Oncology

Jul 27 2008

Short Essay on Mesothelioma

Mesothelioma

It is a rare tumour complicating asbestos exposure.

Clinical Features

The person develops cough, severe progressive exertional dyspoea

Signs:

Finger clubbing on auscultation during the end of inspiration end inspiratory basal crackles
1. Chest X-ray shows linear shadowing of the basal areas of lung like a honey comb appearance
2. Calcified pleural plaques are seen on X-ray giving a shaggy appearance

Prevention:

Only by a detailed occupational history. 
Protective measures during work.
Avoid smocking.

Treatment:

Commonly using medicines are:-

Ars.alb, Ars.iod, Aur, Apis, Carb.an, Carb.veg, Con., Hydr., Kali.ars, Kali. cy, Phyt., Sil, Thuja

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Apr 27 2008

CARCINOMA OF CERVIX

CARCINOMA OF CERVIX

Dr.Sreeja L

Carcinoma of the cervix was one of the most common causes of cancer death in women, but over the past 30 years, mortality rate has decreased by 50% due to the widespread screening with the PAP smear. It remains the major gynecologic cancer in undeveloped countries. It is more common in lower socioeconomic groups, in women with early initial sexual activity and/or multiple sexual partners, and in smokers. Venereal transmission of human papilloma viruses has an important etiologic role. Over 66 types of HPV have been isolated, and many are associated with cervical carcinoma are 16,18,31,45, and 51 to 53. These along with many other types are also associated with cervical intra epithelial Neoplasia (CIN). Vaccination against pathologic HPV appears quite promising as a cervix cancer prevention strategy.

Uncomplicated HPV lower genital tract infection and Condylomatous atypia of the cervix can progress to CIN. This lesion precedes invasive cervical carcinoma and is classified as low grade squamous intraepithelial lesion (SIL), high-grade SIL, and carcinoma in situ. Carcinoma in situ demonstrates cytologic evidence of Neoplasia without invasion through the basement membrane can persist unchanged for 10 to 20 years, but eventually progresses to invasive carcinoma.

The PAP smear is 90-95% accurate in detecting early lesions such as CIN but is less sensitive in detecting cancer when frankly invasive cancer or fangating masses are present. Inflammation, necrosis, and haemorrhage may produce false-positive smears, and colposcopic directed biopsy is required when any lesion is visible on the cervix, regardless of PAP smear findings. The PAP smear can be reported as normal, atypical squamous cells of undetermined significance (ASCUS) or cannot exclude high grade SIL (ASEH); low-or high grade CIN; or frankly malignant. Women with ASCUS, ASC-H, or low-grade CIN should have repeat smears in 3-6 months and be tested for HPV. Women with high grade CIN or frankly malignant PAP smears should have colposcopic directed cervical biopsy.

Approximately 80% of invasive cervix cancers are squamous cell tumour, 10-15% are adenocarcinomas, 2-5% are adenosquamous with epithelial and glandular structures, and 1-2% are clear cell mesonephric tumours.

Patients with cervix cancer generally present with abnormal bleeding or post coital spotting that may increase to inter-menstrual of prominent menstrual bleeding. Yellowish vaginal discharge, lumbo-sacral back pain, and urinary symptoms can also be seen.

The staging of cervical carcinoma is clinical and generally completed with a pelvic examination under anesthesia with Cystoscopy and proctoscopy. Chest x-rays, intravenous pyelograms, and computed tomography are generally required and magnetic resonance imaging (MRI) may be used to asses extra-cervical extension.

Stage 0 is carcinoma in situ

Ø Stage I is disease confined to the cervix

Ø Stage II is disease invades beyond the cervix but not to the pelvic wall or lower third of the vagina

Ø Stage III-disease extends to the pelvic wall or lower third of vagina or causes hydronephrosis

Ø Stage IV is present when the tumour invades the mucosa of bladder or rectum or extends beyond the true pelvis.

Five year survivals are follows

Stage I- 85%

Stage II- 60%

Stage III- 33%

Stage IV- 7%

Carcinoma in situ (Stage 0) can be arranged successfully by biopsy or by abdominal hysterectomy. For Stage I disease, results appear equivalent for either radical hysterectomy or radiation therapy. Patients with Stage II to IV diseases are primarily managed with radical radiation therapy or combined modality therapy

Dr.Sreeja.L

Apr 27 2008

UTERINE CANCER

UTERINE CANCER

Synonyms of Uterine Cancer are Endometrial/uterine adenocarcinoma, Uterine cancer, Adenocarcinoma of the endometrium/uterus, Cancer – uterine, Cancer – endometrial & Uterine corpus cancer.

