All about Cancer and its types: causes, symptoms, diagnosis and treatments
Cancer and its types: causes, symptoms, diagnosis and treatments
Table of contents
1. recover after cancer2 Cancer in pregnancy
3 nutrition and cancer
4. how cope with chemotherapy
5. head and Neck Cancer
6. Colorectal Cancer
7. Cervical Cancer
8. esophagus Cancer
9. stomach Cancer
10. Liver Cancer
11 laryngeal Cancer
12. Breast Cancer
13. Ovarian Cancer
14. Pancreatic Cancer
15 Cancer of penis
16. Skin Cancer
17. Prostate Cancer
18 of Lung Cancer
19. Testicular Cancer
20. Thyroid Cancer
21. Bladder Cancer
22 oral Cancer
23. Bone Cancer
24 leukemia
25 melanoma
26 mesothelioma
27. brain tumors
Note: this translation is only presented for educational purposes. Any translation of this web site may be inaccurate and imprecise.
1. recover after cancer
However, the therapies used to treat cancer still appear aggressive to healthy cells, and have side effects that impair the physical aspect of the sick. Specialists encourage patients to take care of your image, because feel beautiful despite the cancer helps them cope with chemotherapy and improves mood.
How does the treatment of cancer
To the physical and emotional disorders that
can cause the disease and its symptoms, should add the side effects
which usually results in the treatment of cancer. Although
the pathology manifests itself differently in each person, and there
are even those who suffer no discomfort associated with therapy, than
usual, as explains Dr. Raúl Márquez, medical oncologist of the MD
Anderson Cancer Center of Madrid, is that chemotherapy affects healthy
cells from the patient and can cause various disorders, especially in
the digestive system and skin. The problems that, according to this expert, are associated with more frequent treatments against cancer are:• Alterations in the skin: may be changes in color and texture. In general, the skin becomes more sensitive, is drier, and may present small eruptions or rashes. Also you can hiperpigmentar and burns easily, so you have to take extra precautions to protect it from the Sun.
• Alopecia: Hair falls. Chemotherapy alters the cycle of the hair and leave it in the stage of detachment, in which the hair that will grow again dropped after completed treatment (between two and three weeks later). Although it depends on the type of chemotherapy and its intensity, in 80 to 90 percent of cases patients lose hair.
• Nails also suffer modifications: the base of the nail tends to fall off, or they grow in the form of irregular layers. Also they can discolor or acquire a purple tone, grow up, weaken. Some patients may even lose toenails.
• Nausea and vomiting, changes in the sense of taste and smell. Patients lose appetite as a result of these disorders and tend to stop eating.
• Emotional disturbances: patients may also suffer depression or be affected emotionally to a greater or lesser extent because of the physical discomfort that experience and to the deterioration of his physical appearance caused by the treatment.
Beautiful with cancer: how to care for your image
Expert Ángela Navarro, from the center of Integral
aesthetics (www.angelanavarro.net) which bears his name and is
specialized in aesthetic advice to patients with cancer, says that to
care for the image after the cancer diagnosis, 'it is essential to begin
as soon as possible to improve the levels of hydration, both facial and
hair, as well as treat the scalp, so it is in the best possible
conditions and achieve to neutralize possible effects that drugs have on
the skin'.This specialist notes that there are products and services designed specifically for these patients:
• Wigs: is necessary that the interiors are as soft as possible to not cause irritation to the scalp; In addition, it is essential to not adhere to the scalp with adhesives, since we can result in injury in the same and undergo chemotherapy of alopecia (hair grow once again comes to an end with medication) to cicatricial alopecia, which does not grow hair in the area.
• Creams: is very important to use creams with special characteristics: free of perfumes, preservatives and oil derivatives, formulas, simplified to avoid possible allergic reactions...
• Personal hygiene: it is important to find deodorant without aluminum in its composition.
• Advice to take advantage of the aesthetic techniques: how to wear the wig, makeup patterns, how make-up eyebrows, facial hydration and hygiene tips...
Beauty tips for cancer patients
The main advice specialists give patients to improve their physical appearance and feel better are:• Hair: cut the hair as soon as appear the first signs of fall, use soft shampoos, wash with warm water and no rub, and protect the scalp from exposure to the Sun with appropriate sunscreen. Use breathable wigs, leaving air head about six hours a day to promote scalp to breathe. When you turn out the hair, it can even be dyed, but must be used in dyes that do not contain ammonia. the best are the vegetable dyes that are sold in pharmacies.
• Eyebrows: If the hair of the eyebrows is dropped, they may be drawn with the help of templates and specific pencils. It is best to consult with a specialist to explain how to do it.
• Nails: they should not be long, but it is better to file them that cut them with scissors to avoid possible injury. It is not advisable to use nail polish remover or nail lacquers because they are aggressive substances. In addition, it is necessary to protect them with gloves when going to perform any manual task, and moisturize cuticles frequently.
• Skin: Dr. Raúl Márquez, oncologist at MD Anderson Cancer Center, compares the skin of patients undergoing chemotherapy for a baby. Therefore, his advice is that you avoid the hours of maximum intensity of the Sun, which you always use scarves or hats when you leave, use sunscreen, and seek the shade, and drink at least one couple of litres of water a day. In terms of hygiene, this specialist recommends soaps, soft and with little perfume, the bath water is not very hot, and use hypoallergenic moisturizers.
• Makeup: you can make up, but as explained by Dr. Márquez, it is necessary to use maximum security products and which offer all the guarantees that they will not produce adverse reactions.
• Micropigmentation: it's an alternative that allows you to hide the loss of hair from eyebrows and eyelashes. That Yes, keep in mind that if you go by this aesthetic solution, we need to make it at least one month before chemotherapy to prevent scarring problems. You can find more information about this technique in our interview with Mª Dolores Pérez Sancho.
The Foundation Angela Navarro offers free workshops to hospital centres and associations of patients in which the three main areas that need to know the patients are dealt with: the auto-makeup, the diagnosis of the condition of the skin, and the necessary care and the use of wigs and scarves. They are three different two-hour each, free workshops, and which have been launched before the great demand for information by patients.
Emotional well-being in the cancer patient
Cancer and its treatment have a major emotional impact on those affected. As
we have seen, take care of your image will help you to deal with the
disease with more optimism, but there is also a subspecialty of Oncology
- which falls within the psychology-, which is known as Psycho-Oncology
and is based on applying the same tools and techniques of the
psychology in the Oncology field.The psicooncologo, therefore, is the professional who can help you to successfully overcome the different phases of the cancer and its treatment. In addition, explains Marta de la Fuente, psicooncologa of the MD Anderson Cancer Center of Madrid, therapy is also indicated for the family or the people closest to the patient: ' although many times family members say that they don't need help are wrong, because the family, the friend, is subjected to very high levels of stress in that situation , and also need in many cases specific guidelines and advice to manage that stress '.
The DRA. De la Fuente explains that physical exercise or perform any alternative therapy help to cancer patients to recover their emotional well-being. This expert prefers to refer to these therapies not as alternatives, but as complementary to traditional medicine, and considers that in addition to medical treatment and psychological treatment, some techniques such as yoga, reiki and chi kung, are having good results with cancer patients.
' I like to say the guidelines we give always accompanied of a depends on each patient ', explains the psicooncologa, and added that overall it is recommended that patients:
• Avoid isolation.
• Ask for help.
• Allow the moments of downturn (crying doesn't mean that they're taking it badly).
• Do not maintain a passive before the disease coping, because to a large extent it depends on them.
• Seek information and advice on what other tools or techniques can be applied in your treatment, for example ecological techniques, other complementary treatments...
• Practice relaxation techniques, because they serve to reduce the activation response to stressful situations like that are living.
• Carry out any physical activity within its possibilities.
• Support in their social environment and express their emotions without fear of 'what will others think'.
• Banish the idea that ' go to the psychologist's mad ', because the counselling can come you handy to all patients.
More information: MD Anderson, free workshops of Psycho-Oncology
2 Cancer in pregnancy
The occurrence of cancer in a pregnant woman is a process with unique characteristics, because the same person occurs in a controlled growth of the fetus and its placenta along with an uncontrolled growth of a malignancy that can influence the life of the mother and the fetus. In addition, usually in a pregnant cancer tends to be more advanced than in women of the same age who are not.
For the patient and the doctor presents a dilemma: if treatment is delayed to not harm the fetus is likely to endanger the life of the mother; If it is just reaching the diagnosis the son's life risks. In addition, there are other problems, such as difficulties in diagnosis and in the study of the spread of cancer, the effect of the treatment on future pregnancies, or ethical problems in the mother or health professionals. Thus, the management of these patients is complicated and must be customized.
Most frequent types of cancer during pregnancy
Of all cancers that occur during pregnancy, one in four are breast cancers. Approximately at the same frequency is cancer of the cervix. The
following two types of cancer most frequently are derived from blood
cells and are leukemias (15% of cancer in pregnant women) and lymphomas
(10%). 8% of cancers are melanomas, which is a type of cancer that begins in the skin, and 4% are thyroid cancers.
Diagnosis of cancer in pregnant women
The diagnostic and therapeutic management of
cancer during pregnancy is especially difficult, because it involves two
people: the mother and the child.Many times the tumor is detected late in pregnancy. This is because cancer symptoms may be masked by symptoms of pregnancy, such as e.g. nausea, breasts, genital bleeding in the first trimester increase, etc.
In addition, changes in the anatomy of women during pregnancy may confuse the doctor during the physical examination, for example when it carries out exploration of moms.
Finally, during the pregnancy are elevated in the blood, normal form, some markers that indicate inflammation and some tumor markers, which may delay the diagnosis of the enfermedad.cd
Some techniques that help the diagnosis are safe and do not involve damage to the fetus as the cervical cytology (for cervical cancer), mammography (for breast cancer), abdominal ultrasound (to ovarian cancer) or blood (for leukemias) analytics. However, there are other techniques such as computed tomography (CT), nuclear medicine studies, in which radioactive substances, iodinated contrast are used, radiographs..., they can be harmful to embryo and try to not be performed.
Therefore, the diagnosis is difficult and often the treatment proposed is based on incomplete information on the disease.
How to treat cancer during pregnancy
Regarding the therapeutic management of
cancer during pregnancy, obstetricians and oncologists are concentrated
in offer optimal treatment for mother at the same time and hold the
maximum time needed for fetal well-being, which may be essential for the
mother may be, on the other hand, very harmful or even fatal to the
fetus. For a woman with a diagnosis of cancer,
wait 40 weeks can be a death sentence, especially if it is an aggressive
cancer, or if there are metastases.As well, several factors are valued in the handling of these cases:
• The type of cancer, their Stadium (extension of the tumor) and its prognosis.
• The weeks of gestation to diagnosis and fetal viability.
• Possible adverse effects of the treatment in the fetus.
• Risks to the mother of delayed therapy.
• Risk to the fetus if it did lack induce a premature birth.
Taking all these factors into account, there are several possibilities:
• Delay treatment until the child can be born safely. In this case would have to quantify the risk that this entails for the mother and also assume that the mother will have to take care of a premature infant, that he may also have sequels while she faces the side effects of his cancer treatment. This option is more feasible the more advanced pregnancy and earlier is cancer.
• Terminate the pregnancy to start treatment as soon as possible. It is the option safer for the mother, but also unacceptable for many of them. It is more considered the more is early pregnancy.
• Treat the cancer as effectively as possible while continuing with the pregnancy, trying to minimize the risks to the fetus. It is the most accepted choice.
Problems with treatment
In addition to late diagnosis, chemotherapy and radiation are harmful to the fetus.Breastfeeding is contraindicated in patients who are being subjected to chemotherapy
The effects of radiation on the fetus are varied depending on the weeks of gestation: before 10 weeks it may be lethal, until week 16 can cause mental retardation, retardation of growth, and from six months until the birth can cause sterility, malignant tumors or genetic alterations. Therefore, generally radiotherapy is contraindicated, although occasionally used above the diaphragm with abdominal protection, especially at the end of the pregnancy.
The problem with chemotherapy is almost all drugs that are used to cross the placenta and reach the fetus. These drugs they do is inhibit cell division so the tumor does not grow, and this is a risk for fetal development. A: associated chemotherapy during pregnancy, miscarriage, malformations, genetic mutations, tumors and delay development. If the pregnancy finally reach its term, breastfeeding is contraindicated in patients who are being subjected to chemotherapy.
If the treatment includes surgery, is usually well-tolerated, provided it does not affect the genital tract.
Breast cancer and pregnancy
Within all cancers during gestation, we must make special mention to breast cancer, because it is the most frequent. It is estimated that breast cancer takes place in one of every 3,000-10,000 women pregnant or postpartum women. 10% of patients with breast cancer are under 40 years of age and pregnant to the diagnosis. 3% of breast cancers are associated with pregnancy. Its prevalence figures include cancers that appear during pregnancy and those that occur up to one year after childbirth.As we have seen, diagnosis is often delayed, because the physiological changes that occur in the breast can hide small tumors. To help the diagnosis, suspected breast cancer, a mammogram and an ultrasound can be done. A suspicious lesion thick needle biopsy may also be done. MRI is contraindicated during pregnancy, although it may be done in the postnatal period.
When you start the treatment, fetal development should be evaluated to decide when to end the pregnancy. After the birth, could not be breastfeeding while mother is in treatment with radiotherapy or chemotherapy. Yes it is possible by the healthy breast lactation when the treatment is completed.
Following pregnancy not should be planned until after at least two years after treatment of breast cancer, as a new pregnancy could increase the risk of relapse (reappearance of the tumor).
Overall survival at 5 years is 70%, although it depends on the spread of the disease. It is important to know that pregnancy does not alter the prognosis of breast cancer.
Preservation of fertility after cancer
One of the problems that arise in the management
of cancer in women in fertile age is that many of the treatments of the
disease may prevent future pregnancies by natural way.You should not be maintained intact reproductive system of the mother, there are various techniques to preserve their fertility. Different techniques depends on the type of tumor and the time available until the oncologist to start cancer treatment.
There are several options to achieve the preservation of fertility after cancer:
• Can vitrification oocytes from women or, in case of a couple, embryos are can vitrify. Vitrification is a special form of freezing allowing the pregnancy of women through the implementation of the oocytes or fertilized embryos when the disease has passed. The problem is that they need 2-3 weeks to stimulate the ovaries with hormones before collecting the oocytes. This can delay the start of chemotherapy. In addition, this technique is contraindicated when the tumors are sensitive to the hormones that are given to stimulate the ovaries.
• Can be removed and tissue to cryopreserve ovarian. After the cure of the disease this tissue may placement instead of origin, what can get the ovaries to recover its natural functions.
Surgery • you can change the location of the ovaries so radiation therapy do not damage them.
• Also can be administered a drug to inactive ovaries during treatment and thus damage as little as possible.
Many of these techniques results in reproductive prognosis of women is same as before the illness.
3 nutrition and cancer
We must consume adequate nutrients, before, during and after the treatment that follows the patient, such as vitamins, minerals, proteins, carbohydrates, fats and water. This will provide a very significant improvement in the quality of life.
Consider that these patients suffer in many cases malnutrition (40-80%), showing a decrease in weight loss of visceral and somatic proteins.
We will take into account the impact of malnutrition:
• A poor prognosis of the evolution of the disease.
• Less possibility of response to treatment.
• Worsening of quality of life.
• Increased morbidity and mortality associated with the treatments.
Therefore, it is necessary to know the causes that can lead to malnutrition in the patient of cancer in order to control them.
The type of cancer-related causes of malnutrition
• Mechanical or functional alterations.• Metabolic disorders.
• Secretion of chemicals: tumors may produce chemicals that change the way in which the body uses nutrients. This affects how the body uses proteins, carbohydrates and fats, especially when the tumor is located in the gastro-intestinal tract (stomach or intestines).
Causes of malnutrition related to patient
• Acquired habits: patients bring with them a
wrong feeding habit, so once it becomes a cancer patient, continues with
the same habits.• Anorexia: it is the lack of appetite. It is one of the causes of malnutrition in cancer patients. It can appear either at the beginning of the illness or later.
• Cachexia: it is a syndrome of physical wear and tear that causes weakness and weight loss, including fat and muscles. It is more often depending on what type of cancers. Anorexia and cachexia tend to go together, so weight loss may be due to one lower calorie intake, since they have decreased appetite, either because the body does not absorb properly ingested nutrients, hence cachexia.
Causes of malnutrition related to treatment
• Surgery: surgery increases the nutrient and
energy needs since our body is going to be used in healing wounds, to
avoid possible infections and a speedy recovery.• Radiation therapy: it is a treatment that uses radiation with high energy content so that the cancer cells are removed. It can affect healthy cells, this will depend on the treated area and the dose. As side effects can be anorexia, changes in taste, swelling of the mouth and gums, vomiting, infections, as well as fatigue.
• Chemotherapy: this is another cancer treatment consisting of different drugs that Act preventing proliferation of cancer cells, either by removing them. In this way it just also affecting healthy cells, and again causing effects side that can affect the entire body. They may appear related to nutrition, side effects such as anorexia, nausea, vomiting, diarrhea and constipation, inflammation and sores in the mouth, change in the taste of food and infections.
Evaluation of nutritional status
Both the treatment and the identification of
nutritional problems since it begins may improve the prognosis of the
patient, improving the response to treatment and being able to achieve
recovery. It is important to conduct an
assessment of the nutritional status of the patient, to determine
possible problems that could affect the treatment of cancer; patients
with overweight or malnutrition may be that they do not respond well to
treatment, even sometimes the disease itself that causes malnutrition.This is carried out assessments and exams before and following periodic reviews during the treatment. To start is usually ask the patient the following information:
• Weight changes that have arisen in the past six months.
• Changes in the amount and type of food consumed in comparison with usual.
• Problems that have been able to affect food consumption (nausea, vomiting, dry mouth, etc).
• Ability to perform everyday, walking...
To this is added the realization of a physical exam, where the doctor will look for loss of weight, fat and muscle, or any fluid retention. All these evaluations are carried out by health professionals with experience in nutrition.
The goals of nutrition therapy for these patients are:
• To minimize the side effects caused by treatment.
• Improve the quality of life.
• Prevent or correct malnutrition.
• Prevent the atrophy of muscle, bone, blood, organs, and other lean tissue.
• Help the patient to tolerate maximum treatment.
• Maintain the strength and energy.
• Protect the body's defenses to combat potential outbreaks.
• To contribute to the recovery and healing.
Adequate nutrition must continue once completed the treatment, since it remains important for patients who are in remission or they have healed (symptoms have disappeared, but does not mean that it is permanently curing).
Therefore the quantitative assessment of the nutritional status of the patient serves to define in which cases it is recommended nutritional intervention, highlighting:
• Nutritional education of the patient and family.
• Management of different symptoms.
• Pharmacological intervention.
• Nutritional intervention.
Relief from lack of appetite in the cancer patient
Lack of appetite is one of the most common problems in cancer patients. Suggestions that help to this problem are:• Eat small meals with high protein content and high in calories, instead of three big meals, every 1-2 hours.
• Cook adding to food proteins and calories without increasing its volume. Some ways to son:• Add honey, cream, milk powder or soy to the food being prepared. Alternatively, add butter, margarine, cream, cream, cheese to Italian pasta, rice and potatoes.
• Use milk instead of water to dilute the condensed soups or purees.
• Add chopped dried fruit, boiled eggs, strips of ham, cheese soups, purees, and creams.
• Add honey, liquid candy, nuts, condensed milk, hot chocolate, ice cream desserts.
• Prefer ice cream nougat, hazelnut, coconut fruit ice cream.
• Sauté vegetables with Bacon, ham, sauces, sauces like bechamel sauce, mayonnaise or tartar sauce.
• Drink liquid supplements, soups, milk, juices, smoothies, fruit, etc.
• Eat foods with pleasant aromas.
• Obtain aid for meals and try new foods, because the preferences and the rejection of certain foods change daily.
• High calorie foods are meat, fish, eggs and milk derivatives.
• Use large plates to make it look like there is less food.
• Keep food when no one is eating.
• Walk before meals can stimulate the appetite.
Relief of taste alterations in the cancer patient
Alterations in cancer patients taste may be due to different causes, such as medication, radiation or even dental problems. When they experience these changes in taste may appear weight loss, or that notice certain rejection of specific foods.For example, when they receive chemotherapy, patients experience a feeling of bitter. It is therefore convenient to consume lots of fluids, change the types of food consumed, and add spices or flavorings (flavor enhancers, as such sweeteners) food.
Here are some recommendations to deal with these changes in taste:
• Rinse the mouth with water before meals.
• Try citrus like oranges, tangerines or lemons.
• Eat your favorite foods.
• Eat foods cold or tempered so that they give off odor and diminish its taste.
• Cook with soft foods such as basil, mint, oregano, Rosemary, thyme, laurel, fennel, marjoram, orange or lemon juice.
• Replace red meat by poultry, fish, eggs and cheese.
• Add spices and sauces to foods.
• Eat when hungry and not necessarily at the established times, whenever they perform necessary meals.
• Eating with family and friends.
• Use candies of lemon without sugar, chewing gum or mints when they suffer the bitter or metallic taste.
Tips in case you notice a metallic taste
• Choose flavors strong as the cheese, ham, etc.• If not tolerated meat, replace it with other protein-rich foods: fish, seafood, cheese, eggs, legumes, soy...
• Enhance the taste of food with different sauces: béchamel sauce, mayonnaise, egg base, cream sauces, or similar.
• Drink tea with lemon or Mint.
• Eliminate tastes strange in your mouth with mouthwash and candy and chewing gum.
• Use plastic cutlery.
• Use wooden utensils for cooking.
• Avoid contact of acid products (vinegar, fruit juices, tomatoes.) with metal containers, because they facilitate the dissolution of the latter (some stainless steel pans release nickel in contact with acidic foods).
Relief of dry mouth in the cancer patient
The oral dryness may occur as a result of radiation therapy or be caused by different drugs. This
symptom affects speech and may cause oral problems, since there is
deficiency of saliva, the sense of taste is reduced and even appear
difficult to swallow. For comeback, the most important is to drink plenty of fluids during the day, in addition to:• Eat moist foods with sauces, butter...
• Take liquids or soft foods: flan, ice cream, soups, stews, juices.
• Suck on hard candy or chewing gum.
• Use vinegar and lemon juice to season food.
• Avoid milk, can cause more Pasty mouth feel.
• Increase fluid intake in the diet.
• Eat little, but often, performing more than three meals a day.
• Always carry a small bottle of water to moisten the mouth when dry. Remember that he must drink two to three litres of water a day.
• Take drops of lemon juice to stimulate saliva.
• Do not use mouthwashes that contain alcohol.
• Chew two pearls of evening primrose oil before bedtime (also can be used during the day)
• Avoid foods or liquids with high sugar content
Relief from sores and oral infections in the cancer patient
Mouth sores or infections are a result of chemotherapy and radiotherapy. Among other recommendations to control them we have to:• Eat soft foods that you chew and swallow easily.
• Avoid dry foods (toast, nuts), strong spices (pepper, paprika), acidic flavors (lemon, kiwi), very salty, sweet or bitter.
• Use sauces, cream, butter, or jelly to get the desired consistency for easy swallowing.
• Drinking water daily.
• Avoid alcoholic beverages, cigarettes, pipe and any form of tobacco.
• Eat foods at room temperature or cold to reduce pain.
• Cook foods until they are soft and tender.
• Have good oral hygiene, brushing your teeth and rinse your mouth after each meal and before bedtime.
Relief of nausea and vomiting in the cancer patient
Nausea and vomiting appear with some
frequency in people treated for cancer, something that also usually
normally affect the amount and types of food consumed. As recommendations to alleviate them or avoid them in cancer patients, we propose:• It is advisable to begin the day with dry foods such as toast and oily little cookies.
• Eat soft foods, soft texture, avoiding heavy meals.
• Avoid fried foods, sauces and dressings with vinegar.
• Preferably steaming.
• Use spices like cinnamon, mint, fennel, thyme, basil, laurel or ginger in your dishes.
• Drink liquids in small SIPs throughout the day.
• Rinse your mouth before and after eating.
