Types of Prostate Cancer

Prostate cancer is an abnormal, uncontrolled growth of cells that results in the formation of a tumor in the prostate gland. Prostate, the walnut sized gland, is a part of the reproductive system which lies deep in the pelvis. It is located in front of the rectum and underneath the urinary bladder and surrounds the urethra, (the urine tube running from the bladder, through the prostate and the penis). It contains gland cells that produce some of the seminal fluid, which protects and nourishes sperm cells in semen and supports the ejaculatory ducts, or sperm tubes. The prostate continues to grow till a man reaches adulthood and is maintained after it reaches normal size as long as male hormones are produced.

Prostate cancer begins most often in the outer part of the prostate. It is the most common cancer in men older than age 50. In most men, the cancer grows very slowly. In fact, many men with the disease will never know they have the condition. Early prostate cancer is confined to the prostate gland itself, and the majority of patients with this type of cancer can live for years with no problems. In some cases, it may spread from the prostate to nearby lymph nodes, bones or other organs. This spread is called metastasis. Most Prostate cancers originate in the posterior prostate gland, the rest originate near the urethra.

Types of Prostate Cancer

There are many types of prostate cancer and the condition is often present in many different parts of the prostate. The precursor to prostate cancer is known as prostatic intraepithelial neoplasia, this is also found in many different locations within the prostate.

Although there are many different kinds of prostate cancer the vast majority (around 95%) are of the type known as adenocarcinoma. As this is the most wide spread from it has become synonymous with the term prostrate cancer.

Adenocarcinoma

The most common site of origin of prostate cancer is in the peripheral zone (the main glandular zone of the prostate). The term adenocarcinoma can be split up to derive its meaning. Adeno means ‘pertaining to a gland’, whilst Carcinoma relates to a cancer that develops in epithelial cells. The term epithelial simply relates to cells that surround body organs or glands. aldara and basal cell carcinoma

Small cell carcinoma

This kind of cancer is made up of small round cells, and typically forms at nerve cells. Small cell carcinoma is very aggressive in nature and as it does not lead to an increase in prostate specific antigens it can be somewhat harder to detect than adenocarcinoma; this usually means that it has reached an advanced form upon detection.

Squamous cell carcinoma

This is a non glandular cancer, like small cell carcinoma there is no increase in prostate specific antigens when this is present. Squamous cell carcinoma is very aggressive in nature.

There are other, more rare, forms of prostate cancer these include sarcomas and transitional cell carcinoma; the latter rarely develops in the prostate but derives from primary tumours present in the bladder or urethra.

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Risks and Causes of Prostate Cancer

The cause of this cancer is not established but hormonal, genetic, environmental and dietary factors are involved in some cases. The male sex hormone testosterone aids the growth of prostrate cancer cells. Risk increases with age more rapidly than any other cancer. Men who have a history of prostate cancer in their family, especially a close relative such as father, brother etc are at an increased risk. Racial predisposition is another factor, incidence of prostrate cancer is highest in Blacks and lowest in Asians.

Inhalation or ingestion of chemicals such as cadmium, a mineral found naturally in certain foods and cigarette smoke, plastics, paints, nickel cadmium batteries etc increases the risk for developing prostate and lung cancer.

People involved in battery manufacture, welding, soldering, manufacture of paint, plastic, cadmium alloy, textile etc are at high risk. A diet high in animal fat also has been implicated in the development/increased risk of prostate cancer.

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Signs and Symptoms of Prostate Cancer

Often the disease has no symptoms until the disease is well advanced. However, as the tumor grows, it may spread from the prostate to surrounding areas like lymph nodes, bones or other organs. This may result in back pain. Men with prostate cancer may experience any of the following symptoms.

A need to urinate frequently, especially at night;

Difficulty starting urination or holding back urine;

Weak or interrupted flow of urine;

Painful or burning urination or bowel movement;

Difficulty in having an erection;

Painful ejaculation;

Blood in urine or semen; or

Frequent pain or stiffness in the lower back, hips, or upper thighs.

It is advised to consult a doctor immediately if you have experienced any of the above symptoms. Men aged 50 and above have the chances of developing prostate cancer. Those who have a family history of prostate cancer should consider screening at age 45.

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Diagnosis of Prostate Cancer

Doctors may feel the prostate gland via the rectum (Digital rectal examination) in order to detect any abnormality. A small, hard nodule may reveal the presence of cancer.

Further tests by measuring Prostate-specific antigen (PSA) levels in your bloodstream followed by an Ultra sound scan, can help to detect the disease. Preferably men older than age 40 should have an yearly Digital Rectal Examination and men older than 50 should check their PSA levels yearly.

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Stages of Prostate Cancer

If you are diagnosed with prostate 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.

Prostate cancer can be staged as 'A,B,C,D'. Stage A and B cancers are curable. Stages C and D are treatable, but their prognoses are discouraging.

Stage A - This is the very early stage without any symptoms, in this stage cancer cells are confined to the prostate. It can be identified with PSA tests and Biopsy. This type of cancer is usually curable.

Stage B - In this stage, it is known that cancer is in several places within the prostate. It is detectable by Digital rectal examinationand by elevated PSA.

Stage C - In this stage, cancer cells can be found throughout the prostate as well as near by tissue or the bladder. This stage is determined by Digital Rectal Exam, or CT/ MRI scans, and/or Sonography. Some Stage C cancers are curable.