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).Uterine cancer usually occurs after menopause. Being obese and taking estrogen-alone hormone replacement therapy also increase your risk. Treatment varies depending on your overall health, how advanced the cancer is and whether hormones affect its growth. Treatment is usually a hysterectomy, which is surgery to remove the uterus. Other options include hormone therapy and radiation.

No one knows the exact causes of uterine cancer. However, it is clear that this disease is not contagious. No one can “catch” cancer from another person.

Women who get this disease are more likely than other women to have certain risk factors. A risk factor is something that increases a person’s chance of developing the disease.

Most women who have known risk factors do not get uterine cancer. On the other hand, many who do get this disease have none of these factors. Doctors can seldom explain why one woman gets uterine cancer and another does not.

Studies have found the following risk factors:

  • Age. Cancer of the uterus occurs mostly in women over age 50.
  • Endometrial hyperplasia. The risk of uterine cancer is higher if a woman has endometrial hyperplasia. This condition and its treatment are described above.
  • Hormone replacement therapy (HRT). HRT is used to control the symptoms of menopause, to prevent osteoporosis (thinning of the bones), and to reduce the risk of heart disease or stroke.

    • Women who use estrogen without progesterone have an increased risk of uterine cancer. Long-term use and large doses of estrogen seem to increase this risk. Women who use a combination of estrogen and progesterone have a lower risk of uterine cancer than women who use estrogen alone. The progesterone protects the uterus.

    Women should discuss the benefits and risks of HRT with their doctor. Also, having regular checkups while taking HRT may improve the chance that the doctor will find uterine cancer at an early stage, if it does develop.

  • Obesity and related conditions. The body makes some of its estrogen in fatty tissue. That’s why obese women are more likely than thin women to have higher levels of estrogen in their bodies. High levels of estrogen may be the reason that obese women have an increased risk of developing uterine cancer. The risk of this disease is also higher in women with diabetes or high blood pressure (conditions that occur in many obese women).
  • Tamoxifen. Women taking the drug tamoxifen to prevent or treat breast cancer have an increased risk of uterine cancer. This risk appears to be related to the estrogen-like effect of this drug on the uterus. Doctors monitor women taking tamoxifen for possible signs or symptoms of uterine cancer.The benefits of tamoxifen to treat breast cancer outweigh the risk of developing other cancers. Still, each woman is different. Any woman considering taking tamoxifen should discuss with the doctor her personal and family medical history and her concerns.
  • Race. White women are more likely than African-American women to get uterine cancer.
  • Colorectal cancer. Women who have had an inherited form of colorectal cancer have a higher risk of developing uterine cancer than other women.

Other risk factors are related to how long a woman’s body is exposed to estrogen. Women who have no children, begin menstruation at a very young age, or enter menopause late in life are exposed to estrogen longer and have a higher risk.

Women with known risk factors and those who are concerned about uterine cancer should ask their doctor about the symptoms to watch for and how often to have checkups. The doctor’s advice will be based on the woman’s age, medical history, and other factors.

Associated conditions include the following:

  • Obesity
  • Hypertension
  • Polycystic ovarian disease

Symptoms

Uterine cancer usually occurs after menopause. But it may also occur around the time that menopause begins. Abnormal vaginal bleeding is the most common symptom of uterine cancer. Bleeding may start as a watery, blood-streaked flow that gradually contains more blood. Women should not assume that abnormal vaginal bleeding is part of menopause.

  • Abnormal uterine bleeding, abnormal menstrual periods
    • Bleeding between normal periods before menopause
    • Vaginal bleeding or spotting after menopause
  • Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
  • Lower abdominal pain or pelvic cramping
  • Thin white or clear vaginal discharge after menopause

A woman should see her doctor if she has any of the following symptoms:

  • Unusual vaginal bleeding or discharge
  • Difficult or painful urination
  • Pain during intercourse
  • Pain in the pelvic area

These symptoms can be caused by cancer or other less serious conditions. Most often they are not cancer, but only a doctor can tell for sure.

Diagnosis

If a woman has symptoms that suggest uterine cancer, her doctor may check general signs of health and may order blood and urine tests. The doctor also may perform one or more of the exams or tests described on the next pages.

  • Pelvic exam — A woman has a pelvic exam to check the vagina, uterus, bladder, and rectum. The doctor feels these organs for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.
  • Pap test — The doctor collects cells from the cervix and upper vagina. A medical laboratory checks for abnormal cells. Although the Pap test can detect cancer of the cervix, cells from inside the uterus usually do not show up on a Pap test. This is why the doctor collects samples of cells from inside the uterus in a procedure called a biopsy.
  • Transvaginal ultrasound — The doctor inserts an instrument into the vagina. The instrument aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture. If the endometrium looks too thick, the doctor can do a biopsy.
  • Biopsy — The doctor removes a sample of tissue from the uterine lining. This usually can be done in the doctor’s office. In some cases, however, a woman may need to have a dilation and curettage (D&C). A D&C is usually done as same-day surgery with anesthesia in a hospital. A pathologist examines the tissue to check for cancer cells, hyperplasia, and other conditions. For a short time after the biopsy, some women have cramps and vaginal bleeding.

