used to avoid a biopsy, so that in these cases, the diagnostic mammogram is very helpful.

The lump may have a classic appearance of breast cancer and biopsy is clearly indicated. In this case, the mammographic findings could prevent a delay in diagnosis by making it clear that a biopsy is needed.

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Magnetic Resonance Imaging

MRI is useful to locate a suspicious mammographic lesion that cannot be located by CBE or ultrasonography. Especially useful in young women with dense breast, women with implant in situ, previously operated breasts, recurrent lesions, wherein mammography may not be accurate.

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Pathology

Needle Biopsy / FNAC

Confirmation of malignancy with cytology or histology is the minimum requirement for “indeterminate” or “high-risk” solid lesions.

Fine-needle aspiration / Tru cut / core biopsy / surgical excision/ Incision biopsy / percutaneous breast biopsy for non-palpable disease are the various methods used to obtain tissue for pathological confirmation.

If a woman is being treated with neoadjuvant therapy it is essential to perform a biopsy to obtain the ER/PR status of the tissue.

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Staging

The TNM staging is traditionally used to stage breast cancer (link) Patients are clinically grouped into one of the following categories

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Treatment

Evidence Based Guidlines

Breast cancer can be treated using a multimodality approach of surgery, chemotherapy, radiotherapy and targeted therapy. The treatment options vary as per the stage of the tumor. There are multiple ongoing clinical trials in breast cancer; TMH is involved in many of the same.


Information for Patients

Breast cancer is one of the commonest cancers in women in India. It is also one of the curable cancers if detected early. Any woman would dread getting cancer of the breast. Cancer subjects the family to unimaginable emotional stress. If you or someone you know has been diagnosed to have breast cancer it is important that you understand the disease, since ignorance breeds myths. We then have to fight not just the 'CANCER' but also the 'MYTHS'.

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Cervical Cancer

Cervical cancer is cancer of the cervix -- the opening of the uterus, extending into the upper end of the vagina. Some 12,000 American women will be diagnosed with cervical cancer this year. Thanks to effective screening,which can detect cervical precancers and cancers early, most of them can be cured.

With the advent of widespread screening by a vaginal smear test developed by George Papanicolaou in the 1950s (commonly known as the "Pap smear"), the number of deaths from cervical cancer has fallen dramatically -- from more than 35,000 per year to about 4,000 per year today.

A Slow-Growing, Treatable Cancer

Cervical cancer usually grows slowly over many years. Before true cancer cells develop, the tissues of the cervix undergo changes -- called dysplasia, or precancers -- that a pathologist can detect in a Pap smear. These changes range from mild dysplasia or cervical intraepithelial neoplasia (CIN1) to moderate (CIN2) to high-grade lesions (CIN3). They can also resemble cancer cells without invasion, also known as carcinoma in situ.

If left untreated, these precancers have the propensity to invade and become cancerous. Once they spread beyond the borders of the cervix, they can invade tissues more deeply, into either the vagina or the uterus, and ultimately metastasize to other parts of the body.

Overview

There are two main types of cervical cancer:

  • Squamous Cell Carcinoma
    The majority of cervical cancers -- 85 to 90 percent -- are squamous cell carcinomas.
  • Adenocarcinoma
    The remaining 10 to 15 percent of cervical cancers are adenocarcinomas.

Cancers that have features of both cell types are known as mixed, or adenosquamous, carcinomas.

 

Risk Factors

The most significant risk factor for cervical cancer is infection with the human papillomavirus (HPV), which can be transmitted during sex.

Papillomaviruses have been known to cause cervical dysplasia, or precancers, for more than two decades. More recently, DNA from these viruses has been found to exist in virtually all cervical squamous cell carcinomas (the most common type of cervical cancer).

By avoiding the following known risk factors for HPV infection, women can reduce their likelihood of developing cervical cancer:

  • early age at first sexual intercourse (15 years or younger)
  • having a history of many sexual partners (more than seven)
  • smoking (which produces chemicals that can damage cervical cells, making them more vulnerable to infection and cancer)
  • infection with HIV (which reduces the body's ability to fight off HPV infection and early cancers)

Women without these risk factors rarely develop cervical cancer. Although all women can help protect themselves from disease by having their sexual partners use condoms, condoms do not provide complete protection from HPV infection because this virus (unlike HIV) can be spread by contact with any infected area of the body.

 

Symptoms

Cervical cancer, especially in its earliest stages, often causes no symptoms. That's why it's so important to see your doctor for regular screening with a Pap test.

When symptoms do occur, they may include the following:

  • pain or bleeding during or after intercourse
  • unusual discharge from the vagina
  • blood spots or light bleeding other than a normal period

These symptoms can be caused by cervical cancer or by a number of serious conditions, and should be evaluated promptly by a medical professional.

 

Diagnosis

A Pap test is used to detect the possibility of a cervical cancer or dysplasia (precancer).

Biopsy

If a Pap test shows an abnormality, your doctor will perform a biopsy (by removing a sample of cervical tissue for microscopic examination). A gynecologist will often use a colposcope (a viewing tube attached to magnifying binoculars) to find the abnormal area and remove a tiny section of the surface of the cervix, which a pathologist will examine to see if it contains precancer or cancer cells. He or she may also perform a Schiller test, in which the cervix is coated with an iodine solution. Iodine causes the healthy cells to turn brown, while abnormal cells appear white or yellow.

Cone Biopsy

If the diagnosis isn't clear, a surgeon may remove a slightly larger, cone-shaped piece of tissue (called a cone biopsy). At Tata Memorial Centre, cone biopsies are often performed by loop excision, in which an electrical current is passed through a thin wire loop to remove the sample tissue. Loop excision takes only about 10 minutes under local anesthetic. The cone biopsy is also a treatment, and can completely remove many precancers and early cancers. More than 90 percent of cervical cancers can be halted with this technique without further treatment.

Cytoscopy & Other Imaging Tests

If your doctor suspects that the cancer may have spread beyond the cervix, you may have cytoscopy (examination of the bladder using a lighted tube), proctoscopy (examination of the rectum), a chest x-ray, or other imaging tests -- such as a computerized tomography scan (CT scan) of the abdomen and pelvis to check for metastatic disease, or magnetic resonance imaging scan (MRI scan) of the pelvis to check the extent of local disease.

Treatment

Options for treating cervical cancer depend chiefly on the stage of disease -- the size of the cancer, the depth of invasion, and whether the cancer has spread to other parts of the body. The primary forms of treatment are surgery and combined radiation therapy and chemotherapy.

Carcinoma In Situ

These cancers are preinvasive and can be treated conservatively, sparing the uterus. Options for treatment include

  • laser surgery (in which a narrow beam of intense light is used to kill the cancerous cells)
  • loop excision (in which an electrical current is passed through a thin wire loop to remove the cells)
  • cone biopsy (to surgically remove a cone-shaped piece of tissue containing the cancer)

These treatments are almost always effective in removing precancers and stopping them from developing into true cancers.

Early Cervical Cancer (Stages I-IIA)

For early cervical cancers that are confined to the cervix, surgical options may include hysterectomy (removal of the uterus), sometimes along with the tissue next to the uterus. Lymph nodes from the pelvis are also removed and examined for cancer cells. If the cancer is associated with "high-risk" features -- such as involvement of the pelvic lymph nodes, invasion of the lymph channels or blood vessels of the cervix, or involvement of the tissue along the uterus -- doctors recommend chemotherapy combined with radiation therapy.

Advanced Cervical Cancer (Stages IIB-IVA)

If cervical cancer has spread beyond the cervix and into the surrounding pelvic tissues, surgery alone is usually not an effective cure. Patients with this degree of invasive cancer have traditionally also been treated with radiation therapy (the use of x-rays or other high-energy waves to kill cancer cells and shrink tumors), either alone or in addition to surgery.