Stage D : At this stage, cancer has spread beyond the prostate and nearby lymph nodes, distant bones, organs such as liver, lungs and also to other tissues. This is usually determined by bone scan, Prostascint scan or other studies. Stage D cancer is not curable but treatable.

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Treatments of Prostate Cancer

Treatment depends on individual circumstances such as the man's age and general health, extent of the cancer etc. Elderly patients with minor symptoms, early stage cancer, or coexisting illness may be treated conservatively.

There are many different ways to treat prostate cancer. It is advisable to get advise from two or more doctors before making a final decision about the treatment. Treatment includes Prostatectomy and Hormone Therapy or anti-antrogen drugs, Chemotherapty and Radio Therapy.

Hormone Therapy : Hormone therapy, is used either alone or in combination with surgery or radiation. It is based on the fact that prostate cancer cells frequently use the male hormone , testosterone as a fertilizer and the absence of this hormone may lead to the death or weakening of prostate cancer cells. So It is used to stop the production of testosterone hormone and hence a person with Stage C and D cancer can have their life extended and improved by the use of hormonal therapy.

There are side effects associated with Hormone therapy. They include hot flashes, weight gain, erectile dysfunction, decrease in muscle mass and strength, personality changes, decreased mentation and osteoporosis.

Prostatectomy : Patients in good health and under age 70 is usually offered surgery as a treatment option. Various types of surgical procedures are done depending on the stage of prostate cancer and patient's over all health.

Prostatectomy is the most common treatment option for localised prostate cancer. It involves surgical removal of prostate gland and some other near by tissues and reattaching the urethra and bladder. It will prevent further spread of the cancer. If the prostate cancer is in the early stages, prostatectomy can treat the cancer completely. This is done either through a surgical incision in the lower abdomen or the space between the scrotum and rectum.

This procedure also produce side effects like impotency, Urinary incontinence, narrowing of the urethra and difficulty in urination.

Radio Therapy : It is a form of treatment 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 more effective for early stage prostate cancer.

Good nutrition is an important part of recovering from the side effects of radiation therapy.

Slight skin changes will be visible after radiation. Skin may become red, swollen, warm and sensitive, as if in a sunburn but it is temporary. The long term effects include, slight darkening of the skin, enlarged pores, increased or decreased sensitivity of the skin and a thickening of tissue or skin.

Chemotherapy : It is a combination of drugs which is effective to kill or slow the growth of rapidly multiplying cells. Chemotherapy is usually prescribed to men with advanced prostate cancer. Chemotherapy drugs are carefully controlled in both dosage and frequency so that cancer cells are destroyed while minimizing the risk to healthy cells. As the drugs circulate throughout the whole body, they can effect the healthy cells also.

The side effects of chemotherapy include hair loss, nausea, vomiting, diarrhea, lowered blood counts, reduced ability of the blood to clot, and an increased risk of infection.

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Types of Mesothelioma Cancer

Mesothelioma is a rare form of cancer in which malignant cells are found in the mesothelium. When it occurs, the cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also spread to other parts of the body.

Mesothelium is a membrane that covers and protects most of the internal organs of the body. A layer of specialized cells called mesothelial cells lines the chest cavity, abdominal cavity, and the cavity around the heart. These cells also cover the outer surface of most internal organs. The tissue formed by these cells is called mesothelium. The mesothelium of chest is called pleura, of the abdomen is peritoneum and of the pericardial cavity, i.e the sac-like space around the heart, is called pericardium.

Most cases of mesothelioma begin in the pleura or peritoneum. The fibrous sheets, pleura helps to protect the lungs. There are 2 pleura and they can be called pleural membranes. Pleural space is the gap between them and they produce a lubricating fluid that fills the gap. This helps the lungs to move smoothly in the chest when they are inflating and deflating as we breathe. Peritoneal or Peritoneum is a smooth membrane, which lines the cavity of the abdomen (stomach). It helps to protect the contents of the abdomen. It also produces a lubricating fluid which helps the organs to move smoothly inside the abdomen as we move around.

Types of Mesothelioma Cancer

The three types of mesothelioma are

Pleural mesothelioma or cancer of the lung lining is the most common form.

Peritoneal mesothelioma or cancer of the abdomen lining

Pericardial mesothelioma

The structural appearance of cells under the microscope determine the cell or sub-type of mesothelioma. They are

Epithelioid - which is the least aggressive, most common, and considered the most amenable to treatment

Sarcomatous - the most aggressive form


Biphasic or mixed - a combination of both of the other cell types.

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Causes of Mesothelioma

Mesothelioma is caused by asbestos exposure. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles and insulation. Asbestos is a very dangerous substance and can cause a lot of damage to your health. It is made up of very small fibers. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed and can their way to pleura. Once these fibers work their way into body tissues, they may stay there indefinitely. Of the white, brown and blue asbestos used, brown and blue are commonly associated with mesothelioma.

Men are typically affected more, due to the common presence of asbestos in industrial settings. Once exposed to asbestos particles a person may have no symptoms of the disease from between 30 to 50 years. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. But smoking along with asbestos exposure significantly increases a person's risk of developing cancer. An increased risk of developing mesothelioma was found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other trades people.

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Symptoms of Mesothelioma Cancer

Symptoms of pleural mesothelioma include shortness of breath, pleural effusions (fluid in the chest cavity), persistent cough, loss of appetite and pain in the chest due to an accumulation of fluid in the pleura. Weight loss, abdominal pain, swelling due to a buildup of fluid in the abdomen, bowel obstruction, blood clotting abnormalities, nausea, anemia, and fever are some of the symptoms of peritoneal mesothelioma.

