Types of Breast Cancer

Sometimes abnormal cells develop in the breast tissue, forming a lump or tumor. This is the most common type of cancer in women.

The breast has several lobes, which are divided into lobules and end in the milk glands. Tiny ducts run from the many tiny glands, connect together, and end in the nipple. Any tissue in the breast can be affected and it will destroy the nearby tissues also. Usually the cancer arises from tissue that forms milk ducts. There are at least 15 different kinds, depending on the site of development . Both women and men can develop breast cancer, but it is very rare in men.

Breast cancer occurs more commonly in the left breast than the right and more commonly in the outer upper quadrant. The tumor may distort the shape of the breast or the texture of the skin as it becomes larger. It can be detected when it grow large enough to either be felt or seen on a mammogram.

The cancer cells spread through the specialised channels in the breast called lymphatics to the lymph nodes to form tumors. It also spread or metasize to the other parts of the body through the blood stream. It spreads through the right side of the heart to the lungs, and eventually to the other breasts, the chest wall, liver, bone and brain. Spreading of the tumor to other parts of the body can cause death.

Breast cancer can be classified by histologic appearance and location of the lesion.

Adenocarcinoma - arising from the epithelium.

Intraductal - developing within the ducts

Infiltrating - Occurring in parenchyma of the breast.

Inflammatory - reflecting rapid tumor growth, in which the overlying skin become edematous, inflamed and in-durated.

Lobular carcinoma in situ - reflecting tumor growth involving lobes of glandular tissue.

Medullary or circumscribed - large tumor with rapid growth rate.

Types of Breast Cancer

Invasive (or infiltrating) ductal carcinoma

Accounting for 70 percent of all breast cancers, this is the most common type of breast cancer. It begins inside the duct and then penetrates the duct's wall to reach the fatty tissue of the breast. From there, it has the potential to spread (or metastasize) to other parts of the body through the lymphatic system and bloodstream.

Invasive (or infiltrating) lobular carcinoma

This is the second-most common tumor type, accounting for ten percent of all breast cancer. It begins in the terminal ducts of the breast milk-producing glands.

Medullary carcinoma

Although only three to six percent of all breast cancers are medullary carcinomas, this type of cancer is much more common in women with a genetic predisposition to breast cancer. In fact, different studies have found that between 13 and 19 percent of all cancers in women who carry a BRCA1 mutation are medullary carcinomas. In this type of cancer, the border between the cancer tissue and the normal tissues is relatively well-defined. Generally, the prognosis for patients with medullary carcinoma is better than for women with other types of invasive ductal or lobular carcinoma.

Paget's disease

This unique type of breast cancer only accounts for three percent of all breast cancer. It involves the nipple and areola, and is often associated with abnormal scaling and redness of the skin of the nipple and areola. Women may also have burning or itching. Paget's disease may be associated with in situ or invasive cancer. If there is no lump or evidence of ductal carcinoma in situ by biopsy, the prognosis is very good.

Inflammatory breast cancer

This cancer accounts for only approximately one percent of all breast cancers. It is named after its characteristic initial symptoms, which include redness, warmth, and swelling of the skin of the breast — often without a distinctive lump. These symptoms, which have the appearance of an infection or inflammation, are caused by cancer cells blocking lymph vessels or channels in the skin over the breast.

Other rare forms of cancer/variants of invasive ductal carcinoma

Mucinous, or colloid, carcinoma accounts for three percent of breast cancers and is more common among older women. Tubular carcinoma and papillary carcinoma each represent approximately one percent of breast cancer diagnoses. Both mucinous and tubular carcinomas have a better prognosis than the more common type of invasive ductal or lobular breast cancer. Even more rare, adenocystic breast cancer accounts for 0.4 percent of all cases and carcinosarcoma breast cancer accounts for only 0.1 percent of all cases.

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Causes and Risk factors of Breast Cancer

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

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

Not having children

Early menarchy (before age 12)

Late menopause

Over weight especially in the upper body

Use of alcohol

Excessive radiation

Hormonal contraceptives.

Hormone replacement therapy for more than five years.

Usage of diethylstilbestrol to prevent miscarriage.

Ovarian cancer patients.

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Signs and Symptoms of Breast Cancer

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

Breast or nipple skin that is warm, red, swollen, or scaly

Change in the shape or size of the breast

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

Nipple discharge that is not breast milk

Nipple tenderness

A nipple that is turned inward, or inverted

A rash around the nipple that may bleed, itch, or cause skin breakdown

Ridges or pits in the breast

Skin that is dimpled like an orange.

Women are recommended to examine their breasts once in a month to detect any changes or lumps. If breast self -examination detects a lump, the family doctor should be consulted. ment include cesium, iridium, iodine, phosphorus, and palladium. The side effects of implant therapy depend on the area being treated.

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Diagnosis of Breast Cancer

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

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

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

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

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

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Stages of Breast Cancer

If you are diagnosed with breast cancer, it is important to know how far the cancer has spread. The physician stages the tumor based on its size, the character of its cells, and the extent of metastasis. Knowing the stages help them to decide the best treatment options.

The staging of breast cancer is divided into five. Stages 0,1 & 2 refers the term 'early breast cancer' while the stages III & IV denotes the 'Advanced breast cancer'.

Stage 0

At stage 0 cancer cells are present in either the lining of a breast lobule or duct. But they have not spread to the surrounding fatty tissue. Two types of Stage 0 cancer are lobular carcinoma in situ (LCIS) and Ductal Carcinoma in situ (DCIS). LCIS does not behave as a cancer but indicates high risk for breast cancer. This risk of cancer is increased for both breasts. Some women with LCIS may take a drug called tamoxifen, which can reduce the risk of developing breast cancer.

In DCIS the cancer cells are confined to milk ducts in the breast and have not spread into the fatty breast tissue or to any other part of the body. women with DCIS are at an increased risk of getting invasive breast cancer. Some women with DCIS have breast-sparing surgery followed by radiation therapy. Or they may choose to have a mastectomy

Stage I

The primary cancer is 2cm or less in diameter and has not spread to the lymph nodes.

Stage II

Stage II is further divided in to two

Stage IIA : The cancer is no larger than 2 centimeters but has spread to the lymph nodes under the arm (the axillary lymph nodes). OR
The cancer is between 2 and 5 centimeters but has not spread to the lymph nodes under the arm.

Stage IIB : The cancer is between 2 and 5 centimeters, and has spread to the lymph nodes under the arm. OR
The cancer is larger than 5 centimeters, but has not spread to the lymph nodes under the arm.

Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy to the breast, or they may have a mastectomy. Many women with stage I and most with stage II breast cancer have chemotherapy and hormonal therapy after primary treatment with surgery or surgery and radiation therapy.

Stage III & IV is known as 'Advanced Breast cancer'

Stage IIIA : The cancer is smaller than 2 inches (5 centimeters) and has spread to the axillary lymph nodes (the lymph nodes under the arm), and the lymph nodes are attached to each other or to other structures. OR
The cancer may be larger than 2 inches (5 centimeters) and has spread to the axillary lymph nodes and the lymph nodes may be attached to each other or to other structures.

Stage IIIB : It has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest) OR
spread to lymph nodes inside the chest wall along the breastbone.

Patients with stage III breast cancer usually have both treatment to remove or destroy the cancer in the breast and to stop the disease from spreading. Surgery and/or radiation therapy, chemotherapy, hormonal therapy are the standard treatments.

Stage IV

This stage is known as metastatic. Cancer has spread from the breast and lymph nodes under the arm to other parts of the body, such as bone, liver, lung, or brain.

The treatment of Stage IV breast cancer focuses on extending survival time and relieving symptoms.