In recent years, however, there has been a major shift in the treatment of advanced cervical cancer. Based on the results of large clinical trials, the standard of care for regionally advanced cervical cancer is now chemotherapy combined with radiation therapy. The radiation therapy may be delivered externally and/or internally (by placing an implant to deliver radioactive material immediately around the cervix).

Stage IVB & Recurrent Cervical Cancer

For women whose cancer spreads beyond the pelvis (into the lungs or liver, for example) or who have recurrent disease, treatment is aimed at reducing cancer-related symptoms in order to improve a patient's quality of life, and hopefully to prolong her survival. Chemotherapy is the primary modality of treatment for these patients, and several drugs are available for treating these women.

For women whose disease recurs in the pelvis, extensive surgery may be the only curative option and requires a highly experienced multidisciplinary team.

Colorectal Cancer

Prevention and early detection are key factors in controlling and curing colorectal cancer. Indeed, colorectal cancer is the second most preventable cancer, after lung cancer. When the cancer is found early, initial treatment can often lead to an excellent outcome. Colorectal cancer is cancer that occurs in the large intestine and rectum. The colon is a muscular tube that is about five feet long. It absorbs water and nutrients from food. The rectum, the lower six inches of the digestive tract, serves as a holding place for stool, which then passes out of the body through the anus. This year, about 148,000 people in the United States will be diagnosed with colorectal cancer. Although many people think of colorectal cancer as a disease that primarily affects men, it is slightly more common in women. Today, the average person has about a 1 in 20 chance of developing colorectal cancer during his or her life.

How Colorectal Cancer Develops?

The colon is divided into four sections: the ascending colon, transverse colon, descending colon, and sigmoid colon. Most colorectal cancers arise in the sigmoid colon -- the portion just above the rectum. They usually start in the innermost layer and can grow through some or all of the several tissue layers that make up the colon and rectum. The extent to which a cancer penetrates the various tissue layers determines the stage of the disease. Most colorectal cancers grow slowly over a period of several years, often beginning as small benign growths called polyps. Removing these polyps early, before they become malignant, is an effective means of preventing colorectal cancer.

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Symptoms

Colorectal cancer sometimes arises without any symptoms. For this reason, screening tests (such as colonoscopy and a test for blood in the stool) are recommended to detect the cancer early, when it is more curable.

When symptoms do occur, however, they may include the following:

  • rectal bleeding or blood in the stool
  • a change in bowel habits (such as diarrhea, constipation, and narrowing of the stool) that lasts for more than a few days
  • abdominal pain
  • a continuous feeling that you need to have a bowel movement, which does not resolve after passing stool
  • weakness

Some of these symptoms may be caused by other conditions. But you should see your doctor if they persist. Any incidence of rectal bleeding or blood in the stool should be brought to your doctor's attention.

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Screening & Diagnosis

The best way to cure colorectal cancer is to prevent it from occurring in the first place. A regular program of screening examinations is the best way to ensure an early diagnosis, and an early diagnosis offers the best chance for a cure.

Screening & Diagnostic Tests

Colorectal cancer screening and diagnosis may involve one or more of a number of procedures:

  • Colonoscopy
    This examination allows the doctor to inspect the rectum and colon, using a thin tube that has a light on the end. It is inserted into the rectum while the patient lies on his or her side. Patients often receive a mild sedative during this procedure to ensure their comfort. Any polyps or other growths that are found during these examinations are usually removed at the time and sent to a laboratory for examination.
    A ten-year study by Tata Memorial Centre investigators showed that colonoscopy was more effective than another screening technique called double-contrast barium enema for detecting precancerous colon polyps. The findings of this study were the first to show that the various surveillance tools used to follow patients who have had colon polyps removed are not equally reliable. Moreover, unlike barium enema, colonoscopy allows the doctor to remove any polyps at the time of the examination.
  • Fecal Occult Blood Test
    Also known as a stool blood test, this laboratory test looks for blood in the stool. The patient is asked to follow a special diet and then bring in stool specimens (usually applied to small, folded cards) from three successive days.
  • Flexible Sigmoidoscopy
    This examination is similar to the colonoscopy exam, but it uses a shorter tube to inspect the lower colon.

Virtual Colonoscopy

Virtual colonoscopy is a new technique that uses CT scans to create a 3-D image that can be used to evaluate the bowel. At this time, it is still a research tool and is not generally available. It is also important to note that, while this is a promising technique, it does not allow for a biopsy or polyp removal at the same time an abnormality is found.

For more information about diagnostic tests, see Staging.

Screening Guidelines

If you do not have an increased risk of colorectal cancer because of your personal or family medical history, we recommend the following screening tests, beginning at age 50:

  • colonoscopy every 10 years
  • a yearly test for blood in the stool, preferably combined with flexible sigmoidoscopy every five years

If you have an increased risk of colorectal cancer because of your personal or family medical history, you should have a colonoscopy every 5 years beginning at age 40, or younger if hereditary non-polyposis colorectal cancer (HNPCC) is suspected. For first-degree, direct relatives of patients with colorectal cancer that has presented before age 50, screening should begin 10 to 20 years before the age of the diagnosed patient. For example, if your father is diagnosed with colorectal cancer at age 48, then you should begin your own colorectal cancer screening between ages 28 and 38.

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Staging

If tests show that you have colorectal cancer, additional examinations may be performed to determine its extent -- a process called staging. Knowing how far your cancer has progressed is important when deciding what regimen of treatment might be most appropriate for you. The following tests are routinely used to stage colorectal cancer:

  • computed tomography (CT) and magnetic resonance imaging (MRI) scans, which may be used to see if the cancer has spread to other organs, such as the liver and lungs
  • chest x-ray, which may be performed to see if the cancer has spread to the lungs
  • blood tests for CEA, a protein that acts as a marker for colorectal cancer

Depending on your specific clinical situation, these additional tests may be ordered:

  • positron-emission tomography (PET) scanning, which may be conducted to find other places where cancer may be lurking
  • angiography, which may be done to find blood vessels next to cancer that has spread to the liver, allowing doctors to plan surgery to minimize blood loss
  • endorectal ultrasound probe, which uses sound waves to produce an image of the tumor; it may be placed in the rectum to see how far a cancer has invaded the rectal wall. This procedure is used for staging rectal cancer only.
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Treatment

The choice of treatment for colorectal cancer depends on the stage of the disease -- that is, how large the tumor has grown, how deeply it has invaded the layers of the colon or rectum, and whether it has spread to other organs (most commonly the liver), lymph nodes, or other parts of the body.

Treatment options include surgery, radiation therapy, chemotherapy, and combinations of these approaches.

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Gastric (Stomach) Cancer

Your stomach is a J-shaped organ in the upper abdomen where digestion begins before food is passed to your intestines. Cancer can arise in any part of the stomach, and is believed to develop slowly over many years.

Stomach cancer -- also referred to as gastric cancer -- is usually preceded by precancerous changes in the stomach lining, although these changes rarely produce symptoms. Because stomach cancer often does not cause symptoms until it is quite advanced, it is not often detected in its earliest stages.

Most stomach cancers (90 to 95 percent) are classified as adenocarcinomas. Other types of stomach cancer include squamous cell carcinoma, lymphoma, stromal tumors (cancer of the muscle or connective tissue of the stomach wall), and carcinoid tumors (cancer of the hormone-producing cells of the stomach).