If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging.Stages of endometrial cancer:

  1. The cancer is only in the uterus.
  2. The cancer is in the uterus and cervix.
  3. The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
  4. The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.

Treatment

Treatment options involve surgery, radiation therapy, and chemotherapy.

A hysterectomy may be performed in women with the early stage 1 disease. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended.

Abdominal hysterectomy is recommended over vaginal hysterectomy. This type of hysterectomy allows the surgeon to look inside the abdominal area and remove tissue for a biopsy.

Surgery combined with radiation therapy is often used to treat women with stage 1 disease that could return and stage 2 disease. Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.

Expectations (prognosis)

Endometrial cancer is usually diagnosed at an early stage. The 1-year survival rate is about 94%.

The 5-year survival rate for endometrial cancer that has not spread is 96%. If the cancer has spread to distant organs, the 5-year survival rate drops to 25%.

Complications

Complications may include anemia due to blood loss. A perforation (hole) of the uterus may occur during a D and C or endometrial biopsy.

[email protected]

Apr 27 2008

LUNG CANCER

LUNG CANCER

Cancer of the lung, like all cancers, results from an abnormality in the body’s basic unit of life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that cells divide to produce new cells only when needed. Disruption of this system of checks and balances on cell growth results in an uncontrolled division and proliferation of cells that eventually forms a mass known as a tumor.

Tumors can be benign or malignant; when we speak of “cancer,” we refer to those tumors that are considered malignant. Benign tumors can usually be removed and do not spread to other parts of the body. Malignant tumors, on the other hand, grow aggressively and invade other tissues of the body, allowing entry of tumor cells into the bloodstream or lymphatic system which spread the tumor to other sites in the body. This process of spread is termed metastasis; the areas of tumor growth at these distant sites are called metastases. Since lung cancer tends to spread, or metastasize, very early in its course, it is a very life-threatening cancer and one of the most difficult cancers to treat. While lung cancer can spread to any organ in the body, certain organs—particularly the adrenal glands, liver, brain, and bone—are the most common sites for lung cancer metastasis.

lungcancer 300x227 LUNG CANCER

Lung cancer, or carcinoma of the lung, is a disease where epithelial (internal lining) tissue in the lung grows out of control. This leads to invasion of adjacent tissue and infiltration beyond the lungs (metastasis). Lung cancer, the most common cause of cancer-related death in men and the second most common in women, is responsible for 1.3 million deaths worldwide annually. The most common symptoms are shortness of breath, cough (including coughing up blood), and weight loss.

The main types of lung cancer are small cell lung cancer and non-small cell lung cancer. This distinction is important because non-small cell lung cancer is sometimes treated with surgery, while small cell cancer is not. Also, small cell lung cancer usually responds better to chemotherapy.

The most important cause of lung cancer is exposure to tobacco smoke. The occurrence of lung cancer in non-smokers, who account for less than 10% of cases, appears to be due to a combination of genetic factors. Radon gas, asbestos, and air pollution may also contribute to the development of lung cancer.

Lung cancer may be seen on chest x-ray and CT scan. The diagnosis is confirmed with a biopsy. This is usually performed via bronchoscopy or CT-guided biopsy.

Treatment and prognosis depend upon the histological type of cancer, the stage (degree of spread), and the patient’s performance status. Possible treatments include surgery, chemotherapy, and radiotherapy. Even with treatment, the overall five-year survival rate is 14%.

The lung is also a very common site for metastasis from tumors in other parts of the body. Tumor metastases are made up of the same type of cells as the original, or primary, tumor. For example, if prostate cancer spreads via the bloodstream to the lungs, it is metastatic prostate cancer in the lung and is not lung cancer.

Lung cancers can arise in any part of the lung, and 90%-95% of cancers of the lung are thought to arise from the epithelial, or lining cells of the larger and smaller airways (bronchi and bronchioles); for this reason, lung cancers are sometimes called bronchogenic carcinomas or bronchogenic cancers. Cancers can also arise from the pleura (the thin layer of tissue that surrounds the lungs), called mesotheliomas, or rarely from supporting tissues within the lungs, for example, blood vessels.