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Treatment of Breast Cancer

Women are recommended to examine their breasts once in a month to detect any changes or lumps. If breast self -examination detects a lump, the family doctor should be consulted. In choosing therapy, the physician takes into consideration the stage of the disease, the woman's age and menopausal status. Breast cancer is usually treated surgically along with chemotherapy, radio therapy and hormone therapy. Radio therapy kills cancer cells using gamma radiation. Chemotherapy may use Cytotoxic drugs to kill cancer cells both in the breast and elsewhere in the body. Modern treatments have greatly improved the quality and quantity of life for breast cancer patients.

Surgery

Surgery is the first line of attack against breast cancer. There are two main type of surgeries for breast cancer

Lumpectomy (Breast-conserving surgery) : Any form of surgery that removes only part of the breast is considered "breast-conserving" or "breast preservation" surgery. Lumpectomy is the most common surgery used for best cancer today. It is used for patients with early stage invasive breast cancers. A part of the breast which contains the tumor and some normal tissues that surrounds the tumor is removed during the surgery. Usually women with tumors 5 cm (2 inches) or less in diameter with positive or negative axillary lymph nodes, are gone under this treatment. After the surgery, the patient may receive five to seven weeks of radiotherapy in order to eliminate any cancer cells that may be present in the remaining breast tissue.

Mastectomy : A method of surgery which involves the removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer or entire breast. Breast cancer surgery is done under general anesthesia and usually takes two to three hours. The surgeon may also remove the lining over the chest muscles below the tumor and some lymph nodes under the arm. Women who undergo a mastectomy have the option of breast reconstruction.

Side effects include, wound infection, hematoma (accumulation of blood in the wound), and seroma (accumulation of clear fluid in the wound).

Chemotherapy

It is a combination of drugs which is effective to kill or slow the growth of rapidly multiplying cells. The drugs are given directly to vein or orally. The drug will travel to entire body through blood stream and will destroy the cancer cells beyond the breast. Chemotherapy is given in cycles of treatment followed by a recovery period. The entire chemotherapy treatment generally lasts three to six months, depending on the type of drugs given. When breast cancer is limited to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is known as adjuvant treatment and may help reduce the chance of breast cancer recurrence.

The side effects will depend up on the type and amount of drugs you are given. The side effects include
Nausea and vomiting
Loss of appetite
Hair loss
Mouth sores
Changes in menstrual cycle
Higher risk of infection (due to decreased white blood cells)
Bruising or bleeding
Fatigue

Radiation Therapy

Radiotherapy is a highly effective treatment option which uses high levels of radiation to kill cancer cells or keep them from growing and dividing thus reducing damage to healthy cells. It is usually given to the breast to destroy cancer cells that may remain in your breast after breast conserving surgery, or in any breast tissue left on your chest after mastectomy. Having radiotherapy after surgery reduces the chance that reoccurrence in the same place in the next 10 years. Radiation therapy is usually delayed until chemotherapy is complete. Early side effects of radiotherapy include skin reactions, tiredness and breast tenderness. These are usually mild and pass after a few weeks. Radiation therapy is not given during pregnancy because it can harm a fetus.

Two main types of radiotherapy are used to treat breast cancer: External Radiotherapy and Internal Radiotherapy

External Radio therapy : This is the usual method of radio therapy. In this therapy, radiation is focused from a source outside the body on the area affected by the cancer. Patients need to face the therapy at least six to eight weeks continuously. Deodorants and antiperspirants can interfere with external beam radiation therapy of the underarm area, so you should avoid using them until treatments are complete. In some women, the breast becomes smaller and firmer after radiation therapy.

Internal Radio Therapy ( Brachytherapy ) : This is a method of placing radioactive seeds directly into the breast tissue next to the cancer. The radiation is sealed in needles, seeds, wires, or catheters. This type of radiation has the advantage of delivering the radiation from a close distance, and thereby deliver a higher dose of radiation while not causing as much damage to other structures. Some of the radioactive substances used for internal radiation treatment include cesium, iridium, iodine, phosphorus, and palladium. The side effects of implant therapy depend on the area being treated.

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Types of Testicular Cancer

Testicular cancer is a rare disease in men caused by abnormal growth of cells in the tissues of one or both testicles. The male sex gland, testicles (testes or gonads) are the body's main source of male hormones which is involved in the production of sperm. The testicles, two in number, which look round and a little smaller than golf balls, are located behind the penis in a pouch of skin called the scrotum.

Testicular cancer usually arises between the ages of 15 and 49, more likely between 20-35. Testicular cancer or malignant tumour (also called germ cell tumour) begins when cells within the testicle become cancerous and begin to grow out of control. Seminoma and Nonseminoma are the two types of testicular cancer. Nonseminomas include four sub-types namely Choriocarcinoma, Embryonal Carcinoma, Teratoma, and Yolk sac tumors. Seminomas, made up of immature germ, are slow growing and tend to stay localized in the testicle for long periods. Nonseminomas arise from more mature, specialized germ cells and tend to be more aggressive than Seminomas. Tumors can also arise in the supportive and hormone-producing tissues of the testicles and are called Gonadal Stromal tumors. Leydig cell tumors and Sertoli cell tumors are two types. Secondary testicular tumors are those that start in another organ and then spread to the testicle. The most common secondary testicular cancer lymphoma, arise from lymphatic tissue (tissue that forms part of the immune system) within the testicle. These are very rare.

Types of Testicular Cancer

The testicles contain several types of cells, and each type of cell can develop into different types of cancer. The most common type of testicular cancer (that represents more than 95 percent of all testicle cancers cases) is germ cell tumor or germinal tumor. This type of cancer develops within the germ cells. The germ cells are reproductive body cells which produce sperm in men. Sperm production begins with puberty. The germ cells within the testes produce immature sperm which travel through a network a tubes (called collecting tubes) into the epididymis (the tube within the testicles where collecting tubes join together), where it matures and is stored.
There are two main types of germ cell tumors:

I. Seminomas, represents about 40 percent of all germinal tumors, and it develops in men between the age of 30 and 40. In most cases, the cancer is confined to the testes, but in 25 percent of patients the cancer spreads to the lymph nodes. One of the main characteristics of this type of tumor is that the germ cells become malignant in an early stage of development. Seminomas are more responsive to treatment than the non-seminomas.

II. Non-seminomas, represents about 60 percent of the all germinal tumors, and it develops in men who are in their mid-30s. This type of cancer tends to develop early, grows fast, and spreads quickly. There are four types of non-seminomas:

1. Embryonal carcinomas - This type of tumor represents 25 percent of the non-seminomas, and it develops in men between the age of 20 and 30. Embryonla carcinomas are highly malignant and aggressive tumors, which grow rapidly and tend to spread to the lungs and liver.

2. Teratoma carcinomas - This type of tumors represents 20 to 30 percent of all non-seminomas tumors and it affects young boys more then adult men.

3. Yolk-sac tumors is a rare type of testicular cancer that can affect adult men but more commonly occurs in young boys.

4. Choriocarcinomas is a rare type of testicular cancer.

There is another type of testicular cancer, called stromal cell tumor, which represents only 3 to 4 percent of all testicular cancers and 20 percent of childhood testicular tumors. This type pf cancer develops within the testicles supportive tissues (called stroma).

The stromal cell tumors are a type of tumor made up of Leydig cells (testis cells that produce testosterone), Sertoli cells (the cells where sperm matures), and granulose cells. Sometimes, these tumors secret a hormone called estradiol, which can cause an excessive development of breast tissue - gynecomastia (a testicular cancer symptom).

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Causes of Testicular Cancer

The causes of testicular cancer are unknown, but it is not contagious. It is more common in men who have a testicle that has failed to descend. Men with a family history of testicular cancer may have an increased risk of developing testicular cancer. Baby boys born with undescended testicles (also called cryptorchidism) have a higher-than-average risk of developing testicular cancer in later life. It is a condition where the testicle does not move into the scrotum before birth. The male children of women who takes hormones while pregnant may also be at greater risk. Men who have already had testicular cancer have a higher risk of developing a tumor in the other testicle.