If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face. These symptoms may be caused by mesothelioma or by other conditions. If any symptoms is found, consult a doctor because only he can make a diagnosis.

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Diagnosis of Mesothelioma

Mesothelioma is typically difficult to diagnose and treat, because of its uncommon nature. Symptoms like cold, cough and chest pain are so similar to pneumonia that they are often misdiagnosed.

Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. Asbestos exposure can be diagnosed through tests of urine, feces, mucus and material rinsed out of the lungs. A CT scan or MRI may also be helpful. If any of these preliminary tests prove suspicious for mesothelioma; a biopsy is necessary to confirm the diagnosis.

If further examination is warranted, the following tests may be done:

Thoracoscopy
This test is for pleural mesothelioma. A small cut is made through the chest wall and a special instrument called thoracoscope will be inserted into the chest between the two ribs. If fluid has collected in the chest, it is removed through a needle and the process is called thoracentesis.

Peritoneoscopy
It is the test for detecting peritoneal mesothelioma. A special instrument, peritoneoscope is put into an opening made in the abdomen to look inside. The process of removing collected fluid is called paracentesis.

Drugs may be given through a tube in the chest to prevent more fluid from accumulating.

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Stages of Mesothelioma

Once malignant mesothelioma is found, staging will be done to find out if cancer cells have spread to other parts of the body. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans. Peritoneal mesothelioma is not staged while there are three staging systems for pleural mesothelioma.

1. The most often used Butchart System is based mainly on the extent of primary tumor mass and divides mesotheliomas into four stages.

Stage I - Mesothelioma is present in the right or left pleura and may also involve the lung, pericardium or diaphragm on the same side.

Stage II - Mesothelioma invades the chest wall or involves the esophagus, heart, or pleura on both sides. Lymph nodes in the chest may also be involved.

Stage III - Mesothelioma has penetrated through the diaphragm into the peritoneum. Lymph nodes beyond those in the chest may also be involved.

Stage IV - There is evidence of metastasis or spread through the bloodstream to other organs.

2. The recent TNM system is similar to staging systems used for most other cancers.

Stage I - Mesothelioma involves right or left pleura and may also have spread to the lung, pericardium, or diaphragm on the same side. Lymph nodes are not involved.

Stage II - Mesothelioma has spread from the pleura on one side to nearby lymph nodes next to the lung on the same side. It may also have spread into the lung, pericardium, or diaphragm on the same side.

Stage III - Mesothelioma has spread into the chest wall, muscle, ribs, heart, esophagus, or other organs in the chest on the same side as the primary tumor, with or without spread to subcarinal or mediastinal lymph nodes on the same side as the primary tumor. Subcarinal nodes are located at the point where the windpipe branches to the left and right lungs. Mediastinal lymph nodes are located in the space behind the chest bone in front of the heart.

Stage IV - Mesothelioma has spread into the lymph nodes in the chest on the side opposite the primary tumor, or directly extends to the pleura or lung on the opposite side, or into organs in the abdominal cavity or neck. Any distant metastases is included in this stage.

3. The latest Brigham System stages mesothelioma according to resectability (the ability to surgically remove) and lymph node involvement

Stage I - Resectable mesothelioma and no lymph node involvement

Stage II - Resectable mesothelioma but with lymph node involvement

Stage III - Unresectable mesothelioma extending into chest wall, heart, or through diaphragm, peritoneum; with or without extrathoracic lymph node involvement

Stage IV - Distant metastatic disease.

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Treatments of Mesothelioma Cancer

Treatment options for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy and chemotherapy. Sometimes combination of these treatments are used.

For treatment options click here

Mesothelioma is a life-threatening disease and cannot be left untreated. The sooner it is diagnosed the better a patient's chances are of fighting this deadly cancer.

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Types of Lung Cancer

Lung cancer or bronchogenic arcinoma, a life threatening disease, is the uncontrolled growth of abnormal cells in one or both of the lungs. While normal lung tissue cells reproduce and develop into healthy lung tissue, these abnormal cells reproduce rapidly and never grow into normal lung tissue. As a result, lump mass known as a tumor are formed, disrupting the lungs and making it difficult to function properly. Tumors can be benign (non-cancerous) or malignant (cancerous). Benign tumors may grow causing discomfort and bleeding, but they do not spread to other parts of the body and can be removed.

Malignant tumors grow aggressively, spread into other areas of the body and destroy normal tissue. The process of spreading the tumor is called metastasis (secondary tumors) and the areas of tumor growth at these distant sites are called metastases.

Usually lung cancer, develops within the wall or epithelium of the bronchial tree. But it can start anywhere in the lungs and affect any part of the respiratory system. Lung cancer mostly affect people between the ages of 55 and 65 and often takes many years to develop. Once it occurs, cancer cells can break away and may spread to the lymph nodes or other tissues in the chest, including the lung opposite to where it originated. It may also spread to other organs of the body, such as the bones, brain or liver.

Types of Lung Cancer

There are two major types of lung cancer. They are Non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) or oat cell cancer. The classification of the lung cancer is based upon the microscopic appearance (i.e. cell size) of the tumor cells. Each type of lung cancer grows and spreads in different ways, and is treated differently. If the cancer has features of both types, it is called mixed small cell/large cell cancer.