• Distribute food in small frequent meals.
• Infusions of Chamomile, mint, anise, orange blossom and Lemongrass after meals help to find better.
• Have fresh air in the House, since the breathe more oxygen helps calm the stomach and the feeling of nausea
• Encourage rest and relaxation.
Relief of diarrhea in the cancer patient
Diarrhea can be caused by different causes, such
as the treatment of the disease, if it has undergone intestinal or
stomach surgery, or simply by the State of anxiety or nerves which
entails the cancerous process.It can cause dehydration or deficiencies of nutrients in the body, such as minerals, salt and potassium, so it is important to solve it. It is recommended to relieve diarrhea in patients with cancer:
• Avoid foods rich in fiber, since this facilitates intestinal transit.
• Do not take fatty foods.
• Drink lots of fluids during the day.
• Are better tolerated temperature ambient hot or cold liquids.
• Limit the consumption of milk and its derivatives, until the end of the period of acute diarrhoea.
• Drink 2-3 liters of water everyday.
• It is recommended to isotonic beverages.
• Food, cooking it in a simple way: steamed, boiled, baked...
• Take food and drinks to warm temperature.
• Avoid milk, coffee, chocolate, acidic juices and fresh fruits.
• Do not eat foods that produce gas.
Relieve constipation in the cancer patient
Constipation is defined as less than three
bowel movements per week, and is very common in cancer patients, lack of
fiber, water and by treatments such as medication and chemotherapy. Recommendations to relieve it as we have:• Drink plenty of fluids a day.
• To increase peristalsis or movement of the intestines, you can take in a glass of lukewarm water, coffee, orange juice, two or three plums and juice fasting.
• Cook preferably steamed, baked, grilled or broiled, boiled or Papillote.
• Use the wines after the vegetables have cooked.
• Take the fruit fresh and preferably with skin, can also be prepared in compote, macedonia or baked.
• Eat fish blue and white.
• Avoid foods rich in tannins, such as quince, tea, red wine and Apple.
• Get regular exercise helps with the evacuation. The simple act of walking can help you.
• Eat foods rich in fiber, such as legumes, vegetables and fruits, and cereals.
• Other tips to treat constipation.
4. how cope with chemotherapy
Chemotherapy, how to face it?
Among the most common to combat treatments cancer disease is chemotherapy along with radiotherapy, hormone therapy. These techniques, according to each patient's needs, can be applied separately or jointly.Chemotherapy is a treatment by which a drug or a set of them is used to remove cancer cells in the body. This implies that other healthy cells can see affected, producing negative side effects.
Negative effects of chemotherapy
Among the adverse effects of chemotherapy is
hair loss generalized in body, fatigue, loss of appetite, nausea and
vomiting, diarrhea or sores in the mouth and lips. One
of the consequences of introducing foreign materials in the body is
that it reacts aggressively to them, trying to remove them as you can,
hence the appearance of vomiting and diarrhoea. But the most problematic symptom associated with this type of healing is the loss of sensitivity to odors and flavors.As happens to a hospitalized patient, which seems to him that all food from the hospital know same, smells which are under this treatment food and tastes bad. Actually the foods you eat are the same as always, but as you have stomach stirred by drugs that has consumed causes Kickback at lunchtime. In addition, when you eat it can be found quickly has to go to the bathroom to vomit it, because the stomach is irritated by chemicals and food is not well supported.
This problem is seen sharpness when we have people that they need to be served to eat, as in the case of minors and the elderly. It is not that they might have a unit that needed to be assisted for these tasks, but with chemotherapy prior to treatment and its effects there is a loss of appetite, refusing to take any food. It must be borne in mind that not all of these effects will be present, since it depends on the chemotherapy treatment administered and the strength of the body, but yes it can appear several of these consequences.
Are these effects permanent?
It is important to think that almost all of
these side effects are usually temporary, staying more or less time
depending on the strength of the body. He thinks that, in the end, when the treatment is completed these effects will disappear.Check that it is deteriorated progressively, when it should be improving, tends to be the hardest part of treatment with chemotherapy; but keep in mind that it is fighting the disease and as happens when we resfriamos, we encamamos and have fever as a healing mechanism, so also in the fight against cancer the body suffers.
How should patient cope with chemotherapy?
Chemotherapy treatment is applied according to the
age of the patient, to the type of cancer, its extension and the
general State of health of the affected.The going from a chemotherapy session to another is the time that the person needs to recover from its effects. For this reason it is so important that the person receives the necessary advice to carry out a reorganization of its life, which take into account not only of treatment sessions, but the side effects that truck, which often limit the development of a normal life.
The patient must learn to understand that the experience of receiving chemo will not only affect you physically, but it can totally change your life. The person depends on taking advantage of these changes to learn and grow as a person, adapting to them, or suffer to see how his life cannot remain as he had known it so far.
They will present difficulties, moments that you have to make important decisions, are going to arise problems, disillusions and disappointments, but it will also experiment support, affection, respect and love, dedication and patience, companionship and the delivery of family, friends and medical personnel. One same depends on know to appreciate the nuances of these new experiences that can both enrich your life, without therefore remain alien to the difficulties. Learning that many will change, becoming delivered people to squeeze every moment, helping others and sharing with others the good life.
Many are the changes that the person with cancer should take in his new life. It is not only put a dent in the agenda, to make revisions or for treatment sessions, it is much more. It is creating a new style of life around the disease: now has to take care of more physically, you will have to change your way of eating and drinking, you will have to work to reduce anxiety, avoid excesses and do daily exercises of maintenance.
How does chemotherapy to couple and family relationships?
One of the aspects to planning during cancer
treatment is the relationship, since this can be seriously damaged, can
cause the separation or divorce. This is both
due to the exhaustion from the couple, by having to attend to the
patient, be always aware of it, take care of him and also take their own
life and obligations later, as because the relationship between them is
not stable.To overcome all these difficulties is convenient that there is good communication between the couple, is necessary to make a schedule in which decide how to deliver patient care time, so this is not the only activity of the couple. Leaving it thus time of relaxation and recreation that can exercise any activity that separate you and serve you to disconnect from the status of patient care.
How it affects affiliates relations and how to help?
Parents, when a child is who is sick of
cancer and treatment, typically remain at his side, dividing the tasks
of your care and combining that careful with their own chores, to the
extent possible in order to continue life as normal as possible. Thinking between two care and household tasks are made more bearable.An aspect to be considered by the parents is that their children behave certain way depending on the reactions that they see in others, if they feel rejected or overprotected them will tend to worry, because they will understand that what they have is more serious. Hence the importance that parents overcome their own fears and concerns, and obtain all the necessary information about the disease, its evolution and cure to offer sincere support to their children, without having to hide crying when he not look, or fights between the couple for not released tensions.
In the case where the adult is the patient, an important error which sometimes incurred is seek the support of the children for part of the patient or his partner.
Sometimes the children reflect the concern of parents, endorsing it and putting them bad, other times ill looking for the attention they have lost when donning one of his sick parents. In all these cases, best thing to do is to talk to them calmly to clean off any fears they may have.
How can friends help a patient with cancer?
Sometimes, the cancer can produce a prejudice in personal and social relationships. With
regard to relations of friendship, if these are strongly established
will be an important source of support, especially in times of recovery
between the stages of the treatment. On the other
hand, if it's superfluous friendships, where it unites them is not a
loop of sincerity and trust, but only share a few concerns or activities
in common, is possible that the patient will be losing those
friendships. First, because a person with cancer
that follow a treatment of this type will not have the same time than
before to cultivate that friendship, and may not have health or
encouragement to continue with these activities. Secondly,
because for the reasons some friends will begin to count less and less
with that person, until a time that no longer have it in mind in their
plans.Is therefore necessary also to establish a management regarding friendships, to address them as far as possible when the patient this recovered between sessions of chemo treatment.
Anyway, the patient should not judge the behavior of others based on their own point of view, as for others, life has not changed, they are still with the same expectations and way of living and has been the patient who has been separated from that life because of their personal circumstances.
5. head and Neck Cancer
• Tumors of paranasal sinuses and nasal cavity.
• Cancer of the nasopharynx, Oropharynx (tonsils, soft palate and base of the tongue), hypopharynx, larynx (glottis, supraglottis and subglottis).
• Cancer of the oral cavity (oral mucosa, gingiva, hard palate, mobile tongue and floor of mouth), lip and glands salivary.
• Exempt via upper Aero, cutaneous tumors, tumors of the central nervous system and thyroid.
It's an extraordinarily complex anatomic region, so that is has reached an agreement on the standardization of different levels of neck to unify criteria of treatment. They are divided from level I to VI, and limits are the base of the skull, collarbone and front edge of the trapezius muscle.
Prevalence of head and neck cancer
As a whole, head and neck cancers are the
fifth most common malignancy and the third tumor is more prevalent,
second only to breast cancer and colon. It represents 7% of all new cancer cases. The commonest histology (80%) are epidermal, and can also be found lymphomas, sarcomas and melanomas.Head and neck cancer is one of the tumors whose incidence grows more, due to the increase in the consumption of tobacco and alcohol. Worldwide more than half a million cases of cancer of the head and neck (oral cavity, Oropharynx, hypopharynx and larynx) a year, are accounted for by what is seventh place in frequency over the total number of malignant tumors. In Spain, only about 5,000 new cases occur each year. It is estimated that in 2020, the growth and aging of the population will result in a doubling of the figures, with more than one million new cases and more than half a million deaths each year.
The distribution by sex is four to one for males. In Spain is responsible for 5% of cancer deaths. It is the most common cancer among men over 55 years, being the average age of onset is age 60 (lower if it is of nasopharynx and glands salivary).
Experts predict that in a few years in men the risk of tumors will decrease by 2% and in women will increase (24% in the oral cavity, 37% in the larynx and 67% in other locations of the mouth and neck), which responds to changes in the social habits of consumption of tobacco and alcohol.
Causes of head and neck cancer
In Western countries, the main risk factors
for the emergence of head and neck cancer are consumption of alcohol and
tobacco, which together represent approximately 75% of the disease. Exception of nasopharyngeal tumors, tobacco and alcohol are at the origin of the 90% of tumors.However, the abandonment of these habits is to decrease the risk of a malignant tumor of the head and neck, according to a review of works international, which last year participated in the Catalan Institute of Oncology, published in the International Journal of Epidemiology magazine.
The main risk factors for head and neck cancer are consumption of alcohol and tobacco, which together represent approximately 75% of disease
The results of the combined analysis showed a reduction in the risk of developing a tumor in head and neck after quitting in only 1 - 4 years. On the other hand, is only estimated a 40% profit on the risk of head and neck cancer after approximately 20 years to stop drinking alcohol. This may be due, whether that requires a longer time between cessation of alcohol abuse and the decrease of the risk of head and neck cancer, or a certain amount of irreversible damage associated with consumption that persist over time.
Other risk factors for head and neck cancer
The classic causes of head and neck cancer are tobacco and alcohol, but there is more, like:• Infections.
• Dietary factors.
• Occupational factors.
• Exposure to radiation.
• Genetic susceptibility.
Advances in surgery of head and neck cancer
In operation of head and neck cancer, oral and
Maxillofacial surgeons are responsible for remove tumor areas affected
as well as of its reconstruction, providing the minimum amount of
sequels.The technique of the Sentinal, able to identify the lymph node that could be invaded by the tumor has begun to be used in formal way in head and neck cancer in oral and maxillofacial surgery services of various Spanish hospitals will allow to avoid the realization of cervical surgery in nearly 8 of every 10 patients, as it was evident in the National Congress of the Spanish society of Oral and maxillofacial surgery held in Valladolid.
So far was a cervical emptying virtually all of head and neck cancer patients, well it was therapeutic, preventive or to determine the extent of the disease, but less than the third part of the patients presented metastasis lymph nodes. The application of the technique of Sentinel lymph node and a more selective lymph node draining, according to their Stadium, will reduce side effects of the intervention and accelerate the recovery of the patient.
The technique consists of injecting a radioactive isotope which can detect the nodes in which occurs the tumor area drainage to intraoperative way then determine if it is infiltrated by cancer cells, so that you can indicate the need for a more aggressive attitude.
Lymphatic metastases occur in between 20% to 30% of patients with oral cancer at early stages and on most of the centers was conducted so far elective neck dissection, so that 70% to 80% were exposed to possible morbidity without benefits. The usefulness of the Sentinal, melanoma and breast cancer, biopsy has been also validated in cancer of the oral cavity after the publication last year of a study in the journal of Clinical Oncology. This compared the technique of node sentry with the rest of lymph nodes in neck dissection. Showed that the rate of false negatives in floor of mouth cancer reaches 25%, not so for the rest of the oral cancers that reached around 10%. In addition, false negatives not found in early stages or procedures performed by surgeons with experience.
In early stages (stages I and II) surgery gets close to 80% cure figures. However, only one-third of the patients are diagnosed at these stages, says Dr. Redondo. When the disease occurs in local advanced stage (stage III and IV), the 5-year survival is 30% of the patients.
6. Colorectal Cancer
Although malignant neoplasms of the lung and breast are which arise with greater assiduity in the sexes, male and female, respectively, cancer of the colon and rectum is neoplasm that affects both sexes more frequently, resulting in one of the leading causes of death by cancer in Western countries.
Cancer of the colon and rectum occurs especially after age 50, and is more common in males. Almost always develops over an initial benign lesion called polyp, which takes years to grow and just in 5-10% of cases are very.
Various types of cancer at this level can be distinguished according to the microscopic characteristics of the tumor, but in 95% of cases it's adenocarcinomas, it will refer to this variety at all times.
In Spain, the incidence of colon cancer has increased in recent years, as it has happened, in general, in all industrialized countries. In our country, it is the second leading cause of death by cancer, with about 14,000 deaths per year.
Causes and risk factors for colon cancer
Environmental factors and genetic factors may be involved in the development of colon cancer. See below some of the causes of colon cancer.
Power
Specialists say that a diet rich in saturated fats favours the appearance of colon cancer. There
is also an increase in the risk of developing the disease when the
individual is obese or maintains a high caloric intake. On the other hand, aspirin and calcium supplements may decrease this risk. However, studies in which no has been demonstrated that fiber intake lowers the risk have been conducted.
Age
Usually colon cancer appears above age 50,
although there is an increased risk to develop from the age of 40, and
most of the patients have around 75 years.
Polyps as a possible cause of colon cancer
There is an important relationship between colorectal cancer and adenomatous polyps. A polyp is a bump that appears on the surface of the intestinal mucosa. There are different types, but only the adenomatous are clearly premalignant; In
addition, only a minority of these become cancer, so cancers due to the
transformation of a polyp represent 1% of all cancers.
Associated diseases
The fact of having an inflammatory bowel
disease (Crohn's disease or ulcerative colitis) is an increased risk for
developing cancer of the colon, especially in the case of ulcerative
colitis. There are other situations that also
constitute an increased risk of this disease, as having suffered genital
and breast cancer, or have had adenomas in the colon.Also poses a high risk have family members who have had cancer hereditary colon or polyposis syndrome.
Genetic factors as a cause of colon cancer
You have categorized various genetic alterations
related to the development of colon cancer, in particular genes altered
in familial polyposis and hereditary colon cancer.90% of colon cancers arise sporadically, while 5-10% are hereditary non polyposis-associated cancer, i.e., that the patient has more relatives with cancer. Around 1% of colon cancers originate from a polyposis syndrome adenomatous (presence of multiple polyps in the colon), which also affects more than one family.
Symptoms of colon cancer
Clinical presentation and symptoms of colon cancer vary depending on the location of the tumor.• In the left colon tumors symptoms manifested in general in form of blood in stools, alteration in the bowel (diarrhea or constipation), and a feeling of incomplete evacuation after the deposition, among other symptoms.
• The transverse colon tumors in their symptoms usually manifest itself causing pain and obstructive symptoms. Although it is more common in this location, the growth of the tumor can occlude the intestinal lumen and caused an acute intestinal obstruction resulting in a pain of cramping, bloating and vomiting.
• The right colon tumors usually cause hidden hemorrhage (not seen with the naked eye), causing chronic anemia due to blood loss, which is that will lead to the symptoms (fatigue, pallor, and so on).
A complication of colon cancer rare, but very serious, is intestinal perforation. If it occurs it can lead to peritonitis which should be addressed urgently.
In addition to these local symptoms, colon cancer also can lead to general symptoms such as tiredness, loss of appetite and weight, tumor fever, etc.
Diagnosis of colon cancer
Time to diagnose colon cancer can save your
life, since it is estimated that this tumor is cured in nine out of ten
detected at an early stage. These are the methods used to diagnose colorectal cancer:
Diagnosis of cancer of colon through physical examination
The doctor observes pallor presenting the patient as a result of chronic anemia. It
can also detect nodes increased in size, abdominal masses, and other
significant physical manifestations through the examination of the
patient. It is very important to practice a
rectal examination to rule out that the location of the tumor is in the
rectum, and to study the content and fecal color and detect bleeding in
stools if there was.
Diagnosis of cancer of colon through Imaging tests
The best method of diagnosis that must always be used at the suspicion of a colon cancer is colonoscopy. With this test you can see inside the digestive tract and remove suspicious lesions samples for later analysis.In the event that there are lesions that clog the intestinal lumen and does not allow the passage of the endoscope, must be a barium enema to be able to see the silhouette of the colon by means of x-rays.
Once it has confirmed the presence of a colon cancer should do a series of tests to determine the extent of the disease. These tests must include a chest x-ray to rule out pulmonary metastases, and abdominal CT or ultrasound to rule out liver metastases.
Stages of colon cancer
Depending on the extent of the tumor in the colon
wall can be classified the cancer at different stages (classification of
Astler-Coller) that are important to establish adequate treatment, and
also facing the prognosis.• Stadium A: single tumor affecting the lining of the colon.
• Stadium B: the lymph nodes are not affected (depending on the extension on the wall are distinguished within this stage: B1, B2 and B3).
• Stage C: lymph nodes are affected (can also be distinguished in this stadium: C1, C2 and C3).
• Stadium D: there is metastasis.
Carcinoembryonic Antigen (CEA)
It is a protein that is detected in the blood in
these patients, but is not specific to colon cancer, i.e., may appear in
other even benign processes, so it is not useful to diagnose the
disease, but is useful for the follow-up of the operated patients, and
must determine its value prior to the surgery to be able to compare them
later.
Early diagnosis of colon cancer
It consists of programs of detection of cancer in
patients who have no symptoms, so the disease can detect and treat very
soon to improve the prognosis in the long run.Currently it is recommended to make the test of occult blood in stool annually starting at age 50. In patients with a family history of colon cancer or diseases associated with the same, revisions must start from an earlier, and include endoscopy from the beginning.
Currently is recommended test of occult blood in feces annually starting at age 50 in order to detect early colon cancer
This immunological tests is a safe and simple laboratory testing, does not require prior preparation by the patient (no need to diet) and is very easy to pick up.
If the results of the analysis are negative it should be repeated every 1-2 years and if they are positive must be a full colonoscopy to confirm the diagnosis. In other situations, it may be necessary to practice initially optical colonoscopy either complement the study with a virtual colonoscopy.
Its average cost is very economical, around two euros, especially in relation to its preventive efficacy, since they get to reduce one third of colon cancer deaths. According to data from the year 2013, the average cost of the treatment of a colorectal cancer in Spain exceeded the 27,000 euros, unposted new biological therapies and neoadjuvant treatments which may be required in patients with more advanced cancers.
Colon cancer treatment
There are different possibilities for the treatment of colorectal cancer:
Surgery
The treatment of choice in colon cancer is surgery. The
type of resection will depend on the location of the tumor, so in some
cases you can remove neoplasia area simply, and in others there will be
to remove older segments that include healthy colon.There are occasions in which the tumor can not be resected, so you have to place denture in the interior of the intestinal lumen to allow transit to that level and relieve the symptoms, or perform a palliative operation to prevent intestinal obstruction.
In the event that there are metastases in other organs, surgery will be in the colon and will study the possibility of also removed these metastases, depending on their location and size and the general condition of the patient.
Radiotherapy
Used in rectal cancer. It
can be used prior to surgery in the case of large tumors to reduce its
size, and also after the surgery, from stage B2, to decrease the risk of
recurrence of the cancer. See more about radiation therapy
Chemotherapy
It can be used as a treatment in cancer of colon and rectum from the B2 stage after surgery to improve survival. In the case of disseminated disease (stage D) can also be used as palliative chemotherapy. See more about chemotherapy
Postoperative follow-up of colon cancer
After treatment, the mortality caused by this
tumor is due to the emergence of local recurrences or distance, so has
to carry out a subsequent monitoring to detect these potential
developments early.Currently there is a pattern defined on how to track this, but there are a number of tests that can not miss, such as:
Colonoscopy: is the best method for the diagnosis of local recurrence or cancer metacronico (new tumor in the colon that occurs at a location other than the one in which the initial malignancy was located). A colonoscopy should be a year of surgery and, subsequently, every 2-3 years. If no tumor findings are not can be once every 5 years.
Measurement of carcinoembryonic Antigen: it should return to its normal values after resection of the tumor, and is recommended to measure it every 3 months. The elevation of the CEA is very good marker of tumor recurrence, and on many occasions the first data that appears, so if it is detected elevated CEA recommends testing to locate recurrence (x-ray of thorax, abdominal CT and bone scintigraphy).
Prognosis of colon cancer
The prognosis of colon cancer depends on the
extension that has the tumor in the wall of the colon, the existence or
not of lymph nodes affected, and presence or not metastasis.There are a number of factors that determine a worse prognosis:
• Preoperative CEA elevation above 5 ng/ml.
• Existence of venous invasion.
• Presenting himself as an obstruction.
• That there is perforation of the wall of the colon.
• Specific genetic alterations in tumor cells.
The overall survival of patients with cancer of colon five years after surgical resection radical is around 40-50%, but this percentage is distributed differently in relation to different stadiums, in such a way that in A stadium survival at 5 years reaches 75%, while in the stage D does not exceed 1%.
Prevention of colon cancer
Despite being the cancer with the highest
rates of mortality in our country, paradoxically, it is one of the most
treatable, and one of that better offers if you detect it early. The current median survival in Spain is around 50% at five years from diagnosis. However, if caught in time, it is estimated that colorectal cancer can be cured in 90% of cases. To
do this, it is necessary to activate a series of preventive measures in
two ways: improving the habits of life and early detection tests.Primary prevention of colorectal cancer
Having a healthy lifestyle habits is essential to prevent the risk of any cancer, also this. In this sense, it is useful to know which of these simple changes can start from today itself:
It carries a balanced diet
• The Mediterranean diet is the epitome of healthy diet, follow it.
• Fiber-rich foods (whole grains, legumes, integral flours, dried fruit, vegetables...) they are good for your body, take them frequently.
• Attempts to comply with the recommendations of the experts and taken five portions of fruit or vegetables a day.
• Labels of products that you eat is always looking, keep them according to the instructions of the manufacturer and consume them before they spoil.
• Red meat, and fat intake in general, increases the risk of cancer, moderated their intake.
• Reduces making sweets and foods high in sugars.
• Alcohol is one of the most obvious risk factors, giving side.
Don't smoke
• Tobacco is causing direct and indirect of large number of cancers. You do not play it, it turns off the cigar.
Practice regular physical exercise
• A minimum of 30 minutes a day or at least 3 or 4 days a week go out to run, swim or walk at a good pace. Any sport is good for staying in shape and having cancer at Bay.
Avoid sedentary lifestyle
• Obesity and overweight are risk factors for many diseases, including cancer.
• Try to stay active and control your weight based on your physical characteristics. In addition, you will feel better avoiding sedentarism.
Secondary prevention of colon cancer
Starting at age 50 and up to 90 is recommended to perform periodical screening strategies to detect a possible colorectal cancer and act in time. Don't have to wait for obvious symptoms to go to talk to your doctor about this matter, especially if you have a family history who have gone through this type of cancer (one of every four cases of colon cancer have a family or hereditary component). From the Alliance for the prevention of the Cancer of Colon are recommended to perform the following diagnostic tests:
• Analysis of detection of blood stool occult every one or two years. This simple test can reduce mortality by between 30% and 35% colon cancer, which would save 3,600 lives a year.