Causes of Lung Cancer

Smoking

The incidence of lung cancer is strongly correlated with cigarette smoking, with about 90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes smoked over time; doctors refer to this risk in terms of pack-years of smoking history (the number of packs of cigarettes smoked per day multiplied by the number of years smoked). For example, a person who has smoked two packs of cigarettes per day for 10 years has a 20 pack-year smoking history. While the risk of lung cancer is increased with even a 10 pack-year smoking history, those with 30 pack-year histories or more are considered to have the greatest risk for the development of lung cancer. Among those who smoke two or more packs of cigarettes per day, one in seven will die of lung cancer.

Pipe and cigar smoking can also cause lung cancer, although the risk is not as high as with cigarette smoking. While someone who smokes one pack of cigarettes per day has a risk for the development of lung cancer that is 25 times higher than a nonsmoker, pipe and cigar smokers have a risk of lung cancer that is about five times that of a nonsmoker.

Tobacco smoke contains over 4,000 chemical compounds, many of which have been shown to be cancer-causing, or carcinogenic. The two primary carcinogens in tobacco smoke are chemicals known as nitrosamines and polycyclic aromatic hydrocarbons. The risk of developing lung cancer decreases each year following smoking cessation as normal cells grow and replace damaged cells in the lung. In former smokers, the risk of developing lung cancer begins to approach that of a nonsmoker about 15 years after cessation of smoking. For more, please read the Smoking and Quitting Smoking article.

Passive smoking

Passive smoking, or the inhalation of tobacco smoke from other smokers sharing living or working quarters, is also an established risk factor for the development of lung cancer. Research has shown that nonsmokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with other nonsmokers. An estimated 3,000 lung cancer deaths occur each year in the U.S. that are attributable to passive smoking.

Asbestos fibers

Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue following exposure to asbestos. The workplace is a common source of exposure to asbestos fibers, as asbestos was widely used in the past for both thermal and acoustic insulation materials. Today, asbestos use is limited or banned in many countries, including the Unites States. Both lung cancer and mesothelioma (a type of cancer of the pleura or of the lining of the abdominal cavity called the peritoneum) are associated with exposure to asbestos. Cigarette smoking drastically increases the chance of developing an asbestos-related lung cancer in exposed workers. Asbestos workers who do not smoke have a fivefold greater risk of developing lung cancer than nonsmokers, and those asbestos workers who smoke have a risk that is 50 to 90 times greater than nonsmokers.

Radon gas

Radon gas is a natural, chemically inert gas that is a natural decay product of uranium. It decays to form products that emit a type of ionizing radiation. Radon gas is a known cause of lung cancer, with an estimated 12% of lung cancer deaths attributable to radon gas, or 15,000 to 22,000 lung cancer-related deaths annually in the U.S., making radon the second leading cause of lung cancer in the U.S. As with asbestos exposure, concomitant smoking greatly increases the risk of lung cancer with radon exposure. Radon gas can travel up through soil and enter homes through gaps in the foundation, pipes, drains, or other openings. The U.S. Environmental Protection Agency estimates that one out of every 15 homes in the U.S. contains dangerous levels of radon gas. Radon gas is invisible and odorless, but it can be detected with simple test kits.

Familial predisposition

While the majority of lung cancers are associated with tobacco smoking, the fact that not all smokers eventually develop lung cancer suggests that other factors, such as individual genetic susceptibility, may play a role in the causation of lung cancer. Numerous studies have shown that lung cancer is more likely to occur in both smoking and nonsmoking relatives of those who have had lung cancer than in the general population. Recent research has localized a region on the long (q) arm of the human chromosome number 6 that is likely to contain a gene that confers an increased susceptibility to the development of lung cancer in smokers.

Lung diseases

The presence of certain diseases of the lung, notably chronic obstructive pulmonary disease (COPD), is associated with a slightly increased risk (four to six times the risk of a nonsmoker) for the development of lung cancer even after the effects of concomitant cigarette smoking are excluded.

Prior history of lung cancer

Survivors of lung cancer have a greater risk than the general population of developing a second lung cancer. Survivors of non-small cell lung cancers (NSCLCs, see below) have an additive risk of 1%-2% per year for developing a second lung cancer. In survivors of small cell lung cancers (SCLCs), the risk for development of second cancers approaches 6% per year.

Air pollution

Air pollution from vehicles, industry, and power plants can raise the likelihood of developing lung cancer in exposed individuals. Up to 1% of lung cancer deaths are attributable to breathing polluted air, and experts believe that prolonged exposure to highly polluted air can carry a risk similar to that of passive smoking for the development of lung cancer.

Viruses

Viruses are known to cause lung cancer in animals and recent evidence suggests similar potential in humans. Implicated viruses include human papillomavirus, JC virus, simian virus 40 (SV40), BK virus and cytomegalovirus. These viruses may affect the cell cycle and inhibit apoptosis, allowing uncontrolled cell division.