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Risk Factors

The following factors increase the risk of stomach cancer:

  • infection with the Helicobacter pylori bacterium, which may lead to chronic inflammation of the inner layer of the stomach and possibly precancerous changes; recent research has shown that antibiotic treatment may reduce the risk of stomach cancer -- particularly stomach lymphoma -- in people infected with this bacterium
  • a diet high in consumption of smoked and salted foods, such as smoked fish and meat and pickled vegetables; conversely, eating a diet high in fruits and vegetables (particularly those high in beta-carotene and vitamin C can decrease stomach-cancer risk
  • high consumption of red meat; studies show that eating red meat more than 13 times per week can double the risk of stomach cancer
  • smoking
  • alcohol abuse
  • previous stomach surgery, such as removal of stomach tissue in patients with ulcers
  • pernicious anemia, a severe inability to produce red blood cells, due to a deficiency of vitamin B12
  • Menetrier's disease, a very rare condition associated with large folds in the stomach and low production of stomach acids
  • blood type A (for unknown reasons)
  • family cancer syndromes, such as Lynch syndrome and familial adenomatous polyposis, which increase colorectal-cancer risk and slightly increase stomach-cancer risk
  • family history of stomach cancer
  • stomach polyps (small benign growths that sometimes develop into stomach cancers).
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Symptoms

When symptoms of stomach cancer arise, they may include:

  • indigestion and stomach discomfort
  • a bloated feeling after eating
  • mild nausea
  • loss of appetite
  • heartburn

In the more advanced stages of stomach cancer, a patient may experience the following symptoms:

  • blood in the stool
  • vomiting
  • unexplained weight loss
  • stomach pain

These symptoms may also result from more benign illnesses, such as simple indigestion or a stomach virus. However, if you have these symptoms over a long period of time, you should see your doctor.

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Diagnosis

If your doctor suspects that you may have stomach cancer, you may have a barium x-ray of your upper gastrointestinal system. For this test, you will be asked to drink a liquid containing barium, which makes your stomach easier to see on an x-ray. This test can be performed in a doctor's office or a hospital's radiology department.

The doctor may also look inside your stomach using a gastroscope, a thin, lighted tube that is inserted into your mouth and guided into your stomach (also called upper endoscopy). A camera at the end of the tube enables your doctor to see inside your stomach. Your doctor may take small samples of tissue to examine for cancer cells. (You will receive a spray of anesthetic into your throat or other medication to ensure that you are comfortable during this examination.)

A third, newer technique to diagnose stomach cancer is called endoscopic ultrasound. Similar to gastroscopy, endoscopic ultrasound relies on a thin tube inserted into the mouth and down into the stomach. At the tip of the tube is a small ultrasound probe that bounces sound waves off the stomach walls. This test is useful for estimating how far cancer has spread into the wall of the stomach, to nearby organs, and to nearby lymph nodes -- a process called staging.

Another staging technique is called laparoscopy. This procedure involves minor surgery using a small tube with a camera at the end to look inside your abdomen. Doctors can look at the outside wall of your stomach, examine the lymph nodes, and evaluate the surfaces of other abdominal organs to determine if the cancer has spread to those areas.

In addition to these diagnostic tests, your doctor will take your medical history into account, perform a physical examination, and order laboratory studies such as blood tests.

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Treatment

The choice of treatment for stomach cancer depends on the stage of the disease -- that is, how large the tumor has grown, how deeply it has invaded the layers of the stomach, and whether it has spread to nearby organs, lymph nodes, or other parts of the body.

Recent investigations suggest that a three-pronged attack on stomach cancer -- utilizing surgery to remove most of the tumor and chemotherapy and radiation therapy to control cancer spread -- may improve the survival of patients with stomach cancer. This combination approach is expected to become the standard of care for patients with this disease.

Surgery

Surgery is the most common form of treatment for stomach cancer. If the results of staging indicate that surgery is likely to help you, your doctor may perform one of these operations to remove the cancer:

  • subtotal gastrectomy : removal of the part of the stomach that contains the cancer and parts of other tissues or organs near the tumor (such as the small intestine or esophagus, depending on the location of the tumor)
  • total gastrectomy : removal of the entire stomach and parts of the esophagus, small intestine, and other tissue near the tumor; in this case the esophagus may be connected to the small intestine so that you can continue to eat and swallow.

During the surgery, the surgeon will also remove nearby lymph nodes to examine them for cancer cells. Sometimes the spleen (an organ in the upper abdomen that filters blood and removes old blood cells) and part of the pancreas are also removed.

Chemotherapy

Chemotherapy -- treatment with cancer-killing drugs -- is another option for treating stomach cancer. It can be given to patients whose cancers have invaded the layers of the stomach wall, nearby lymph nodes, and nearby organs. Chemotherapy may be given before surgery (so-called neoadjuvant therapy) -- to shrink the tumor first -- or after surgery (adjuvant therapy), to kill any remaining cancer cells. These approaches are being evaluated in clinical trials.

When given alone or with radiation therapy, chemotherapy is also useful in some patients to relieve stomach-cancer symptoms or to delay cancer recurrence and extend a patient's life, especially in patients whose cancers cannot be completely removed through surgery. 5-fluorouracil and cisplatin are the drugs most commonly used to treat stomach cancer; other drugs (including paclitaxel, docetaxel, and irinotecan) and new combinations of conventional drugs are currently under investigation. Some are given intravenously (through a vein), while others are given intraperitoneally (delivered directly into the abdominal cavity).

Radiation Therapy

Radiation therapy is most commonly used in combination with chemotherapy for the treatment of gastric cancer. New studies reveal that for many patients with gastric cancer, the addition of radiation therapy plus chemotherapy after surgery improves survival compared to surgery alone.

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Head & Neck Cancer

The term "head and neck cancer" encompasses a wide range of tumors that occur in several areas of the head and neck region, including the nasal passages, sinuses, mouth, throat, larynx (voice box), swallowing passages, salivary glands, and the thyroid gland. Skin cancers that develop on the scalp, face, or neck may also be considered head and neck cancers.

Each year, approximately 60,000 Americans are diagnosed with a head or neck cancer (not including skin cancers that occur in the region). Most of these cancers are preventable. Head and neck cancer can develop in anyone, but people who use tobacco (including cigarettes, cigars, pipes, and smokeless tobacco) or drink alcohol excessively are much more likely than others to develop the disease.

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Type of Head & Neck

There are many different types of head and neck cancer. Several of them are described below. Most head and neck cancers are termed squamous cell carcinomas, because they begin in the flat squamous cells that form a thin outer layer on many parts of the body. When a cancer is limited to that layer of cells, it may be called a carcinoma in situ. When it has grown beyond that layer and moved into deeper tissues it may be termed an invasive squamous cell carcinoma. Cancers that arise in glandular cells, such as those in the salivary glands, are called adenocarcinomas.

  • Oral cancer is cancer that arises in the mouth, or oral cavity. The oral cavity includes the lips, the gums and the area behind the wisdom teeth, the inside of the lips and cheeks, the floor and roof (hard palate) of the mouth, and the front two-thirds of the tongue.
  • Laryngeal cancer begins in the larynx, an organ also known as the voice box. The larynx sits at the top of the trachea, the tract that leads to the lungs. Air passes through the larynx on the way to the lungs. The vocal cords, two bands of muscle, are found within the larynx and are used for speech. The larynx also prevents food from entering the lungs. The larynx is visible on most men's throats as the Adam's apple.
  • Nasal cavity and paranasal sinus cancers are found in the tissues that line these hollow structures. The paranasal sinuses are hollow areas in the bones of the face near the nose that produce mucus. The nasal cavity is found just behind the nose and is used to pass air to the throat.
  • Nasopharyngeal cancer is found in the nasopharynx, the uppermost portion of the throat (pharynx). It begins just behind the nose and extends to the oropharynx, the portion of the throat found just behind the mouth. It also includes two openings that lead to the ears. (The entire throat is called the pharynx, and is made up of the nasopharynx, the oropharynx just below that, and the hypopharynx, the lower region that meets the esophagus.)
  • Oropharyngeal cancer is found in the section of the throat (oropharynx) located just beyond the mouth. The region also includes the base of the tongue, the soft palate (the soft area just beyond the roof of the mouth), and the area around the tonsils.
  • Hypopharyngeal cancer is found in the hypopharynx, the uppermost portion of the esophagus (the tube through which food travels to the stomach). The hypopharynx surrounds the larynx.
  • Salivary gland cancer is found in the salivary glands, the structures that produce saliva to keep the mouth from drying out and aid in the digestion of food. Salivary glands may be found under the jaw, in front of the ears, underneath the tongue, and in other areas of the upper aerodigestive passages including the nose, sinus, mouth, and throat.
  • Thyroid cancer develops in the thyroid gland, a small butterfly-shaped structure that wraps around the front of windpipe in the lower part of the neck. The thyroid gland is the source of important hormones that help regulate metabolism, blood pressure, heart rate, temperature and other functions.
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Symptoms

Below are some of the symptoms and warning signs of head and neck cancer. Many of these symptoms can be caused by other, non-cancerous conditions as well. See your doctor if you notice any of these problems.