Non-small cell lung cancer is more common than SCLC and it generally grows and spreads more slowly. There are three main types of NSCLC. They are :
1. Squamous cell carcinoma or epidermoid carcinoma usually starts in the large bronchi and very often stays in the central chest area, without spreading, for longer periods of time than other lung cancers.
2. Adenocarcinoma are found along the outer or peripheral areas of the lungs and under the lining of the bronchi. Bronchioloalveolar carcinoma, a sub type of adenocarcinoma develops around scars on the outer edges of the lungs.
3. Large cell carcinoma, can be found in any part of the lung and tends to grow and spread quickly. It is also known as undifferentiated carcinomas.

SCLC are almost related with smoking and grows more quickly and form large tumors that can spread widely through the body. They often starts in the bronchi near the center of the chest.

Other tumors found in the lungs are :

Carcinoid tumor which arise from glands near the bronchi. This slow-growing tumor is usually cured by surgery.

Lymphoma or metastatic

Mesothelioma, a less common type is found in people who have been exposed to asbestos. It is a cancer of the membrane which covers the surface of the lungs and lines the inside of the chest. Exposure to asbestos particles in the air increases the risk of developing malignant mesothelioma.

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Causes of Lung Cancer

Cigarette smoking is the main cause for developing lung cancer. Air pollution and industrial exposures also may cause problem to the lungs. Persons exposed to harmful substances, such as arsenic, asbestos, radioactive dust, and radon have a greater chance of developing lung cancer if they smoke. Not all smokers develop lung cancer and not all people with lung cancer are smokers.

The most significant cause of lung cancer is exposure to carcinogenic (cancer-causing) agents. Harmful substances, called carcinogens, in tobacco damage the lung cells. Squamous cell carcinoma and small cell carcinoma are the most common types found in smokers. Lung cancer in smokers is related with the age at which smoking began, how long the person has smoked, the number of cigarettes smoked per day, and how deeply the smoker inhales. Smoking at a younger age raises the risk and the death rate from lung cancer. Stopping smoking greatly reduces a person's risk for developing lung cancer.

Cigar and pipe smoking increases the risk of lung cancer but not as much as smoking cigarettes does. The chance of developing lung cancer is increased by exposure to environmental tobacco smoke or secondhand smoke- the smoke that non-smokers are exposed to when they share air space with someone who is smoking.

Radon, the radioactive gas found in substantial concentration in soil, rocks and some building materials, is considered to be the second leading cause of lung cancer. This is a detectable and preventable problem. Smokers are sensitive to the effects of radon. High radon levels in some mines can increase the lung cancer risk for miners.

Asbestos is another risk factor for lung cancer. If inhaled, asbestos particles can lodge in the lungs, damaging cells and increasing the risk for lung cancer. People who work with asbestos have a higher risk of getting Mesothelioma, cancer of the lining of the lung. If they smoke as well, the risk is greatly increased.

Certain lung diseases, such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD), increase a person's chance of developing lung cancer. Air pollution from motor vehicles, factories, and other sources may increase the risk for lung cancer, but it has not been established accurately. A person who has had lung cancer once is more likely to develop a second lung cancer compared with a person who has never had lung cancer. Contact with certain chemicals and substances, such as uranium, chromium and nickel, can cause lung cancer, but these are very rare causes. Certain reports indicate that diet low in fruits and vegetables may increase the chances of getting cancer, if you are exposed to tobacco smoke.

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Symptoms of Lung Cancer

Symptoms

Lung cancer in its early stage and sometimes even later may not cause any signs and symptoms. In its advanced stage, the cancer cells interfere with normal lung function. The symptoms associated with lung cancer can result from the original tumor or from tumors that have spread to other organs. The cancers are usually identified incidentally when a chest x-ray is performed for another reason.

Common signs and symptoms of lung cancer are :

A cough that does not go away and gets worse over time

Coughing up blood (hemoptysis) or bloody mucus.

Chest, shoulder, or back pain that doesn't go away and often is made worse by deep

hoarseness

Weight loss and loss of appetite

Increase in volume of sputum

Wheezing

Shortness of breath

Repeated respiratory infections, such as bronchitis or pneumonia

repeated problems with pneumonia or bronchitis

fatigue and weakness

new onset of wheezing

swelling of the neck and face

Clubbing of the fingers and toes. The nails appear to bulge out more than normal.

Some patients may have paraneoplastic syndromes which are caused by biologically active substances that are secreted by the tumor.

If any symptoms is found, it is better to consult a doctor because only doctor can make a diagnosis.

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Diagnosis of Lung Cancer

To find out if lung cancer may be present, the doctor evaluates a person's medical history, smoking history, their exposure to environmental and occupational substances, and family history of cancer. The doctor will also give the patient a physical examination. This is for detecting any signs of cancer such as swollen lymph nodes in the neck or collarbone area. If lung cancer is suspected, a patient must undergo a series of diagnostic tests.

In some people lung cancer doesn't show any symptoms. In such people a method called screening is used to detect the cancer. The two main test used for this are chest x-rays and sputum cytology

Chest x-ray : This is the first test to verify any spot on the lungs. X-rays are plain pictures of the lung, which will help to identify any abnormal growths. If lung cancer is suspected, a simple test called sputum cytology is performed. It is the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs. The presence abnormal or cancerous (malignant) cells can be discovered by this test.