• Sigmoidoscopy every five years.
• Colonoscopy every ten years.
7. Cervical Cancer
The cervix is the second most common cancer in women aged between 15 and 44 years in Europe, although their frequency varies from some countries to others. As normal is to appear in over 54 years of age, but has been observed in recent years affecting more and more young women.
Risk factors for cervical cancer
• Age: older women are more vulnerable to suffering from it.• Genetics: it is common that appears in women whose mothers also had cervical cancer.
• Tobacco and alcohol.
• Incidence is greater in low socioeconomic environments.
• Early age of first intercourse.
• High number of sexual partners (major factor in prostitutes).
• Suffer or have suffered from a sexually transmitted disease. Infection with the human papilloma virus is especially important in this risk group.
• It is believed that he can also play an important role of hormonal contraceptives.
• It is most common in women who have given birth ever than those who have not had children.
• Immunosuppression: AIDS, women who have undergone a transplant...
Symptoms of cervical cancer
Cervical cancer is often asymptomatic in the early days of the disease. Once
it begins to manifest itself, appear (this feature the difference of a
menstruation) acyclic vaginal bleeding, painless and, often after
intercourse. At the beginning is of small losses that are becoming more abundant progressively.On the other hand, vaginal discharge becomes a pinkish as "water washing meat". In addition, is pelvic pain that radiates to the legs. Other cervical cancer symptoms are: pain during urination, blood in stool and urine, constipation, and tenesmus (desire continuous, painful and ineffective from defecating or urinating).
At all times the main manifestations of the disease are accompanied by a series of symptoms common to many other diseases such as: loss of appetite, weight loss, fatigue and malaise.
In very advanced stages are bladder or rectal fistulae. Fistulas are abnormal communications between neighbouring organs which should not be present.
Diagnosis of cervical cancer
In sexually active women and childbearing age, is a routine cytology in the gynecological consultation. In
this way it can be evaluated to a large majority of the population at
risk, and it is possible to detect cancer of the uterus in the very
early stages, thus improving the prognosis of the disease. This test is known as PAP, and is used to study cervical cells and the possible presence of abnormal cells. Take samples of at least three areas of the cervix so that it will not be any area without studying.Other tests are also used to elucidate this cancer diagnosis:
Colposcopy
This is done when the cytology has been positive, or when looking at a glance any cervical abnormality. This test is a purely visual exploration that uses an instrument equipped with light and a set of bases of increase.
Schiller test
It consists of brush around the cervix with a specific solution and check if it is stained dark brown. The malignant cells are not dyed.
Biopsy
A piece of the lesion is taken for study in the laboratory. This determines the specific type of cell that makes up the tumor; Thus are able to offer the best possible treatment.
Imaging techniques
Involvement of pelvic lymph nodes and kidneys can be evaluated using imaging as the TAC.
Classification of cervical cancer
Before establishing a cancer treatment, it is necessary to know at what stage. The greater the stadium, the worse the prognosis and more aggressive must be the way to combat it.• 0: carcinoma in situ. The malignant cells are confined to the uterine epithelium.
• I: carcinoma limited to the cervix. At this stage the patient remains asymptomatic and only you can diagnose the disease by biopsy or cytology
• II: tumor invades the upper part of the vagina and the ligaments of the uterus clamp, but without reaching the pelvic wall.
• III: is affected throughout the vagina and the pelvic wall. Due to the size of the tumor may have kidney and hydronephrosis (distention of a ureter by any obstruction).
• IV: extension to the bladder and/or rectum.
Prognosis of cervical cancer
It depends on several factors:• The stadium in which the cancer is found to be diagnosed.
• Characteristics of the patient: prognosis worse in obese patients and older.
• The treatment that is put in place and when to start. Soon begins to treat, more likely to survive.
Treatment of cervical cancer
Depending on the degree of cancer of the uterus of the patient will be a type of treatment or other:
Chemotherapy
You have different indications depending on the type and extent of carcinoma. Normally
used in advanced stages, or well before the surgery to try to minimize
the size of the tumor and thus facilitate the operation. In recent years it used associated with radiation therapy in cases of poor prognosis. See more about chemotherapy
Radiotherapy
Uterine cancer is used in two forms: external and contact (also called curieterapia or brachytherapy). Brachytherapy
aims at the destruction of the primary tumor, and is mainly used when
the cancer has not spread to lymph nodes or other organs. It involves placing some applicators within the uterus, which are connected to a shielded container containing cesium-137. This
type of localized radiation allows a treatment more individualized, and
therefore more useful, at the same time that protects organs not
affected by cancer with radiation.External radiotherapy is aimed at lymph node involvement. Consists in applying x-ray therapy can have some complications as the formation of rectal and bladder fistulas, and digestive disorders.
See more about radiation therapy
Surgery
It may be conservative (conization, cryocoagulation, electrodiathermy, or CO2 laser) or radical (hysterectomy). Here are what is each one of these techniques:
Electrodiathermy
Through the application of high-frequency currents, the affected area is destroyed. This method requires anesthesia. It can destroy up to a depth of 10 mm.
Cryocoagulation
It destroys the injury due to the cold. It can be performed without anesthesia. The depth of action is 4 mm. The advantages of this method are the speed, which is painless and which leaves no sequelae.
CO2 laser
If done properly the damage to adjacent tissues is minimal and does not have side effects.
Conization
Removes a piece of cone shaped cervix. The basis of the same corresponds to the complete tumor area.
Hysterectomy
It is the removal of the womb full. In the majority of cases it is accompanied by removal of the lymph nodes. In very advanced cases, it may be necessary to include the ovaries. This technique is used only for cases in which the cancer is widespread or in older women.
Prevention of cervical cancer
Most importantly to prevent cervical cancer
is to avoid risk factors mentioned above, especially the modification of
the lifestyle and of sexual behavior. The use of
condoms is a good prophylactic measure against sexually transmitted
diseases and, therefore, to prevent the onset of cervical cancer.In recent years has developed a vaccine against the human papilloma virus. According to the World Health Organization (who), the systematic administration of this vaccine protects girls from more than 55 countries around the world already. It is important to vaccinate girls between nine and 14 years to prevent infection before they begin to have sex life, and more and more middle-income countries there are medium and low, says the who, which are introducing human papillomavirus vaccine in the vaccination calendar.
Routine cytology gynecologist consultation is very important for early diagnosis, especially in cases of possible family heritage. In this way, you can start with the proper treatment as soon as possible to avoid potential complications.
In the new version of the Guide comprehensive cervical cancer Control - essential practice guide that presented the who in December 2014, the agency recommended to use tests for detecting human papillomavirus (HPV) as a method of screening to prevent cervical cancer. Thus the frequency of screening will be reduced because if the result is negative, it is not necessary to repeat the test in a minimum of five years, but if before it may take ten.
8. esophagus Cancer
How is the esophagus
The esophagus is a relatively straight tube that connects the pharynx with the stomach. In
humans is about 25 cm and its structure shows typical layers of the
gastrointestinal tract, which are (from inside to outside): mucosa,
submucosa, muscular and serous (or adventitia).The mucosa is formed by a stratified flat epithelium, usually non-keratinized (without keratin, as the epidermis), while the submucosa is dense connective tissue with a large amount of elastic fibers that allow its expansion as it passes the food bowl. Light (inside) of the esophagus consists of numerous longitudinal folds of the mucosa and submucosa. Externally, we have the adventitia layer, which is made up of loose connective tissue and is responsible for attaching the esophagus to the rest of the body.
Cancers of the esophagus and incidence
90% of the cancer of the esophagus are squamous
histology (normally localized in the third upper and middle) or
adenocarcinomas (in the lower third), the remaining 10% are other types
such as mixed (adenoescamosos), etcetera, sarcomas, small cell.Its incidence by races and countries is highly variable. Until the sixties of the last century, 90% of esophageal tumors were squamous and adenocarcinomas were so infrequent that even he doubted its existence. Since then, the incidence of adenocarcinoma of the esophagus (gastro-oesophageal and Cardia union) has been increasing in Western countries. While the incidence of scaly has not changed or being reduced by the decrease of the causes that produce it (alcohol and tobacco), adenocarcinomas have increased in the Western world probably in proportion to the increase of reflux gastro-oesophageal (associated with obesity) and subsequent development of Barrett's oesophagus (change or replacement - mataplasia - the cells that normally line the final portion of the esophagus by others more resistant to the acidity of the stomach).
Patients with recurrent symptoms of reflux have a risk of developing adenocarcinoma of esophagus seven times greater and up to 40 times if in addition to prolonged symptoms are severe. Unlike squamous, adenocarcinoma is not related to alcohol consumption (even if with the smoking habit).
Other risk factors for esophageal cancer
Certain socio-economic factors can also influence
the appearance of a cancer of the esophagus, since has been an increase
in its incidence on poor diets in fruit and vegetables in economically
depressed regions.The habit of taking very hot beverages (tea or coffee) in regions like the Middle East and China also has been linked to an increased incidence of cancer of the esophagus, as well as eating foods rich in nitrous (certain vegetables in vinegar) and other foods (producers of fungi), or some nuts preparations in endemic areas.
The abuse in the intake of red meat, low levels of selenium, zinc and folic acid in the diet, history of esophageal achalasia (disorder of esophageal motility that a dilatation of the same or megaesophagus), scars caustic (by ingestion of lye, acids, etc.), history of gastrectomy, atrophic gastritis... are other risk factors for the occurrence of cancer of the esophagus.
Symptoms of esophageal cancer
The early symptoms of esophageal cancer are subtle and little specific; and they are very similar both in the squamous type adenocarcinoma.Dysphagia (difficulty in swallowing solid food) tends to be the initial symptom and is most frequent. It is usually accompanied, in addition, weight loss. This usually occurs when the light of esophageal stenosis (narrowing) is important (starting from 13 mm), and that often correspond to an insanely advanced stage already. Weight loss is related to the reduction in intake, changes in dietary habits and tumor-related anorexia.
The feeling of difficulty swallowing is often fight the patient more chewing the food and swallowing it with water, but little by little this dysphagia arises also when taking liquids and to one degree more becomes odynophagia (pain and difficulty) swallowing.
Other symptoms of esophageal cancer are a feeling of discomfort retrosternal (part of the chest above the diaphragm), heartburn, regurgitation of saliva, hoarseness or digested food, bi-tone voice - when the recurrent laryngeal nerve this infiltrate - (signs of poor prognosis).
Other common symptoms of esophageal cancer is the associated chronic of small amounts of blood loss, however patients do not usually refer Manes (expulsion of blood digested by the year) or hematemesis (fresh blood through the mouth), the latter in relation to the erosion of the tumor in the esophagus wall.
Diagnosis of esophageal cancer
(Esophagoscopy) upper endoscopy and biopsy are the fundamental test for the diagnosis of cancer of the esophagus. Other
tests such as the transit esophageal (take a porridge with barium -
radiocontrast - and subsequent x-ray) can guide the diagnosis and mostly
ruled out the existence of fistulas tracheoesophageal (communications
of the esophagus with the trachea).The study was completed with the completion of Bronchoscopy (to rule out the involvement of the respiratory system), and has recently added a new technique, endoscopic (scanning that allows direct visualization of the inside of the esophagus and the inside of your wall ultrasound visualization, as well as the structures that surround these viscera - mediastinum - through the introduction of a flexible tube through the mouth) to check as well the locoregional disease involvement set the depth of the lesion and the involvement of the lymph nodes.
The extension study is performed with CT of the chest and abdomen. Numerous investigations have demonstrated the utility of PET-CT in the diagnosis of esophageal cancer, detecting up to 15% more injuries to distance not evidenced by TAC, by what increasingly is used on a more regular basis to the detriment of the first.
For the (classification of the extension and severity of a malignant tumour disease) staging of esophageal cancer using the TNM system - T (tumor size), N (lymph nodes), and M (distant metastases) - AJCC (American Joint Comitee of Cancer):
Factors associated with a worse
prognosis of esophageal cancer are weight loss prior, the length of the
tumor and the presence of micro-metastasis in regional lymph nodes.
Primary tumor (T)
| TX | The primary tumor cannot be assessed. |
| T0 | There is no evidence of primary tumor. |
| Tis | High grade dysplasia. |
| T1 | The tumor invades the lamina propria, the muscularis mucosa or submucosa... |
| T1a | The tumor invades the lamina propria or the muscularis mucosa... |
| T1b | The tumor invades submucosa. |
| T2 | The tumor invades the own musculari. |
| T3 | The tumor invades the adventitia. |
| T4 | The tumor invades adjacent structures... |
| T4a | Unresectable tumor invades the pleura, pericardium, or diaphragm. |
| T4b | Unresectable tumor invades adjacent structures, such as the aorta, vertebral body, trachea, etc... |
Regional lymph nodes (N)
| NX | Regional lymph nodes cannot be assessed. |
| N0 | There are no regional lymph node metastasis. |
| N1 | 1-2-regional lymph node metastasis. |
| N2 | 3-6 regional lymph nodes or submucosa metastasis... |
| N3 | ≥7 regional lymph node metastasis. |
Distant metastasis (M)
| M0 | There is no distant metastasis. |
| M1 | There are distant metastases. |
Prognosis of esophageal cancer
According to staging we can see the chances of survival with esophageal cancer at age 5.| Stadium | T | N | M | 5-year survival |
| 0 | Tis | N0 | M0 | > 95% |
| I | T1 | N0 | M0 | 50-80% |
| IIa | T2-3 | N1 | M0 | 30-40% |
| IIb | T1-2 | N1 | M0 | 10-30% |
| III | T3 | N0-1 | M0 | 10-15% |
| T4 | N0-1 | M0 | 10-15% | |
| IV | T1-4 | N0-1 | M1 | 1-5% |
Treatment of esophageal cancer
More than 80% of patients with esophageal cancer
are diagnosed in advanced stages of the disease, so we already know that
they will have a survival very low (less than 10% at 5 years).The existing therapeutic weapons for the treatment of esophageal cancer are:
Surgery
It is the standard treatment for cancer of
the esophagus in stages I to III (although we have already seen the
prognosis to 5 years). The esofaguectomia
(removal of the esophagus) is a very aggressive surgery, with high risk
of postoperative complications and mortality rate of 5% (20 years ago
was close to 20%) thanks to the best selection of patients, improvements
in surgical techniques and perioperative care. This technique is resection of locoregionales lymph nodes (cervical, Mediastinal and celiac disease).
Preoperative chemotherapy
This mode (especially with cisplatin and 5-fluorouracil-based regimens) has activity moderated in later stages. The
goal is to treat the micro-metastasis present at diagnosis and reduce
the size of the primary for a better local control of cancer of the
esophagus. Several studies have shown that,
effectively, get greater control of the disease (it seems that in
adenocarcinomas respond better), but this does not translate into better
survival after surgery.
Preoperative radiotherapy and chemotherapy
Radiotherapy (RT) as a unique treatment of
esophageal cancer is understood as palliative therapy, to improve pain
or difficulty when swallowing (odynophagia and dysphagia). Does
it not benefit with respect to surgery alone, but in combination with
certain drugs radiosensitizing (which increase the biological potency of
the RT to equal doses) extend local cancer control, while it is
systemic disease (injuries to distance). Several
studies have shown that that better control over the disease has an
impact on the survival of patients with cancer of the esophagus and a
reduction in mortality of up to 13% at 2 years. This benefit is observed both in adenocarcinomas and the scaly.
Chemotherapy + radiotherapy (RQT) radical
As a result of a study that compared single
RT front RQT, and showing that the Group of patients who had received
RQT had better survival and that this survival was very similar to other
studies in patients operated, arose the need (or not) of surgery in
these patients who received the combination treatment. Several studies show that controlling the disease is greater if Complete RQT treatment with surgery, but survival is the same. In addition, there is an increase in mortality from surgery. The
doubt arises in the subgroup of patients where with the previous RQT
disease is not controlled and observed that they benefit from back
surgery.The conclusion that we can get is that option RQT and back surgery should be offered to patients with cancer of the esophagus locally advanced (T3-4N0 - 1 M 0) have criteria of resectability. On the contrary, if patients are not in physical conditions (by age, associated diseases, and so on) radical RQT option is most suitable, as well as in those with criteria of irresecabilidad (T4).
Treatment of cancer of the esophagus in advanced stages
In these cases, chemotherapy (cisplatin and
5-fluorouracil) is of choice, with a rate of response that does not
extend beyond the 35% (57% with new drugs such as taxanes and
irinotecan) and a survival which is less than 10 months. Gets control of symptoms (dysphagia) in 90% of cases.
Support treatment
This support in esophageal cancer treatment aims to allow the intake of food and improve symptoms. We have radiation therapy and resection of the tumor with laser (in certain locations, sizes and shapes). Another
option is placement of prostheses using endoscopy to allow the passage
of food, or in those patients with tracheo-oesophageal fistula to ensure
the integrity of the digestive and respiratory tube respectively.
New drugs for the treatment of esophageal cancer
There has been an overexpression of the EGFR (Epidermal Grow Factor Receptor) 70%. A
receiver of the membrane of cells that is triggered with the
circulating protein specific binding (ligands) triggers a series of
intracellular mechanisms that ultimately lead to replication (division)
cell and the growth of the tumor.We have drugs (monoclonal antibodies such as Cetuximab, or inhibitory tyrosine kinase such as Erlotinib and Gefitinib) able to cancel this interaction (ligand-receptor) in way that does not engage the cascade of intracellular mechanisms and cell division. These new drugs for the treatment of cancer of the esophagus, alone, get 9% of objective responses (full and partial responses) and a median survival of seven months. Classical or radiation therapy are being studied in combination with chemotherapy.
9. stomach Cancer
Benign tumors of stomach cancer
• They are gastric polyps. They are lesions that protrude (protrude from their limits, move forward) toward the lumen of the stomach.
• At the beginning of his appearance, often give nonspecific symptoms such as nausea, stomach pain, and bloating.
• With this symptomatology, the patient goes to query and perform you radiologic or endoscopic studies to rule out anything more serious.
• The most frequent complication is gastrointestinal bleeding.
• The curative treatment is resection of polyp, which is usually done endoscopically. If the lesions are multiple it must be a follow-up of the case through periodic gastroscopias.
Malignant tumours of stomach cancer
The most common type is adenocarcinoma of stomach. This type of tumor can spread to other parts of the body in various ways: locally to neighbour as the duodenum, or esophagus organs; If the tumor cells reach the blood vessels the tumor may affect liver, peritoneum, lung, bone or skin.
The second most frequent stomach tumor type is lymphoma. The clinical manifestations are similar in both cases. Only differ in the biopsy, the cells that compose it are different in each case.
Epidemiology of cancer of stomach
30 years ago the stomach cancer was a disease with a very high mortality rate, but in recent decades this number has decreased very significantly, thanks to early detection.
It is more common in countries like Japan, Colombia and Chile. Within Spain, the areas with lower incidence of this disease occur in the Mediterranean area. It usually affects males aged 60 and older. In the case of lymphoma, it usually appears in patients something younger, about age 50. When it appears in people under this age, it is almost always due to family inheritance of cancer.
Symptoms and risk factors for stomach cancer
As in the case of benign tumors, the initial symptoms of stomach cancer are very non-specific. This may delay the diagnosis a few months. Abdominal discomfort can be accompanied by nausea and vomiting, weight loss, fatigue and malaise; Therefore any abdominal symptoms that are persistent over time should be investigated.Later you can manifest other most important symptoms as alterations in bowel evacuation (either diarrhea or constipation), difficulty to ingest food, bad breath, persistent cough, and abdominal pain.
Physical examination in early stages does not usually reveal any characteristic data. As it progresses the disease can find nutritional deficits in varying degrees, pallor, and even an abdominal mass may be felt.
The prognosis is better in the adenocarcinoma, since in this survival is superior to 50% at five years.
Risk factors for gastric cancer
• Genetic factors: sometimes families are with a high frequency of gastric cancer.
• Advanced age.
• Be male.
• The presence of infection by H. pylori.
• Tobacco or alcohol consumption.
• Diet high in salt (which damages the gastric mucosa), smoked foods high in nitrates.
• Previous gastric surgery.
• Gastric diseases: chronic gastritis, ulcers, polyps and Ménétrier disease.
Diagnosis of stomach cancer
To diagnose a stomach cancer, you can follow the following points:• Medical history information is requested to the patient about the symptoms and possible family history.
• Data obtained in laboratory: Analytics is often seen anemia. It can also detect a tumor marker called CEA that, although it is not specific of gastric cancer, may be an indication.
• Study of the gastric juice: in advanced stages are usually lack of acid secretion.
• Radiology: intestinal transit tests that allow detection of masses are performed.
• Endoscopy: using gastroscopias polyps and other tumors is can reveal. Also in the case of tumors of small size, can be removed during the test itself. In fact, this is the best test for the detection of expansive processes in the gastrointestinal tract, but is first recommended an x-ray to be less invasive.
• Biopsy: sample is also taken by endoscopy and allows you to check what is the exact type of tumor with which we are confronted.
Treatment of stomach cancer
Stomach cancer treatment is individualized
because it depends on the stadium where the tumor is located and the
characteristics of the patient, but surgery is the only really healing
method. It has shown to increase survival and quality of life of patients.Among the existing types of surgery, usually prefer open surgery rather than the endoscopic resection for large tumors. In this way all the lesion in one intervention can be resected.
As for radiotherapy, it is fairly effective in this type of tumor. Used especially to facilitate surgery or to alleviate pain.
Chemotherapy also improves short and long term survival. It is also used as adjuvant to surgery
Prevention of stomach cancer
It is not easy to prevent stomach cancer. There are certain factors that can't be avoided as the family inheritance, being male, advanced ages...However, precautions can reduce the risk of gastric cancer, such as:
• Follow a healthy diet rich in fruits and vegetables, and to include an adequate amount of vitamin C.
• Avoid eating smoked and salted products.
• Do not smoke and do not abuse alcohol consumption.
• Carry out periodic reviews with endoscopy patients with gastric ulcers. This measure is not really preventive, but allows the early detection of cancer, thus increasing the chances of survival of the affected.
• Patients who have suffered some type of stomach surgery and also have anemia must also follow a program of periodic reviews.
• Although it is known that infection by H. pylori is a risk factor, not shown if its eradication is a protective factor.
10. Liver Cancer
The data confirm that it is a tumor of high prevalence and prognosis. It is the most frequent 5th and the 4th cause of death by cancer. There are major differences with regard to their incidence according to regions, and so we can distinguish countries with:
• High incidence: (> 20 cases/100000 inhabitants/year): Asia, Japan, and sub-Saharan Africa.
• High average incidence (11-20 cases): Spain, Italy and Latin America.
• Low average incidence (5-10 cases): France, Germany and United Kingdom.
• Low incidence (< 5 data-blogger-escaped-b = "" data-blogger-escaped-cases = "" >) United States, Canada and Scandinavia.
In developed countries an increase in prevalence, is being partly by improvement of diagnostic methods, partly because of the improvement in the survival of liver cirrhosis that underlies in the majority of cases of liver cancer (which increases the exposure time) and in part by immigration from countries with high incidence.
It is a disease that occurs more in men than in women (4:1 ratio) and a peak of higher incidence from age 65.
Risk factors for liver cancer
The most common underlying cause of liver
cancer is liver cirrhosis, disease that underlies the majority of
patients with this tumor, especially in cases involving hepatitis viral
and alcoholic, although not all the cirrhosis liver cancer end or all
hepatocarcinomas settle on cirrhosis. These are the other risk factors for cancer of the liver (CH):
Virus hepatitis C (HCV)
Of the 170 million people infected with the
virus of hepatitis C (HCV), only 20% will develop cirrhosis of the
liver, these are the greater risk of developing liver cancer (between 1%
and 4% per year). In our environment, of all diagnoses of hepatocarcinoma, 65% have antibodies anti HCV. It
seems that the HCV has carcinogenic intrinsic, and independent of the
fact of developing cirrhosis, pro-inflammatory phenomena and phenomena
that prevent cell death (apoptosis) scheduled. However,
the vast majority of cases of liver cancer in people infected with the
hepatitis C virus occurs when there is already cirrhosis of the liver.