  • a sore in the mouth that won't heal (the most common symptom) or that bleeds easily
  • a red or white patch in the mouth that doesn't go away
  • frequent nosebleeds, ongoing nasal congestion, or chronic sinus infections that do not respond to treatment
  • persistent sore throat
  • persistent hoarseness or a change in the voice
  • pain in the neck, throat, or ears that won't go away
  • blood in the sputum
  • difficulty chewing, swallowing, or moving jaws or tongue
  • numbness in the tongue or other areas
  • loosening of teeth
  • dentures that no longer fit
  • a lump or swelling in the neck
  • changes in a mole or discoloration, or a sore on the skin that is crusting, ulcerated, or fails to heal (these are also signs of skin cancer).
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Diagnosis

Our doctors perform any of several types of tests that can help to make a definitive diagnosis of a head and neck cancer and to determine the stage of the cancer, or how far it has progressed.

Physical Examination and History

First, the doctor or nurse will take a complete medical history, noting all symptoms and risk factors. Then you will have a thorough examination of the head and neck area, during which the doctor will feel for abnormalities and looking at the inside of your mouth and throat.

Endoscopy

The doctor may use mirrors and lights to examine hard-to-see areas and may also use a flexible, lighted tube to examine areas that are less accessible. The tube may be inserted through the nose or mouth; an anesthetic spray may be used to make the examination more comfortable. This examination is called a nasopharyngoscopy, pharyngoscopy, or laryngoscopy, depending on which area is examined. Occasionally, this type of examination will be done while the patient is under general anesthesia so a very thorough inspection can be done; this is called a panendoscopy.

Imaging Tests

The doctor may also suggest several other tests, including imaging procedures such as a CT or computed tomographic scan (a special type of x-ray), an MRI or magnetic resonance image scan (which uses magnetic waves to produce pictures), or an ultrasound exam (which uses sounds waves to produce images). At Tata Memorial Centre, doctors also use PET (positron emission tomography) scans to help diagnose head and neck cancers. Currently, we are investigating whether PET scans will improve the ability to detect the spread of cancer to lymph nodes in the neck and other areas of the body.

Other possible tests include a panorex (a special x-ray of the jaws), a barium swallow, dental x-rays, chest x-rays, and a radionuclide bone scan.

Biopsy

If a suspicious area is noted, the doctor may do a biopsy: he or she will remove a small piece of tissue with either a scalpel or a needle, and send it to a laboratory for examination under a microscope. Biopsies are often done when the patient is under general anesthesia.

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Treatment

Many cancers of the head and neck can be cured, especially if they are found early. Treatment varies according to the type, severity, and location of the disease. It may include surgery (the primary treatment method), radiation therapy, or chemotherapy. Increasingly, Tata Memorial Centre's physicians are combining treatment modalities to maximize chances of curing the cancer.

Although cure of the cancer is the primary goal in treatment, preserving a patient's appearance and ability to function, and thus the quality of life, also are very important goals and are considered an integral part of treatment. Today, advances in surgical techniques, reconstruction, and nonsurgical treatment methods -- combined with a comprehensive team approach, which brings the expertise of numerous specialists to each patient's care -- have made it possible to attain those quality of life goals in nearly every patient receiving treatment.

Surgery

Surgery is the mainstay of treatment for most cancers of the head and neck. Loss of speech was once common after head and neck surgery, because of damage to the larynx (voice box). Continual advances in surgical techniques, however, allow more patients to preserve normal functioning. Surgeons have perfected techniques, for example, that remove only part of the larynx instead of the entire organ. Indeed, larynx-preserving surgery is possible in more than half of the cases that once would have required that organ to be completely removed. Other advances now allow doctors to spare the eye when a tumor is crowding that area.

Some patients may need a surgical examination of the lymph nodes in the neck (called a neck dissection) to see if any cancer cells have spread beyond the site of origin; today, new techniques allow surgeons to remove these lymph nodes while sparing nerves that are important for shoulder function. Complex operations for tumors at the base of the skull -- once considered a very difficult prospect -- are now routinely performed. The skull base surgery team at Tata Memorial Centre is recognized as a world leader in this specialty.

When surgery is extensive, immediate reconstruction of the area is often possible. For example, in cases where the jaw bone must be removed, a surgeon can fashion a new jaw using bone from the patient's own leg. Blood vessels are moved along with the leg bone and are attached to blood vessels in the neck, creating a blood supply for the new jaw. Tata Memorial Centre surgeons developed this pioneering technique some 15 years ago. Similarly, skin and muscle from a patient's back or abdomen can now be used to replace part of the scalp. Dental implants can be used to replace teeth.

Radiation Therapy

Radiation therapy may involve external beam treatment or brachytherapy, a technique in which tiny radioactive seeds are implanted directly in a tumor. In some cases, both approaches are used. A three-dimensional method of delivering external beam radiation, known as intensity modulated radiation therapy, or IMRT, is used at Tata Memorial Centre for very precise delivery of radiation therapy to tumors. For example, this technique allows the radiation oncologist to "mold" the dose of radiation to encompass the tumor and spare the spinal cord, an approach that was impossible not long ago. IMRT helps to avoid damage to healthy tissues (thus reducing side effects) and makes possible the use of higher, more effective doses of radiation, as well as additional radiation to the area in some cases. Radiation therapy is often given in conjunction with surgical treatment, but studies are showing that in some cases, radiation therapy -- sometimes combined with chemotherapy -- is just as effective as surgery. These new approaches can often preserve the ability to speak and swallow normally, even in patients with advanced disease.

Chemotherapy

The use of chemotherapy in head and neck cancer is also expanding, especially in cases that previously would have been considered untreatable. Chemotherapy is often used to enhance the response of cancer cells to radiation therapy, and often makes it possible to preserve organs, such as the larynx, that once would have been removed. For patients with advanced disease, too, chemotherapy is helping to increase longevity; this is especially true in patients who have cancer of the nasopharynx or other areas that are not easily treated surgically. Chemotherapy drugs used include cisplatin, fluorouracil, methotrexate, carboplatin, and paclitaxel.

Investigational Approaches to Chemotherapy

Because head and neck cancers vary widely in their response to chemotherapy, Tata Memorial Centre researchers are looking at new tools to determine whether a particular cancer will be sensitive to treatment. One such experimental tool, the histoculture drug response assay, might one day permit rapid testing of cancer cells' response to commonly used drugs before treatment.

Tata Memorial Centre's clinical research protocols in head and neck cancers -- ranging from new approaches to preventing pre-cancers from becoming malignant to new treatments for advanced and recurrent cancers -- are sometimes offered to eligible patients through the clinical trial process. For up-to-date details about current clinical trials at Tata Memorial Centre, please visit our clinical trial database.

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Leukemia

Leukemia is cancer that originates in the bone marrow, the soft, spongy inner portion of certain bones, and in which the malignant cells are white blood cells (leukocytes).

Leukemia develops when a leukocyte undergoes a transformation into a malignant cell -- one capable of uncontrolled growth. Leukemia cells begin to multiply in the marrow, and as they do so they crowd out the normal blood cells -- those that carry oxygen to the body's tissues, fight infections, and help wounds heal by clotting the blood. Leukemia can also spread from the marrow to other parts of the body, including the lymph nodes, brain, liver, and spleen.