Not all abnormalities are cancers. Some people develop scarring and calcium deposition in their lungs that may look like tumors on a chest x-ray film. In such cases, to confirm the diagnosis various scanning are prescribed by the specialist.

CT (Computed tomography) or CAT scan : It is a special kind of x-ray which reveal much more than chest x-ray. A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. It gives a detailed information about the size, shape, and place of a tumor. CT scan helps to determine whether the cancer is in the chest wall and rib area. It also helps to find the enlarged lymph nodes that might contain cancer and the tumors in other organs that might be affected by the spreading of lung cancer.

MRI (Magnetic Resonance Imaging) scan :MRI use radio waves and strong magnets to create an image. This scanning is useful in finding lung cancer, that has spread the brain or spinal cord.

PET (Positron Emission Tomography) scan : PET uses a low-dose radioactive sugar to trace the activity of body cells on sugar. A very small amount of radioactive substance is injected into a vein (usually on hand) and a scan is then taken. Areas of cancer are usually more active than surrounding tissue so they take up more of the radioactive substance and show up on the scan. PET helps to determine whether lung cancer has spread to lymph nodes. It is also helpful in telling whether a spot on your chest x-ray is cancer.

Bone Scans : A bone scan can determine whether the cancer has spread to the bones. It is usually done in patients with small cell lung cancer. A small amount of radioactive substance is injected into a vein and this substance builds up in areas of bone that may be abnormal because of cancer. In patients with non-small cell lung cancer, bone scan is done when other tests or symptoms suggest that the cancer has spread to the bones.

To confirm the presence of lung cancer, the doctor must examine tissue from the lung. This is called biopsy which is the removal of a lung tissue sample for examination under a microscope. Biopsies are obtained in different ways depending on the location of the tumor: They are :

Bronchoscopy : Bronchoscope is a thin, lighted, flexible tube with a tiny camera on the end. This is passed through the mouth or nose and down through the windpipe. From there, the tube can be inserted into the airways (bronchi) of the lungs. Small samples of tissue are collected through this tube. Bronchoscopy, which is used to determine the extent of the tumor, has some risks and requires a specialist proficient in performing the procedure.

Needle biopsy : If a tumor is on the periphery of the lung, it usually cannot be seen with bronchoscopy. After the chest surface is cleaned and prepared, the skin and the chest wall are numbed. A long, thin needle is inserted through the chest wall in the lung to remove a lung tissue sample. A chest x-ray or CT scanning is used to guide the needle.

Thoracentesis : Lung cancers, both primary and metastatic, can cause fluid to collect in the sac surrounding the lung. This is called pleural effusion. Thoracentesis, which is important for both staging and diagnosis, is similar to needle biopsy. The skin is numbed and a needle is placed between the ribs to remove a fluid sample.

Thoracoscopy : It uses a thin, lighted tube connected to a video camera and monitor to view the space between the lungs and the chest wall. It is used to check whether the fluid around the lungs is caused by cancer.

Thoracotomy : Sometimes a lung cancer tumor cannot be reached by bronchoscopy or needle procedures. In such cases the only way to obtain a biopsy is by performing a surgery. The chest is opened and as much of the tumor as possible is removed surgically. A biopsy is taken from the removed tumor. This procedure is a major operation performed in a hospital.

Mediastinoscopy : It is performed to determine the extent that the cancer has spread into the area of the chest between the lungs. A small cut is made into the lower part of the neck, above the breastbone. A mediastinoscope is inserted and sample tissues are taken from the enlarged lymph nodes along the windpipe. Mediastinoscopy is a very important step to determine whether the tumor can be surgically removed or not.

Bone marrow biopsy : After the area is numbed, a needle is used to remove a small piece of bone, usually from the back of the hip bone. This is done mostly to help find if small cell lung cancer has spread to the bones.

Blood tests : Blood tests are performed to identify any chemical imbalances, blood disorders, or other problems that might complicate treatment. A complete blood count (CBC) shows whether your blood has the correct number of different cell types. This test will be done often if you are treated with chemotherapy because these drugs can affect the blood-forming cells of the bone marrow.

Once a tumor is found, it must be determined if and how widely the cancer has spread. It is known as staging.

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Stages of Lung Cancer

Stages of Lung Cancer

Staging is very important and should be performed before treatment started. It is based on size of the tumor, location of the tumor, and degree of metastasis of the tumor. Staging is beneficial to plan a treatment program, to determine eligibility for surgery, to assess response by stage for results reporting and to estimate prognosis. The higher the tumor stage, the less likely the disease will be cured. Staging of tumor is according to the TNM classifications. T refers to the size and extent of the primary tumor, N refers to involvement of regional nodes and M refers to the presence or absence of metastatic disease.

There are different staging systems for small cell lung cancer and non-small cell lung cancer. Limited and extensive are the two stage system in SCLC. In limited stage, cancer is found only in one lung and in lymph nodes on the same side of the chest or in fluid around the lung. If the cancer has spread beyond one lung, to lymph nodes on the other side of the chest or to other organs, it is called extensive.

There are 4 stages for NSCLC. They are :

Stage 1 - It is very localised and tumor of any size is found only in the lung.

Stage 2 - Tumor has spread to lymph nodes associated with the affected lung

Stage 3 - Tumor has spread into the tissue around the lung near to where the cancer started. This can be into the chest wall, the covering of the lung (pleura), the middle of the chest (mediastinum) or other lymph nodes.