Virus of hepatitis B (HBV)
It is the main causal agent of worldwide
liver cancer, although in Western countries we have already commented
that the most frequent cause is the HCV. The World Health Organization considers it the most potent carcinogen second after tobacco. The problem is that the population (primarily in countries of East Asia) acquires very early HBV, which is chronic; in
this way, those affected are exposed many years to damage posed by
chronic liver inflammation, hence the cirrhosis and liver cancer. There
is a study that shows that the risk of liver cancer is 100 times higher
in carriers of Antigen against hepatitis B than in non-carriers.Carcinogenesis is due to chronic inflammation mediated by immune response, which is not enough to kill the virus, but it is enough to perpetuate the death of hepatocytes and the rapid cell turnover with consequent increased risk of having genetic alterations. Also, HBV is direct carcinogen, as it is integrated into the genome of the hepatocyte (not as HCV) and is able to induce liver cancer without causing cirrhosis prior. The risk varies depending on multiple factors such as viral load or the type of strain (viral genotype). The risk decreases if there is a seroconversion, i.e. If a patient can control the disease, and antibodies to the Antigen of hepatitis B. or seroconversion has occurred.
There is no doubt that universal HBV immunization in newborn infants campaigns will decrease the prevalence and incidence of HBV, liver cirrhosis and liver cancer.
Aflatoxin
Toxins produced by fungi of the genus Aspergillus that abound in plant foods improperly stored in humid environments. It is carcinogenic, as does mutation of the p53 tumor suppressor gene. It is very common in sub-Saharan Africa and Asia.
Alcohol
It is not a direct carcinogen, but there is a
direct relationship between alcohol consumption and the risk of
developing liver cancer which nearly doubled among drinkers of 100
gr/day. (To get an idea if we ingest 100 cc of a
drink with 42 degrees, the amount of absolute alcohol consumed was 33.6
grams of absolute alcohol in accordance with the following formula:100 x
42/100 x 0.8 = 33.6 grams). The risk increases by cirrhosis, is considered that the risk is seven times greater in alcoholic cirrhotic.
Other causes
Tobacco, insulin resistance, schistosomiasis (a
parasitic disease common in Africa and in some points of the Middle East
and Latin America) overload iron (as in hemochromatosis), dietary
factors, drugs and chemicals, etc.
Diagnosis of liver cancer
Liver cancer suspected to be established in
patients with underlying liver disease or an elevation in the blood of a
substance called the alpha-fetoprotein protein (AFP). In
this case image tests are performed and subsequent histological
confirmation by taking a sample to study histological (microscopic
examination of cellular changes contained in a biopsy).The most common symptoms are abdominal pain, weight loss, intense fatigue (tiredness), early satiety or fullness others (at the end of a meal) sensation, abdominal distention, ascites (accumulation of fluid in the abdominal cavity) or jaundice (yellowing of the skin by an elevation of bilirubin). Other symptoms may be due to the existence of metastasis.
Up to 25% of patients with advanced liver cancer are asymptomatic
However, it is important to note that up to 25% of patients with advanced liver cancer remain asymptomatic.
The marker tumor (tumor) most important serological is the AFP that rises in the blood even in 50% of cases (in our environment). However, you can see elevations in chronic hepatitis or cirrhosis without associated tumor. He is considered diagnostic of liver cancer (without doing a biopsy) figures above 400 ng/ml with compatible imaging test.
Abdominal ultrasound is the imaging test better and easier, but CT (computed axial tomography) and MRI (magnetic resonance imaging) and PET (positron emission tomography) can be used to assess the local extension of the tumor, the number and size of lesions.
Most liver cancers based on cirrhotic livers so these patients not only depends on the tumor itself, but liver function. They have been defined several prognostic scales that integrate features of staging (tumor size, number of lymph nodes affected, etc.) and parameters of how the liver works. The classification more used to evaluate the function of the liver in patients with cirrhosis is the classification of CHILD-PUGH, who also gives us a prognosis of the disease. (functional and prognostic) There are other classifications which give us an idea of the prognosis of the patient according to the extension of the tumor and the function of the liver such as that of Okuda, CLIP, BCLC, etc.
The Child-Pugh classification is as follows:
1 point |
2 point |
3 point |
|
| Ascites | Absent | Mild | Moderate |
| Encephalopathy | Not | Grade 1/2 | Grade 3/4 |
| Albumin | > 3.5 | 2.8-3.5 | |
| Bilirubin | > 2 | 02/03/12 | > 3 |
| INR | 1.8-2.3 | > 2.3 |
- Chid-Pugh: 5-6 points; survival at 2 years: 85%
- Child-Pugh b: 7-9; survival at 2 years old: 60%
- Child-Pugh C: 10-15 points; survival at 2 years: 35%
- Tx: The tumor can not be measured.
- T0: There is no evidence of primary liver cancer, only they are nodes or metastasis.
- T1: Solitary tumor without vascular infiltration.
- T2: Solitary tumor with vascular infiltration or multiple tumors (no more than 5 cm).
- T3a: Multiple tumors with one of them greater than 5 cm.
- T3b: Single or multiple tumor of any size that invade the vena porta or the liver.
- T4: Direct involvement of neighboring structures (excluding the gallbladder) or peritoneal drilling there.
- Nx: Lymph node involvement cannot be measured.
- N0: There are no affected nodes.
- N1: Regional node metastasis.
- M0: There is no distant metastasis.
- M1: If there is distant metastasis.
Stadium |
5-year survival |
|||
| I | T1 | N0 | M0 | 55% |
| II | T2 | N0 | M0 | 37% |
| IIIa | T3a | N0 | M0 | 16% |
| IIIb | T3b | N0 | M0 | 16% |
| IIIc | T4 | N0 | M0 | 16% |
| VAT | Any T | N1 | M0 | |
| IVb | Any T | Any N | M1 |
Treatment of liver cancer
Liver cancer can face from different treatments, which will depend on the State of the patient and tumor. Surgical resection, ablation and transplantation are the only ones that offer possibilities of cure:
Surgical resection
Given that in the majority of patients there
is cirrhosis of base, should establish very strict selection criteria,
to prevent liver failure later. The best
candidates for a surgical resection are the ones with single tumors are
asymptomatic and have a preserved liver function. In these cases survival rates to age 5 of 70% can be achieved. Predictors
of recurrence factors are vascular invasion, presence of satellite
lesions, low degree of differentiation, the size of the tumor, the AFP
and the positive resection margins.
Liver transplant
This is the best option, since it removes the injury and also cure preneoplasica liver disease that had. The best candidates for a transplant are those with tumors of less than 5 cm, or with two or three tumors less than 3 cm. If
the patient meets one of these conditions, which have been called the
Milan criteria, it is established that the patient may be selected for
transplant, because you get a similar to the patients without liver
cancer survival.The biggest problem is the tight supply of this resource, as patients die or progress while they are on the waiting list (of dead donor). New classification systems have been proposed to try to prevent the loss of patients on the waiting list to assign patients to such a list, as the MELD (Model of End-staged Liver Disease), is a mathematical model for prediction of life of a patient with liver cancer based on bilirubin, coagulation and renal function tests. It is more objective ranging from 6 to 40 Child-Pugh classification, and patients with higher score have priority to receive the transplant.
Another reasonable option is the living donor, which have shown a benefit in the cost-effectiveness analysis when the waiting time is over seven months. The morbidity and mortality of the donor is around 0, 3-0, 5%. In this case, the criteria official of transplantation (Milan criteria) do not have why to keep it. In this regard have been made several study to expand these criteria, provided remain the same survivals. It has established a new criterion called 'up to seven being the result of the sum of tumor nodules and size them at no. 7. With this system you could offer transplant to a larger number of patients.
Ablation
It's applying thermal energy (heat) radiofrequency through an electrode directly on the injury. Recommended
for lesions less than 3 cm (even multiple), provided they are on the
inside of the parenchyma and away from the hepatic hilum (entrance of
the liver), great vessels (porta, vein or hepatic artery) or other
structures nearby such as stomach, colon or gallbladder, by the
increased risk of perforation of these structures because of the heat. It has very good answers (5-20% recurrence rate) and with excellent tolerance by the patient. Serious
side effects are rare, but may include liver failure, portal vein
thrombosis, liver abscess, pleural effusion, skin burn... and has been
described a syndrome post-ablacion that is self-limited and consists of
flu-like symptoms and elevated transaminases.The radio frequency has replaced other ablation techniques such as the application of cold (Cryoablation) or injection of alcohol (ethanol), since it has demonstrated its superiority in all comparative study. Can be done by percutaneous (through the skin) or laparoscopic using radiological control (ultrasound).
Chemoembolization
Taking into account that most of the blood
supply of the liver comes from the hepatic artery, various techniques
have been developed to deprive of such contribution to the areas where
the tumor is occluding the artery of that territory; This is embolization. You can do with particles (including alcohol-etanol-) or chemotherapy (TACE: TransArterial ChemoEmbolization). The
technique consists in channeling the hepatic artery and there release
accompanied chemotherapy (or not) of substances which retain longer
chemotherapy in the area where was released and which are procoagulant,
i.e., they favor the formation of a thrombus (clot) in the hepatic
artery. The most common adverse effect is
(similar to postablacion) post-embolization syndrome and ischemic
cholecystitis, hypothyroidism, or pleural effusion are less frequent.They will never get higher response rates of 50% and very few get benefit on survival.
Generally recommended in symptomatic patients with nonresectable hepatocarcinomas in which the tumor is too large for radio frequency.
Medical treatment
No medical treatment is curative in liver cancer. Has
been classically considered a chemoresistant tumor by the existence of
multiple genes responsible for the development of resistance to drugs; also liver disease of base presenting the majority of patients, conditions tolerance to most of the drugs used. The medical treatments available are as follows:
Chemotherapy
The efficacy of chemotherapy for liver
cancer is modest, no schema Monochemotherapy or combination chemotherapy
has shown higher 25% response rates. Used schemes based on anthracyclines, 5FU, Gemcitabine or Capecitabine without any impact on overall survival. Schemes with combination chemotherapy only increase toxicity, without better results. Therefore, that we must find other ways of treatment.
Molecular therapies
The better understanding of the molecular
pathways and cellular signaling at the origin of the tumors
(carcinogenesis) has made possible the development of large number of
molecules which are effective in the treatment of various tumors. It is what we know as therapies diana (and translational Oncology).Fruit of this discipline have released drugs for oral administration as sorafenib reaching stabilizations in 40% of cases, with medium-sized survival of 9.2 months, with impact on overall survival and very little toxicity. We have other drugs called diana as sunitinib, bevacuzumab, etc, with response rates that hover around 18% and median survival of 15 months alone or in combination with traditional chemotherapy schemes.
Other therapies for the treatment of liver cancer
Somatostatin or interferon alpha are drugs that have been useful in the past, but now already hardly used. The
hormonal therapy with tamoxifen has been used for many years as a
first-line treatment in the absence of other drugs more assets, since it
showed the presence of estrogen receptors in 30% of the
hepatocarcinomas. Many studies have shown that
such anti-tumoral effect or benefit on survival there is no by what is
no longer considered a treatment option.11 laryngeal Cancer
Anatomical description of the larynx
To understand better what is laryngeal cancer, we start by making a brief anatomical description of the area which affects.Next to the nasal cavity, sinuses and nasopharynx are the upper airways. The area includes from the base of the tongue into the windpipe. With reference to the vocal cords, we can divide it into three parts: upper (supraglottis) where is the epiglottis, the part of the own vocal cords (glottis) and the subglottis.
These zones have different lymphatic vascularization and, therefore, different pattern of spread of lymph node involvement (which is the more common, even in early tumors situation).
Hematogenous dissemination (through the blood vessels) is uncommon, and is produced in very advanced tumors that recur after a first surgical manoeuvre. The most common locations are followed lung, far, skeleton and liver.
Causes of larynx cancer
The causes of larynx cancer, as it is customary in
this type of Pathology, are always multiple, and among them we can
highlight:• Viral infections as herpes of papillomavirus (HPV) virus and Ebstein Barr virus (has been isolated DNA from the virus even in 50% of cases); It seems that these virus inhibit certain tumour suppressor genes such as p53 and pRb (of retinoblastoma).
• Use and abuse of alcoholic beverages (mostly in supraglottic tumors, where it has been found that up to 88% of the patients had a history of significant alcohol intake). Although no one knows very well how does alcohol, seems to exert an irritant action tobacco which exerts its carcinogenic action.
• A diet high in animal fat and low in fruit and vegetables (rich in vitamin A and beta carotene). High intake of red meat, smoked, fried, is also considered to increase the risk.
• Some occupational and hormonal factors (is more frequent in males) and immunological.
• The most important is the habit of smoking cigarettes. There are epidemiological studies showing that up to 97% of patients diagnosed with a tumor of larynx were smokers (this is not to say that 97% of smokers will have cancer of larynx).
• We know that consumption greater than 40 cigarettes per day increases 13 times the risk with respect to non-smokers, and if this habit has started before the age of 15, this number is doubled. As in lung cancer, this risk remains until ten years after leaving the smoking; passive smokers also have increased risk of developing larynx cancer. Tobacco produces an increase in the thickness of the layers of keratin, with subsequent hyperplasia, metaplasia, edema and chronic inflammation of the submucosa. Several promoters chemicals present in tobacco smoke have been identified, and that also induce mutations in these tumor suppressor genes that we have seen.
Symptoms of laryngeal cancer
The symptoms of laryngeal cancer depend on the
location where originated, but the most frequent are the scratchy,
dysphonia (hoarseness), Dyspnea (difficulty breathing), difficulty or
pain when swallowing (dysphagia and odynophagia), foreign body sensation
in the throat or earache (otalgia).Lymph node involvement means inflammation of glands in the neck (cervical) or in another location, as well as symptoms resulting from metastases are located where (lung, liver, skeletal, etc).
Laryngeal cancer can sometimes begin as an aspiration pneumonia (pneumonia that occurs when passing food to the Airways due to incompetence of the epiglottis).
Diagnosis of laryngeal cancer
After the diagnosis of laryngeal cancer, is typically the Otolaryngologist (ENT) who has the equipment especially for lean, look in the larynx, and the corresponding sample for histopathological study.For this we have indirect laryngoscopy (through a mirror): if it reaches to see the tumor, the doctor can do an approximate idea of the extension of the same, and with the fibrolaringoscopia (Endoscopy), with hose or, when a better view of the larynx, with rigid endoscope; the latter requires general anesthesia.
Taking of sample (biopsy) should be done on all suspected areas. Once the diagnosis, as in all tumor pathology, we must make the extension study for a correct classification TNM, with a cervico-thoraco-abdominal CT and a complete analytic (hemogram and biochemistry including liver and kidney function).
Tuning can be more in the cervical region with a MML; a good radiologist can give a diagnosis of extension almost as accurate as the surgical staging. The PET, for the time being, has not demonstrated benefit about these other two techniques or to the extension study, although it is true that it is very useful to differentiate fibrosis recurrences by radiotherapy.
Staging of laryngeal cancer
For staging (classification of the extent and severity of a malignant tumour disease) is used the System NWT - T (tumor size), N (lymph nodes), and M (distant metastases) - of the AJCC ('American Joint Comitee of Cancer):
T1a: limited to a vocal cord.
T1b: affects both strings.
T2: extends to supraglottis or subglottis. Decreased mobility.
T3: limited to the larynx with fixation of vocal cord.
T4: Invasion of thyroid cartilage, soft tissue, trachea, thyroid gland and pharynx.
T2: affects two areas. Normal chordal mobility.
T3: limited to the larynx with a fixed rope. Preepiglotico, base of tongue space invasion.
T4: Invasion of thyroid cartilage, soft tissue, thyroid gland and esophagus.
N0: No lymphatic metastases.
N1: Metastasis only unilateral less than 3 cm.
N2a: Metastasis only unilateral greater than 3 and less than 6 cm.
N2b: Metastasis multiple ipsilateral less than 6 cm.
N2c: Metastasis bilateral or contralateral less than 6 cm.
N3: Metastasis in a ganglion of more than 6 cm.
M0: No distant metastasis.
M1: distant Metastasis.
The supraglottis includes many individual sections. The survival of the patient without suffering a relapse may be different depending on the section and groups T and N at each stage.
The glottic presentation may differ according to factors such as tumor volume, the anatomical region affected, and the presence or absence of normal mobility of the rope. The survival of the patient without suffering a relapse can be changed by these and other factors, in addition to T and N subgroups in each stage.
Glottic laryngeal cancer
T1: Tumor limited to strings. Normal mobility.T1a: limited to a vocal cord.
T1b: affects both strings.
T2: extends to supraglottis or subglottis. Decreased mobility.
T3: limited to the larynx with fixation of vocal cord.
T4: Invasion of thyroid cartilage, soft tissue, trachea, thyroid gland and pharynx.
Supraglottic laryngeal cancer
T1: Tumor that affects only one zone. Normal chordal mobility.T2: affects two areas. Normal chordal mobility.
T3: limited to the larynx with a fixed rope. Preepiglotico, base of tongue space invasion.
T4: Invasion of thyroid cartilage, soft tissue, thyroid gland and esophagus.
N0: No lymphatic metastases.
N1: Metastasis only unilateral less than 3 cm.
N2a: Metastasis only unilateral greater than 3 and less than 6 cm.
N2b: Metastasis multiple ipsilateral less than 6 cm.
N2c: Metastasis bilateral or contralateral less than 6 cm.
N3: Metastasis in a ganglion of more than 6 cm.
M0: No distant metastasis.
M1: distant Metastasis.
The AJCC TNM classification
|
|||
| 0 | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| II | T2 | N0 | M0 |
| III | T3 | N0 | M0 |
| T1 | N1 | M0 | |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| VAT | T4a | N0 | M0 |
| T4a | N1 | M0 | |
| T1 | N2 | M0 | |
| T2 | N2 | M0 | |
| T3 | N2 | M0 | |
| T4a | N2 | M0 | |
| IVB | T4b | Any N | M0 |
| Any T | N3 | M0 | |
| IVC | Any T | Any N | M0 |
The supraglottis includes many individual sections. The survival of the patient without suffering a relapse may be different depending on the section and groups T and N at each stage.
The glottic presentation may differ according to factors such as tumor volume, the anatomical region affected, and the presence or absence of normal mobility of the rope. The survival of the patient without suffering a relapse can be changed by these and other factors, in addition to T and N subgroups in each stage.
Treatment of laryngeal cancer
Surgery remains the mainstay of the curative
treatment of larynx cancer, although in recent years the combined radio
and chemotherapy (RQT) treatment has become a choice of similar results
while preserving the body in advanced stages. Let's look at the features of each type of treatment:
Surgery:
• Functional: in addition to the (radical) total removal of the tumor, allows conserve the larynx (the function). This technique includes laser surgery.• Radical: in this case the curative intent is above the function of the body, so that the quality of life gets worse, since it tends to lead to loss of voice (as expanded total or total laryngectomy).
• Mixed: where attempts to preserve despite surgical mutilation phonatory function.
The surgery is completed with resection (removal) of the cervical lymph nodes. From this point of view, we can find ourselves with patients without or with lymph node involvement in the extension study. Approximately 40% of patients N0 (see above 'Staging of laryngeal cancer') to the diagnosis presented ganglionic metastases surgical resection, although this varies depending on the location of the tumor; for example, glottal, having tumors little lymphatic drainage, if they are home N0 don't usually make emptying nodal, unlike the supraglottic. In any case, the emptying has to be bilateral and functional or radical. Patients N + Diagnostics is performed a radical cervical bilateral emptying.
The difference between functional and radical is that the first dry out the lymph nodes and tissue around, and in the second, as well as the nodes and tissue, dries the sternocleidomastoid muscle, vein jugular internal and spinal nerve. Today, almost all patients receive functional conservative treatment and it is complemented by radiotherapy (RT).
Radiotherapy:
Radiotherapy is a treatment alternative to
surgery in T1 or T2 tumours, as well as complementary (adjuvant
treatment) to surgery in locally advanced stages, and the treatment of
unresectable disease. The improvement of
technology in the treatment of images (helical CT, MRI, PET, etc.),
techniques of radiotherapy (intensity modulated, hyperfractionated
accelerated, etc.) imply greater precision when it comes to delimit
tumoral volume, being more radical and less toxic in surrounding healthy
tissues.Another important aspect is its combination with chemotherapy (CT) and new therapies (called diana therapies) in locally advanced tumours, with impact on the local control of the disease and overall survival; This has been demonstrated both in the adjuvant setting (QT) (with chemo and therapies diana) unresectable disease with radiation therapy alone.
Thanks to the better understanding of molecular biology found an overexpression of the EGFR (Epidermal Grow Factor Receptor) in the majority of cases. A receiver of the membrane of cells that is triggered with the circulating protein specific binding (ligands) triggers a series of intracellular mechanisms that lead to replication (division) cell and the growth of the tumor. Currently available drugs (such as cetuximabmonoclonal antibodies), able to cancel this interaction (ligand-receptor), in such a way that the cascade of intracellular mechanisms is not activated and not activated cell division.
Quimioterapia (QT):
Tumors of the ORL sphere are considered very chemosensitive; It is estimated that 90% objective response rate, and up to 60% complete responses can be achieved with chemotherapy. You can ask:• Chemotherapy in metastatic disease or recurrent unresectable: symptom control and improvement of the quality of life of the patient.
• Neoadjuvant chemotherapy: before radical treatment (either surgery or radiation therapy), to increase the chances of preserving the body.
• Chemotherapy concurrent to the RT: we have already seen in which cases.
• Adjuvant chemotherapy: after radical treatment (surgery or radiotherapy), with the aim of preventing local recurrence or distance.
Future of the treatment of laryngeal cancer
Present and future strategies are aimed at
the optimization of conservative treatments, since the functional
impairment in these patients is very important to survival is improved. These
pass through the use of neoadjuvant chemotherapy (triplets of
taxane-Platinum and 5FU) and treatments that combine traditional chemo
with antibody monoclonal or radiotherapy.Finally, the study of the mechanisms of resistance and predictive factors of response to treatment of laryngeal cancer will facilitate us the design of new strategies that improve the prognosis and quality of life of these patients.
12. Breast Cancer
Approximately one in eight women will have breast cancer throughout his life, and one of every 30 will die for this cause.
Risk factors of breast cancer
• Genetic factor, such as the existence of a family history of breast carcinoma. Two genes, BRCA-1 and BRCA-2, are related to more than 50% of hereditary breast cancers• Age.
• Be female (since, although men can also get breast cancer, is much rarer).
• First pregnancy with more than 30 years; or worse still if there has been no pregnancy.
• Personal history of prior breast pathology.
• Late menopause, and menarche (first menstruation) early.
• Do not give a brief lactation or lactation.
• A personal history, especially endometrial cancer.
• Treatment with hormones: replacement therapy or hormonal contraceptives.
• Exposure to radiation.
• Immunosuppression.
• Obesity.
• Alcohol consumption.
Symptoms of breast cancer
The home is usually asymptomatic. Normally,
the first manifestation is the presence of a lump, although some women
may seek medical attention for having alterations in nipple and areola,
and a group (although this is less and less frequent) goes by
retraction, ulceration and Orange skin, which usually indicates an advanced process.
Types of breast cancer
These are the most common types of breast cancer:
Non-invasive cancers
Intraductal Carcinoma
Also called ductal carcinoma in-situ, forms 80% of non-invasive carcinomas. It is considered a local phenomenon and, therefore, without invasion of surrounding tissues. The average age of onset is 49 years. It is usually asymptomatic, identified on mammograms.The treatment of intraductual carcinoma is chosen based on size, free allowances and tumor grade; in this way, well minimal surgery is used to remove only the injury, either remove the entire breast with/without the axillary nodes.
Pager of nipple disease
It is a variety of intraductal carcinoma, which
extends from the nipple ducts to adjacent skin, causing fissures and
ulcerations.