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Signs and Symptoms of Testicular Cancer

Testicular cancer does not always produce symptoms. In some cases there are few or no symptoms and it is only after the cancer has spread, that the primary tumour can be detected in the testicle itself. The first sign is usually a firm, painless and smooth testicular mass or lump varying in size and sometimes producing a sense of testicular heaviness. Most lumps in the scrotum are not testicular cancer.

Other symptoms include :

Testicular swelling and hardness

A feeling of heaviness or aching in the scrotum or lower abdomen.

A dull ache in the abdomen or groin

Any change or pain in the testicle or scrotum.

Enlarged male breasts and nipples.

Blood or fluid that accumulates suddenly in the scrotum.

Some types of testicular cancer produce high levels of human chorionic gonadotropin [HCG], estrogen and testosterone hormones. Increased levels of HCG may cause breast tenderness and abnormal growth of breast tissue (gynecomastia). Increased levels of estrogen may cause a loss of sexual desire (libido) and increased levels of testosterone may cause premature growth of facial and body hair in boys. In advanced stages, signs and symptoms include urethral obstruction, abdominal mass, cough, hemoptysis, shortness of breath, weight loss, fatigue, pallor and lethargy.

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Diagnosis of Testicular Cancer

Routine regular self examination of the testicle should be done by all men, beginning at the age of 15 years. Most testicular cancers are found by men themselves. The best method of examination is known as testicular self-exam or TSE. Men should be familiar with the normal weight, texture and consistency of their testicles. With early detection, there are 90% chances of a complete cure.

Testicular self examination

Testicular self examination should be carried out once in a month and the best time to feel the testicles is following a bath or shower when the organs are warm and relaxed. Use a mirror to become familiar with the normal size and appearance of the testicles. Check out for any swelling on the scrotal skin. Examine each testicle with both hands. Place the index and middle fingers under the testicle with the thumbs placed on top. Roll the testicle gently between the thumbs and fingers. If you are familiar with the epididymis, a small firm, soft, tubelike structure at the back of the testicle that collects and carries sperm, you won't mistake it for a suspicious lump. Look out for any extra increase in size or weight which might indicate abnormality. Cancerous lumps usually are found on the sides of the testicle but can also show up on the front. Lumps on the epididymis are not cancerous.

Any change or pain in a testicle should be shown to a general practitioner, preferably a Urologist, with out delay. He will carry out a physical examination to rule out any other conditions or infections that can cause similar symptoms. If the doctor suspects testicular cancer he may perform an ultrasound scan or blood test to clarify the diagnosis. An ultrasound scan using sound waves determines if a mass is solid or fluid filled. A solid tumour in the testicle is usually cancerous. Certain types of testicular cancer raise the level of substances known as tumor markers (which are found in higher than normal amounts when a tumor is present) in the blood. Blood tests that measure the levels of these substances are used to diagnose testicular cancer and, in some cases, to determine the extent of the disease.

When a solid tumor is detected by ultrasound, a Computed Tomography (CT scan) or chest x-ray is performed to check for any signs that the cancer has spread to lymph nodes or other organs. CT scans are helpful in staging the cancer or determining the extent of its spread.

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Stages of Testicular Cancer

Once the tumor is identified, more tests will be done to find out if the cancer has spread from the testicle to other parts of the body. This is known as staging. There are three stages for the testicle cancer and they are :

Stage I - Cancer is confined only in the testicle.

Stage II - Cancer has spread to the retro peritoneal lymph nodes in the abdomen (lymph nodes are small, bean-shaped structures), located in the rear of the body below the diaphragm and between the kidneys. They produce and store infection-fighting cells.

Stage III - Cancer has spread beyond the lymph nodes in the abdomen. There may be cancer in parts of the body far away from the testicles, such as the lungs, brain, liver and bones.

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Treatments of Testicular Cancer

The treatment of testicular cancer is determined by the type and stage of the tumor. It is a highly treatable and usually curable form of cancer. Treatment methods include surgical removal of the lump or testicle (Orchidectomy), Chemotherapy and Radiation therapy and surveillance. Chemotherapy and radiotherapy can temporarily interfere with sperm production and therefore fertility.

Surgery

Surgery which is the normal treatment for testicular cancer involves removal of the affected testis. An incision is made in the groin, and the testicle is withdrawn from the scrotum through the opening. A cut is made through the spermatic cord that attaches the testicle to the abdomen. This procedure is known as a radical inguinal orchiectomy. The removal of one testicle does not affect a man's sex life or his ability to have erections or father children.

If the testicular cancer has spread to the lymph nodes in the abdomen, a major surgery, called retroperitoneal lymph node dissection (RPLND) is often performed. In this procedure all of the lymph nodes connected to the affected testicle are removed .

Side Effects : Pain at the incision site and numbness in the area surrounding the incision are common, and pain relievers are often prescribed. Driving and heavy lifting should be avoided for several weeks.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs can be swallowed in pill form or can be injected by needle into a vein or muscle. It is an effective way to destroy any cancer cells that break off from the main tumor and travel in the bloodstream to lymph nodes or distant organs. The most commonly used drugs to treat testicular cancer are cisplatin, vinblastine, bleomycin, cyclophosphamide, etoposide, and ifosfamide. In some cases, chemotherapy is given to patients after surgery to kill any remaining tumor cells in the body. This is referred as adjuvant chemotherapy.

Side Effects : Drugs used in chemotherapy can cause side effects, but these can usually be well controlled with medicines.
The possible side effects are lowered resistance to infection, bruising or bleeding, anaemia (low number of red blood cells), nausea and vomiting, sore mouth, hair loss, breathlessness, hearing changes, fatigue, diarrhea or constipation. Most side effects disappear when your course of treatment ends. Some drugs can cause long-term side effects like damage to kidney's and lungs, small blood vessels and nerves, abnormal tingling and hearing loss etc.

Radiation Therapy

Radiation therapy is the treatment using a beam of high-energy rays or particles to destroy cancer cells or slow their rate of growth. It is given to prevent the cancer coming back after surgery or to treat any cancer cells that have spread to the lymph glands at the back of the abdomen. Seminomas which very sensitive, can be treated with radiation. Radiation therapy is also called x-ray therapy, radiotherapy, cobalt treatment, or irradiation.

The main drawback of radiation therapy is that it may destroy nearby healthy tissue along with the cancerous cells. The side effects of radiation are diarrhea, fatigue, nausea and skin irritation that resembles sunburn.

The earlier the stage at which your cancer is diagnosed, the better your chances are for recovery. After treatment, a patient should regularly examine the opposite testicle for possible recurrence for many years. Patients will probably have check-ups once per month during the first year after surgery, every other month during the next year, and less frequently after that.

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Types of Penile Cancer

Cancer of the penis or penile cancer is a rare disease in which cancer cells or malignant cells are found on the external skin and in the tissues of the penis. It is generally an aggressive form of cancer that has a tendency to spread.

Penile cancer is relatively rare in Western countries; In some South Asian countries, Africa and South America, however it ranks first among malignancies. Although this type of cancer is rare, it is estimated that more than 75% of people older that 60 years are affected by penile cancer. It usually responds well to treatment, and many patients can be cured.