Leukemia is ten times more common among adults than among children. Leukemias are evenly split between the acute and chronic forms, but among children one form -- acute lymphocytic leukemia -- accounts for about two-thirds of cases. Acute myeloid leukemia and chronic lymphocytic leukemia are the most common types in adults.

Blood cell development begins in the marrow with the formation of stem cells. These primitive cells are capable of developing into any kind of blood cell. The first step in this evolution, or differentiation, is into one of two slightly more mature types of stem cells: lymphocytic progenitor cells and myeloid progenitor cells. These cells then undergo further specialization. Lymphocytic stem cells mature into either T cells, B cells, or natural killer cells. Myeloid stem cells mature into erythrocytes (red blood cells); platelets (which clot the blood); monocytes (a type of white blood cell); or granulocytes (a group of white blood cells that includes neutrophils, basophils, and eosinophils). Each of these types of cell has a very specific job in the functioning of the body.

A malignant transformation can happen at any stage of blood cell development. The leukemia cells that result carry many characteristics of the cell from which they began. Most leukemias fall into one of two general groups: myeloid leukemia and lymphocytic leukemia. Physicians also classify leukemias according to whether they are acute or chronic. In acute leukemias, the malignant cells, or blasts, are immature cells that are incapable of performing their immune system functions. The onset of acute leukemias is rapid, and, in most cases, fatal unless the disease is treated quickly. Chronic leukemias develop in more mature cells, which can perform some of their duties but not well. These abnormal cells also increase at a slower rate, so the disease develops more slowly than in acute leukemia, and in many cases is more difficult to cure.

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Type of Leukemia

Acute Myelogenous Leukemia (AML)

Acute myelogenous leukemia (AML, also sometimes called acute myeloid leukemia or acute nonlymphocytic leukemia) is a malignancy that arises in either granulocytes or monocytes, white blood cells that battle infectious agents throughout the body.

Chronic Lymphocytic Leukemia (CLL)

Acute Myelogenous Leukemia (AML)

Acute myelogenous leukemia (AML, also sometimes called acute myeloid leukemia or acute nonlymphocytic leukemia) is a malignancy that arises in either granulocytes or monocytes, white blood cells that battle infectious agents throughout the body.

Chronic Myelogenous Leukemia (CML)

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Risk Factors

Acute Myelogenous Leukemia (AML)

Risk factors for different types of cancer are those traits that increase the likelihood that an individual will develop disease. Risk factors include certain kinds of behavior such as smoking, inherited (genetic) traits, and exposure to cancer-causing agents in the environment. There is only a very small chance that a person who has one of the few known risk factors for AML will develop the disease.

Cigarettes, which contain dozens of cancer-causing chemicals, are most often implicated in the development of solid tumors such as those of the lung, bladder, and head and neck, but smoking is also believed to be a risk factor for leukemia. Researchers estimate that about 20 percent of AML cases are related to smoking.

People who are exposed to high doses of radiation (from the explosion of an atomic bomb, by working in an atomic weapons plant, or from a nuclear reactor accident) have a heightened risk of developing leukemia. This is also true of people who are exposed over long periods of time to high levels of solvents such as benzene in the workplace.

People who have received previous chemotherapy or radiation treatments for cancer have an increased risk of developing leukemia, as the chemotherapeutic agents and radiation target rapidly dividing cells such as those of the bone marrow. These agents can cause mutations, or changes in a cell's DNA, that can lead to later malignancies including leukemia. AML is linked to treatments for Hodgkin's disease, non-Hodgkin's lymphoma, childhood acute lymphocytic leukemia, and to treatment for other malignancies such as breast and ovarian cancer.

People who have a myelodysplastic syndrome, a preleukemia condition, or who have rare genetic syndromes such as Down's syndrome, Fanconi's anemia, ataxia-telangiectasia, and Bloom's syndrome are at slightly higher risk of developing leukemia.

Many people with one or more of these risk factors never develop leukemia. And most of the people who do develop AML have no risk factors at all. Scientists do know that most leukemias are associated with specific gene mutations, but, in most cases, it is not clear what causes those mutations.

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Acute Myelogenous Leukemia (AML)

Risk factors for different types of cancer are those traits that increase the likelihood that an individual will develop disease. Risk factors include certain kinds of behavior such as smoking, inherited (genetic) traits, and exposure to cancer-causing agents in the environment. There is only a very small chance that a person who has one of the few known risk factors for AML will develop the disease.

Cigarettes, which contain dozens of cancer-causing chemicals, are most often implicated in the development of solid tumors such as those of the lung, bladder, and head and neck, but smoking is also believed to be a risk factor for leukemia. Researchers estimate that about 20 percent of AML cases are related to smoking.

People who are exposed to high doses of radiation (from the explosion of an atomic bomb, by working in an atomic weapons plant, or from a nuclear reactor accident) have a heightened risk of developing leukemia. This is also true of people who are exposed over long periods of time to high levels of solvents such as benzene in the workplace.

People who have received previous chemotherapy or radiation treatments for cancer have an increased risk of developing leukemia, as the chemotherapeutic agents and radiation target rapidly dividing cells such as those of the bone marrow. These agents can cause mutations, or changes in a cell's DNA, that can lead to later malignancies including leukemia. AML is linked to treatments for Hodgkin's disease, non-Hodgkin's lymphoma, childhood acute lymphocytic leukemia, and to treatment for other malignancies such as breast and ovarian cancer.

People who have a myelodysplastic syndrome, a preleukemia condition, or who have rare genetic syndromes such as Down's syndrome, Fanconi's anemia, ataxia-telangiectasia, and Bloom's syndrome are at slightly higher risk of developing leukemia.

Many people with one or more of these risk factors never develop leukemia. And most of the people who do develop AML have no risk factors at all. Scientists do know that most leukemias are associated with specific gene mutations, but, in most cases, it is not clear what causes those mutations.

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Symptoms

Acute Lymphocytic Leukemia (ALL)

The symptoms of acute leukemia generally appear suddenly and can be similar to those of a virus or flu. They can be severe enough that they prompt patients see their physicians shortly after their onset, and include:

  • fever, headache
  • loss of weight and/or appetite
  • easy bruising and/or bleeding
  • weakness and fatigue
  • coughing, shortness of breath
  • frequent minor infections or poor healing of minor cuts
  • swollen lymph nodes, stomach, head, arms, and gums
  • tiny red spots in the skin
  • bone or joint pain
  • difficulty maintaining balance
  • blurred vision
  • seizures, vomiting
  • an enlarged, painless testicle

These symptoms are associated with a wide range of conditions and illnesses. But if these problems persist, consult a physician.

Acute Myelogenous Leukemia (AML)

The symptoms of acute leukemia generally appear suddenly and can be similar to those of a virus or flu. They can be severe enough that they prompt patients see their physicians shortly after their onset, and include:

  • fever, headache
  • loss of weight and/or appetite
  • easy bruising and/or bleeding
  • weakness and fatigue
  • coughing, shortness of breath
  • frequent minor infections or poor healing of minor cuts
  • swollen lymph nodes, stomach, head, arms, and gums
  • tiny red spots in the skin
  • bone or joint pain
  • difficulty maintaining balance
  • blurred vision
  • seizures, vomiting
  • an enlarged, painless testicle

These symptoms are associated with a wide range of conditions and illnesses other than leukemia. But if these problems persist, consult a physician.

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Treatment

Acute Lymphocytic Leukemia (ALL)

Physicians devise a course of treatment for each ALL patient that takes a number of factors into consideration: the ALL subtype; whether the patient has been treated already, with what, and how successfully; the number of leukemic cells detectable in the blood; which chromosomal alterations are present; and the patient's age and overall health. For this reason, ALL patients with the same disease subtype may receive different treatments.