Signs and symptoms

Symptoms that suggest lung cancer include:

  • dyspnea (shortness of breath)
  • hemoptysis (coughing up blood)
  • chronic coughing or change in regular coughing pattern
  • wheezing
  • chest pain or pain in the abdomen
  • cachexia (weight loss), fatigue and loss of appetite
  • dysphonia (hoarse voice)
  • clubbing of the fingernails (uncommon)
  • difficulty swallowing

If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia.

Many lung cancers have a rich blood supply. The surface of the cancer may be fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be coughed up.

Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease. In lung cancer, these phenomena may include Lambert-Eaton myasthenic syndrome (muscle weakness due to auto-antibodies), hypercalcemia or SIADH. Tumors in the top (apex) of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner’s syndrome), as well as muscle weakness in the hands due to invasion of the brachial plexus.

Many of the symptoms of lung cancer (bone pain, fever, weight loss) are nonspecific; in the elderly, these may be attributed to comorbid illness. In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of metastasis include the bone, such as the spine (causing back pain and occasionally spinal cord compression), the liver and the brain. About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest x-rays.

Other changes that can sometimes occur with lung cancer may include repeated bouts of pneumonia, changes in the shape of the fingertips, and swollen or enlarged lymph nodes (glands) in the upper chest and lower neck.

These symptoms can happen with other illnesses, too. People with symptoms should talk to their doctor, especially if they smoke, but even if they don’t. Doctors can help find the cause.

When should one consult a doctor?

One should consult a health care provider if they develop the symptoms associated with lung cancer, in particular, if they have

  • a new persistent cough or worsening of an existing chronic cough

    • ,

  • blood in the sputum,
  • persistent bronchitis or repeated respiratory infections

    • ,

  • chest pain

    • ,

  • unexplained weight loss and/or fatigue

    • , and/or

  • breathing difficulties such as shortness of breath or wheezing.

Diagnosis and Treatment

180px thorax ct peripheres brronchialcarcinom li of LUNG CANCER180px thorax pa peripheres bronchialcarcinom li of markiert LUNG CANCER

Picture 1: CT scan showing lung cancer in the left lung

Picture 2: Chest x-ray showing lung cancer in the left lung

A person’s lung cancer diagnosis depends on the type of lung cancer present. The two main types of lung cancer are small cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer is more common than small cell lung cancer. These categories refer to what the cancer cells look like under a microscope.

Performing a chest x-ray is the first step if a patient reports symptoms that may be suggestive of lung cancer. This may reveal an obvious mass, widening of the mediastinum (suggestive of spread to lymph nodes there), atelectasis (collapse), consolidation (infection) and pleural effusion. If there are no X-ray findings but the suspicion is high (such as a heavy smoker with blood-stained sputum), bronchoscopy and/or a CT scan may provide the necessary information. In any case, bronchoscopy or CT-guided biopsy is often necessary to identify the tumor type.

The extent of disease is referred to as the stage. Information about how big a cancer is or how far it has spread is often used to determine the stage. Doctors use information about stage to plan treatment and to monitor progress.

The differential diagnosis for patients who present with abnormalities on chest x-ray includes lung cancer, as well as nonmalignant diseases. These include infectious causes such as tuberculosis or pneumonia, or inflammatory conditions such as sarcoidosis. These diseases can result in mediastinal lymphadenopathy or lung nodules, and sometimes mimic lung cancers.

There are several ways to treat lung cancer. The treatment depends on the type of lung cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation. People with lung cancer often get more than one kind of treatment.

Surgery
Doctors cut out and remove cancer tissue in an operation.

If investigations confirm lung cancer, CT scan and often positron emission tomography (PET) are used to determine whether the disease is localised and amenable to surgery or whether it has spread to the point where it cannot be cured surgically.

Blood tests and spirometry (lung function testing) are also necessary to assess whether the patient is well enough to be operated on. If spirometry reveals a very poor respiratory reserve, as may occur in chronic smokers, surgery may be contraindicated.

Surgery itself has an overall operative death rate of about 4.4%, depending on the patient’s lung function and other risk factors. Surgery is usually only an option in non-small cell lung cancer limited to one lung, up to stage IIIA. This is assessed with medical imaging (computed tomography, positron emission tomography). A sufficient pre-operative respiratory reserve must be present to allow adequate lung function after the tissue is removed.

Procedures include wedge resection (removal of part of a lobe), lobectomy (one lobe), bilobectomy (two lobes) or pneumonectomy (whole lung). In patients with adequate respiratory reserve, lobectomy is the preferred option, as this minimizes the chance of local recurrence. If the patient does not have enough functional lung for this, wedge resection may be performed. Radioactive iodine brachytherapy at the margins of wedge excision may reduce recurrence to that of lobectomy. Chemotherapy
Chemotherapy involves the use of drugs to shrink or kill the cancer. The drugs could be pills or medicines given through an IV (intravenous) tube. Sometimes chemotherapy includes both IV drugs and pills.