The penis is the external male organ that contains many types of tissue, like skin, nerves, and blood vessels. Penile cancer evolves from a disruption in one or more genes in a cell's DNA. Genes control cell activities including division and growth. When cells die, they are replaced by new cells as the body needs them. However, when the genes that orchestrate this natural replacement process are disrupted by chemicals, illness, or other unknown factors, control over cell division and growth is lost. The resultant uncontrolled mass of tissue is a tumor. The tumor spreads gradually becoming larger in the area of the skin where it first develops. Ultimately, it spreads to deep tissues inside the body of the penis and to lymph nodes in the groin (inguinal area) or pelvis. Different types of penile cancer can develop in each kind of cell.

Types of Penile Cancer

There are several types of penile cancers:

Epidermoid Carcinoma :

95% percent of penile cancer is epidermoid, or squamous cell carcinoma. Epidermoid carcinoma develops from squamous cells. This scale like skin cells can develop anywhere on the organ usually found in the glans but may occur on the corona glandis and rarely, in the preputial cavity.

Verrucous Carcinoma :

Verrucous carcinoma also called Buschke-Lowenstein tumor is an uncommon form of squamous cell carcinoma This low-grade tumor can occur on the genitals, skin, mouth, larynx and anus. These tumors rarely spread outside of the penis and it is often difficult to distinguish this condition from a benign genital wart.

Adenocarcinoma :

A very rare type of penile cancer called adenocarcinoma can develop in thee sweat glands in the skin of the penis.These tumors have the potential to invade below the skin and may eventually spread to lymph nodes.

Melanoma :

Another small percentage of penile cancer can develop in the pigment producing cells of the skin on the penis. These are called melanomas. Melanomas are considered more dangerous because they grow and spread quickly. Usually melanomas develop on sun-exposed areas of the skin, though occasionally they develop on other areas not likely to be sunburned. Usually appear as blue-brown flat growths and tend to spread more rapidly and more widely.

Basal Cell Cancer :

Less than 2% of penile cancers are basal cell cancers and are slow-growing tumors that rarely spreads to other body parts. These tumors develop in skin cells.

Sarcomas :

Sarcomas develop from the blood vessels, smooth muscle and other parts of the penis. About 1% of penile cancers are sarcomas.

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Causes of Penile Cancer

The exact cause of penile cancer is unknown. However scientists have identified a number of risk factors that increase a person's chance of getting penile cancer. Certain risk factors are associated with poor hygiene and is much less common in men who have been circumcised (circumcision is the surgical removal of the foreskin of the penis) soon after birth. This does not mean that being circumcised will prevent penile cancer but it is thought to be a contributing factor.

Infection with a type of virus (human papilloma virus types 16 and 18) that causes penile warts also increases the risk of cancer of the penis. This may account for the low incidence among jews, Muslims and people of other cultures that practice circumcision at birth or shortly thereafter.

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Symptoms of Penile Cancer

Symptoms of penile cancer may include any of the following:

Growths or sores on the penis or a wart-like lump on the penis

Any unusual liquid coming from the penis (abnormal discharge).

Pain or Bleeding from the penis

Once cancer is found, more tests will be done to find out if the cancer has spread from the penis to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. Pain and bleeding may develop as the cancer continues to grow.

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Diagnosis of Penile Cancer

If your physician suspects that you have penile cancer, he may refer you to a urologist, a doctor who specializes in the genitourinary tract. Like most cancers, cancer of the penis is easiest to treat if it is diagnosed early. If left untreated, it will spread slowly across the skin and invade deeper layers of tissue. 

To diagnose penile cancer, the urologist asks about personal and family medical history and does a complete medical exam. The doctor may examine the patient's penis for lumps, open sores or any other abnormalities. If the cancer has spread to the lymph node,s they may be enlarged.

To make a firm diagnosis, the doctor may suggest a biopsy, in which a small piece of the offending area is taken out, and is sent for histopathological diagnosis, in which the pathologist (a doctor specializing in laboratory diagnosis of diseases) visualizes the tissue section under the microscope and tells you conclusively whether it is a cancer or not. In penile cancer, incisional or excisional biopsy is performed to obtain the diagnosis. If the results confirm a diagnosis of cancer, the doctor will perform additional tests to determine whether the disease has spread to other parts of the body. This process is called staging.

Magnetic resonance imaging (MRI) and ultrasonography may be used to determine the extent (stage) of the cancer. MRI uses magnetism to build up a picture of the inside of the penis instead of X-rays. This test can show how deeply the cancer has invaded into the penis.

Chest x-ray: This test checks whether penile cancer has spread to the lungs.

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Stages of Penile Cancer

The stages of a cancer is a term used to describe the extent of a cancer within the body, including whether the disease has spread from the original site to other parts of the body. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment. The doctor needs to know the stage of your disease to plan treatment. The following stages are used for cancer of the penis.

There are four stages of penile cancer. They are:

Stage I - At the first stage cancer cells are found only on the surface of the glans (the head of the penis) and on the foreskin (the loose skin that covers the head of the penis).

Stage II - In the second state the cells are found in the deeper tissues of the glans and have spread to the shaft of the penis (the long, slender cylinders of tissue inside the penis that contain spongy tissue and expand to produce erections)

Stage III - At the third stage they are found in the penis and have spread to nearby lymph nodes in the groin (Lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells) and have spread to other parts of the body.

Stage IV - In the fourth state the cancer cells are found throughout the penis and the lymph nodes in the groin area or have spread to other parts of the body.

Recurrent - Recurrent disease means that the cancer has come back (recurred) after it hasbeen treated. It may come back in the same area or in another place.

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Treatments of Penile Cancer

Treatment of penile cancer depends on the type of cancer and the stage of the cancer. It is usually a slow-growing cancer and is curable if it is discovered and treated in an early stage. Unfortunately, men delay treatment of penile cancer because they fear disfigurement and loss of sexual function. Patients often try to treat themselves with various skin creams and lotions. These may appear to be effective for a time, which further delays the diagnosis. If left untreated, the infection may spread from the penis to the lymph nodes in the groin and eventually to other parts of the body.

The type of treatment that you are given will depend on a number of things, including the position and tumor size, whether it has spread, the grade of the cancer and your general health. If the tumor appears on the skin surface, doctor may be able to treat the problem with a topical cream that has minimal side effects. Local tumors can be treated surgically that continues to shave layers of abnormal tissue until normal tissue is reached without major damage to the appearance, sexual activity or function of the penis. Radiation is an option but results are less certain.

There are treatments for all patients with cancer of the penis. Four kinds of treatment are used:

Surgery - the main penile cancer treatment (taking out the cancer in an operation).

Surgery is the most common treatment of all stages of cancer of the penis. A doctor may take out the cancer using one of the following operations: Different types of surgical procedures given below.

Wide local excision takes out only the cancer and some healthy tissue on either side. This is used when cancer has spread over a wider area.

Microsurgery is an operation that removes cancerous tissue and the smallest amount of healthy tissue. During this surgery, the doctor uses a microscope to check at the cancerous area to make sure all the cancer cells are removed.

Laser (Light Amplification by Stimulated Emission of Radiation) surgery uses a narrow beam of light to dissolve or burn away cancer cells. It's advantage is that is causes very little post operative scarring and is very exact, not damaging surrounding tissues.

Circumcision (A circumcision is an operation in which the doctor takes away part or the entire foreskin from the penis- The foreskin is the skin, which covers the tip of the penis.)

Removing the penis (penectomy) is an operation that takes out the penis. It is the common and most effective treatment for the penile cancer. This may be advised if the cancer is large and is covering a large area of the penis. This is an operation In a partial penectomy, part of the penis is taken out. In a total penectomy, the whole penis is removed. Lymph nodes in the groin may be taken out during surgery. If the tumour is near the base of the penis, total penectomy may be the only option.