The standard treatment approaches for adult leukemia are chemotherapy, immunotherapy, and bone marrow transplantation. Radiation therapy -- treatment with high-energy rays that destroy cancer cells -- is sometimes used for leukemia in the central nervous system or testicles and for pain caused by bone destruction. But because leukemia is systemic, surgery is almost always ineffective.

Treatment for ALL is typically divided into three phases:

  • Remission Induction
  • Remission Continuation (consolidation, intensification),
  • Maintenance

Remission Induction

The goal of the remission induction phase is to induce a remission, a state in which there is no visible evidence of disease and blood counts are normal. Patients may receive a combination of drugs during this phase including vincristine, prednisone, L-asparaginase, doxorubicin, daunorubicin, or cyclophosphamide. Treatment can last up to four weeks, and patients may need to be hospitalized during remission induction therapy.

Remission Continuation (Consolidation, Intensification)

In the second phase, the continuation, consolidation, or intensification phase, patients may receive high doses of chemotherapy, which are designed to eliminate any remaining leukemic cells. During this phase, treatment may include a combination of two or more of the agents 6-mercaptopurine, methotrexate, vincristine, prednisone, cytarabine, doxorubicin, daunorubicin, mitoxantrone, etoposide, ifosfamide, and cyclophosphamide.

Maintenance

During the third phase, the maintenance phase, patients may receive lower doses of drugs but for long periods of time -- up to two years. The goal of this phase is to destroy any stray leukemia cells that have evaded the agents used in the remission induction and consolidation stages; these cells may not be detectable by laboratory tests. Commonly used drugs for maintenance include methotrexate, 6-mercaptopurine, vincristine, and prednisone.

Immunotherapy

Physicians may include immunotherapeutic drugs throughout the course of treatment. These agents are designed stimulate the patient's own immune system to recognize and attack the leukemic cells. Immunotherapy agents include interferon alpha, which occurs naturally in the body, and monoclonal antibodies, which are genetically engineered proteins designed to target specific sites (antigens) on the surface of tumor cells. Monoclonal antibodies may be able to destroy diseased cells directly, or they may be used in a "conjugated" form, with radioisotopes (radioactive substances that radiate tumor cells), drugs, or toxins designed to destroy tumor cells attached to it.

Chemotherapy

It is not uncommon for ALL to spread to the central nervous system (CNS) -- the brain and the spinal cord. This occurs more frequently among patients who have the ALL subtype L3. Treatment to prevent or control CNS involvement is included in most patients' treatment regimen. To prevent spread of the disease to the CNS, physicians may administer chemotherapy intrathecally -- directly through the spinal column into the fluid that bathes the spinal cord and brain. Alternatively, patients may receive high-dose systemic chemotherapy or cranial irradiation -- radiation therapy to the head -- to prevent the spread of disease to the CNS.

Bone Marrow Transplant

A stem cell or bone marrow transplant is an option for some ALL patients; this procedure is done after an initial remission is achieved. In this procedure, bone marrow or stem cells -- blood-forming cells -- are filtered from the patient's (autologous transplantation) or a donor's (allogeneic transplantation) marrow or bloodstream and then frozen. The patient then receives a high dose of chemotherapy or radiotherapy, which destroys tumor cells but also damages the stem cells in the patient's bone marrow. The harvested stem cells or marrow are then administered, or transplanted, to help rebuild the patient's immune system.

New, highly sensitive laboratory tests can now probe for minimal residual disease -- the very few leukemia cells that may remain in the body after treatment ends -- in patients with certain specific types of leukemia. With the information derived from such tests, physicians can chart out further treatment options for leukemia patients.


Acute Myelogenous Leukemia (AML)

Physicians devise a course of treatment for each AML patient that takes a number of factors into consideration: the AML subtype; whether the patient has been treated already, with what, and how successfully; the number of leukemic cells detectable in the blood; which chromosomal alterations are present; and the patient's age and overall health. For this reason, AML patients with the same disease subtype may receive different treatments.

The standard treatment approaches for adult leukemia are chemotherapy, immunotherapy, and bone marrow transplantation. Radiation therapy -- treatment with high-energy rays that destroy cancer cells -- is sometimes used for leukemia in the central nervous system or elsewhere. But because leukemia is systemic, surgery is almost always ineffective.

Treatment for AML is typically divided into two phases: remission induction and post-remission therapy.

The goal of the remission induction phase is to induce a remission, a state in which there is no visible evidence of disease and blood counts are normal. Patients may receive a combination of drugs during this phase including daunorubicin, idarubicin, or mitoxantrone plus cytarabine and thioguanine.

In the next phase, the post-remission therapy phase, patients may receive high doses of chemotherapy, designed to eliminate any remaining leukemic cells. During this phase, treatment may include a combination of two or more of the agents cytarabine, daunorubicin, idarubicin, etoposide, cyclophosphamide, mitoxantrone, or cytarabine.

A stem cell or bone marrow transplant is an option for some AML patients; this procedure is done after an initial remission is achieved. In this procedure, bone marrow or stem cells -- blood-forming cells -- are filtered from the patient's (autologous transplantation) or a donor's (allogeneic transplantation) marrow or bloodstream and then frozen. The patient then receives a high dose of chemotherapy, which destroys tumor cells but also damages the stem cells in the patient's bone marrow. The harvested stem cells or marrow are then administered, or transplanted, to help rebuild the patient's immune system.

Liver Cancer

Malignant, or cancerous, liver tumors fall into two types: primary or metastatic. Primary tumors originate in the liver itself. Hepatocellular carcinoma is the most common type of primary liver cancer.

Metastatic, or secondary, liver tumors have spread to the liver from a cancer elsewhere in the body. Because one of the liver's main functions is to filter blood, cancer cells from other parts of the body may become lodged in the liver and become tumors. The most common type of metastatic liver tumors are those caused by colon cancer that has spread to the liver.

Primary liver cancer, or hepatocellular carcinoma, is the most common type of cancer originating in the liver itself. (Most tumors in the liver do not originate there; they start elsewhere in the body and spread, or metastasize, to the liver.) In the United States, primary liver cancer is relatively rare -- it accounts for less than one percent of all cancers. But worldwide, hepatocellular carcinoma is the most common solid organ tumor. This is believed to be due to widespread viral hepatitis infection, a known risk factor for primary liver cancer.

Most primary liver cancers originate in the liver's parenchymal cells -- the cells that perform most of the organ's blood-filtering functions. Other rarer forms of primary liver cancer include peripheral cholangiocarcinoma (tumors in the sections of the bile ducts that are within the liver), sarcomas and angiosarcomas (cancer in the connective tissue of the liver), hemangioendotheliomas (tumors that arise in the blood vessels of the liver), and hepatoblastomas (a highly curable form of liver cancer most often found in children).

Hepatocellular carcinoma most commonly occurs in people whose livers have been damaged. This damage may be caused by alcohol abuse, by chronic infection with the hepatitis B or hepatitis C virus, from food contaminants called aflatoxins (though this is rare in the United States), or from metabolic diseases. Cancer can spread from the liver to other areas in the body through the blood or the lymph system, most often to the lungs, bones, and abdomen.

Several benign, or non-cancerous, tumors can occur in the liver. The most common form of benign tumor is called a hemangioma. Hemangiomas can occur anywhere in the body but occur most frequently in the skin and subcutaneous tissues (tissues beneath the skin). In nearly all cases, hemangiomas of the liver are harmless. In only rare instances do they cause pain or other problems. Once checked and deemed harmless, they can be left alone.

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Risk Factors

Hepatocellular cancer is one of the most common cancers in the world. As hepatitis B virus and hepatitis C are known risk factors for liver cancer, areas with higher rates of these infectious diseases -- including some areas of Africa, China, and Southeast Asia -- have higher rates of liver cancer. These viral infections are less prevalent in the United States, although the incidence of hepatitis C infection is growing.