Lobular in situ Carcinoma
It is usually multicentric and tends to be bilateral. Just as in the intraductal not usually palpable injury or symptoms.In the treatment of carcinoma lobular in situ is widely removed tumor or breast, by placing an implant, however, the most important is a good control of the patient.
Tubular Carcinoma
It usually occurs in young women, and is the better prognosis.
Invasive cancers
Infiltrating ductal or invasive ductal carcinoma is the most frequent.
Expansion of breast cancer
Breast cancer spreads so easily that it is often considered from the beginning as a disease of the whole organism. These are forms of expansion of breast cancer:• Lymphatic spread: is the main route of dissemination; lymph node involvement tends to be established, so it is important the analysis of ganglion Sentinel, or first ganglion irrigated by the tumor, since, if it is positive (if tumor cells are found), will have to remove the rest of the nodes in the area (lymphadenectomy).
• Metastasis: the size of the primary tumor is related to the percentage of pulmonary metastases. Pulmonary metastases are the most frequent (63%), and also breast cancer is the leading cause of metastasis of bone (pelvis, spine, femur, ribs, skull), brain and eye.
Poor prognostic factors
Factors related to the extension of breast cancer are:• Number of affected nodes.
• More than 2 cm tumor.
• More than 35 years.
• Little differentiation.
• Fixed (non mobile) Cancer to chest and/or rib.
• Infiltration to the skin.
• Multicenter nature of the lesion.
• Invasion of blood or lymph vessels.
• New vascularization in the tumor zone activity.
• Free surgical edge little, or edge with tumor cells.
• Receiving negative estrogen.
• Gestation.
Breast cancer staging
The staging is used to determine the type
and duration of treatment that must manage, and evaluate the response to
treatment of breast cancer. And to make the classification final held after the operation.In addition different diagnostic tests are made to assess the extension before the surgery, such as chest x-ray, analytical, scan and liver ultrasound.
After the operation, the data that interests you to find out about the tumor are mainly the microscopic Anatomy of the removed tumor, tumor characteristics, and the extent of axillary involvement.
Diagnosis of breast cancer
The prevention of breast cancer might say that it is synonymous with early diagnosis; Therefore, it is important to women mammograms after a certain age. Also
recommend regular monitoring of those diseases which could degenerate
into breast cancer (mainly non-cancerous diseases of the breast).Not breastfeeding give children may increase the risk of breast cancer, so it is advisable to (in addition to all the benefits that this entails for the baby) to breastfeeding after birth if there are no contraindications.
The techniques used for the early diagnosis of breast cancer are:
• Auto scan. It has not demonstrated so far that it is useful in the reduction of mortality, but advises women to examine monthly (after the menstrual phase, or choosing a day a month if it's postmenopausal women).
• Clinical examination. Visual inspection and palpation of the breasts and armpits (as the preferential lymphatic area).
These are the suspicious signs of malignancy of breast cancer:
• Nodule hard, fixed and irregular contour.
• Skin or nipple retraction.
• Secretion with blood, especially if it is one-sided.
• Presence of adenopathies (enlargement of the lymph nodes) hard, fixed.
Mammography
Mammography is currently the most important method for early diagnosis. Signs of possible malignancy mammographic are considered:• Presence of a nodule dense, irregular edges, retraction of the skin or edema (their typical manifestation is the orange peel).
• Microcalcifications: it is the suggestive sign of malignancy before appearing on the mammogram.
• Alteration of the breast tissue.
• Focal asymmetric density.
BIRADS
They are the categories of the radiological findings in mammography, indicating the result of the same:• 0: other techniques are necessary.
• 1: negative (normal).
• 2: benign finding.
• 3: probably benign finding.
• 4: suspicious abnormality.
• 5: highly suggestive of malignancy.
When get a mammogram?
• In women with breast cancer with first-degree relatives, annually.• In women without a family, aged between 35-40 years, have a mammogram of reference.
• From 40 years: annual clinical examination, and annual or biannual mammograms.
• From age 50 is suitable to carry out a full study every 2 years, until the age of 70.
• If it is carrier of breast prostheses, magnetic resonance is made.
Ultrasound
It is a more effective method in young women.
Biopsies
• Puncture fine needle aspiration: before any
suspicion of breast pathology there be carried out, to analyze the
extracted material, what gives explanation about the possible diagnosis.• Thick needle biopsy: distinguishes the invasive forms of non-invasive. When the tumors are very small it can be used to remove them.
• Biopsy: it offers the definitive diagnosis. It must be every woman with suspected malignant breast disease.
Special cases of breast cancer
There are two special cases of breast cancer that have specific characteristics:
Breast cancer in men
Is 100 times less common than in women, and
is associated with increased estrogens (female hormones) in males (for
example, after the treatment of prostate cancer); as
in the case of women, there are more incidence of breast cancer if
there is a family history of Gynecomastia (breast augmentation).Treatment is similar to which women receive, and normally consists of mastectomy, or radiation therapy.
Breast cancer and pregnancy
Breast cancer is the malignant neoplasm that most frequently detected during pregnancy or the postpartum period.The worst prognosis is associated with the delay in diagnosis, so it is recommended breast scan during pregnancy and postpartum as well as analysis of lesions that are suggestive of malignancy, without waiting for the delivery.
For the treatment of breast cancer during pregnancy, as well as factors related to the tumor and the patient, should take into account the fetus, and on that basis a decision for treatment.
As in the rest of the patients, the approach is surgical, resecting the affected area (and the lymph nodes if necessary); If you require radiotherapy must wait partum, but yes we must administer chemotherapy if necessary, to try to avoid the first quarter.
With respect to the fetus, not been shown that abortion will improve the prognosis of the disease, so it is not indicated. However, miscarriages, not because of the disease may occur (because the fetus extension is something which it is not), but due to the treatments and the deterioration of the mother.
Treatment of breast cancer
Breast cancer could be considered since its
inception as a disease that affects the entire organism, therefore, to
surgical treatment must be add one adjuvant.It tends to apply a treatment as conservative as possible that guarantees maximum safety in action.
In addition, it is very important to take into account the potential psychological impact of the disease in the patient, so you have to evaluate the possible indication of psychological treatment.
Surgical treatment of breast cancer
The initial treatment of breast cancer will be
surgical, except in cases in which chemotherapy is first necessary to
reduce the volume of the tumor, and then perform the surgery.
Conservative
This treatment applies to stadiums lowest, provided there is no invasion or poor prognosis criteria.It will dry out the tumor, with or without more breast tissue, according to the stage of the cancer. Sometimes, in addition, removal of the lymph nodes in the area and the management of radiotherapy is required.
Radical mastectomy
Radical mastectomy is carried out when it is
unable to perform, the stadium of the breast cancer, surgery, or because
there is contraindication of it.There are different types, which vary primarily in the preservation or not the chest muscles.
Sometimes is an immediate breast reconstruction, provided that you have low risk of local recurrence.
Axillary Lymphadenectomy
If the Sentinel node is positive, shall be
completed with the full axillary node dissection surgery, and if it is
negative, is not necessary.The only contraindication clear Sentinel node test is the axillary nodes metastatic affectation.
Radiotherapy
It is indicated after the conservative
surgery in all cases and postmastectomy, in patients at high risk of
local recurrence, since it decreases the number of relapses and
increases survival; It is also used in large tumors and when there is alteration lymph node. See more about radiation therapyYou have to wait two weeks after the surgery, and not must be delayed more than 16 weeks after the surgery.
Chemotherapy
He is administered to patients with positive axillary nodes, or negative armpit with poor prognostic factors. See more about chemotherapy
Hormone replacement therapy
The only hormone replacement therapy is indicated
in patients with hormone receptor-positive breast cancer (which is
confirmed by histological study).So far most commonly used drug is tamoxifen, but has the problem that can increase the size of the endometrium, so it controls ultrasound are needed and, in the case of vaginal bleeding, should be made a histological study to rule out changes in the endometrium. However, it reduces the risk of cardiovascular disease and the risk of breast cancer in the other breast.
There is another drug, raloxifene, which has the same efficacy in the treatment of breast cancer, and does not affect the endometrium, so it is beginning to progressively replace tamoxifen by the latter.
There is also another type of newer drugs that are monoclonal antibodies, and that are administered in case of overexpression of certain genes; an example of these drugs is trastuzumab, and is used in the case of States with metastasis.
Finally, on the issue of the treatment breast cancer chemotherapy, should be noted that another drug, the Group of aromatase inhibitors should be administered in postmenopausal women with hormone receptor-positive.
After the completion of treatment should carry out periodic checks to detect possible relapses, or the emergence of other tumors (in the breast or elsewhere in the body), which usually consist of interview and clinical, analytical exploration with markers and mammography, mainly.
Prevention of breast cancer
Prevention against breast cancer can be classified as primary or secondary. In
the first case, it's adopt a healthy lifestyle, eliminating all those
habits harmful to health as the sedentary lifestyle, smoking or drinking
alcohol or abuse of foods high in fat or sugar.A balanced diet, based on the Mediterranean diet, avoid overweight, not exposed to the Sun without protection, and perform a moderate regular physical activity are the best tips to decrease the risk of developing any type of cancer.
In the case of breast cancer, secondary prevention to avoid the development of these tumors is based on early diagnosis, which detect the disease in its early stages to establish the most appropriate treatment as soon as possible. Other alternatives when it comes to hereditary breast cancer, are managing preventive chemotherapy, or remove the healthy breast - what is known as a prophylactic mastectomy - to reduce to the maximum the possibilities of developing a tumor in this tissue.
Gene mutation and cancer
In the prevention of breast cancer there are
considered special cases of high risk, that they are those of patients
in which it has determined the presence of a mutation in the BRCA1 and
BRCA2 genes, indicating that they have a high percentage of odds -
between 60% and 84% - develop cancer in their lifetime. In addition, this genetic alteration also increases the possibility of neoplasia to appear at a younger age.In people who have the mutant gene, explains Dr. Raúl Márquez, oncologist at MD Anderson Cancer Center in Madrid, the most frequent types of cancer are breast and ovarian cancer, but also have predisposition to other types of tumors such as melanoma or colon cancer, although to a lesser extent.
These patients, says Dr. Márquez, is subject to close monitoring and testing such as mammography, breast ultrasound, or MRI on a regular basis. To minimize the high risk - continues the oncologist-in certain cases also it would be justified to take other measures such as administration of chemoprophylaxis or preventive chemotherapy, and even prophylactic mastectomy (the removal of the healthy breast).
The doctor Márquez requires that "inherit a mutated gene that predisposes you to cancer is relatively rare and uncommon". But, to check, add this expert, "patients who have suffered cancer of the breast or ovary, or have a close with this type of tumor family history, should speak with their oncologist so it may decide whether they meet the criteria that do refer to a unit of genetic counseling".
The factors that the oncologist has in mind to refer a patient to one of these Council genetic are units that have been several cases of breast or ovarian cancer in the same family - three or more - or, if there has been one case, this present a series of unusual features, such as for example when a male has had breast cancer. In the unit are performed genetic analysis - analysis of blood or doing a biopsy a tumor removed - to check if the patient has the mutated genes that favor the development of a cancer.
The doctor Márquez insists that the overall percentage of hereditary cancers is small - around 5% - and that, of these, breast and ovarian cancer represent only another percentage, so few people positive BRCA.
What is prophylactic mastectomy
Prophylactic mastectomy is the surgical removal of
the healthy breast, with the aim of preventing the development of a
cancerous tumor in this tissue, and is estimated to reduce the chance of
breast cancer between 90 and 95 percent.It is a measure only recommended to people who, like the famous American actress Angelina Jolie, they have mutated BRCA gene. "It is a decision that has to be very consensual and agreed with the geneticist and oncologist", says Dr. Raúl Márquez.
Prophylactic mastectomy is different which is performed when a tumor has already been developed. In this case, is usually to leave a small amount of breast tissue, as well as the skin and the nipple-areola complex.
On the other hand, the intervention that is performed when it has already released the cancer is more radical, and often is removed the whole breast, although this depends on the cases, since nowadays it tends more and more to conservative surgery.
According to Dr. Márquez, it is suitable for anyone is to determine that a risk as high as that of Angelina Jolie undergo this surgical treatment. "Not all the people who have had breast cancer or have a family history of this tumor is because they have this mutated gene - says the oncologist- but, if they have the mutated gene, you have to take radical measures."
13. Ovarian Cancer
Ovarian cancer is the leading cause of death by cancer in the female reproductive tract, although it is not the most frequent; and the sixth cause of death by cancer in women
One of every 70 women suffering from this cancer, occurs most often between 65 and 80 years of age and prognosis, as in all cancers, is worse the bigger Stadium (degree of development of the disease) of the same. In this case, when the tumor is detected the stadium is already advanced, and the tumor tends to have spread beyond the ovaries, that is why you have so much mortality.
Why early of this tumor diagnosis, is important since it allows to improve the prognosis, which, on the other hand, every time is somewhat better thanks to advances that are occurring in medical treatment and surgery related to the control of this disease.
It is also a very important psychological support given to the patient to be diagnosed and, in general, for all treatment, because that will help you to better cope with this process.
Causes of ovarian cancer
The causes of ovarian cancer are not known
although Yes it has been observed that there are a number of factors
that predispose a woman to develop this type of cancer, while other
factors reduce the risk of developing the disease.
Risk factors of ovarian cancer
• Theory of incessant ovulation: the
traumatismo-rotura that occurs during each ovulation to leave the egg
from the ovary can be a stimulus for the emergence of ovarian cancer. For
this reason, childless women are at greater risk, since pregnancy is a
period of rest ovulatory, and those who have not been pregnant will have
suffered a greater number of ovulations.• Genetic: it appears more frequently in women with a family history of ovarian cancer. It was noted that 30% of ovarian cancers express high levels of certain genetic mutations.
• Age: older, higher risk.
Protective factors of ovarian cancer
• (PCOS) polycystic ovary syndrome, since this condition prevents ovulation occur in women affected by this disorder.• Oral contraceptives; take hormonal contraceptives may prevent ovulation.
• Tubal ligation and hysterectomy, cause a decrease of ovulation by altering the Vascularity of the area.
• Pregnancies.
Types of ovarian cancer
When we talk about ovarian cancer we can distinguish various types of tumors. Below are some of the most common related:
Epithelial tumors
They make up the majority of ovarian tumors, 75% (including benign and malignant) and 90% of the malignant. This
definition includes a set of tumors derived from the epithelium of the
ovary (tissue that covers it), and the most common are:• Serous (60-80%): Cystadenoma, cystadenocarcinoma. They are the most common, and tend to be bilateral. Globally they malignizan 3 times more than the Mucinous.
• Mucinosos (25%): Cystadenoma, cystadenocarcinoma. They are usually benign and can reach a large size.
• Endometrioid (20%): (endometrioma, carcinoma). The majority are malignant, and sometimes are associated with endometrial adenocarcinoma.
Germ
They constitute 25% of the total, but they are 60% of tumors that appear in young women, and usually produce pain and bloating.• Mature cystic teratoma is the most frequent (90%) and it is benign, but the rest of this group of tumors are malignant. The most prominent are:
• Benign cystic teratoma or dermoid cyst: is very common and usually benign. In its composition predominate fabrics such as sweat, sebaceous glands, hair...
• Dysgerminoma: it is the most frequent malignant tumor of this group, and the evil one more frequent in patients younger than 30 years.
Shoelaces sexual-Stromal Tumors
It is the least frequent group, and they constitute 5% of ovarian tumors.• Granulosa: they are more common in postmenopausal women, and produce estrogen (female hormone), therefore they symptoms may occur early due to increased estrogen, such as absence of menstruation or, on the contrary, abundant bleeding, endometrial thickness increased... To manifest symptoms early, diagnosed in stages soon advanced, which improves the prognosis.
• Of the teca-fibroma: tend to be benign, and approximately half producing estrogen or androgens (mainly male hormone), which may facilitate a diagnosis early, as in the case of tumors derived from the granulosa.
• SGOT: they are usually benign, and reproduce testicular elements, therefore half of these tumors may produce androgens, and this can lead to symptoms such as: acne, enlargement of the clitoris, decrease in menstrual bleeding, i.e., signs of virilization, and thus constitute the first cause of virilization of ovarian origin.
Secondary tumors
They represent 10% of ovarian tumors.
Symptoms of ovarian cancer
The symptoms of ovarian cancer does not tend to be
specific, they are common to other less serious illnesses, for example
of the digestive tract, it is frequent that the diagnosis comes when the
tumor is already at an advanced stage.In addition, symptoms manifest themselves when time is suffering from disease and, being similar to those caused by digestive disease, can be treated erroneously for a while, in many cases with antacids.
The most common symptoms of ovarian cancer are:
• Abdominal swelling.
• Abdominal pain.
• Irregular vaginal bleeding, that appears outside of the menstrual period.
• Constipation, gas, strong urination.
• Nausea and vomiting.
• Loss of appetite.
• Decrease or unexplained weight gain.
• Back pain.
• Constitutional syndrome (fatigue, loss of weight...) in tumors with high growth and who are in advanced stages.
They can appear complications such as: ascites (accumulation of fluid in the abdominal cavity), torsion, rupture, bowel obstruction, spread of the cancer to other organs, infection...
Diagnosis of ovarian cancer
The definitive diagnosis of ovarian cancer is
established through the study of the affected tissues, but the clinical
history and imaging techniques and serum markers Guide (very faithfully
in some cases) on the diagnosis.
Imaging techniques
Vaginal ultrasound doppler
It is the imaging technique more effective in the
diagnosis of ovarian cancer, and to evaluate if a detected mass is solid
or a fluid-filled cyst is.Malignancy is suspected when the ultrasound detected, among others, any of the following characteristics:
• Bilateral location.
• Solid and cystic appearance.
• The presence of thick walls, solid parts inside.
• Size of 10 cm in women of childbearing age, or greater than 5 cm in postmenopausal women.
• Presence of ascites (fluid in the abdomen).
• Detection of new vascular formations.
CT
Its main use is to determine if ovarian cancer has spread to other organs. In addition serves to check the size of the tumor and the lymph nodes are enlarged.
Magnetic resonance
The images obtained with this technique are more
complete than the achieved by computed tomography, in terms of the
definition of the lesions and the assessment of the spread of the tumor.
Tumor markers
Tumor markers (segregated by the tumor substances) that have been associated with ovarian cancer are:• Ca 125: can be elevated up to 80% of ovarian tumors, but it may be associated with benign processes, as for example the gestation, so it tends to be more specific in postmenopausal patients.
• CEA (carcinoembryonic Antigen): is elevated less often, but yes it is in almost 70% of Mucinous cancers.
• Alpha fetoprotein: is associated with endodermal sinus tumor, because it increases even in 95% of patients, although it can also increase in teratomas and disgerminomas.
• Inhibin: increase in granulosa tumor and Mucinous.
• CA19.9: mainly rises in Mucinous Tumors.
• HCG: it rises in 95-100% of embryonic lung, which also have augmented the alpha-fetoprotein in 70%. The HCG in choriocarcinoma is also increased.
• SCC (growth of squamous cell carcinoma Antigen): immature teratomas increases.
Sex cord tumors also secrete hormones, as seen above, that help your diagnosis; Thus, teak and granulosa cell tumors produce estrogen; of Sertoli and Leydig cells secrete testosterone, and the ginandroblastomas secrete estrogens and androgens.
Early diagnosis of ovarian cancer: screening
In women with a first-degree relatives affected by
ovarian cancer or breast cancer, is usually advised (although there is
no scientific evidence of the utility of this screening) ultrasound and
measurement of Ca 125 annually, to rule out possible familial syndromes
including ovarian cancer.
Treatment of ovarian cancer
Usually, treatment of ovarian cancer is addressed by the following techniques:
Surgery
The basic treatment of ovarian cancer is surgical,
and usually consist of a radical surgery, in which the uterus and
ovaries are removed, it explores the peritoneum (and biopsies are taken
if there are suspicious lesions), removed the lymph nodes in the area,
and may even need to remove intestinal segments, in order to eliminate
all the possible locations of the tumor.In the young patients who wish to have children, more conservative surgery may be performed in some cases, which would be completed later, once fulfilled the wishes of descendants.
In advanced stages is removed most of the tumor, so that the remainder can try treated with chemotherapy after surgery.
If there is no option of surgery is treated with chemotherapy.
Chemotherapy
It is used according to the stadiums and the
success of the surgery, as adjunctive therapy to eliminate possible
malignant cells that have survived the operation. The
number of treatment cycles that the ovarian cancer patient you will
receive will depend on the stage of your disease that is. In this type of cancer chemotherapy can be administered into a vein (intravenous or IV) or in the womb (intraperitoneal or IP). See more about chemotherapyRecently experts have incorporated therapy anti-angiogenic with a monoclonal antibody against VEGF which significantly improves the prognosis of ovarian cancer to treatment with chemotherapy.
Tracking
It is very important to detect early recurrences, it is to do periodic reviews, which can include:• Physical exam.
• Analytics: Hematology, biochemistry and tumor marker (Ca 125).
• Imaging tests: ultrasound, CT or resonance.
14. Pancreatic Cancer
That is why more than half of these tumors already have spread when finally detected, so the life expectancy of these patients exceeds just the five months. This makes the pancreas is currently the fourth cause of death by cancer in the EU, charging more than 80,000 deaths a year.
The pancreas is a gland that belongs to the digestive system, and as such is responsible for secreting various substances and hormones, of great importance for the Agency. Elongated pear-shaped and three parts are in it: it is called head to the end of the pancreas, the other end, finest, is what is known as a tail, and the intermediate zone between the two extremes is the body.
Endocrine and exocrine tumors of prostate
Speaking of cancer of pancreas should
differentiate the disease depending on the type of pancreatic cells that
are affected, and who are distinguished by their different functions:• Exocrine pancreas cells are responsible for secreting pancreatic, vital juice for the digestion of nutrients.
• The endocrine pancreas cells are responsible primarily secrete insulin and glucagon, which are essential for controlling blood glucose levels and providing the Agency the tasks of storing and using energy obtained from food.
The involvement of one or other cells - exocrine or endocrine - originating a type of different tumor, with different symptoms, diagnosis, and treatment. In the following sections, we will see in more detail.
What are exocrine tumors of pancreas
95% of tumors of the pancreas arise in its exocrine portion. Pancreas exocrine tumors are malignant tumors with very bad prognosis. The
five-year survival is less than 5%, mainly because the vast majority
already have disease disseminated at the time of diagnosis. However,
it is one of the tumors where most progress is being made to establish a
palliative that lengthen the survival of patients.The incidence of this type of cancer is located in Spain, in 8 of every 100,000 inhabitants per year. Around the world, it represents the fourth cause of death by cancer in men and the fifth in women.
Although it can appear at any age, most often is that it occurs in over 60 years of age. It most affects males.
Risk factors of pancreatic exocrine tumors
These are the most common causes that may predispose to an exocrine pancreas cancer:• Tobacco: people who smoke are between two and three times more likely to develop this type of cancer. It is estimated that 30% of cases of pancreatic cancer are related to tobacco.
• A diet rich in fat and protein, especially animal. On the contrary, the incidence of pancreatic cancer is lower in people who eat a diet rich in fresh fruit and vegetables. Vegetables and fruits rich in folate and lycopene (pigment plant of the family of carotenoids that gives color to tomatoes and other vegetables and fruits) can be especially good for reducing the risk of pancreatic cancer.
• Exposure to organochlorine pesticides.
• Obesity.
• Chronic pancreatitis, especially that caused by the excessive consumption of alcohol.
• Cause hereditary pancreatitis. This is a genetic disorder that is characterized by alterations in the enzymes produced by the pancreas, causing chronic inflammation of the body, which may facilitate the emergence of cancer.
• Long-standing diabetes is a moderate risk. Some studies indicate that the risk of developing a cancer of the pancreas in patients with diabetes of at least five years of evolution is multiplied by two.
• The black race has also partnered to an increased risk of pancreatic cancer.
• Age: older, more likely to develop pancreatic cancer. Except the pancreatitis of hereditary origin or because of a chronic pancreatitis, pancreatic cancer is almost always diagnosed in over 60 years.