2. Radiation therapy

In Radiation therapy uses high-dose x-rays or other high-energy rays to kill malignant cells and shrink tumors. This is used alone or as an alternative to surgery. Radiation therapy to the penis may work best in patients with low stage disease. This may improve effectiveness after resection of localized lesions without metastasis; it may also reduce the size of lymph nodes before nodal resection. Radiation may come from a machine outside the body (external radiation) or from putting materials that contain radiation through thin plastic tubes into the area where the cancer cells are (internal radiation). Each treatment takes 10–15 minutes. The number of treatments will depend on the type and size of the cancer but the whole course of treatment for early cancer will usually last up to six weeks.

3.Chemotherapy

Chemotherapy (using drugs to kill the cancer cells). It can be one drug or several drugs used together. It is not commonly used to treat cancer of the penis. Chemotherapy cream may sometimes be used to treat very small, early cancers that are confined to the foreskin and end of the penis (glans). Chemotherapy may also be given as tablets or by injection into a vein for more advanced cancer. It may be given along with surgery or radiotherapy (or both). This treatment is still experimental and is given as part of research trials (clinical trials). The side effects of chemotherapy are hair loss, nausea, vomiting, diarrhea, lowered blood counts, , and an increased risk of infection.

4.Biological therapy

Biological therapy (BRM Therapy restores the body's natural defenses against disease)

The chance of recovery and choice of treatment depend on the stage of the cancer and the patient's general state of health. There are incidents of the cancer recurring after it has been treated.

Treatment by Stage

Treatment of penile cancer depends on the type of cancer and the stage of the cancer.

For stage I - If cancer is limited to the foreskin, treatment will be wide local excision and circumcision. If cancer is only on the glans, treatment may involve the use of a Fluorouracil cream or microsurgery. If the tumour originating from the glans, has started to invade adjacent parts of the penis, partial penectomy with or without groin node dissection (GND), teletherapy. microsurgery, laser may involve.

For stage II - Stage II cancer may managed by amputation of the penis that is; partial penectomy, total penectomy or radical penectomy is an alternative approach. Radiation treatment may also involve.

For stage III - Treatment may be amputation of the penis, followed by removal of lymph nodes on both sides of the groin or amputation of the penis followed by partial or total penectomy, with one sided (unilateral) or both sided (bilateral) GND. Some form of penectomy followed by irradiation, Chemotherapy with or without irradiation.

For stage IV - Treatments are similar to that for Stage III cancer.

For recurrent - If the cancer has come back, treatment may partial or total penectomy, radiation, or chemotherapy.Biological therapy is also being conducted.

Ways to Reduce Penile Cancer

Penile cancer is very treatable and is often cured. Adding these tips to your daily routine can help to lower your penile cancer risk. The chance of recovery and choice of treatment depend on the stage of the cancer (whether it is just in the penis or has spread to other places), and the general state of health of the patient.

Clean the penis routinely and effectively, especially under your foreskin.

Practice safe sex and limit the number of sexual partners during your lifetime.

Do not smoke cigarettes. Cigarette smokers have a higher risk of developing penile cancer than non-smokers.

Know the symptoms of penile cancer (growths or sores on the penis or abnormal discharge or bleeding from the penis). Notify your doctor if you notice any of these changes.

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Types of Melanoma - Skin Cancer

Melanoma is the least common but most dangerous and serious type of skin cancer. It can develop anywhere on the body. Most melanomas develop in your skin. But it can also form in the eye and in rare cases in internal organs such as intestine. The skin is the body's largest organ which protects us against sunlight, injury, and infection. It helps regulate body temperature, stores water and fat, and produces vitamin D. Skin is divided into two main layers namely, epidermis and dermis. Epidermis is the layer nearest the surface of the skin and is mostly made up of flat, scalelike cells called squamous cells. Round cells called basal cells lie under the squamous cells in the epidermis. The lower part of the epidermis also contains melanocytes. Dermis is the layer underneath epidermis and itcontains blood vessels, lymph vessels, hair follicles and glands.

Malignant melanoma develops in cells known as melanocytes. These cells, which produce a pigment called melanin, lie in the lower part of the epidermis. Melanin gives skin its natural color. Moles are groups of melanocytes that lie close together. They are usually tan, brown or flesh-colored.

Melanoma affects people of all ages but the chance of developing it increases with age. It occurs when melanocytes become malignant (cancerous). When melanoma starts in the skin, it is called cutaneous melanoma and when it occur in eye, the disease is called ocular melanoma or intraocular melanoma. In men, melanoma is found most often on the area between the shoulders and hips or on the head and neck. In women, melanoma often develops on the lower legs. It may also appear under the fingernails or toenails or on the palms or soles. It rarely appears in the conjunctiva, choroid, pharynx, mouth, vagina or anus.

Types of Melanoma - Skin Cancer

The four types of melanomas are Superficial spreading melanoma (SSM), Nodular melanoma (NM), Acral-lentiginous melanoma (ALM) and Lentigo maligna melanoma (LMM)


Superficial spreading melanoma (SSM) - It is the most common type of melanoma. An SSM usually first appears as a flat or slightly raised mark. It has a red, white and blue colour over a brown or black background and an irregular, notched margin. Initially, an SSM spreads through the epidermis. If not caught and treated at this stage, it eventually begins to grow into the dermis and may then spread to other parts of your body. SSM is commonly found on the trunk, upper arms, and thighs.

Nodular melanoma (NM) -This type of melanoma is flesh coloured with flecks of pigment around its base. NM usually appears as a small, round bump (nodule) with a smooth border. Most NMs are black, although some may be brown, blue, gray or even red in color. It can occur on any skin surface but is found more commonly on the trunk, upper arms, and thighs. NM spreads so rapidly, it is often quite advanced by the time it's diagnosed.

Acral-lentiginous melanoma (ALM) - ALM usually develops on the palms, soles or nails and is most common in dark-skinned races. It is normally brown or black with irregular borders. Because ALM is often mistaken for a minor problem, such as a bruise or blister, it may have penetrated deep into the underlying layers of skin before it's diagnosed.

Lentigo maligna melanoma (LMM). It is relatively rare and the lesions looks like a large flat freckle of tan, brown, black, whitish or slate colour and has irregularly scattered black nodules on the surface. LMM commonly develops under the fingernails, on the face and on the back of the hands. Generally they do not spread to other parts of the body. It may remain flat and confined to the epidermis for months to many years, but at some point will penetrate into the deeper levels of skin, increasing the potential for metastases.

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Causes of Melanoma - Skin Cancer

The main cause of malignant melanoma is ultraviolet (UV) rays from the sun. These rays damage the skin. Melanoma occurs more frequently in people who have fair skin than in people with dark skin. Risk of developing melanoma increases with increased number of moles. The risk of developing melanoma is greatest for people who have a large number of dysplastic nevi. Dysplastic nevi is a kind of abnormal mole that are generally larger than ordinary moles and have irregular and indistinct borders. Usually they are flat but parts may be raised above the skin surface.

Personal and family history of melanoma is also a risk factor. People who have had melanoma have a high risk of developing a new melanoma. Artificial sources of UV radiation such as sunlamps and tanning booths can also cause skin damage and increase the risk of melanoma.

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Symptoms of Melanoma - Skin Cancer

Most melanomas start with a change in the appearance of normal skin. The signs of melanoma are change in the shape, size, color, or feel of an existing mole. Newly formed fine scales and itching in a mole are the most common symptoms of melanoma. It have a black or blue-black area. Usually melanomas do not cause pain. Itching, crusting or bleeding may also occur in melanomas.


In advanced stage, the mole may become hard or lumpy. Changes in the skin, such as a change in a mole, should be reported to the health care provider right away. The person may be referred to a dermatologist, a doctor who specializes in diseases of the skin. It is difficult to differentiate between a mole and a melanoma. The guideline 'ABCD' is helpful for identifying malignant melanoma.