Viral hepatitis is often a silent disease. The hepatitis virus can be present in the body for years and cause no pain or symptoms. As many as four million Americans may carry the hepatitis C virus, and most may not be aware that they are infected. Viral hepatitis is contracted through contact with infected blood or body fluids. In many cases, people became infected through blood transfusions administered before 1992 (before blood was first routinely screened for the disease). A small number of cases are still associated with recent blood transfusions. Intravenous drug users may become infected through contact with unsterilized needles. These infections are considered so serious that the U.S. Centers for Disease Control and Prevention issued guidelines in October 1998 requiring hospitals to track down and notify anyone who may have received infected blood prior to 1992.

Early in the infection hepatitis B can be treated with a combination of the anti-viral drugs alpha-interferon and ribavirin. In some cases the virus can be eradicated from the bloodstream and eliminated from the body. For this reason, doctors recommend that people at a high risk for developing the disease be screened. If the infection progresses, it can lead to chronic liver disease, or cirrhosis, a progressive disease of the liver, and, eventually, liver cancer. There is also a vaccine for hepatitis B. Doctors recommend that children, and those at high risk for developing the disease be vaccinated.

The risk of primary liver cancer is greater for those whose livers have been damaged by excessive alcohol consumption. Approximately 15 percent of alcoholics will develop cirrhosis of the liver. Cirrhosis also makes the surgical treatment of primary liver cancer more difficult.

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Symptoms

Many patients with primary liver cancer have no symptoms. In some instances, jaundice, malaise, or a general feeling of poor health, loss of appetite, weight loss, fever, fatigue, bloating, itching, swelling of the legs, or weakness may be present. Abdominal pain or discomfort may also occur.

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Diagnosis

Diagnosis of primary liver cancer is generally made using blood tests, diagnostic imaging, surgical biopsy or laparoscopy, or a combination of the above. The alpha-fetoprotein blood test and ultrasound imaging of the liver are also used to screen high-risk populations (including those with hepatitis B and hepatitis C infections) for the disease. Since the risk of liver cancer is relatively low for healthy individuals, these tests are not used to screen the general population.

The alpha-fetoprotein (AFP) blood test measures the level in the blood of a certain protein produced by the liver. Elevated levels of AFP can be an indication of hepatocellular carcinoma, the most common type of primary liver cancer. If liver cancer is suspected, other blood tests are done to measure liver function. These tests can help doctors determine the condition of the liver. Since successful treatment for liver cancer involves removing a substantial part of the normal liver tissue in addition to the cancer, other treatments might be used in people with blood tests that indicate a high degree of liver disease.

As non-invasive diagnostic imaging techniques have become more sophisticated, they can be used to gather important information about a newly diagnosed tumor -- including its exact size, and density. These techniques can also be used to gauge how well a tumor will respond to treatment.

In some cases, diagnosis is performed invasively, by removing a small amount of tissue for a biopsy, or by laparoscopy (insertion of a small tube with an attached camera into the abdomen to survey the cancer site). Laparoscopy can also be used to remove a sample of tissue for biopsy.

Noninvasive Diagnostic Imaging Techniques

  • CT (computed tomography) scanning -- is useful for determining the extent of tumor growth within the gallbladder or bile duct. It can also be used to tell whether tumor cells have spread into the lymph nodes or other nearby parts of the body.
  • MRI (magnetic resonance imaging) -- can be used to determine if a tumor can be surgically removed. It shows the extent of tumor growth within the gallbladder or bile duct and reveals whether the tumor has invaded any blood vessels
  • Magnetic resonance cholangiopancreotography (MRCP) -- gives a detailed examination of the bile ducts. It is useful for determining the stage of a tumor in the bile duct.
  • Ultrasound -- useful for detecting the location and number of tumors as well as tumor involvement with blood vessels (tumors situated close to blood vessels may be more difficult to remove). It can also be used to distinguish a cancerous mass from a benign tumor.

Invasive Diagnostic Techniques

  • Biopsy -- a small amount of tissue is removed from a specific area of the body so it can be examined more closely.
  • Endoscopy -- the interior lining of a body cavity, such as the esophagus, stomach, bile duct, or colon, is examined using a device called an endoscope
  • Laparoscopy -- allows for the examination of the abdominal cavity and its contents. A tube with an attached camera (called a laparascope) is passed through an incision made in the abdominal wall.
  • Cholangiography -- a needle is inserted into the bile ducts within the liver. The ducts are injected with dye so they can be seen more clearly.
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Treatment

For treatment purposes, primary liver tumors are classified in four ways. Localized and resectable tumors are found in one place and can be removed. Localized and unresectable tumors are found in one area but cannot be totally removed safely. In advanced cases, cancer has spread throughout the liver and/or to other parts of the body. In recurrent cases, the cancer has returned to the liver or another part of the body after initial treatment.

Surgery

Most primary liver cancers are best treated by surgery to remove the diseased portion of the liver. Until the early 1980s, surgery to remove primary liver tumors was rarely done. But now highly complex liver operations are performed with great frequency, success, and safety at Tata Memorial Centre. Our researchers have recently shown that hepatobiliary surgery can also be successfully performed in elderly patients. These patients can have outcomes comparable to those of younger patients, so chronological age alone should not be the determining factor when deciding upon surgery in patients over the age of 70.

Operating on the liver can be difficult for several reasons. Many of the major blood vessels to and from the heart pass behind or through the liver, so in essence, the liver is "attached" to the heart. Also, the anatomy of the liver is not always obvious from the surface. The organ is large, dense, and delicate, and covered in part by the rib cage. It bleeds profusely when injured and it tears easily. Since hepatocellular cancer is relatively rare in the United States, many surgeons may not be experienced in performing liver resections. Our surgeons perform the highest number of liver resections of any cancer center in the country -- 200 to 300 per year.

The liver has the capacity to regenerate: Up to 80 percent of the organ can be surgically removed and within several weeks, the liver will have entirely regenerated itself. If one lobe--along with its associated blood vessels--is surgically removed, the remaining lobe will compensate for the loss. A new technique which stimulates regeneration before surgery is also being evaluated here. The technique is called pre-operative portal vein embolization. If doctors feel the portion of the liver remaining after resection would be too small to allow for a good outcome, they can shift the blood supply to the normal portion of the liver before the resection is done. That normal area grows larger, and when it reaches sufficient size, the resection can be performed.

When the liver is burdened with another disease aside from the cancer, surgery is complicated and sometimes impossible. A disease such as cirrhosis dramatically weakens the liver and often leaves it permanently damaged, with limited regenerative capacity. A patient with a liver hampered by both cirrhosis and a tumor is more likely to be treated with a method other than surgery. Some of these treatments are listed below.

Ablative Therapies

Ablation uses a chemical agent or energy to destroy a tumor. Ablative procedures can be performed both percutaneously (through the skin without an incision) or during surgery. Procedures which can be performed percutaneously include cryosurgery (freezing and killing the tumor cells), radiofrequency (RF) ablation, alcohol ablation, and embolization. These therapies can be very effective but are usually intended to control cancer rather than cure it.

Ablative therapies can be used alone or in combination with surgical removal of a tumor. For example, a patient with hepatocellular cancer who is not a candidate for surgery may first be treated with embolization to shrink the tumor so that it is small enough to make another form of ablative therapy or surgery possible.

In cryosurgery, a needle is introduced into the middle of a tumor to freeze it. Residual tumor cells can be left behind, making this method less effective than surgery. It can also be difficult to keep the tumor at temperatures low enough to completely freeze it, since tumors are often near large blood vessels. Nevertheless, cryosurgery can be a very effective way to control liver tumors.

Radiofrequency ablation is the opposite of cryosurgery. Rather than freezing the tumor, physicians use radio waves to heat it up to such a high temperature that the tumor is destroyed. RF ablation is effective, but can only be used for smaller tumors. This therapy is not curative; it is intended to control tumor growth.