Small cell lung cancer is treated primarily with chemotherapy, as surgery has no demonstrable influence on survival. Primary chemotherapy is also given in metastatic non-small cell lung cancer.

The combination regimen depends on the tumor type. Non-small cell lung cancer is often treated with cisplatin or carboplatin, in combination with gemcitabine, paclitaxel, docetaxel, etoposide or vinorelbine. Combinations with carboplatin, gemcitabine, paclitaxel, vinorelbine, In small cell lung cancer, cisplatin and etoposide are most commonly used.topotecan and irinotecan are also used.Radiation
Radiation uses high-energy rays (similar to x-rays) to try to kill the cancer cells. The rays are aimed at the part of the body where the cancer is.

Radiotherapy is often given together with chemotherapy, and may be used with curative intent in patients with non-small cell lung cancer who are not eligible for surgery. For small cell lung cancer cases that are potentially curable, in addition to chemotherapy, chest radiation is often recommended. The use of adjuvant thoracic radiotherapy following curative intent surgery for non-small cell lung cancer is not well established and controversial. Benefits, if any, may only be limited to those in whom the tumor has spread to the mediastinal lymph nodes.

For both non-small cell lung cancer and small cell lung cancer patients, smaller doses of radiation to the chest may be used for symptom control (palliative radiotherapy). Unlike other treatments, it is possible to deliver palliative radiotherapy without confirming the histological diagnosis of lung cancer.

Patients with limited stage small cell lung carcinoma are usually given prophylactic cranial irradiation (PCI). This is a type of radiotherapy to the brain, used to reduce the risk of metastasis. More recently, PCI has also been shown to be beneficial in those with extensive small cell lung cancer. In patients whose cancer has improved following a course of chemotherapy, PCI has been shown to reduce the cumulative risk of brain metastases within one year from 40.4% to 14.6%.These treatments may be provided by different doctors on your medical team. Pulmonologists are doctors that are experts in diseases of the lungs. Surgeons are doctors that perform operations. Medical oncologists are doctors that are experts in cancer and treat cancers with medicines. Radiation oncologists are doctors that treat cancers with radiation.

Prognosis

Prognosis depends on the cell type (histology), stage (degree of spread), and the patient’s performance status. Overall 5 year survival rates vary from 8.9% in developing countries to 15% in the United States.

For non-small cell lung cancer, prognosis is poor. Following complete surgical resection of stage IA disease, five-year survival is 67%. With stage IB disease, five-year survival is 57%. The 5-year survival rate of patients with stage IV NSCLC is about 1%.

Patients with extensive-stage SCLC have an average five-year survival rate of less than 1%. The For small cell lung carcinoma, prognosis is also poor. The overall five-year survival for patients with SCLC is about 5%.median survival time for limited-stage disease is 20 months, with a five-year survival rate of 20%.

Prevention

Prevention is the most cost-effective means of fighting lung cancer. While in most countries industrial and domestic carcinogens have been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of lung cancer, and smoking cessation is an important preventative tool in this process.

Policy interventions to decrease passive smoking in public areas such as restaurants and workplaces have become more common in many Western countries, with California taking a lead in banning smoking in public establishments in 1998, Ireland playing a similar role in Europe in 2004, followed by Italy and Norway in 2005, Scotland as well as several others in 2006, and England in 2007. New Zealand has also recently banned smoking in public places.

The state of Bhutan has had a complete smoking ban since 2005. In many countries, pressure groups are campaigning for similar bans. Arguments cited against such bans are criminalisation of smoking, increased risk of smuggling and the risk that such a ban cannot be enforced.

[email protected]

Apr 27 2008

CANCER OF OESOPHAGUS

CANCER OF OESOPHAGUS

The Gastrointestinal tract is the second most common noncutaneous site for cancer and the second major cause of the cancer related mortality in the United Stated.

Incidence

Cancer of the Oesophagus is a relatively un-common but extremely lethal malignancy. It occurs frequently within a geographic region extending from the southern shore of the Caspian Sea on the west to northern China on the east and encompassing parts of Iran, Central Asia, Afghanistan, Siberia, and

Mongolia. The disease is more common in Blacks than whites and in males than females; it appears most often after age 50 and seems to be associated with a lower socioeconomic status.