Symptoms of exocrine tumors of pancreas
Head of pancreas (70%) tumors invading the
duodenum; and those of body and tail of pancreas (20% and 10%
respectively) affect the liver, spleen and peritoneum left adrenal
gland.Exocrine tumors of the pancreas symptoms are fairly non-specific. Usually, tumors of the pancreas head are presented with abdominal pain, jaundice, and loss of weight without just cause; While the body and tail is dominated by pain. We will now see each symptom in more detail:
• Abdominal pain: tends to be constant. It is located in the upper area of the abdomen and radiates on the sides and back, as a belt. It predominates at night, preventing sleep the patient. It gets worse after meals, and is relieved by bending the body forward.
• Jaundice: it is called in this way to the yellowing of skin and mucous membranes caused by an increase of bilirubin in blood, and is due to obstruction of the bile duct by the tumor itself. It is often the initial symptom of cancer of the head of the pancreas. Sometimes, before warning the yellowing of the skin and mucous membranes, it shows a darker urine, due to bilirubin, and the more whitish stool. The increase of bilirubin in the blood produced generalized itching of the body, which you can check injury scratch to examine the patient. Many times the itching is the most annoying symptom for the patient.
• Weight loss: is due to lack of appetite, satiety, and phobia coming to feel the patient for food due to abdominal pain that causes it, which implies a lower caloric intake. Another factor that contributes to weight loss is that there is a lack of intestinal absorption which causes diarrhea; This is due to the blockage of the duct pouring pancreatic juice to the intestine.
• Other:
or nausea and vomiting.
or swollen Abdomen and digestion.
or gastrointestinal bleeding.
or thrombophlebitis and venous thrombosis, Embolic phenomena sometimes, since the tumor can increase the coagulability of the blood.
or neuropsychiatric disorders, such as depression or personality changes. Even the risk of suicide is very increased.
or the appearance of edema and ascites (accumulation of fluid in the abdomen) indicates advanced disease.
Diagnosis of pancreas exocrine tumors
To reach the diagnosis of an exocrine pancreas tumor it may be necessary to perform the following tests:• Lab tests: non-specific tumor pathology, but if the pancreatic enzymes are high they are oriented to possible injury at this level. In addition, so-called "tumor markers", which are substances that are elevated in the blood in certain types of tumors can be determined in the blood. Although they are not always specific cancer, sometimes along with other tests, they help the diagnosis and especially the follow-up of this disease. The most widely used in the study of pancreatic cancer is CA 19.9.
• Ultrasound: many times, the pancreas is not adequately with this test because it is a body which is relatively deep and you can place the gas from the stomach, duodenum or colon. Neither matches well tumors less than 2-3 cm. Ultrasound may detect only 60-70% of pancreatic cancers. However, usually the initial study test because it is a very accessible, not painful test and serves to assess the bile. Sometimes, performed an endoscopic ultrasound, which is done through an endoscope that is inserted through the digestive tract, which greatly increases the sensitivity of the routine ultrasound.
• CT: computed axial tomography is capable of detecting smaller than ultrasound masses, and also with this test you can check if the tumor has spread to neighboring organs or lymph nodes.
• MRI (magnetic resonance imaging): may be useful in some cases where there are diagnostic doubts with the TAC.
• PET: Positron Emission Tomography is a test image that is not available on most of the centers. It is especially useful in the detection of possible hidden metastases. Often occurs at the same time than a CT (PET-CT) which allows a greater sensitivity in the diagnosis of pancreatic cancer.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): this test consists in the introduction of an endoscope through the mouth of the patient previously numbed, to see the light of the digestive tract; a contrast is then inserted via biliary and pancreatic and x-rays are taken to observe possible obstructions or calculations. It can differentiate between a pancreatic cancer and chronic pancreatitis.
• Biopsy: allows the obtaining of tumor tissue samples. It is usually done by means of a guided fine needle with imaging such as CT and endoscopic ultrasonography test. It is not always necessary to do biopsy as it sometimes has diagnostic imaging tests safety and goes directly to the surgery to remove the tumor.
Treatment of pancreas exocrine tumors
Given that this is a disease with a high mortality
rate and is often diagnosed in advanced stages already, an exocrine
pancreas tumor treatment must be as aggressive as possible to try to
remove all of the tumor cells of the organism.
Surgery
Not all tumors of pancreas are suitable for resected with surgery. 10% of those who affect the head can undergo this treatment in a way fully healing, and almost none of the body and tail.Palliative surgery attempts to minimize symptoms resulting from the tumor, eliminating obstruction of the bile, via removal of the tumor and part of the gland healthy to avoid leaving tumor remains that grow back.
In the case of high-risk surgical patients (for example of very advanced age or with a very serious general condition) is preferred to place a prosthesis in the bile duct by endoscopic route, to avoid to intervene. This will allow the remission of symptoms and gives opportunity to continue with other symptomatic or palliative treatments like those they see below
Chemotherapy
Recent studies show that the use of these
drugs on its own is not effective, so it is currently preferred to
manage a combination of chemotherapy drugs. However, they lack of curative action, and often used in palliative way in tumors that are inoperable. And in these cases they do manage to increase survival time. There
are numerous investigations underway in order to verify the
effectiveness of various combinations of drugs, as well as to develop
new targeted therapies, which are designed to combat cancer cells
without damaging healthy cells.
Radiotherapy
In advanced stages, it can decrease the symptoms of the disease. Unlike
chemotherapy, the radiotherapy treatment is usually used as support
after surgery to eliminate cells that have been left. Its use has been shown to increase the survival of patients undergoing surgical resection of the tumor.
Immunotherapy
It is stimulating the patient's immune system so that it is able to distinguish and to fight cancer cells. These treatments are under investigation.
Symptomatic treatment
• Abdominal pain are given anti-inflammatory and in very advanced, morphine or related cases. Some Antidepressants can enhance the effect of analgesics. Sometimes
it may be necessary to block the nervous plexuses originating pain
through surgery or percutaneous needle guided by ultrasound. Radiotherapy on the organ can also alleviate pain but it does not increase survival.• Antiemetic to prevent nausea and vomiting.
• Inductors and nutritional supplements such as megestrol acetate appetite.
• When there is a lack of intestinal absorption by insufficient secretion of the pancreas, need to manage pancreatic enzymes which develop this mission.
• Anticoagulants in the case that there is already some phenomenon thrombotic or Embolic in the patient.
Prevention of pancreatic exocrine tumors
It is not possible to complete prevention that
ensures no never suffer this type of tumor, but if that life habits that
make their appearance to be less likely to have.It is essential to take a healthy diet rich in fruits and vegetables, associated with the practice of moderate exercise two or three times a week to combat obesity.
It is also essential to quit smoking, not only for prevention of pancreatic cancer, but for other many who has been associated with, such as the lung or bladder cancer.
However, in many cases, pancreas exocrine tumors appear spontaneously or by genetic inheritance.
What are its symptoms and endocrine tumors of pancreas
Pancreatic endocrine tumors are rare, and his prognosis is better than in the exocrine tumors of the pancreas. Although
they may appear at any age, in the vast majority of the patients they
do between 30 and 60 years, affect similar to both sexes, and in 80% of
cases are located in body and tail of the pancreas.Endocrine tumors originate from cells that produce different types of hormones such as insulin, glucagon or gastrin among others. According to the cell originating tumor, neoplasia, insulinoma, glucagonoma, gastrinoma, etc are called.
Occasionally, this type of tumors are associated with other Neoplasms in a syndrome that has a genetic origin. This syndrome is known as MEN or multiple endocrine neoplasia syndrome.
Symptoms of endocrine tumors of pancreas
Cancer may progress, and even spread to other parts of the body without causing symptoms. The most frequent is it occurs with an excessive hormone secretion that segregates the cell that caused the tumor. Thus, insulinomas secrete insulin, making it produce decrease of sugar in the blood or hypoglycemia.On the contrary, glucagonoma secretes glucagon, which raises blood sugar and produces diabetes.
Excessive gastrin producing gastrinoma increases the secretion of acid by the stomach and produces multiple and difficult to treat gastro-duodenal ulcers.
There are other tumors that produce substances that diarrhea and disorders electrolytic VIPoma, or cramping bile and diabetes as somatostatinoma.
Diagnosis and treatment of pancreatic endocrine tumors
Some endocrine tumors secrete substances like the Chromogranin A that can be measured in the blood and help the diagnosis.In the case of insulinoma, measured blood glucose levels and insulin levels in the blood at certain time intervals and when appears a hypoglycemia.
Certain substances which are precursors of proinsulin and insulin as the petido C can also be measured. This definition allows for hypoglycemia caused by an insulinoma of the produced by the surreptitious insulin administration.
Other tumors such as glucagonoma, gastrinoma, etc., can be suspect if there are elevated levels of glucagon, gastrin or other hormones in blood.
To check the location of the tumor, it is essential to perform any test image, such as an ultrasound or a CT scan.
Treatment of endocrine tumors of pancreas
An endocrine tumor of pancreas patients
require treatment individualized depending on the size and the hormone
that they secrete. Requires a proper correction of blood glucose and disorders electrolyte which have taken place.In some cases, the effect of the hormone can be overridden with an analogue of somatostatin called octeótrido. Many tumors require surgical treatment and chemotherapy may be necessary.
15 Cancer of penis
80% of primary tumors are squamous carcinomas (originating from the epithelium of the skin or mucosa, unlike adenocarcinomas, which originate from the glands epithelium) and, although less frequent, may be metastatic, fundamentally in the bladder and prostate lesions. They are located in the Glans (up to 80%), the foreskin, sulcus balanoprepucial and the shaft of the penis. Only 5% is multicentric. Its growth pattern can be in (horizontal) extension, depth (vertical) or "out" (Verrucous or exophytic).
Left to its natural evolution, penile cancer can be finished with the life of the patient in two years, since the tumor affects corpora cavernosa and urethra, and in a following season metastasizes in locoregional lymph nodes and Hematogenous via (by blood) can produce metastases in other organs (at distance).
Anatomy of the penis
The penis is composed of three cylindrical
masses joined by fibrous tissue, two sides (corpora cavernosa) and a
bottom (corpus spongiosum), which houses most of the urethra. It is attached to the pubic arch. The
overlying skin is loose and is connected to the deeper parts of the
body, in the root, the skin continues with the scrotum and distally (in
the probe) retracts onto itself forming the prepuce.Regional lymph nodes are the inguinal (superficial and deep-) of Rosenmüller or Cloquet - external iliac and internal, and the pelvic.
Causes and symptoms of penile cancer
Although not known the exact why causes penis
cancer develops, it has been classically associated lack of hygiene and
prolonged exposure to the own sperm in patients not circumcised, but not
circumcised population has no increased incidence, so for this case
cannot be recommended prophylactic neonatal circumcision has been.There are various studies that relate it with the virus of the human papillomavirus (HPV), demonstrating the presence of this pathogen in 80% to 100% of the tumors in-situ and in 15-80% of the infiltrating (genotypes 16 and 18, associated with high risk), and high incidence of penile cancer (intraepithelial) in patients with genital condylomas pairs have been described , intraepithelial Carcinoma of neck of uterus (and vice versa), so the relationship is suggested (although not demonstrated by conclusive epidemiological studies). It has also suggested a possible relationship between infection by HIV and penis cancer, since increases the incidence of HPV in patients with AIDS.
Other factors influencing their incidence are tobacco (dose dependent and well-defined mechanisms), the UVA and UVB rays and radiation therapy, Lichen Sclerosus, obliterans balanitis.
Symptoms of penile cancer
Regarding the symptoms of penile cancer, the
earlier injury who suspect the presence of this type of tumor generally
is an ulcer or a mass exophytic (wart) that do not usually hurt or
bleed, delaying early diagnosis; This, and the
negligence of the patient, out of shame or ignorance (reviewing the
literature described delays between the discovery of the injury and the
first consultation between two and eight months).When symptoms appear, such as hematuria (blood in urine) or pain, it is because the tumor is locally advanced and is usually accompanied by a breakthrough infection. In any case, before any injury, persistent, smelly, discharge or abnormal inflammation, irritation, pain, or bleeding from the penis, it is necessary to consult your doctor.
Diagnosis of cancer of the penis and TNM classification
A good medical history and physical examination are essential in the diagnosis of the cancer of penis; lymph node involvement is the most important prognostic factor and therapeutic implications.Biopsy of the lesion helps determine its nature, and is required a complete resection, with sufficient safety margins.
For the diagnosis of suspicious lymph nodes a puncture-aspiration (FNA) needle (guided by ultrasound, or not) is usually sufficient, although there are up to 50% of false negatives (i.e. not disease diagnosed when there it is). In this case, it is necessary to perform a lymph node biopsy. According to some studies, when almost half of the cases diagnosed cancer of penis are palpable inguinal lymph nodes, but only half of them are tumor; i.e., the rest are reactive Lymphadenopathy: infectious or inflammatory.
(CT and MRI) imaging techniques are reserved for the extension study and locate lesions distance; Lung, liver and bone, are the most common locations.
Classification of penile cancer
For the TNM classification follows that of the AJCC (American Joint Comitee on Cancer )):
T: primary tumor
| TX | The primary tumor cannot be assessed. | |
| T0 | There is no evidence of primary tumor. | |
| Tis | In situ carcinoma. | |
| Ta | Verrucous Carcinoma non-invasive. | |
| T1a | The tumor invades the Subepithelial connective tissue without lymphatic vascular invasion, and it is not poorly differentiated (grade 3). | |
| T1b | The tumor invades the Subepithelial connective tissue with lymphatic vascular invasion, or is poorly differentiated. | |
| T2 | The tumor invades the body sponge or cavernous. | |
| T3 | The tumor invades the urethra. | |
| T4 | The tumor invades adjacent structures. | |
N regional lymph nodes
| Definition of the clinical stage (radiological) | |
| cNX | Regional lymph nodes cannot be assessed. |
| cN0 | There is no palpable or visibly enlarged inguinal lymph nodes. |
| cN1 | Lymph node inguinal unilateral mobile palpable. |
| cN2 | Inguinal lymph nodes palpable, mobile, multiple, or bilateral. |
| cN3 | Fixed palpable inguinal nodular mass or unilateral or bilateral pelvic Lymphadenopathy. |
| Definition of the pathological stage (once operated) | |
| pNX | Regional lymph nodes cannot be assessed. |
| pN0 | There are no metastases in regional lymph nodes. |
| pN1 | Single inguinal lymph node metastasis. |
| pN2 | Multiple or bilateral inguinal lymph nodes metastasis. |
| pN3 | Extranodular extension of metastasis in lymph node or node (s) lymphatic (s) pelvic (s) (s) unilateral or bilateral (s). |
| M0 | There is no distant metastasis. | |||
| M1 | There are distant metastases. | |||
| Stadium | T | N | M | |
| 0 | Tis | N0 | M0 | |
| Ta | N0 | M0 | ||
| I | T1a | N0 | M0 | |
| II | T1b | N0 | M0 | |
| T2 | N0 | M0 | ||
| T3 | N0 | M0 | ||
| IIIa | T1-3 | N1 | M0 | |
| IIIb | T1-3 | N2 | M0 | |
| IV | T4 | Any N | M0 | |
| Any T | N3 | M0 | ||
| Any T | Any N | M1 | ||
STAGE description (Jackson)
I confined to the Glans or foreskin.
II Invasion of body or corpus cavernosum.
(III) operable Metastasis to inguinal nodes.
IV Invasion of adjacent structures, or inoperable nodes in the groin.
Treatment of penile cancer
Provided that there is no disease at distance, the treatment of penile cancer aims to treat the primary tumor and lymph nodes. Given
that patients demand ever-increasing quality of life (and more talking
about the organ in question) have to try not to compromise the life of
the patient allowing the preservation of the body.In this sense, in 1994 Opjordsmoen S. and collaborators published a curious study in the journal British Journal of Urology where almost 70% of the patients included decide treatments with greater guarantee of survival at the expense of compromising his sexual activity. There are other very interesting data in this study.
Conservative treatment of penis would be indicated in tumors small and not infiltrating, always ensuring safety between 1.5 and 3 cm margins:
• Creams with QT topical (Imiquimod 5FU).
• Mohs surgery: the surgeon is removing each layer of skin until there is no injury.
• Cryosurgery: application of cold.
• Conservative surgery: local resection of the lesion (circumcision in the case of the foreskin), or glandectomia in the case of the lesion in the glans.
• Laser: indicated for tumors less than 2 cm and with excellent results.
• Radiation (external or interstitial): indicated for not infiltrating tumors less than 4 cm, not exceeding balanoprepucial Groove.
In all these cases required a strict monitoring, since early diagnosis of recurrence is the only way to not compromise the survival of the patient.
Tumors infiltrating, or large penectomy (removal of the penis) total or partial is stated, always taking in all those safety margins above.
In what regards to the lymph nodes, once diagnosed lymph node involvement (by PAFF or biopsy), bilateral inguinal lymphadenectomy is diagnostic and therapeutic, although it is not exempt from morbidities (side effects) as Lymphedema of scrotal lower members, etc. It is important to remember that up to 17% of patients without palpable inguinal Lymphadenopathy has microscopic disease involvement, therefore prophylactic inguinal lymphadenectomy is indicated according to risk groups:
It is not suitable to lymphadenectomy if:
• Low risk: patients with T1G1.
• Intermediate-risk: patients with T1G2 or T2G1, although in this group would have to take into account other factors with invasion of the tumor or growth pattern infiltration, before ordering tracking or surgery.
In the case of lymphadenectomy is indicated:
• High risk: T2, T3 and T4 G2 all the G3.
Whenever they dry out (operating) ganglion chains, indicated a treatment of external radiotherapy (to sterilize the entire area with a few added safety margins well), when shown extracapsular involvement (disease outside the lymph nodes), or when shown multiple lymph node involvement; external beam radiotherapy prophylactic, including both inguinal ganglion chains, could also be an alternative to the lymph node surgery.
Finally, the chemotherapy has been used in combination with radiotherapy or after surgery in treatments with intention to conservative, and alone, as palliative strategy in scattered cases, but study series are small (due to the low incidence of this disease) and the results are not conclusive.
16. Skin Cancer
There are two types of skin cancer: melanoma and nonmelanoma. Skin cancer melanoma is not unlike melanoma that develops from cells of the skin other than the melanocytes (cells responsible for drawing up the pigment that gives color to skin, eyes and hair). Both can occur anywhere on the skin, but it is more common in the skin of the head, face, neck, back of the hands, arms and legs. This is due to the fact that these parts are more exposed to the rays of the Sun.
The sun exposure and sunburn are the most frequent of these types of tumors. In fact, sun damage accumulates over the years, so how much greater exposure to the Sun (or tanning booths) has had throughout life, increased risk of skin cancer there.
The skin consists of three layers, which are from outside to inside: the epidermis, the dermis, and the hypodermis.
The two most common types of skin cancer melanoma are:
• Basal cell carcinoma (also called basal cell carcinoma basalioma): it is the most common, and occurs in the basal cells of the outer layer of skin (epidermis).
• Carcinoma squamous or squamous cell: he is second in frequency and occurs in the higher layers of the epidermis (where they are called squamous cells).
Both have easy treatment because its growth is slow and its ability to induce metastasis is very low, but if left untreated can become large tumors difficult to control surgical, or extended as much local, regional (affecting the lymph nodes), or remotely.
Symptoms and diagnosis of skin cancer
Symptoms of skin cancer not melanoma affect the aspect that presents the skin. This type of tumors appear as abnormal areas of skin. They
can be pink, red (erythematous) and lesions inflamed, scaly lesions
(dry), bleeding, similar to open wounds, which can make us suspect the
existence of a skin cancer.Some people (especially those of very white skin) develop, or rough or rough, scaly lesions called Actinic Keratosis; These lesions are most commonly in the skin of the face, ears (ears), arms or scalp (especially in people with alopecia), and can become malignant and become skin cancers. Frequently, these lesions are removed to reduce the risk that this can occur.
Diagnosis of cancer (non-melanoma) skin
Any suspicious lesion indicate the presence of
skin cancer should be examined by a physician for a visual diagnosis or
by digital dermoscopy, or tracking of the lesion and, if deemed
suitable, will a biopsy (removing part or all of the injury), then
examine it under the microscope and diagnose it (histopathological
diagnosis).Suspecting of locoregional spread, or distance, is must complete the study with other imaging tests (ultrasound, CT or MRI - magnetic resonance), analytical, etc.
Treatment and prevention of skin cancer
Skin cancer treatments vary depending on the type
of skin of the patient, the size of the lesion, the depth of
penetration, the aesthetic result, location, as well as age or other
health problems the patient present.The main skin cancer treatment options available are:
• Surgery: resect (remove) totally or partially the tumor. Most of the time the treatment can be performed on an outpatient basis (without income). Local anesthesia is usually used for these surgical procedures. There are several types of surgery that can be used, depending on the type of tumor and its location:
• Mohs surgery (micrographic): consists of the surgeon, assisted by a microscope, is removing each layer of skin that is affected by the tumor. Each layer that dries is examined under the microscope and, if it is infiltrated, continue to remove the last layer infiltrated by tumor. This procedure is very well limited the area that occupies the tumor, respecting to the maximum tissue healthy, and you have close to 98% cure rates. It is used most often in sensitive areas: in general in the lesions of the face - as the eyelids (or close to the eyes), ears, nose, lips.... The resulting scar can be closed by second intention (leave that it heals only), with grafts of skin, stitches, etc. It is usually done under local anesthesia.
• Conventional surgery (excision or surgical resection): total or partial with an adequate margin of safety.
• Curettage: using an instrument called a curette, is scraping the tumor to remove it entirely. This curette can be electric, allowing you to better control the bleeding, because of the heat.
• Radiation: consists of treating the injury with devices that emit radiation to kill tumor cells (linear accelerators, cobalt bombs, etc).
• Cryotherapy: just as is done with vulgar warts, apply liquid nitrogen on the injury and freezes the exposed tissue. This produces a crust that emerges a few days. It is the most widely used treatment, as does not require very violent facilities, is ambulatory, without surgery, without bleeding, and may indicate in almost all patients (including those with clotting problems).
• Topical therapies (creams): like radiotherapy kills tumor cells there where applies.
After treatment, it is essential to carry out routine checks for the early diagnosis of new lesions, or if there is a recurrence of treated lesions. Performs these checks (either of general medicine or dermatologist) physician, but the weekly or monthly "self-review" by the patient is essential.
Prevention of skin cancer
Skin cancer can be prevented by avoiding or reducing exposure to the Sun:• In the Central hours of the day (when the Sun falls more perpendicular).
• Using creams with a suitable protection factor, and by applying the product many times as necessary. Remember that you must leave to take effect for at least 30 minutes, because the effect of sunscreen is usually not immediate.
• Using caps or large hats and shirts long sleeves or long pants when we are outdoors.
• Also used sunscreen when you go to sports activities in the open air.
• Avoiding the use of bronzing (UVA rays, etc.) therapies.
• If you notice any unusual spots on your body goes to your doctor and you make periodic assessments to detect abnormalities in the skin. You can use a small mirror to the harder-to-see areas. An early diagnosis allows dealing successfully with nine of every ten skin cancers.
Of course, it is very important to follow the instructions of the physician, both in regard to prevention, monitoring and diagnosis of pathologies such.
17. Prostate Cancer
It is important to stress that, if diagnosed in time, the vast majority of cases have a high chance of cure.
Adenocarcinomas of prostate originate (even in 95% of cases) in the periphery of the prostate, in contrast to the benign hypertrophy of prostate (BPH), which originates in the central area.
Prostate cancer often has several foci within the prostate, and among them there are different degrees of differentiation; This is based on the classification of Gleason (internationally accepted). It consists of an analysis of prostate tissue from two of the focal points (obtained through a biopsy), and assign a value between 2 and 10, depending on the degree of abnormality of the examined tissue. The Gleason scale indicates the prognosis of the disease, regardless of the stage or phase of development in which the disease is. The TNM classification is normally used to determine the stadium.
TNM classification
You can use the TNM system, that represents the
extent of the primary tumor (T), spread to the lymph nodes (N) and the
spread (metastasis) to other organs (M).