Alcohol ablation or PEIT (percutaneous ethanol injection treatment) is a means of administering toxins directly to a tumor. It is quite effective for small tumors of less than 5 cm. This treatment is usually selected for patients who are not candidates for surgery.

Radiation Therapy

Radiation therapy is used in selected cases to help control tumors. Radiation oncologists here use new techniques to focus the radiation beam on the tumor and spare the normal liver from injury.

Embolization

Embolization is a procedure that cuts off the blood supply to the tumor. Physicians pack a branch of the hepatic artery -- the main artery that carries blood to the liver -- with tiny plastic particles, cutting off most of the blood flow and depriving the tumor of life-giving oxygen.

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Lung Cancer

More than 90,000 men and 79,000 women are diagnosed each year with cancer of the lungs and bronchi (the air tubes leading to the lungs). Among men, the incidence of lung cancer has been declining, but it continues to increase among women. The number of lung cancer deaths among women surpasses those from breast cancer.

Recent studies indicate that female smokers may be more likely to develop lung cancer than male smokers.

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Types of Lung Cancer

There are two major types of primary lung cancer: non-small cell and small cell. Each affects different types of cells in the lung and grow and spread in different ways, so doctors treat them differently. A diagnosis will include not only the type of lung cancer but the stage, which describes the extent and spread of the disease at diagnosis.

  • Non-Small Cell Lung Cancer
    Non-small cell lung cancer, the most common type of lung cancer, is usually associated with a history of smoking. The three main types of non-small cell lung cancer are named for the type of cell found in the tumor: squamous cell carcinoma (also called epidermoid carcinoma); adenocarcinoma; and large cell carcinoma. Non-small cell lung cancer is described using four stages: in stage I, the cancer is confined to the lung; in stages II and III, the cancer is confined to the chest; and in stage IV, the cancer has spread from the chest.
  • Small Cell Lung Cancer
    Small cell lung cancer (sometimes called oat cell lung cancer) accounts for approximately 20 percent of all lung cancer cases and is also associated with a history of smoking. The extent of the disease is described using a two-stage system. A case can either be limited, meaning the cancer is confined to a portion of the chest where it originated, or extensive, meaning the cancer has spread throughout or from the chest.

Mesothelioma, a rare cancer of the chest and abdominal lining, primarily affects persons who have had occupational exposure to asbestos particles.

Tumors found in the lungs sometimes originate from cancers elsewhere in the body. These tumors are called lung metastases.

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Risk & Prevention

Smoking tobacco in any form is the major risk factor for lung cancer. Nonsmokers who breathe the smoke of others, often called secondhand smoke, are also at increased risk for lung cancer. Stopping exposure to tobacco smoke at any age lowers the risk of lung cancer.

Risk factors for lung cancer besides smoking include the following:

  • Radon
    An odourless radioactive gas produced naturally in rocks and soil, radon is found in homes and mines in some areas. Exposure to high indoor radon levels can cause damage to the lungs that may lead to cancer.
  • Asbestos
    If inhaled, asbestos particles can cause lung damage that may lead to lung cancer and mesothelioma (a rare cancer of the chest and abdominal lining).

Smoking Cessation

Not everyone who gets lung cancer has a history of smoking. If you do smoke, however, you can reduce your risk for lung cancer -- and the risk of those around you -- by stopping now.

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Diagnosis

Lung cancer is difficult to detect early because symptoms usually do not appear until the disease is advanced. Symptoms depend on the location of the tumor and can include persistent cough, hoarseness or wheezing, shortness of breath, sputum streaked with blood, recurring bronchitis or pneumonia, weight loss and loss of appetite, and chest pain.

Physicians use several techniques to diagnose lung cancer, including the following:

Imaging Tests

Chest x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) help locate abnormal areas in the lung.

Low-Dose Helical CT

A technique called low-dose helical (or spiral) CT may offer a novel approach for diagnosing lung cancer by exposing the patient to less radiation than a conventional chest CT scan while allowing the doctor to see areas of the chest normally obscured in a standard x-ray.

Bronchoscopy & Biopsies

A sputum sample can be analyzed for the presence of cancerous cells. Doctors may perform a bronchoscopy, which allows them to examine the bronchial passages using an instrument called a bronchoscope. This is a small tube that is inserted through the nose or mouth, down the throat and into the bronchi. During the procedure physicians may remove some tissue for analysis.

A modified form of bronchoscopy called autofluorescence bronchoscopy, which can detect early invasive cancers not seen with standard x-rays or white-light bronchoscopy, is being used to detect very early lung cancer.

To examine areas of the lungs that are not accessible during a bronchoscopy, physicians may perform a needle biopsy ("fine needle aspiration" or FNA) to remove a small sample of tissue for analysis.

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Treatment

Depending on the type and stage of the disease, lung cancer can be treated with surgery, chemotherapy, radiation therapy, or a combination of these treatments.

Surgery

For non-small cell lung cancers that have not spread beyond the lung, surgery is most often used. Over the past several years, surgical techniques for treating lung cancer have improved greatly.

There are three surgical procedures commonly used to treat lung cancer:

  • wedge resection, or segmentectomy (in which a small section of the lung is removed)
  • lobectomy (in which an entire section is removed)
  • pneumonectomy (which involves the removal of an entire lung)

Minimally Invasive Surgery

Where appropriate, we offer minimally invasive surgical procedures, including video-assisted thoracic surgery (VATS), or thoracoscopy. VATS allows the surgeon to operate with roboting assistance by inserting an illuminated tube through a small incision into the lung through the ribs. Because the incisions are much smaller than with an open operation, post-operative healing time and pain are reduced.

Chemotherapy

For patients whose tumors are somewhat more advanced, a program of chemotherapy before surgery increases the cure rate. In some cases, the cancer is completely eliminated with chemotherapy before the patient has even had surgery.

Even if the surgeon removes the entire tumor that can be seen, adjuvant chemotherapy may be offered to kill cancer cells that may still be present in nearby tissues or elsewhere in the body. For small cell lung cancer in particular, chemotherapy, often combined with radiation therapy, is now the most common treatment.

Radiation Therapy

When surgery is not the best option, our radiation therapy system permits the delivery of the highest possible radiation dose targeted precisely to the tumor. This method spares normal tissues and lessens damage to other organs in the chest. Radiation therapy is also sometimes used to relieve pain and bleeding and alleviate problems with swallowing.

Both 3-D conformal radiation therapy and intensity modulated radiation therapy (IMRT) allow doctors to change the shape and intensity of radiation beams so they are focused more effectively on cancer cells and away from the surrounding tissue and organs.

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Skin Cancer

Sunlight and Skin Cancer

Ultraviolet (UV) radiation is the single most important cause of skin cancer, especially when the overexposure resulted in sunburn and blistering. Other, less common causes of skin cancer include repeated exposure to x-rays and exposure to coal tar, arsenic, and other industrial compounds.

Sunlight provides much that is beneficial and even necessary to life and good health. Tanning and burning, however, are not among those benefits -- there is no such thing as a "healthy tan."


Over the past decade, researchers have discovered that the tanning response begins only after DNA in skin cells has been damaged by exposure to sunlight. Although the exact wavelengths and timing of the solar radiation associated with different types of skin cancer are under investigation, the basic preventive lesson remains the same: protect your skin from the sun.

Fortunately there are ways to prevent most non-melanoma skin cancers and to detect them early when they do arise. When treated early, the vast majority of these cancers are curable.

Contact Us

TATA MEMORIAL HOSPITAL
Dr. E Borges Road, Parel, Mumbai - 400 012 India
Phone: +91-22- 24177000, 24146750 - 55
Fax: +91-22-24146937
E-mail : msoffice@tmc.gov.in (for patient care and queries) / hrd@tmc.gov.in(for administrative - HRD matters)

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