Stage 4 - Tumor has spread to another part of the body

There are many options for the treatment of lung cancer at each stage.

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Treatments of Lung Cancer

Sometimes a lung tumor contains more than one type of cancerous cell. So the treatment should be based on the type of lung cancer, the size, location and extent of the tumor and the general health of the patient. There are many treatments, which may be used alone or in combination. The most widely used therapies for lung cancer are surgery, chemotherapy, and radiation therapy. Chemotherapy and radiation are very effective at relieving symptoms.

Surgery
An operation for lung cancer is major surgery. Depending on the type and stage of the cancer, surgery may be used to remove the tumor and some of the lung tissue around it. Removing only a small part of a lobe (section) of the lung is called a wedge resection. If a entire lobe of the lung is removed, the surgery is called a lobectomy. If the entire lung is removed, the surgery is called a pneumonectomy.

Surgery is of two types aggressive surgery and palliative procedures.

Aggressive surgery (long-term control) : Aggressive surgery involves removal of the pleura, the lung, the diaphragm and the pericardium through a procedure known as extra pleural pneumonectomy. This surgery is highly complicated and carries a high risk of fatality within a month. Extra pleural pneumonectomy is therefore performed only on younger patients who are in good health and can tolerate the surgery.

Palliative Procedures (relief of symptoms) : Palliative procedures are performed when the cancer is in its advanced form. These procedures are performed to allay or control the symptoms rather than cure them. Pleurectomy (also decortications) is the surgical removal of the pleura. This reduces the pain caused by the tumor mass and may also prevent the recurrence of pleural effusion (fluid collection that causes breathlessness).

Video-assisted chest surgery is a new kind of surgery done for people with early stage lung cancer. A tiny camera can be placed through a small hole in the chest to help the surgeon see the tumor. Only small incisions are needed and it is most often used for tumors smaller than about 2 inches.

Side Effects : The side effects of surgery are pain, weakness, fatigue, and shortness of breath. Most have problems moving around, coughing, and breathing deeply. Other possible problems include bleeding, wound infections, and pneumonia. The recovery period can be several weeks or even months.

Chemotherapy
Chemotherapy is the treatment using anti-cancer drugs to destroy cancer cells throughout the body. The drugs can be swallowed in pill form or can be injected directly into a vein or by means of a catheter, a thin tube that is placed into a large vein and remains there as long as it is needed. These drugs enter the bloodstream and reach throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the lung. The amount of chemotherapy a patient receives depends on the type of cancer, the drugs, and the patient’s overall response to treatment. Therapy may be given daily, weekly, or monthly, and can continue for months or even years.

Side Effects : Drugs used in chemotherapy can damage some normal cells, causing side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment. The possible side effects are nausea and vomiting, hair loss, fatigue or shortness of breath caused by low red blood cell counts, loss of appetite, diarrhea or constipation, mouth sores, bruising or bleeding caused by a shortage of blood platelets, higher risk of infection caused by a shortage of white blood cells. Most side effects disappear when your course of treatment ends. Some drugs will damage the nerves and this may cause numbness in the fingers and toes, and sometimes the arms and legs may feel weak.

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 before surgery to shrink a tumor, or after surgery to destroy any cancer cells that remain in the treated area. The radiation may come from outside the body (external radiation) or from radioactive materials placed into or next to the tumor (internal radiation). External type of radiation is most often used to treat a primary lung cancer or its metastases to other organs.

Radiation is mainly for patients who are not healthy enough to have surgery. For others, it might be used after surgery to kill small areas of cancer that can't be seen and removed during surgery. It can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or problems caused by the cancer spreading to the brain.

Brachytherapy uses a small pellet of radioactive material placed directly into the cancer or into the airway next to the cancer. This is usually done through a bronchoscope.

A special kind of radiation (called the gamma knife) can be used instead of surgery if the cancer spreads to the brain in only one spot. In this method, several beams of radiation are focused on the tumor over the span of a few minutes to hours. The head is held in place with a stiff frame.

Side Effects : The side effects of radiation include vomiting, diarrhea, fatigue, nausea, mild skin problems and tiredness. Chest radiation may cause lung damage and trouble breathing or swallowing. Side effects of radiation therapy to the brain usually become most serious after 1 or 2 years. They could include memory loss, headaches, trouble with thinking, and less sexual desire.

Targeted Therapy
Targeted therapies use medications or antibodies used to block growth factors that allow some tumors to grow. These drugs taken in the form of pills attack special parts of cancer cells and leave most normal cells alone. Not all lung cancers respond to these drugs.

Side Effects : These drugs seems to cause few side effects than chemotherapy and it include diarrhea, rash, eye problems, nausea, vomiting, loss of appetite, and feeling tired.

Photodynamic therapy (PDT)
This laser therapy using a special chemical which is injected into the bloodstream, leaves normal cells but remains in cancer cells for a longer time. A laser light aimed at the cancer activates the chemical, which then kills the cancer cells that have absorbed it. PDT is used to treat very small tumors in patients for whom the usual treatments for lung cancer are not appropriate. It is also used to control bleeding or to relieve breathing problems due to blocked airways when the cancer cannot be removed through surgery.

After Treatment

Follow-up care after treatment for lung cancer is very important. Regular checkups should be performed so that any recurrence can be identified as early as possible. Checkups may include physical exams, chest x-rays, or lab tests. A person who has undergone surgery should be checked every 3-4 months for the first 2 years and every 6-12 months thereafter.