Asymmetry -Ordinary moles are usually symmetrical in shape. Melanomas are likely to be irregular or asymmetrical

Border - Moles usually have a well-defined regular border. Melanomas are more likely to have an irregular border with jagged edges. The pigment may spread into the surrounding skin.

Colour - Moles are usually a uniform brown. Melanomas tend to have more than one colour. They are often a mixture of black, red, pink, white or a bluish tint.

Diameter - Moles are normally no bigger than the blunt end of a pencil (about 6mm across). Melanomas are usually more than 7mm in diameter

Melanoma can be cured if it is diagnosed and treated when the tumor is thin and has not deeply invaded the skin. However, if a melanoma is not removed at its early stages, cancer cells may grow downward from the skin surface and invade healthy tissue. When a melanoma becomes thick and deep, the disease often spreads to other parts of the body and is difficult to control.

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Diagnosis of Melanoma - Skin Cancer

People at risk for any reason should check their skin regularly. The skin self examination can check for new growths or other changes.

Skin Self-Examination :

The best time to do a skin self-exam is after a shower or bath. You should check your skin in a well-lighted room using a full-length mirror and a hand-held mirror. You should be familiar with your birthmarks, moles and blemishes and what they usually look and feel like. Check the skin for any new mole that looks abnormal, a change in the size, shape, color or texture of a mole. Check yourself from head to toe. Don’t forget to check all areas of the skin, including the back, the scalp, between the buttocks, and the genital area.

By checking your skin regularly, you will become familiar with what is normal for you. It may be helpful to record the dates of your skin exams and to write notes about the way your skin looks. If you find anything unusual, see your doctor right away.

If the doctor suspects that a spot on the skin is melanoma, the patient will need to have a biopsy. It is the only way to make a definite diagnosis.

Biopsy :

It is the method of removal of cells or tissues for examination by a pathologist. When only a sample of tissue is removed, the procedure is called an incisional biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy, core biopsy or fine-needle aspiration.

Biopsy is done using local anesthesia. The pathologist then examines the tissue under a microscope to see if any melanoma cells are present.

The doctor also does a careful physical exam and, if the tumor is thick, may order chest x-rays, blood tests, and scans of the liver, bones, and brain.

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Stages of Melanoma - Skin Cancer

If melanoma is identified, staging is performed to learn the extent of the disease. Staging is helpful to known how deeply the melanoma has invaded the skin and whether it have spread to nearby lymph nodes or other parts of the body.


The different stages of Melanoma are :

Stage 0 - The melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.

Stage I - Melanoma cells are thin and have not spread to nearby lymph nodes. The outer layer (epidermis) of skin may appear scraped. This is called an ulceration

Stage II - The tumor is at least 1 millimeter thick. The melanoma cells have not spread to nearby lymph nodes.

Stage III - The melanoma cells have spread to nearby tissues Stage IV - The melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.

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Treatment of Melanoma - Skin Cancer

Treatment for melanoma depends on the extent of the disease, the patient’s age and general health, and other factors. People with melanoma are often treated by a team of specialists includes a dermatologist, surgeon, medical oncologist, radiation oncologist and plastic surgeon.

The treatment options are surgery, chemotherapy, biological therapy and radiation therapy. Sometimes a combination of these therapies are used.

Surgery :
Surgery is the usual treatment for melanoma. In this procedure, the surgeon removes the tumor and some normal tissue around it. In some cases surgery may not be necessary, because the doctor may be able to completely remove a very thin melanoma during the biopsy. In most cases, additional surgery is performed to remove normal-looking tissue around the tumor (called the margin) to make sure all melanoma cells are removed. If a large area of tissue is removed, the surgeon may do a skin graft. For this procedure, the doctor uses skin from another part of the body to replace the skin that was removed.

If cancer cells are spread through the lymphatic system, the lymph nodes has to be removed. Sentinel lymph node biopsy and Lymph node dissection are the two methods used for this.

Sentinel lymph node biopsy - This is the removal and examination of the sentinel node and is done after the biopsy of the melanoma but before the wider excision of the tumor. To identify the sentinel lymph node, a radioactive substance is injected near the tumor. The surgeon follows the movement of the substance on a computer screen. The first lymph node to take up the substance is called the sentinel lymph node. The surgeon then removes the sentinel node to check for the presence of cancer cells. (The imaging study is called lymphoscintigraphy. The procedure to identify the sentinel node is called sentinel lymph node mapping.) If a sentinel node contains cancer cells, the surgeon removes the rest of the lymph nodes in the area. However, if a sentinel node does not contain cancer cells, no additional lymph nodes are removed.
Lymph node dissection - Also called lymphadenectomy, it is a surgical procedure in which the lymph nodes are removed and examined for cancer cell. For a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; for a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.

Side Effects : The side effects of surgery depend mainly on the size and location of the tumor and the extent of the operation. The side effects are weakness, pain and scarring Sometimes surgery is not effective in controlling melanoma that has spread to other parts of the body. In such cases adjuvant therapy is given. It is the treatment given after the primary treatment to increase the chances of a cure and this may include chemotherapy, radiation therapy, hormone therapy or biological therapy or a combination of these methods.

Chemotherapy :

Chemotherapy which is the method of using drugs to kill cancer cells is sometimes used to treat melanoma. They are usually given through injection, but some may be given by mouth. These drugs enter the bloodstream and can affect cancer cells throughout the body.

Isolated limb perfusion or Isolated arterial perfusion - For melanoma on an arm or leg, chemotherapy drugs are put directly into the bloodstream of that limb. The flow of blood to and from the limb is stopped for a while. This allows most of the drug to reach the tumor directly. Most of the chemotherapy remains in that limb.
Hyperthermic perfusion - Chemotherapy in which drugs are heated before injection is called hyperthermic perfusion. In this procedure, a warmed solution containing anticancer drugs is used to bathe or is passed through the blood vessels of the tissue or organ containing the tumor.

Side Effects : Drugs used in chemotherapy can damage some normal cells, causing side effects. These side effects depend on the specific drugs and the dose. Chemotherapy can affect the blood cells, causing bruise or bleed and the patients are likely to get infections. Other possible side effects are hair loss, tiredness, poor appetite, nausea, vomiting, diarrhea, or mouth and lip sores. Most side effects can be controlled with drugs.

Biological Therapy :

Biological therapy or immunotherapy uses the body's natural ability to fight cancer and helps to prevent the cancer from coming back. Biological therapy for melanoma uses substances called cytokines. The body normally produces cytokines in small amounts in response to infections and other diseases. It can also be produced in the laboratory by recombinant DNA technology. In some cases, biological therapy given after surgery can help prevent melanoma from recurring. For patients with metastatic melanoma or a high risk of recurrence, interferon alpha and interleukin-2 (also called IL-2 or aldesleukin) may be recommended after surgery.

Side Effects : The side effects of biological therapy differ with the types of substances used and from patient to patient. Rashes or swelling where the biological therapy is injected are common. Flu-like symptoms also may occur. Other side effects are fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea.

Radiation Therapy :

Radiation therapy alias radiotherapy is the treatment using a beam of high-energy rays or particles to destroy cancer cells. It may be used to help control melanoma that has spread to the brain, bones, and other parts of the body. It may shrink the tumor and relieve symptoms. The radiation may come from outside the body (external radiation) or from radioactive materials placed into or next to the tumor (internal radiation).

Side Effects : Radiation can cause the scalp or the skin in the treated area to become red, dry, tender, and itchy. The side effects of radiation therapy depend on the amount of radiation given and the area being treated. It can cause tiredness, hair loss, nausea, fatigue, vomiting, and loss of appetite. Most side effects will be disappear after treatment but some may be last.