T defines the tumor
• T1: Tumor inaparente clinically (not palpable or visible) imaging. or T1a: found incidentally. Less than 5% of the resected tissue involvement.
or T1b: found incidentally. Greater of 5% of the resected tissue involvement.
or T1c: Tumor identified puncion-biopsia by increase in PSA.
• T2: Tumor confined to the prostate.
• T3: The tumor Extension on the outside of the capsule.
• T4: Tumor fixed or invades adjacent organs other than the seminal vesicles (bladder neck, straight, external sphincter, levator muscle or pelvic sidewall).
N defines lymph node involvement
• NX: regional nodes not be studied.• N0: There are no lymph nodes metastasis.
• N1: Metastasis to regional lymph nodes.
M defines metastases
• M0: No metastasis.• M1: Distant Metastasis.
Causes of prostate cancer
Hormone dependence on cancer prostate - and
hence the usefulness of hormonal substances in their treatment--seems to
indicate that androgens are involved in its appearance. However,
it could not set the relationship of other factors such as genetic,
environmental or infectious with this type of cancer character.There are, however, a number of risk factors that may favor the occurrence of prostate cancer, and listed below:
Risk factors of prostate cancer
• Age: usually appears from the age of 45, and the possibilities of developing this type of cancer increase with age.• Race: it is more frequent and more aggressive in black men.
• Genetic factors: having relatives with prostate cancer increases the risk, over how much closer is the relationship with the patient.
• Diet: animal fat intake increases the risk. On the contrary, vegetables, such as tomato and soy, and other foods, such as salmon, could protect.
• Hormones: elevation of testosterone and IGF-1 (insulin growth factor) are associated with an increased risk.
• Ejaculatory frequency: seems that you have five or more ejaculations weekly has a protective effect.
• Obesity: as in other the risk of developing prostate cancer increases many cancers, obesity.
Symptoms of prostate cancer
In the early stages of prostate cancer it does not
usually have symptoms, that is why when they do it is usually late and
have already spread outside the prostate.Common symptoms of prostate cancer, we see that:
It can cause obstructive lower urinary tract symptoms, similar to those produced in benign prostate hypertrophy, although the symptom which is not found in the latter is the presence of blood in the urine. There may be difficulty urinating or to stop the pis, or need to get up often at night to urinate. A burning sensation may also appear in doing so.
It has been shown that up to 25% of patients who have acute urinary retention problems present a prostatic carcinoma; and of these, around 25% have metastasis at the time of diagnosis, which can cause bone pain, spinal cord compression, alterations in coagulation...
Other possible symptoms of prostate cancer are pain in the lower part of your back, thighs or hips; or have erectile dysfunction.
Currently these signs are diminishing, due to testing that facilitate the diagnosis of the disease in stadiums early and asymptomatic. However, these symptoms are not an exact indication of the presence of prostate cancer and could be due to other problems, so it should go to the doctor so you dispel your doubts.
Diagnosis of prostate cancer
Early diagnose a tumor in the prostate significantly increases the chances of cure of the same. For
this reason, it is important that all men have annual, or from age 45
revisions if you have a family history of prostate cancer cases. To reach the diagnosis of prostate cancer, the following tests are performed:
Digital rectal examination
It is the fundamental method of diagnostic
approach, so usually advise a rectal examination and an assessment of
PSA (tumor marker) yearly to men over the age of 50 years in order to
precociously detect prostate tumors.In the rectal are detected all stages except the T1 which, as we have seen in the TNM classification, is an incidental finding.
To the touch, carcinoma is presented as an irregular hard nodule.
Tumor markers
Prostatic acid phosphatase (FAP) is a specific
marker, but when cancer rises it tends to be already disseminated
outside the prostate, so it is not useful in the early diagnosis.Prostate-specific antigen (PSA) is a marker of prostate tissue (i.e., how much more prostate mass there, higher will be), and levels tend to be more increased in cancer, but also can soar for benign disease, so if you aren't very increased, alone not oriented towards cancer.
Values of PSA and possible relationship with prostate cancer:
• Less than 4 ng/ml: unlikely cancer.
• More than 10 ng/ml: increase the chances of cancer, so biopsy is performed.
• Between 4 and 10 ng/ml: other parameters should be used to assess the need for a biopsy.
Imaging tests
Ultrasound across the rectum is as useful to check
the local staging, since in addition to rating the prostate are nearby
structures.
TAC
The computed tomography (CT) and magnetic resonance imaging are used primarily to assess nodes, and metastases.Bone scintigraphy is used in the detection of bone metastases, and is usually performed when there is suspicion that has been produced this type of metastasis, i.e. If the score obtained on the Gleason scale is very high and so is the PSA, as there is to find out if there are metastases, especially when implementing the treatment.
Prostate biopsy
It is performed to confirm the diagnosis of prostate cancer. It
is indicated if there is suspicion of cancer, either by the digital
rectal examination, by the increase in tumor markers, or if there has
been any change in Imaging tests.
Treatment of prostate cancer
In cancer that is limited to the prostate gland,
and according to the age and general State of the patient, shall be
given a treatment with curative intent, but if the cancer is
disseminated the goal of treatment is palliative, to improve the quality
of life of the patient. These are the treatment options for patients with prostate cancer:
Therapeutic abstention
It consists of a close monitoring of the patient
during the progression of the disease, until you reach a point in which
establishing palliative care, usually, such as hormone replacement
therapy.This guideline can be offered to patients with tumors of low grade and low volume, asymptomatic, with a less than 10 years, or those patients life expectancy not to accept the possible side effects of the treatments.
Radical prostatectomy
The prostate and seminal glands removed.
Most common complications:
They should be rating the intervention year, since there is improvement so far approximately.• Incontinence (2-57%): most frequent is the greater is the age of the patient.
• Impotence (50%): in men older than 60 years can reach 80%.
External radiotherapy
External radiation therapy is an alternative to
radical prostatectomy radical treatment, and its result is better if
combined with the androgenic blockade, since androgens affect the
progression of prostate cancer.
Complications
Complications are similar to the surgery, but may increase up to 2 years:• Impotence.
• Incontinence.
• Complications and diarrhea, cystitis, digestive and urinary, levels...
See more about radiation therapy
Brachytherapy
It is a special type of radiation therapy in which
radioactive seeds, controlling ecograficamente are implanted into the
prostate.The advantage of this technique against external radiotherapy is that very high doses of radiation located over the tumor may be, and reduce the potential damage to healthy tissue surrounding it.
Brachytherapy is valid in tumors in stage low, such as T1 and T2, with results similar to those obtained by surgery.
Complications:
• Urgency to urinate or defecate.• Retention of urine.
• Bleeding from the rectum or rectal bleeding.
• Impotence.
Hormone replacement therapy
The hormonal suppression can slow the growth of prostate adenocarcinoma cells that have some kind of hormone dependence. Different formulas are used for this:• Castration.
• Estrogen.
• Progestins.
• Sex hormone-releasing hormone agonists.
• Androgen blockers.
• Chemotherapy. It is not very effective in prostate adenocarcinoma.
Side effects of hormone therapy:
• Low libido.• Impotence.
• Hot flashes.
• Breast augmentation.
• Weight gain.
• Loss of muscle mass.
• Hair loss.
• Reduction of bone mass (osteoporosis).
• Anemia.
• Lipid variations.
• Hyperglycemia.
• Hypertension.
• Emotional and mental disorders.
• Change of character.
• Depression and anxiety.
Treatment by stages of prostate cancer
• Stadium T1a: don't need treatment, although in
some cases arises in patients younger than 60 years with a high life
expectancy.• Stadium T1b-T2c: radical prostatectomy, +/-radiotherapy.
• Stage T3a onwards: the patient tends to be one elderly man with poor general condition, there are increasingly fewer patients in these stages thanks to advances in treatments and early detection. In these cases is hormonal treatment, although it is sometimes used radiotherapy as palliative in metastases that produce pain.
Tumor recurrence after treatment with curative intent
After radical prostatectomy patients are monitored
with PSA levels that, after surgery, should be zero, so if it is not
thus may indicate the presence of tumor mass in the body, either because
there are remnants of prostate or because metastasis has occurred.After using radiotherapy as a treatment for prostate cancer located, PSA remains low, but not zero as with surgery, if that low value called nadir value increases, would think of relapse.
Emergency treatment of prostate cancer
In advanced stages of prostate cancer can cause spinal cord compression; in these cases be hormonal treatment and Neurosurgery, to decompress.18 of Lung Cancer
More than 80% of cases of lung cancer derived exclusively from exposure to tobacco smoke. All of this suggests that despite its high mortality is one of the most preventable cancers. However, although tobacco is the main responsible for the appearance of this condition, anyone can develop lung cancer.
In the past 30 years there have been many campaigns against smoking, and this, together with the development of new treatments, has helped significantly reduce the number of men killed by lung cancer. On the contrary, the number of women with lung cancer has increased, because there are more women smokers than before.
Causes of lung cancer
The lungs are organs which consist of many types of cells. The
most numerous are the epithelial cells, which transfer oxygen to the
blood, but there are also hormonal, muscular and fibrous cells for
support.The vast majority of lung cancers arise as a result of inhalation of carcinogenic substances that are found in the smoke of cigarettes. These substances come into contact with the cells of the lung, and are capable of altering them so that they begin to multiply out of control, thus forming an accumulation of malignant cells known as tumor (also bulk, injury or nodule). The tumor will cause complications in the lung itself, and may also that some of these malignant cells to pass into the blood or lymph and be distributed through other areas of the human body, giving rise to the called metastasis.
For this reason, and while not all lung cancers are exclusively due to smoking, cancer lung is tobacco. In general, the risk of a smoker's lung cancer is 13 times greater than for a non-smoker, and in the case of passive exposure to tobacco ("passive smokers") the risk is 1.5 times greater than that of a non exposed person.
There is a direct relationship between death from lung cancer and the number of cigarettes smoked during a certain number of years (measured by number of "diarios-ano packages"); Thus, a person who has smoked more cigarettes during more time will have more risk than someone who has smoked less for less time. It is also important to point out that, on equal terms, women are more risk than men of developing lung cancer. When you leave the tobacco, the risk of lung cancer decreases with time and approaches, but never equal, to that of a person who has never smoked.
As mentioned, some lung cancers are not due to tobacco. There is an important component of genetic in some types of lung cancer; It is most obvious in women than in men, and greatly increases the risk of lung cancer in some families, although not inevitably determined. Another environmental factor is asbestos, a component that was customary in fibrocementos, and whose fibres were inhaled, being highly carcinogenic. For this reason, nowadays this type of fibrocementos require special removal intervention.
Types of lung cancer
There are several types of lung cancer. It
is key to be able to identify what type of cancer suffers from the
patient, treatment and prognosis are radically different between them. First, the types of cancer can be divided into two large groups:• Small cell Lung Cancer: non-small cell cancer is also called or "grains of oats"; It represents 10-15% of all lung cancers. This tumor usually found in the most central part of the lungs and is the most aggressive of all; almost always invading parts of the human body far from the lungs. In addition, it is able to provoke Paraneoplastic syndromes, i.e., can be synthesized hormones and other substances that cause alterations to neurological, endocrinological, level etc.
• Non-small cell Lung Cancer: different types of cancer that are similar in their treatment and prognosis are included in this group. Each type can be distinguished by their microscopic cellular differences, i.e., because of differences in their cells under a microscope.
• Adenocarcinoma: this tumor is located on the periphery of the lung and has a very close relationship with tobacco. It is typical of women, non-smokers, and is related to old scars in the lung (e.g. a pneumonia or ancient surgeries). It can spread through the blood, so their first symptoms often have nothing to do with the lungs.
• Carcinoma epidermoid or squamous: is a tumor that arises in the center of the lungs and is more related to tobacco. It is increasingly rare in men, but the number of cases increases in women. When diagnosed, in half of the cases not extends beyond the chest.
• Large cell carcinoma: are variants of the previous two. As its name suggests, the cells have larger than usual.
Other types of cancer of the lung to take into account are mesothelioma, which is a benign or malignant tumor of the pleura lining the lungs, and different types of benign tumors, which do not have any complications, such as hamartomas and adenomas. You should not be forgotten that lungs are a frequent place of metastasis from other tumors that may appear originally in other organs.
Symptoms of lung cancer
It is detected only 5-15% of people without
symptoms lung cancer, normally to perform a routine chest x-ray, so the
vast majority of people have symptoms when diagnosed with cancer and,
sometimes, the disease is quite advanced. The most common symptoms in a person with lung cancer are as follows:• Cough: compression of the bronchi or trachea; It is the most common in lung cancer symptom. A sudden change in the type of cough of one 50-year-old smoker may be sufficient for a chest x-ray is indicated.
• Hemoptysis: coughing blood, when the tumor causes an open wound in the light of the Airways. It should take into account that the first cause of hemoptysis is not lung cancer, but a respiratory infection (e.g. tuberculosis).
• Wheezing, difficulty in the passage of air, repetition pneumonia... (all by the lower Airways obstruction).
• Chest pain and difficulty to inspire air: by involvement of the pleura and the ribs because of the tumor.
• Malignant pleural effusion: fluid between the ribs and the lung that prevents that the lungs can expand properly.
In addition to these common symptoms, lung cancer can affect other areas of the human body according to their location. Dysphagia disorders, they can also be found, i.e., difficulty swallowing, esophageal compression or to compress any internal nerves may cause hoarseness or aphonia by paralysis of the vocal cords, shortness of breath by the diaphragm, drooping of the eyelid paralysis, weakness of an arm, etc. The large vein, causing the blood from the head, do not return to the heart properly and there is a swelling of the face and neck may also affect.
When the cancer is more developed, the patient begins to lose appetite, lose weight and their defenses decrease. Fever is also a manifestation of cancer, as well as analytical alterations that can be seen in blood tests.
Diagnosis of lung cancer
Early diagnosis of the disease can prevent lung cancer too has spread and is incurable. This requires a high clinical suspicion and the help of complementary tests.• Clinic: you must be alert to the emergence of cough that does not stop or other abrupt changes in the respiratory tract; This alert is of special importance in smokers or ex-fumadores. The doctor must report on the number of packages diarios-ano that consumes the patient so know what your risk level.
• Chest x-ray: is able to detect small stains and injury until two years before symptoms appear.
• CT: computed axial tomography made images of the chest in cuts, and help to see the size of the tumor and if it affects neighboring organs.
• Bronchoscopy: an once located the tumor and if it is close to a bronchus. It consists of introducing a camera with pliers taking samples of the tumor, an analysis under the microscope to be able to differentiate what is; in this way, can be decided what is the best treatment.
• Sputum cytology: a method is less invasive than the former. It consists of an analysis of patient sputum under a microscope to look for malignant cells. This is done when there is prior suspicion of lung cancer.
• Thoracentesis: puncture of the thorax to extract fluid from the pleural effusion, if present, and look under a microscope for malignant cells.
• Biopsy open: when the tumor is accessible by Bronchoscopy and is located in the periphery of the lung can be biopsied by making a small opening to the chest from the outside.
Staging
The staging of lung cancer is to determine
what is the spread of cancer in the human body, to know what is the most
appropriate treatment and if the Outlook is favorable or not. They are this essential Imaging tests such as the TAC, which is capable of displaying the affected structures. If
the TAC is not enough can be used the mediastinoscope, that is, a
device that can be inserted into the cavity between the two lungs
(mediastinum) and show the affected structures.The staging is classified according to three known points that are represented by three letters; shall be assigned to each letter a number according to the level of tumor involvement:
• T: local extension of the tumor and possible affected neighbouring structures.
• N: number and location of affected thoracic ganglia.
• M: existence or not of metastasis.
Treatment of lung cancer
To decide what is the best treatment for a tumor is essential to know what type of lung cancer is and what its extension. Moreover, it is equally important to know the age of the patient and their State of health. All
these data indicate whether a patient is likely to be operated (can be
operated as his physical condition allows it), and if the tumor is
resectable (surgery can remove the tumor).When it is not, the patient can be surgically intervened and, in some cases, surgery is curative. Types of surgery are more or less aggressive depending on the extent of the lung that is necessary to eliminate:
• Wedge resection: only a wedge of the lung with the tumor is removed.
• Lobectomy: a lobe of the lung is removed.
• Neumonectomy: is it removed an entire lung.
If surgery is not enough, or to help cure, radiotherapy and chemotherapy are used. Radiotherapy consists of supplying x-ray directed toward the tumor, in order to destroy malignant cells that are multiplying out of control, that are especially sensitive to radiation. The problem is that radiation also impairs healthy body cells such as skin, blood, or esophageal cells.
Chemotherapy
Chemotherapy involves the administration of drugs that also destroy tumour cells but, like radiation therapy, has harmful effects on the body's healthy cells and causes undesirable such as nausea, vomiting, fatigue, fall hair and sores in the mouth.
Medication
At the present time are being discovered new drugs that would be able to specifically target malignant cells; This is known as targeted therapies, and many of them are in the process of study to apply them in patients.
Prevention of lung cancer
Unfortunately there is a test routine that serve to detect lung cancer, as it is the mammography in breast cancer. There
have been studies with chest x-ray, but they have not given good
results in the detection of cancer, as well as providing unnecessary
radiation.Therefore only possible lung cancer prevention is to avoid exposure to your environmental triggers, the main of them being the tobacco smoke. Leave the tobacco is the only way to prevent a disease which, in most cases, just with the life of those who suffer it. Therefore, physicians are committed to providing all of your help to smokers who are motivated to quit their habit.
However, get to abandon tobacco is really difficult, since the physical and psychological addiction to nicotine is very strong. There are different methods to help smokers, which include counselling, therapeutic behavioral, restitution of nicotine (gum, patches, inhalers) and certain medications (bupropion). However, only get good result in 20-25% of the patients, so the best is to not start smoking.
It should take into account, in addition, that exposure to tobacco smoke is not only in smokers, since many people who inhale tobacco smoke are not having chosen to smoking. That's when the society intervenes to prevent the harm that involves the health of the population, and laws that promote a smoke-free environment are implanted.
Kidney cancer
It is a type of cancer that occurs in the kidneys,
two bodies that have the function of filtering the blood and removing
waste and excess fluid from the body, transforming them into urine that
is sent to the bladder through the ureters, to be subsequently excreted
from the kidneys.Some tumors that originate in the kidneys, as kidney adenoma (the most frequent), are benign.
Renal adenoma is most common in adults and the elderly, and is usually diagnosed by a routine abdominal ultrasound, since usually does not present any clinical manifestation, due to its small size.
However, although hardly cause discomfort to the patient, it is better to remove them so that they may grow in excess they can press renal vessels and cause shortages. He is treated by surgery by laparoscopy, and some small tumors may even destroy are radiofrequency.
Renal Carcinoma
It is the most common adult renal tumor, and tends to affect men aged between 50 and 70 years. The maximum incidence occurs in Nordic countries. Only in 2% of cases, the tumor appears in both kidneys at the same time.
Symptoms of kidney cancer
Today, almost 40% of renal tumors are
diagnosed by accident in an abdominal ultrasound which is carried out
for any other reason. If detected early, the
survival rate is almost 95%, as can be seen from very early stages, when
the mass of malignant cells is still small.The most common symptom of cancer of kidney hematuria (which is defined as the presence of blood cells in urine), and usually is painless. In some cases it may be so abundant that causes cramping kidney by the presence of clots inside the ureter.
Accompanied, moreover, by a very non-specific picture of fever, anemia, weight loss and digestive symptoms. The pain appears in more advanced stages of the disease and usually consist of a stabbing headache type pain.
Just above the kidney the adrenal gland, in some cases is also originate hormonal alterations, which are responsible for symptoms such as hypertension, increased calcium in the blood, increased blood viscosity and Gynecomastia (enlarged breasts in men).
Kidney cancer can give metastasis to regional lymph nodes, but also to other areas of the body such as lung, liver, bones and brain. In some cases, the involvement of these organs may be the first clinical manifestation.
Diagnosis of kidney cancer
To reach the diagnosis of kidney cancer are usually perform the following tests:• Abdominal ultrasound: is the most effective test. Realized very often because it is very cheap and is available in almost all centers of medical specialties.
• Intravenous Pyelogram: this test is intended for the study of a haematuria, and demonstrates the presence of a renal mass.
• CT with contrast: is reserved for cases in which the ultrasound does not give enough data to establish a diagnosis.
• Aspiration: a small part of the renal mass for further analysis is taken in the laboratory.
• Bone scan and chest x-ray: are complementary to the previous tests. Its objective is to check if the malignant cells have spread to other organs.
Treatment of kidney cancer
Surgery is the only treatment currently curing kidney cancer. There are two types of techniques depending on the size and the stage of the disease:• Partial nephrectomy: only a part of the affected kidney is removed. This technique is usually used when the tumor is very small, or in those cases in which the other kidney does not work well or when, directly, there is another kidney.
• Radical nephrectomy: Removes all of the kidney and, in most cases, it must be accompanied also the removal of the adrenal gland.
• Radiotherapy is not indicated in any case, in these tumors, it is totally ineffective.
• Chemotherapy is ineffective, especially in patients suffering from metastasis in different organs; but new drugs that could make a breakthrough in the treatment of kidney cancer are being researched. Among these are those that prevent the blood supply to the tumor, thus preventing their proliferation.
Risk factors and prevention of kidney cancer
The best prevention for kidney cancer consists of avoiding risk factors, which are listed below. Most
importantly, take a form of healthy living doing exercise, following a
diet rich in fruits and vegetables and, above all, to do without
tobacco.Persons with chronic renal disease, and those who have close relatives affected by this type of tumor, it is advisable to ask a follow-up and an ultrasound regularly, to detect the presence of any other associated disease as soon as possible.
Risk factors for kidney cancer
On some kidney cancer risk factors cannot be taken preventive measures, such as age (starting at age 50 is more frequent), sex (higher incidence in males) or race (its prevalence is slightly higher in the black people). But in other cases if we can prevent them:
• Genetic factors: kidney cancer is more common in individuals with first-degree relatives affected by this disease. Some other rare hereditary diseases can also cause kidney cancer and, in that case, should consult their doctor about the convenience undergo Imaging tests periodically.
• Diets rich in fat and cholesterol.
• High blood pressure.
• Tobacco.
• Obesity. Excess weight may cause hormonal disorders that influence the risk of developing the disease.
• Exposure to toxic substances in the workplace like asbestos, cadmium, arsenic, and certain herbicides and oil derivatives.
• Chronic renal failure. Especially in patients requiring dialysis.
Wilms Tumor
This type of tumor is also quite frequent; in fact, it is the most common abdominal tumor in children. It is more normal to it occurs until the minor reaches ten years, but they have seen cases in adolescents of up to 15 years. The exact cause of Wilms tumor is unknown, but it appears to be associated with congenital alteration.Symptoms of Wilms tumor
Physical examination reveals abdominal distention, and even a renal mass can be felt. In general, the child has a good physical condition.
The most common symptoms are hematuria, low grade fever, headache, constipation and nausea. Where metastases are produced, they will find themselves in lung, liver, and lymph nodes.
Diagnosis of Wilms tumor
• Abdominal x-ray: an increase in kidney size, and even a change can be seen in the consistency of the organ.
• Intravenous urography: shows the distortion that occurs on the internal anatomy of the kidney.
• Abdominal ultrasound: report on the presence of a renal mass.
Treatment of Wilms tumor
This type of tumor has a current survival close to 85% thanks to new therapies employed.
If the tumor is small it will proceed to surgical excision. In this disease, radiation therapy and chemotherapy are quite effective.
Prevention of Wilms tumor
General prevention tips, can not be because the causes that trigger the disease are unknown. Therefore, the most effective is control by periodic ultrasounds to pregnant women. From the moment they begin to form the various organs in the fetus, they should see each and every one of them on the ultrasound to detect any malformation as soon as possible, and begin to treat it if it is possible.
19. Testicular Cancer
Its incidence has increased to more than double in the last decades and varies according to geographical zones, being very low and very high in the North of Europe in Asia or Africa.
It has become one of the tumors more treatable, thanks to the advances in Diagnostics and treatments that have taken place since the 1970s to the present day. Before this date, testicular cancer was responsible for 11% of cancer deaths in males between 25 to 35 years, and the 5-year survival was not going beyond 64%; in 2001 this survival was 95%.