Aetiology (Cause of Disease)

A variety of Causative factors have been implicated in the development of the disease. In the

United States, esophageal cancer cases are either squamous cell carcinomas or adenocarcinomas. The aetiology of squamous cell esophageal cancer is related to excess alcohol consumption and/or cigarette smoking. The relative risk increases with the amount of tobacco smoked or alcohol consumed, with these factors acting synergistically. The consumption of whiskey is linked to a higher incidence than the consumption off wine or beer. Squamous cell esophageal carcinoma has also been associated with the ingestion of nitrites, smoked opiates, and fungal toxins in pickled vegetables, as well as mucosal damage caused by such physical insults as long term exposure to extremely hot tea, the ingestion of lye, radiation induced strictures, and chronic achalasia. The presence of an esophageal web in association with glossitis and iron deficiency and congenital hyperkeratosis and pitting of the palms and soles have rich been linked with squamous cell esophageal cancer, as have dietary deficiencies of molybdenum, zinc, and vitamin A.

The rate of adenocarcinoma has risen dramatically, particularly in white males. Adenocarcinoma arises in the distal esophagus in the presence of chronic gastric reflux and gastric maetaplasia of the epithelium, which is more common in obese persons. Adenocarcinomas arise within dysplastic columnar epithelium in the distal esophagus. These adenocarcinomas behave clinically gastric adenocarcinomas and now account for >50% of esophageal cancer.

Clinical Features

About 15% of esophageal cancers occur in the upper third of the esophagus, 35% in the middle third, and 50% in the lower third. Squamous cell carcinoma and adenocarcinomas of the esophagus cannot be distinguished radiographically or endoscopically.

Progressive dysphagia and weight loss of short duration are the initial symptoms in the vast majority of cases. Dysphagia initially occurs with solid foods and gradually progresses to include semisolids and liquids. By the time these symptoms develop, the disease is usually incurable, since difficulty in swallowing does not occur until >60% of the esophagus circumference is infiltrated with cancer. Dysphagia may associate with pain on swallowing, pain radiating to the chest and/or back, regurgitation or vomiting, aspiration pneumonia. The disease most commonly spread to adjacent and supra-clavicular lymph nodes, liver, lungs, pleura. Tracheo-esophageal fistula may develop when the disease advances, and may lead in to severe suffering. As with other squamous cell carcinomas, hypercalemia may occur in the absence of osseous metastasis, probably from parathormone related peptides secreted by tumour cells.

Diagnosis

Various modern techniques are used to find out the carcinomas, some important tests are:

  1. Endoscopic and cytologic screening.
  2. Routine contrast Radiographs.
  3. Computed Tomography Scans.
  4. Positron emission Tomography Scanning

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Apr 27 2008

MESOTHELIOMA

MESOTHELIOMA

Mesothelioma is a rare form of cancer. The cancer cells (Malignant cells) are found in the lining of chest (Pleura), the lining of the abdominal cavity (Peritoneum) or the lining around the Heart (Pericardium).

Peritoneal Mesothelioma is a cancer of the lining of the abdominal cavity. It occurs in one fifth to one third of total number of mesothelioma.

Most people affected had a History of breathing of Asbestos. The exposure may be from their working environment or from their house itself. An exposure of Asbestos for just one or two months can result in Mesothelioma in 30 or 40 years later. The present diseased individual has a History of Asbestos exposure in the 1940s, 50s, 60s and 70s age. That is showing that it has a long latency period.

Like all cancers the prognosis of Mesothelioma is depend on the early diagnosis of the disease and how aggressively it is treated.

MAIN CAUSE OF MESOTHELIOMA- ASBESTOS EXPOSURE

At some point in our lives, nearly all of us have been exposed to asbestos in the air we breathe and the water we drink; from natural deposits in the earth, and from the deterioration of asbestos products around us. Most of us, however, do not become ill as a result of our exposure. More commonly, those who at some point are diagnosed with asbestos disease have worked in jobs where more substantial exposure occurred over longer periods of time. Nevertheless, cases of mesothelioma have been documented as the result of lesser exposure, affecting family members of workers who came into contact with asbestos and brought it home on their clothing, skin or hair, or affecting those who lived in close proximity to asbestos manufacturing facilities. Symptoms of asbestos disease usually are not be apparent until decades after exposure.

Asbestos are commonly used in the North America during 1800s itself. The use of asbestos enormously increased during Second World War, when shipyards produced massive number of ships for War purpose. Since that time the asbestos was commonly used in building construction automotive industry, etc. During that time about 5,000 products containing asbestos are used.

Although it is suggested that the number of mesothelioma cases in the U.S. has reached its peak and has begun to drop, a forecast released by the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER), in April, 2003, projected the total number of American male mesothelioma cases from 2003-2054 to be approximately 71,000. This number, however, does not take into consideration events such as the World Trade Center disaster on September 11, 2001, when millions of New Yorkers were potentially exposed to air filled with carcinogenic asbestos particles. When the latency period for asbestos disease is factored in, cases of mesothelioma will continue to be diagnosed for years to come.