Lung cancer remains a highly preventable disease because 85% of lung cancers occur in smokers or former smokers. The best way to prevent lung cancer is to quit smoking. Lung cancer takes many years to develop. But changes in the lung can begin almost as soon as a person is exposed to cancer-causing substances.

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Colorectal Cancer

Colorectal cancer is the cancer in the large intestine and rectum. It occurs when some of the cells that line the colon or the rectum become abnormal and grow out of control. The abnormal growing cells create a tumor, which is the cancer. Cancer that begins in the colon is called colon cancer and in the rectum is called rectal cancer. It is common in both men and women .The risk of developing colorectal cancer rises after age 50.

The colon, the longest part of the large intestine or large bowel, is a long muscular tube shaped organ connecting the small intestine to the rectum. It extends from the end of the small bowel to the anus, twisting and turning through the abdomen (belly). It is divided into four sections namely, the ascending colon, transverse colon, descending colon, and sigmoid colon. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. The rectum is lower part of the colon that connects the large bowel to the anus. The rectum’s primary function is to store formed stool in preparation for evacuation.

Colon along with the rectum is called the large intestine. Cancers affecting either of these organs also may be called colorectal cancer. Most colorectal cancers arise in the sigmoid colon which is 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. 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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Causes of Colorectal Cancer

The exact reason of colorectal cancer is unknown. But there are certain factors that make cancer more likely. They are age, colorectal polyps, family history, genetic alterations, personal history, drug effects, cigarette smoking etc. Not all polyps become cancerous, but nearly all colon cancers start as polyps.

Eating a diet which is low in fiber is also a risk factor for developing colorectal cancer. Research shows that women with a history of cancer of the ovary, uterus, or breast have an increased chance of developing colorectal cancer. People who have a sedentary lifestyle are more likely to develop cancer than people who take regular physical exercise.

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Symptoms of Colorectal Cancer

Colorectal cancer may occur without any symptoms therefore it is very important to have regular examinations called colorectal screenings, to detect early problems. One of the earliest signs of colon cancer is bleeding, which may be painless. Sometimes the blood is found only during chemical testing of the stool.


When tumors have grown larger, other symptoms may develop. These symptoms may include

Blood on or in the stool

Constipation

Bowel obstruction, causing nausea, vomiting and abdominal distention

Diarrhea

Anemia

Stools that are narrower than usual

Loss of appetite

General abdominal discomfort like stomach or gas pain

Weight loss with no known reason

Fatigue

Constant tiredness

Pelvic pain

For colorectal cancer patients, early diagnosis and treatment can be a life-saver. So if any of these symptoms are found, better consult a physician to ensure proper diagnosis and treatment.

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Diagnosis of Colorectal Cancer

The physician will perform a physical examination for any signs or symptoms of colorectal cancer. Some screening guidelines are used to detect polyps, cancer, or other abnormalities in the colon and rectum. These include:

Fecal occult blood test (FOBT):
FOBT examines the stool for blood not easily noticed by the naked eye. In this test a small amount of stool is placed on a special paper and the physician applies a chemical to it to see if blood is present in the stool sample. If it detects blood, other tests are needed to find the source of the blood.

Sigmoidoscopy:
Sigmoidoscopy is a procedure to detect polyps using sigmoidoscope which is a long, flexible instrument about 1/2 inch in diameter. The physician can view the lining of the rectum and lower (sigmoid) colon through sigmoidoscope. If polyps are found, it is removed and the procedure is called polypectomy.

Colonoscopy:
It is an endoscopic test. The rectum and the inside of the entire colon are examined in colonoscopy, using a long, flexible tube with a tiny camera on the end called colonoscope. If polyps are found, it is removed.

Air contrast barium enema or Double-contrast barium enema (DCBE):
This is a series of X-ray examination of the entire colon and rectum. Before the x-ray is taken, the patient is given an enema with a barium solution. Barium is a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up solid on x-rays. The liquid is introduced into the colon and rectum through the anus. The liquid contains barium, which shows up solid on x-rays. Air is pumped gradually into the colon by a rectal tube to improve visualization. The barium and air outline the colon and rectum on the x-rays. Polyps may show up on the x-ray.

Digital Rectal Exam (DRE):
It is a part of the routine physical examination. The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas in the lower part of the rectum. If an abnormality is detected by a digital rectal examination, then an endoscopy is performed for further evaluation of the cancer.

After initial diagnostic tests, if colorectal cancer is suspected, a biopsy, removal of cells or tissues, is performed by a pathologist. If cancer cells are detected in biopsy, further tests are recommended to know the extent (stage) of the disease. These may include:

Blood test for CEA:
Carcinoembryonic antigen (CEA) is a protein normally found in trace amounts in the bloodstream. People who have colorectal cancer or other conditions or who smoke have a high CEA level. CEA is referred to as a tumor marker.

Endoscopic Ultrasound (EUS) or Endorectal ultrasound :
An endoscopic ultrasound is used to detect the depth of the cancer growth. An ultrasound probe at the tip of an endoscope is inserted into the rectum. The probe sends out sound waves that people cannot hear. The waves bounce off the rectum and nearby tissues, and a computer uses the echoes to create a picture. The picture shows how deep a rectal tumor has grown or whether the cancer has spread to lymph nodes or other nearby tissues.

Chest x-ray:
X-rays of the chest can show whether cancer has spread to the lungs.