After Treatment :

Melanoma patients have a high risk of developing new melanomas. Some are at risk of a recurrence of the original melanoma in nearby skin or in other parts of the body. Regular follow-up exams are very important after treatment. Patients should continue to have regular checkups and examine their skin monthly. They should follow their doctor’s advice about how to reduce their chance of developing another melanoma. Checkups usually include careful physical exam, blood tests, x-rays and scans of the chest, liver, bones and brain.

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Types of Leukemia

Leukemia also known as blood cancer is a malignant disease (cancer) of blood-forming cells in the bone marrow. These deranged, immature cells accumulate within the blood and organs of the body and are unable to carry out the normal functions of blood cells.

The blood is made up of a fluid called plasma and three types of cells, namely white blood cells (WBCs or leukocytes), red blood cells (RBCs or erythrocytes), and platelets (thrombocytes). WBCs helps the body to fight infections and other diseases. RBCs which gives blood its color, carry oxygen from the lungs to the body's tissues and take carbon dioxide from the tissues back to the lungs. Platelets helps to form blood clots that control bleeding. These blood cells are formed in the bone marrow, the soft, spongy center of bones.

Normally, blood cells are produced in an orderly, controlled way as the body needs them. When leukemia develops, the bone marrow produces large numbers of abnormal white blood cells that do not function properly. It also causes low levels of platelets and hemoglobin, which is found inside red blood cells.

Leukemia Types

Leukemias are grouped by how quickly the disease develops as well as by the type of white blood cell that is affected. The two main types of leukaemia are acute and chronic. Acute leukemia is a rapidly progressing disease that affects immature blood cells (blasts) which are not yet fully developed. These blasts cannot carry out their normal functions, increases quickly and the disease gets worse quickly. Acute leukaemia tends to affect younger people. In chronic leukemia, some blast cells are present, but they are more mature and can carry out some of their normal functions. The number of blasts increases less rapidly than in acute leukemia and therefore the disease gets worse slowly.


Leukemia can arise in either of the two main types of white blood cells: lymphoid cells or myeloid cells. Leukemia that affects lymphoid cells is called lymphocytic leukemia and myeloid cells is called myeloid or myelogenous leukemia.

The most common types of leukemia are :

Acute Lymphocytic Leukemia (ALL) - The most common type in young children under 19 years. Also affects adults of 65years and older.

Acute Myelogenous Leukemia (AML) - Found in both adults and children. AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, and acute nonlymphocytic leukemia. There are different subtypes of AML based on how mature (developed) the cancer cells are at the time of diagnosis and how different they are from normal cells.

Chronic Lymphocytic Leukemia (CLL) - Occurs in adults over 55 years. It almost never affects children.

Chronic Myelogenous Leukemia (CML) - Affect mainly in adults.

Human T-cell leukemia and Hairy cell leukemia are less common type of chronic lymphocytic leukemia. Hairy cell leukemia is called so because when viewed under a microscope, these cells appear to be covered with tiny hair-like projections.

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Causes of Leukemia

Leukemia is more often occurs in males than in females and in white population more than black. The actual causes of leukemia is unknown but research has found certain risk factors that increase a person's chance of developing leukemia.

The rick factors are :

Exposure to high doses of radiation such as by atomic bomb explosions (such as those in Japan during World War II) and nuclear power plant accidents (such as the Chernobyl accident in 1986). Also in medical treatment using radiation therapy.

Exposure to electromagnetic fields.

Genetic disorders like Fanconi anemia, Schwachman-Diamond syndrome and Down syndrome.

Workers exposed to certain chemicals like benzene, formaldehyde over a long period of time can cause leukemia

People with myelodysplasic syndrome (a blood disorder) are at increased risk of developing acute myeloid leukemia.

Some cancer-fighting drugs used in the treatment of other types of cancer sometimes later develop leukemia
Human T-cell leukemia virus-I (HTLV-I) can causes human T-cell leukemia

Smoking is also a risk factor.

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Symptoms of Leukemia

Leukemia cells, traveling throughout the body may gradually collect in various parts and can affect skin, central nervous system, digestive tract, kidneys, lungs, testicles or other parts of the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms.

The common symptoms of leukemia include:

Mild fever, chills,other flu-like symptoms

Feeling weak or tired

Pale complexion from anemia

Frequent infections

Loss of appetite and weight

Swollen or tender lymph nodes, liver, or spleen

Prolonged bleeding from minor cuts

Pin-head sized red spots (called petechiae) under the skin

Swollen or bleeding gums

Sweating, especially at night

Slow healing of cuts

Pain in the bones or joints

The leukemia cells collected on the lining of the brain and spinal cause headache, vomiting, confusion, loss of muscle control, and seizures.

In acute leukemia, symptoms appear and worsen quickly. In chronic leukemia, at the early stages, the leukemia cells function almost normally and symptoms may not appear for a long time. When symptoms do appear, they generally are mild at first and get worse gradually.

Doctors often find chronic leukemia during a routine checkup, before there are any symptoms.

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Diagnosis of Leukemia

To find the cause of symptoms, the physician reviews the patient's personal and family medical history and perform a physical examination. In addition to checking general signs of health, the doctor checks for enlargement in the liver, spleen, lymph nodes under the arms, groin, and neck.

The doctor also may order laboratory tests, especially blood test that helps in the diagnosis of leukemia. Blood, drawn from a vein is examined under a microscope to determine the level of blood cell counts (i.e the number of mature cells and blasts). The test also include the examining of blood for signs that leukemia has affected the liver and kidneys.

Blood test disclose leukemia but to confirm, biopsy (removal of tissue to look for cancer cells) is performed in which a sample of bone marrow is examined by a hematologist, oncologist or pathologist. Samples of both liquid (aspirate) and solid bone marrow (biopsy) are taken, usually from a hip bone. In bone marrow aspiration, the doctor withdraws the sample by inserting a needle into a large bone (usually the hip) and removing a small amount of liquid bone marrow. In bone marrow biopsy, the doctor uses a very thick needle to remove a small piece of bone and bone marrow.

If leukemia cells are found in the bone marrow sample, further tests are performed to find the extent of the disease. These include :

Cytogenetic Examination :

Cytogenetic examination of tissue is the method of analyzing the number and shape of the chromosomes or gene abnormalities in the cells. This is very helpful in diagnosing specific types of leukemia and in determining the treatment.

Immunophenotyping :

This laboratory test is used identify specific type of cell, in a sample of blood cells, marrow cells, or lymph node cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose the subtype of AML by comparing the cancer cells to normal cells of the immune system.

If leukemia has been diagnosed the following tests may be done to determine if the cancer has spread to other parts of the body.

Spinal tap or Lumbar puncture (LP) :

Spinal tap checks for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord (cerebrospinal fluid). The collection of leukemia cells in the central nervous system can affect mental processes. The physician uses a long, thin needle to remove fluid from the spinal column. The needle is inserted in between the bones in the spine following a small injection into the skin over the injection site in order to minimize discomfort.

Chest x-rays :

A chest x-ray film of the organs and bones inside the chest is frequently taken to look for signs of infection or lymph node involvement by leukemia.

Ultrasound Scan :

A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the abdomen and make echoes. The echoes form a picture of body tissues called a sonogram.

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Stages of Leukemia

Because leukemia starts in the bone marrow and often has spread to other organs by the time it is detected, there is no need for traditional staging. All leukemias are classified according to their genotypes, or their unique chromosomal arrangements, which also enables the physicians to determine risk factors.

Acute leukemia is classified in the French- American- British (FAB) system based upon the microscopic appearance of leukemia cells. According to FAB classification, acute leukemia is divided into eight subtypes of acute myelogenous leukemia (AML) and three subtypes of acute lymphocytic leukemia (ALL).

Chronic lymphocytic leukemia (CLL) is classified by 2 different staging systems, known as RAI Classification and Binet Staging, both based on the parts of the body affected by the leukemia.