RACE AND MESOTHELIOMA:

Mesothelioma has no racial predilection. Asbestos exposure is the most important factor. Race is not a factor.

SEX AND MESOTHELIOMA:

Malignant mesothelioma is more common in men, with a male-to-female ratio of 3:1. It can also occur in children; however, these cases are not thought to be associated with asbestos exposure.

With regard to women with mesothelioma, a 1996 case series by Ascoli et al showed 86% of tumors arising from the pleura, of which most were the epithelial type. Of the patients in this series, 75% had a history of exposure to asbestos and more than half developed the malignancy secondary to household contact with a worker exposed to asbestos.

With regard to men with mesothelioma, the same case series demonstrated 45.5% with a history of exposure to asbestos and 53% with occupational exposure to asbestos. Most who were involved were construction workers, railroad workers, naval mechanics, bakers, explosive workers, and automobile mechanics.

AGE AND MESOTHELIOMA:

Malignant mesothelioma has a peak incidence 35-45 years after asbestos exposure. It commonly develops in the fifth to seventh decade of life.

MORTALITY/MORBIDITY:

Median survival for patients with malignant mesothelioma is 11 months. It is almost always fatal. Median survival based on histologic type is 9.4 months for sarcomatous, 12.5 months for epithelial and 11 months for mixed. Approximately 15% of patients have an indolent course.

Asbestos exposure is linked to at least 50% of patients developing malignant mesothelioma. Approximately 8 million people in the United States have been exposed to asbestos in the workplace. Family members are also exposed to asbestos embedded in the worker’s clothing. The combination of tobacco and asbestos exposure greatly increases the risk of developing pleural mesothelioma.

SYMPTOMS OF MESOTHELIOMA

The early symptoms of mesothelioma are generally non-specific, and may lead to a delay in diagnosis. Sometimes resembling viral pneumonia, pleural mesothelioma patients may present with shortness of breath, chest pain and/or persistent cough; some patients show no symptoms at all. A chest x-ray may show a build-up of fluid or pleural effusion. The right lung is affected 60% of the time, with involvement of both lungs being seen in approximately 5% of patients at the time of diagnosis. Less common symptoms of pleural mesothelioma include fever, night sweats and weight loss. Symptoms of peritoneal mesothelioma may include pain or swelling in the abdomen due to a build-up of fluid, nausea, weight loss, bowel obstruction, anemia or swelling of the feet.

PLEASE KEEP IN MIND THAT THESE SYMPTOMS MAY BE CAUSED BY MESOTHELIOMA OR BY OTHER LESS SERIOUS CONDITIONS. ONLY A DOCTOR CAN MAKE A DEFINITIVE DIAGNOSIS.

Pleural Effusion:-

One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). Both of these membranes are covered with mesothelial cells which, under normal conditions, produce a small amount of fluid that acts as a lubricant between the chest wall and the lung. Any excess fluid is absorbed by blood and lymph vessels maintaining a balance. When too much fluid forms, the result is an effusion.

Types of Pleural Effusion:-

Pleural effusion is broken down into two categories, transudates and exudates. A transudate is a clear fluid that forms not because the pleural surfaces are diseased, but because of an imbalance between the normal production and removal of the fluid. The most common cause of transudative fluid is congestive heart failure. An exudate, which is often cloudy and contains many cells and proteins, results from disease of the pleura itself, and is common to mesothelioma. To determine whether a fluid is a transudate or exudate, a diagnostic thoracentesis, in which a needle or catheter is used to obtain a fluid sample, may be conducted.

Symptoms of Pleural Effusion:-

As the volume of fluid increases, shortness of breath, known as “dyspnea”, and sometimes pain, ranging from mild to stabbing, may occur. Some patients may experience a dry cough. When the doctor listens to the patient’s chest with a stethoscope, normal breath sounds are muted, and tapping on the chest will reveal dull rather than hollow sounds.

TREATMENT

Pleural effusion caused by heart failure or infection can usually be resolved by directing treatment at the cause, however, when testing has realized no diagnosis, and fluid continues to build or recur, doctors may recommend chest tube drainage and chemical pleurodesis. Chemical pleurodesis is a technique in which a sclerosing agent is used to abrade the pleural surfaces producing an adhesion between the parietal and visceral pleurae. This will prevent further effusion by eliminating the pleural space. Talc appears to be the most effective agent for pleurodesis, with a success rate of nearly 95%. It is highly effective when administered by either poudrage or slurry. Poudrage is the most widely used method of instilling talc into the pleural space. Before spraying the talc, the medical team removes all pleural fluid to completely collapse the lung. After the talc is administered, they inspect the pleural cavity to be sure the talc has been evenly distributed over the pleural surface. Some doctors prefer to use talc mixed with saline solution which forms wet slurry that can roll around the pleural cavity.

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