CT scan:
An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body. The patient may receive an injection of dye. Tumors in the liver, lungs, or elsewhere in the body show up on the CT scan.

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Stages of Colorectal Cancer

Colon cancer and rectal cancer are staged much the same way. But the treatment options may vary because the tumor is much lower down in the colon.

Stage 0: The cancer is found only in the innermost lining of the colon or rectum. Carcinoma in situ is another name for Stage 0 colorectal cancer.

Stage I: The cancer has grown into the inner wall of the colon or rectum. The tumor has not reached the outer wall of the colon or extended outside the colon.

The tumor has broken through the inner lining of the rectum but has not made it past the muscular wall. Dukes A is another name for Stage I colorectal cancer.

Stage II: The tumor extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes. Lymph nodes are small, bean-shaped structures that are found throughout the body that are part of the body's immune system. The cancer may have invaded other organs, like the bladder, uterus or prostate gland. Dukes B is another name for Stage II colorectal cancer.

Stage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body. Dukes C is another name for Stage III colorectal cancer.

Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs. Dukes D is another name for Stage IV colorectal cancer.

Recurrent cancer: This is cancer that has been treated and has returned after a period of time when the cancer could not be detected. The disease may return in the colon or rectum, or in another part of the body.

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Treatments of Colorectal Cancer

Colorectal cancer is highly curable when found in its early stages. The specialists who treat colorectal cancer include gastroenterologists (doctors who specialize in diseases of the digestive system), surgeons, medical oncologists, and radiation oncologists. The treatment mainly depends on the location of the tumor in the colon or rectum, size and the stage of the disease. Treatment methods for colorectal cancer are surgery, radiation therapy or chemotherapy. Some have a combination of these treatments.

Surgery:

It is the most common treatment for colorectal cancer. A colonscope is used to remove small malignant polyp. For larger cancer, surgeon makes an incision into the abdomen to remove the tumor and after that the two open ends are joined together. When a section of the colon or rectum is removed, the surgeon can usually reconnect the healthy parts. If it is not possible, then a colostomy may be needed.

Colostomy - The surgeon makes an opening (a stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. This operation to create the stoma is called colostomy. It is the opening into the colon from the outside of the body. A bag is worn over the stoma to collect the stool. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed.

Side Effects - Patients feel tiredness and uncomfortable and to control their pain, medicines are given. Surgery sometimes causes bleeding, constipation or diarrhea. People who have a colostomy may have irritation of the skin around the stoma.

Chemotherapy:
Chemotherapy uses anticancer drugs to kill cancer cells. They are usually given through a vein, but some also may be given by mouth. These drugs enter the bloodstream and can affect cancer cells throughout the body. The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Chemotherapy before surgery may shrink a large tumor and it is called neoadjuvant therapy. Adjuvant therapy, i.e. chemotherapy after surgery, can destroy any remaining cancer cells and prevent the cancer from coming back in the colon or rectum, or elsewhere.

Side Effects - Side effects of chemotherapy vary from patient to patient and it depends mainly on the specific drugs and doses received. Chemotherapy drugs can affect blood cells resulting in bruising, bleeding, weakness and feeling tired. Other possible side effects are hair loss, poor appetite, nausea, vomiting, diarrhea, mouth and lip sores. Most side effects can be controlled with drugs and will disappear when treatment ends.

Radiation Therapy:
Also called radiotherapy, it uses high-energy rays to kill cancer cells. Radiation therapy affects cancer cells only in the treated area. Some patients may have radiation therapy before surgery to shrink the tumor and others may have it after surgery to kill cancer cells that may remain in the area. External radiation and internal radiation or implant radiation are the two types of radiation therapy used for the treatment of colorectal cancer

External radiation: Radiation is produced by a machine outside the body. The machine targets a concentrated beam of radiation directly at the tumor area. This form of therapy is usually spread out in short treatments given 5 days a week for 5-7 weeks. In some cases, external radiation is given during surgery.

Internal radiation: The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. During the entire treatment, the patient must stay in the hospital and the implants generally remain in place for several days. When the treatment is done, they are removed. Once it is removed, no radioactivity is left in the body.

Side Effects - The side effects of radiation mainly depends on the dose and the part of the body where the radiation is given. Common effects include extreme tiredness, vomiting, increased susceptibility to infections, hair loss, easy bruising or bleeding. Radiation therapy to the abdomen and pelvis may cause nausea, vomiting, diarrhea, bloody stools, rectal leakage, or urinary discomfort. Apart from these, the skin in the treated area may become red, dry, and tender.

Colon cancer and rectal cancer are sometimes treated separately.

Most patients with colon cancer are treated with surgery. But some have chemotherapy along with surgery. A colostomy is seldom needed for people with colon cancer. Radiotherapy is not commonly used to treat colon cancer, but it is used to relieve pain and other symptoms.

Surgery is the most common treatment for rectal cancer. Most rectal cancer patients need a permanent colostomy. Some patients receive the combination of all the treatments. Some patients may have radiation therapy during surgery and it is called IORT (Intraoperative radiation therapy).

After Treatment:

If undetected cancer cells remains somewhere in the body, there are possibilities for the return of the disease. Follow-up care after treatment is very important. Checkups may include a physical exam, lab tests, colonoscopy, x-rays, CT scans, or other tests. The patients should visit their physician between regular scheduled and if any health problems appear.

Getting regular check-ups may be the best way to prevent colorectal cancer.

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