The main features of Rai Classification stage of the chronic lymphocytic leukemia are :
Stage 0 - This stage have high lymphocytes (a type of WBC) count in the blood, but there are no other symptoms of leukemia. It is a slow-growing stage and patients are at low risk.
Stage 1 - Lymph nodes are larger than normal because of high lymphocytes count. Patients are at intermediate risk
Stage 2 - Lymph nodes, liver and spleen are larger than normal as a result of an overabundance of lymphocytes. Patients are at intermediate risk
Stage 3 - Anemia has developed because there are too few red blood cells in the blood. Lymph nodes, spleen and liver may be swollen because of high lymphocytes count. Patients are at high risk
Stage 4 - There are too few platelets in the blood. Lymph nodes, spleen and liver may be swollen. Anemia may be present.

Binet staging system classifies CLL according to which lymphoid tissues, such as the spleen or lymph nodes, are involved as well as the presence of low red blood cell count (anemia) or low number of blood platelets (thrombocytopenia). The major advantage of the Binet system is its ability to highlight the splenic form of CLL.

The stage of binet system are :

Stage A - There are three or fewer areas of enlarged lymph tissue. Lymph nodes in one particular area, such as the neck or underarm, are considered one group, whether they occur on just one side of the body (unilateral) or on both sides (bilateral).
Stage B - There are more than three areas of enlarged lymph tissue.
Stage C - Enlarged lymph tissue is present along with anemia and thrombocytopenia.

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Treatment of Leukemia

Hematologists, medical oncologists, and radiation oncologists are the specialists who treat leukemia. Pediatric oncologists and hematologists treat childhood leukemia. The treatment depends not only on the type but also on leukemia cells, the extent of the disease, patient's age, symptoms and general health and whether the leukemia has been treated before.

Acute leukemia needs to be treated right away and can be cured. Chronic leukemia are seldom to be cured.

Chemotherapy

Most patients with leukemia are treated with chemotherapy. It is the treatment using anti-cancer drugs to destroy cancer cells. Depending on the type of leukemia, patients may receive a single drug or a combination of two or more drugs. Most of the drugs are given by IV injection (injected into a vein) through a thin, flexible tube called catheter. One end of the tube is placed in a large vein, often in the upper chest and the drugs are injected through this. These drugs entering into the bloodstream, affect leukemia cells in most parts of the body but do not reach cells in the central nervous system because they are stopped by the blood-brain barrier. To reach leukemia cells in the central nervous system, intrathecal chemotherapy is given. This is the method of injecting drugs directly into the cerebrospinal fluid through a special type of catheter called Ommaya reservoir. The catheter is placed under the scalp and the doctor injects the anticancer drugs into it. This method avoids the discomfort of injections into the spine. Chemotherapy is given in cycles : a treatment period followed by a recovery period and then another treatment period, and so on. Depending on which drugs are given, and the patient's general health, a hospital stay may be necessary.

Some people with chronic myeloid leukemia receive a new type of treatment called targeted therapy. This treatment use drugs or other substances to identify and attack specific cancer cells without harming normal cells. It also blocks the production of leukemia cells. A monoclonal antibody is a type of targeted therapy

Side Effects : Side effects of chemotherapy depends mainly on the drugs and doses received, as well as how the drugs are given and it vary from patient to patient. When chemotherapy affects healthy cells, it can lower patients' resistance to infection, and patients may have less energy and bruise or bleed easily. Common side effects of chemotherapy include nausea, vomiting, hair loss, diarrhea, poor appetite and mouth sores. Most side effects disappear gradually during the recover periods between treatments or after treatment stops. Some drugs can affect the patient's fertility. Because targeted therapy affects only leukemia cells, it causes fewer side effects than most other anticancer drugs.

Radiation therapy

Radiation therapy alias radiotherapy uses high-energy rays to damage cancer cells and stop them from growing. The radiation comes from a large machine. Radiation therapy for leukemia can be given in two ways. For some patients, the doctor may direct the radiation to one specific area of the body where there is a collection of leukemia cells, such as the spleen, brain or testicles. Some may receive radiation that is directed to the whole body. This type of radiation therapy, called total-body irradiation, usually is given before a bone marrow transplant.

Side Effects : Radiation can cause the scalp or the skin in the treated area to become red, dry, tender, and itchy. It can cause tiredness, hair loss, nausea, vomiting, and loss of appetite. Other side effects depend on the area of the body that is treated. Most side effects will be disappear after treatment but some may be last. Children (especially young ones) who receive radiation to the brain may develop problems with learning and coordination.

Stem Cell Transplantation

It is the method of replacing immature blood-forming cells that were destroyed by cancer treatment. A stem cell transplant allows a patient to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube that is placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.

Bone marrow transplantation, peripheral stem cell transplantation and umbilical cord blood transplantation are the three types of transplantation. Bone marrow transplantation is the procedure of replacing bone marrow and peripheral stem cell transplantation is the method of replacing blood-forming cells. In umbilical cord blood transplantation, umbilical cord blood from a newborn baby which contain high concentrations of stem cells needed to produce new blood cells, is injected to restore an individual's own blood production system suppressed by anticancer drugs, radiation therapy or both.

Transplantation may be autologous, allogeneic or syngeneic.

Autologous stem cell transplantation - Patients own stem cells are used in this transplantation. The stem cells are removed and treated outside the body to kill any leukemia cells. It is then frozen and stored. These stored cells are returned to the patient, after receiving high dose chemotherapy or radiotherapy.
Allogeneic stem cell transplantation - In this transplantation the healthy stem cells come from a donor. Blood test is done to make sure that the donor's cells match the patient's cells.
Syngeneic stem cell transplantation - This type of transplant uses stem cells from the patient's healthy identical twin.

Patients who have a stem cell transplant usually stay in the hospital for several weeks. Until the transplanted stem cells begins to produce enough white blood cells, patients have to be carefully protected from infection.

Side Effects: SPatients who have a stem cell transplantation face an increased risk of infection, bleeding, and other side effects of the large doses of chemotherapy and radiation they receive. In addition, graft- versus-host disease (GVHD) may occur in patients who receive bone marrow from a donor. In GVHD, the donated marrow reacts against the patient's tissues (most often the liver, the skin, and the digestive tract). GVHD can be mild or very severe. It can occur any time after the transplant (even years later). Drugs may be given to reduce the risk of GVHD and to treat the problem if it occurs.

Biological Therapy

Biological therapy involves treatment with substances that affect the immune system's response to cancer. This type of treatment improves the body's natural defenses against cancer. The therapy is given by injection into a vein.

Biological therapies like interferon and monoclonal antibody are used in chronic myeloid leukemia and chronic lymphocytic leukemia respectively. These naturally occurring compounds are directly inserted through a catheter to slow the growth of leukemia cells.

Side Effects : The side effects of biological therapy differ with the types of substances used and from patient to patient. Rashes or swelling where the biological therapy is injected are common. Flu-like symptoms also may occur.

The goal of treatment is to bring about a remission. Remission means a decrease in or disappearance of signs and symptoms of cancer. In partial remission, some signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer may still be in the body.

After Treatment

Leukemia and its treatment can lead to other health problems. Because leukemia patients develop infections very easily, they may receive antibiotics and other drugs to help protect them from infections. They are often advised to stay out of crowds and away from people with colds and other infectious diseases. If an infection develops, it can be serious and should be treated promptly. Dental care also is very important.

Regular follow-up exams are very important after treatment for leukemia. Patients should continue to have regular checkups and should also report health changes or problems to their physician. Checkups usually include careful physical exam, blood tests, x-rays, bone marrow aspiration, or spinal tap.

Avoiding risk factors such as smoking, exposure to toxic chemicals, and exposure to radiation may help prevent leukemia.

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