Anatomical description of the testicle
The testicles are housed in the scrotum. In
the testis gather two types of tissue: sperm-producing seminiferous
tubules and interstitial Leydig cells, producing hormones. Surrounded by seven layers (more external to more internal):• Scrotum: skin.
• Tunica Dartos: Dartos muscle that is attached to the scrotum.
• Subcutaneous cell tissue.
• External spermatic Fascia.
• Muscle cremaster: skeletal muscle fibers in the cremaster muscle (of the oblique lower and transverse), which tend to raise the testicles with the cold.
Internal spermatic Fascia •.
• Tunica vaginalis of the testicle (peritoneal): leaves parietal and visceral.
Embryonic development:
The testicles are formed and are housed in the abdominal cavity. To allow the development of sperm, the testicles have to descend and be out of the abdominal cavity (to be less than 35 degrees). In its descent they drag layers of peritoneum, in such a way that the testicle has a thick white tunic (tunica albuginea: 1st layer of the testicle).
Internal structure of the testis
In addition to the Tunica vaginalis:• Tunica albuginea, very innervated.
• Seminiferous tubules that lead in the straight tubes. Within the seminiferous tubules:
a germ cell.
b. Sertoli cells.
c. interstitial cells of Leydig.
d. myoepithelial cells peritubulares that are externally to the seminiferous tubules and are contracted to mobilize the sperm.
e straight tubes that give rise to the Rete Testis. The network of Testis arise the efferent ducts, which are extratesticulares and form the head of the epididymis.
Histological subtypes of testicular cancer
While we may find ourselves with any of the
testicular and paratesticular structures caused tumors, the vast
majority of tumors originate from epithelial germinal (germinal tumors),
representing 95% of the tumors that affect the testicle.No germinal testicular tumors represent 5% of testicular tumors and encompass different types: those that are derived from cells of Leydig and Sertoli, granulosa cells, etc.
Therefore, we will focus on (TCG) germ cell tumors, since they are the most frequent. Testicular cancer (germinal tumors), for therapeutic purposes, is divided into two types, seminoma and non-seminoma:
• Seminoma: originates in germ cells.
• Non-seminoma: this type of testicular cancer is most common. They are frequently composed of different types of cells and are identified according to these different types of cells:
or Choriocarcinoma.
or embryonal Carcinoma.
or Teratoma.
or the yolk sac Tumor.
Causes of testicular cancer
The most likely cause of testicular cancer
is gonadal dysgenesis which is associated with cryptorchidism - absence
of testicle in scrotal pouch - (up to 10% of cases). Occurs
in testicles that have not fallen or testicles in lift, and gives rise
to a possible infertility by atrophy of the testicles and not subsequent
maturation of gametes.The Undescended testicle is one five times higher risk of present the growth that the population without this background. Abdominal testis location is associated with an increase in the incidence of greater than testicular cancer when it is at groin level.
The orchidopexy (surgery that fixed the testicle to the scrotum) performed in the first two or three years of life reduces the risk and also facilitates the monitoring of the testicle. 23% of the patients suffering from this tumor can develop a second primary tumor in the contralateral testicle.
Symptoms of testicular cancer
Testicular cancer usually presents as nodule or pain without swelling of a testicle. The
presence of testicular pain sometimes makes it difficult to diagnosis,
since it can be confused with benign inflammatory processes such as
epididymitis (inflammation of a tubular structure where they mature and
are transported spermatozoa), varicoceles (dilatation of the veins
ranging from the abdomen to each one of the testicles), etc.Other symptoms of testicular cancer, you can occasionally see thickening of a testis previously atrophic (or small). 30-40% of patients have a dull pain or sensation in the lower abdomen, perineal or area in the scrotum, while acute pain occurs only in 10% of cases.
Other clinical manifestations by the presence of metastasis may occur: low back pain, anorexia, nausea, vomiting or gastrointestinal alterations (usually bulky) retroperitoneal metastases, mass or nodule in neck by supraclavicular lymph nodes, cough or Dyspnea (fatigue) for pulmonary metastases.
Diagnosis of testicular cancer
Early diagnosis of testicular cancer is the best chance for cure. The
diagnosis is relatively simple in every man with a testicular mass, if
we present this possibility, the vast majority are diagnosed by
exploring the testicle.The differential diagnosis of a testicular mass should include testicular torsion, epididymitis (inflammation of the epididymis, tube charge the storage of sperm in the testis) or events (combined inflammation of the epididymis and testicle). Less frequent problems are varicocele, Hydrocele (collection of fluid in the tunica vaginalis), hernia, hematoma, Spermatocele (a kind of epididymal cyst) or the Gumma (necrotic nodule).
Once suspected tumor, is done:
• Testicular Ultrasound (is the technique of choice because of its high sensitivity).
• The diagnosis of a thoraco-abdominal-pelvic CT extension is completed. PET scanning is typically a utility limited in these cases by the high frequency of false negatives
• Complete blood with blood count, biochemistry with tumor markers: alpha-fetoprotein (AFP) and the 'beta' fraction of hormone chorionic gonadotropin (HCG), since the 'alpha' fraction is common to other hormones and LDH. These markers are elevated in 80-85% of patients with tumours germ non-seminoma (even non-metastatic), the elevation of these markers is lower in the seminoma (20%), and AFP is never made in pure seminomas. Individual or joint elevation of tumor markers does not have sufficient sensitivity or specificity to establish the diagnosis of testicular tumor in the absence of histological confirmation, but the monitoring of these markers is especially useful for follow-up after treatment (both surgery and chemotherapy).
Testicular biopsy is not contemplated as part of the study, since a tumor within the scrotal SAC dissemination or inguinal nodes or retroperitoneal lymphatic spread may occur.
Staging and prognostic classification of testicular cancer
The results of radiological and clinical,
previously discussed studies in the diagnosis of testicular cancer, are
used to assign a stadium, in order to establish a prognosis and
treatment appropriate for each patient. This is used (as for almost all tumors) TNM classification, combined with the levels of tumor markers (MT).The NWT qualification for tumors of germ cells (TCG) of testicular cancer provides the following information relating to each symbol (size t, N: If there is involvement or non-regional lymph nodes and m if there is presence or absence of distant metastases). The S reflects the serum levels of certain proteins (tumor markers) produced by some testicular cancers.
These acronyms (T, N, M, or S) is added to numbers (0 to 4), which indicate the gravity in ascending order, and lyrics: after the T ' is' mean 'in situ', which means that the tumor is contained in one place and that it has not penetrated even a deeper layer of tissue. The letter X means that "cannot be determined is" since the information is unknown.
Staging of germ cell tumors
TIS: Ca in situ (cancer cells non-invasive).
T1: Tumor limited to the testicle, no lymphovascular invasion, with commitment of the tunica albuginea, but not of the tunica vaginalis.
T2: Tumor limited to the testicle with lymphovascular invasion, extends to the tunica vaginalis.
T3: Tumor infiltrates spermatic cord.
T4: Tumor infiltrates the scrotum.
N0: No retroperitoneal metastases.
N1: Metastasis retroperitoneal < 2 cm.
N2: Metastasis retroperitoneal 2-5 cm.
N3: Metastasis retroperitoneal > 5 cm.
M0: No metastatic disease.
M1: Disease metastatic distance.
There is also an staging based on the level of tumor markers for diagnosing, follows:T1: Tumor limited to the testicle, no lymphovascular invasion, with commitment of the tunica albuginea, but not of the tunica vaginalis.
T2: Tumor limited to the testicle with lymphovascular invasion, extends to the tunica vaginalis.
T3: Tumor infiltrates spermatic cord.
T4: Tumor infiltrates the scrotum.
N0: No retroperitoneal metastases.
N1: Metastasis retroperitoneal < 2 cm.
N2: Metastasis retroperitoneal 2-5 cm.
N3: Metastasis retroperitoneal > 5 cm.
M0: No metastatic disease.
M1: Disease metastatic distance.
SX: Bookmarks not available or not.
S0: Markers within normal limits.
S1: LDH less than 1.5 times normal, less than 5000 βHCG mlu/ml or αFP > 1000 ng/ml.
S2: LDH 1.5 to 10 times normal, βHCG between 5000 and 50000mlu/ml or αFP between 1000 and 10000ng/ml.
S3: LDH greater than 10 times normal, βHCG greater than 50000mlu/ml or greater than 10000 ng/ml αFP.
S0: Markers within normal limits.
S1: LDH less than 1.5 times normal, less than 5000 βHCG mlu/ml or αFP > 1000 ng/ml.
S2: LDH 1.5 to 10 times normal, βHCG between 5000 and 50000mlu/ml or αFP between 1000 and 10000ng/ml.
S3: LDH greater than 10 times normal, βHCG greater than 50000mlu/ml or greater than 10000 ng/ml αFP.
Stadiums
| Group | T | N | M | S (serum tumor marker) |
| 0 | Names | N0 | M0 | S0 |
| I | pT1-4 | N0 | M0 | SX |
| IA | pT1 | N0 | M0 | S0 |
| IB | pT2 | N0 | M0 | S0 |
| pT3 | N0 | M0 | S0 | |
| pT4 | N0 | M0 | S0 | |
| IS | Any pT/Tx | N0 | M0 | S1-3 |
| II | Any pT/Tx | N1-3 | M0 | SX |
| IIA | Any pT/Tx | N1 | M0 | S0 |
| Any pT/Tx | N1 | M0 | S1 | |
| IIB | Any pT/Tx | N2 | M0 | S0 |
| Any pT/Tx | N2 | M0 | S1 | |
| IIC | Any pT/Tx | N3 | M0 | S0 |
| Any pT/Tx | N3 | M0 | S1 | |
| III | Any pT/Tx | Any N | M1 | SX |
| IIIA | Any pT/Tx | Any N | M1a | S0 |
| Any pT/Tx | Any N | M1a | S1 | |
| IIIB | Any pT/Tx | N1-3 | M0 | S2 |
| Any pT/Tx | Any N | M1a | S2 | |
| IIIC | Any pT/Tx | N1-3 | M0 | S3 |
| Any pT/Tx | Any N | M1a | S3 | |
| Any pT/Tx | Any N | M1b | Any S | |
| Serum tumor markers (S) required for the staging | ||||
| SX | Studies on markers not available or not. | |||
| S0 | Study of the concentrations of markers within normal limits. | |||
| S1 | LDH < 1,5 × Nband HCG (mIu/ml) < 5,000 and AFP (ng/ml) < 1,000. | |||
| S2 | LDH 1.5-10 × N or HCG (mIu/ml) 5,000-50,000 or AFP (ng/ml) 1,000-10,000. | |||
| S3 | LDH > 10 × N or HCG (mIu/ml) > 50,000 or AFP (ng/ml) > 10,000. | |||
In 1997 became an international consensus of various groups for risk stratification in patients with distant metastases or bulky retroperitoneal metastases, the classification of the International Germ Cell Cancer Consensus Group (IGCCG). This is especially important in germinal tumors metastatic, since up to 20% of patients die from this illness today.
There are different factors with prognostic implication:
1 tumor volume:
It has been located around 5 cm but it depends on the location of the tumor volume.
2. histological variety:
High fractions of choriocarcinoma, Yolc sac, immature and mostly not germinal varieties teratoma (rabdomioscarcoma, Leiomyosarcoma...) condition a worse prognosis.
3 levels of tumor markers:
He has been observed correlation between very high levels of tumor markers and a worse prognosis. Tumor markers figures reflect not only the quantity (tumor volume), but also the histological tumor composition as mentioned above.
4 Ploidy (number of complete pairs of chromosomes in a cell) and cell proliferation:
Tumors aneuploidies (chromosomes other than the same healthy cell no.) and with high proliferative index is correlated with a worse prognosis.
5. no pulmonary visceral metastases:
The visceral not pulmonary metastatic affectation is considered worse prognosis.
6 older than 35 years:
Patients with more than 35 years seem to be associated with a worse prognosis.
7 - incorrect treatments management or in centres with limited experience.
Combining these factors these three risk groups were defined:
- Good prognosis: comprise 60% of patients, with a 91% survival at 5 years.
- Seminomas: any primary, no pulmonary visceral metastases, and normal levels of MT
- Non-Seminomas: testicular localization or retroperitoneal, without goals, < 1000 ngr/ml AFP, BHCG < 5000mUI/ml and LDH < 1.5 times its normal value
- Intermediate prognosis: comprise 26% of tumors, with a survival at 5 years of 79%.
- Seminomas: any primary with metastasis that non-pulmonary and normal levels of MT
- Non-seminomas: testicular localization or retroperitoneal metastases that non-pulmonary and one of the following: AFP between 1000 and 10000, BHCG between 5000 and 50000 and LDH from 1.5 to 10 times the normal value
- Poor prognosis (only for patients with non seminoma): are 14% of tumors and with survival at 5 years of 48%.
- Mediastinal, without pulmonary metastases involvement
- Any high tumor marker: AFP > 10000, BHCG > 50000 and LDH > 10 times.
Testicular cancer treatment
The first manoeuvre or treatment of choice
for all germinal tumors is (removal of the testicle) regulated via
inguinal orchiectomy. In very advanced illnesses would be justified to start chemotherapy treatment and subsequently this surgery. Radical orchiectomy via inguinal (never scrotal), is used both for the control of disease and to determine the histology.Given the reliability of tumor (MT) markers and the behavior of these tumors metastatic pattern, most experts do not recommend performing a biopsy at the suspicion of a testicular tumor and advise radical surgery of input. The biopsy is left to unusual situations, such as a testicular mass without elevation of MT or presence of atypical locations (for example: bone).
Treatment of Seminoma
Stage IAlmost 80% of patients are cured with orchiectomy. Subsequently is tracked with determinations of tumor markers and Imaging tests. The recurrence rate is 15% in the first 6-12 months, but required a longer follow-up, since up to 20% may recur beyond two years and you get to rescue with radio- or chemotherapy.
There is a subgroup of patients with stage I, whose likelihood of relapse is greater (tumor size greater than 4 cm and invasion of rete it testis). In these cases, one or two cycles of chemotherapy (carboplatin with an AUC of 7) have shown the same beneficial effect of radiation therapy with fewer side effects.
Disseminated disease
The therapy of choice for retroperitoneal lymph nodes is radiotherapy, obtaining survival at 5 years from 89 to 95% according to the stage of the patient.
Chemotherapy is left to more bulky disease or recurrence after radiotherapy, still healing in about 90% of the cases (schemes such as etoposide-Platinum (EP) or by adding Bloemicina (BEP)).
Treatment of the non-seminoma
Stage IThe follow-up is essential given the incorporation of TAC and tumor markers detecting relapses in early stages and, above all, since chemotherapy achieves very high cure rates; the recurrence rate can be up to 30%, and most frequently in the first 18 months, being the retroperitoneum the location most frequent (78%) and the Lung in 30% of cases. The involvement of other organs is more rare.
The presence of vascular invasion is a bad prognostic factor, increased the risk of relapse to 48%, as well as the presence of component of embryonal carcinoma. These patients are candidates for chemotherapy (BEP) with greater than 95% cure rates.
Retroperitoneal lymphadenectomy is performed only as a method of identification of micrometastases (up to 25%) given the high false negative of the TAC. Both the number and the size of the nodes are prognostic factors.
Disseminated disease
The treatment of choice in these cases is the chemo (BEP by 3 cycles), obtaining more than 90% of healing in patients of good prognosis and about 80% in the intermediate prognosis. Unfortunately the poor prognosis group gets only 50% of cures at age 5.
Cryopreservation
The preservation of sperm in all patients with
testicular cancer who wish to, in principle should be offered even
before you start with Imaging tests to avoid exposure to radiation,
although we must bear in mind that:• The majority of testicular tumors are associated with gonadal dysgenesis and up to 60% of patients have low levels of sperm and it can get after orchiectomy.
• This sperm does not seem to have increased sensitivity to cryopreservation.
• New reproductive technologies allow successful pregnancies in 60% of patients and have not seen congenital malformations.
Not all patients want •.
20. Thyroid Cancer
The incidence of this neoplasm is low, higher in the female sex, and increases with age, and in individuals with a history of radiation therapy to the cervical area.
The majority of thyroid cancers generally have a benign evolution, since the diagnosis is usually early. However, it is a type of cancer that can appear after a few years.
Symptoms of thyroid cancer
Some of the symptoms that we may advertise their presence are:• The appearance of a lump in the neck.
• Frequent neck or ear pain.
• Difficulty swallowing.
• Trouble breathing normally or suffer asthma constantly.
• The voice becomes hoarse.
• Developing a cough that is not related to have caught colds or cold.
• Many people don't notice any symptoms and is the doctor who discovers the tumor in a routine analysis.
Causes of thyroid cancer
The most frequent causes of thyroid cancer are:• Exposure to radiation, mainly when this occurs during childhood. It may take up to 40 years from the irradiation until the appearance of cancer. The incidence of cancer increases with the dose of radiation received.
• Very high levels of TSH may influence the growth of some of carcinomas that develop from goiters.
• 20% of Medullary carcinomas introduces a mechanism of hereditary transmission.
• Thyroid lymphoma is associated with Hashimoto's Thyroiditis.
• A family history of thyroid cancer or MEN 2 (Association of medullary carcinoma of the thyroid, more hyperparathyroidism, more pheochromocytoma).
• Have more than 70 years or less than 20 years.
• Be male.
• Recent palpable nodule, growing fast and painless.
• Hoarseness or paralysis of the vocal cords.
• More than 4 cm size.
• Palpable adenopathies.
• Fixing to deep structures (no scrolling with swallowing).
Types of thyroid cancer
The most common types of thyroid cancer are:
Metastatic tumors
The thyroid is a regular location of metastases, mainly of the following primary cancers:• Melanoma.
• Lung carcinoma.
• Breast Cancer.
• Cancer of the esophagus.
Papillary carcinoma
It is the most frequent thyroid carcinoma (can be up to 70% of thyroid cancers). Its
incidence is higher in women, in people with a history of cervical
radiation, and in the fourth decade of life, although it is observed
with remarkable frequency in childhood.It is a well-differentiated tumor, and characteristically presents images in frosted glass. Calcifications (also called psamoma bodies) are frequently seen.
This type of tumor can metastasize early cervical ganglia (it is very rare that there is metastasis through the blood in this tumor), being frequent diagnosis study of a cervical adenopathy, without other accompanying symptoms.
The clinic normally consists of the presence of a single thyroid nodule, which is painless and has very slow growth. Sometimes there are painless cervical lymph nodes, with or without thyroid nodule.
In advanced stages, after years of evolution, metastases may occur.
Follicular Carcinoma
Follows in frequency to the papillary, but appears
in more elderly people, aged about 50, and is more frequent in patients
with goiter.It is very distinct, and can become like normal thyroid, hence the harder its histological diagnosis, although sometimes there are typical cells, called Hurthle cell. We have detected that his prognosis is somewhat worse than the rest of the follicular carcinomas.
Follicular carcinoma spreads primarily via Hematogenous (blood), mainly lung and bone (metastasis may be the first clinical manifestation) and less by lymphatic route, i.e. Unlike papillary carcinoma. Moreover, the clinic is very similar to the papillary carcinoma: a painless thyroid nodule, consistency variable, but usually hard, on a pre-existing goiter or a healthy thyroid.
Anaplastic Carcinoma
It constitutes 10% of malignant neoplasms of the thyroid. It
is an undifferentiated carcinoma of great malignancy that comes also
from the follicular cells, with a peak incidence after age 65.He is associated with thyroid prior alterations, mainly papillary and follicular carcinomas.
It has no capsule, and appears as a stony mass that invades other structures. Cells, unlike the above mentioned tumors, are atypical.
Ganglion and remote metastases appear early, so it may be present to make the diagnosis.
The clinic is characterized by the appearance of a previous cervical tumor, usually painful, which grows fast and is hard and stony consistency.
Medullary carcinoma
Proceeds of thyroid parafollicular cells or C
cells, production of calcitonin, i.e. having a different to previous
tumors source. In addition, it is typical that
there is a substance (amieloide), which facilitates its histological
identification between the cells.It can appear at any age, but is more common from 50 years and as the previous ones, it is more common in women, although with less difference.
Like the anaplastic carcinoma, it originates metastasis early on, both lymphatic and blood, so the clinic will also be similar to the previous tumor, i.e. a nodule (usually slow-growing) with metastasis to lung, bone and liver. Usually these metastases which manifest symptoms that, after investigating, leading to the diagnosis of thyroid carcinoma.
It is a curious fact that a significant percentage of patients also present as symptoms diarrhea, although the pathogenesis of this process is not yet very clear.
Finally, regarding this carcinoma, to diagnose him should do a family study to determine baseline calcitonin and make an early diagnosis of other possible family members affected, since in some cases it has family Association.
Thyroid Lymphoma
More common in older women and sometimes have
previously suffered from a type of benign disease of thyroid,
Hashimoto's Thyroiditis.The clinic is similar to anaplastic carcinoma, but in this case the growth is slower.
Diagnosis of thyroid cancer
To reach the diagnosis of thyroid cancer a
histological study (examination of tissues) is needed, and data that
will guide to determine what kind of carcinoma is treated will be the
characteristics of each tumor who have commented above.Usually the diagnosis begins by the find of a nodule in the anterior neck area, and there are a number of signs and symptoms that initially suspected malignancy in a thyroid nodule:
• History of cervical radiation.
• Less than 20 years or over 60 years old.
• Male sex.
• Single nodule.
• Greater than 4 cm in diameter nodule.
• Recent emergence.
• Rapid growth.
• Stony consistency.
• Presence of neck nodes.
• Signs and symptoms of compression.
• Invasion of upcoming cervical structures.
Diagnostic tests
• Blood analysis.• Ultrasound.
• Thyroid scan: classifies thyroid nodules, according to their uptake of radioisotope, in "cold" nodule or not captantes (80-85%), isocaptantes (15%) or enhanced (5%). Malignant tumors tend to be "cold", although this requirement is not always fulfilled by what is needed, as he has been said, the histological analysis.
• Fna: the thyroid fine needle aspiration is a safe, simple, painless, inexpensive technique and high reliability (arrives to have an accuracy of 95%). Many times the cytology is diagnostic, and can sometimes be therapeutic, since between 20 and 65% of cystic lesions disappear. The main limitation is that in the event of diagnosis of follicular proliferation, could not be assured that it is a follicular cancer and would have to carry out more tests.
Prognosis of thyroid cancer
The evolution and prognosis of different thyroid Neoplasms depend on basically the type and Stadium at the time of diagnosis.Classification in order from least to greatest degree of malignancy:
1. papillary carcinoma (not forgetting that on occasions it can be transformed into anaplastic).
2. follicular carcinoma.
3. medullary carcinoma.
4. anaplastic carcinoma.
5 lymphoma.
Treatment of thyroid cancer
To summarize, the basic treatment of different
thyroid cancers is as follows (below will be detailing according to
therapeutic techniques):• Papillary and follicular carcinomas: near-total thyroidectomy, administration of iodine 131 and thyroid hormone suppressant dose of TSH.
• Carcinoma anaplastic: external radiation, chemotherapy.
• Medullary carcinoma: total thyroidectomy with lymph node removal.
• Lymphoma: external radiation, chemotherapy.
Surgery
Pillar of the treatment of thyroid cancer, since its purpose is the remove the entire tumor or the greater part of this.In papillary and follicular carcinomas, the treatment of choice is to remove the gland almost in its entirety, along with nodes if they are affected.
The MTC also should remove the gland, along with the removal of prophylactic of the nodes (because of its high frequency of involvement), also in this case it is the only possibility of cure, because neither the radio iodine and thyroid hormones help control the disease.
In anaplastic carcinoma and Lymphoma, surgery is usually not very useful, and there are occasions where the treatment will be based on character palliative interventions.
If the Fna (see diagnostic tests) performed it offered questions, or submit follicular or inconclusive characteristics, with a high risk factor for malignant lesion, could carry out a wide lesion resection, but without removing the entire gland, subsequently performing a biopsy of the piece, to determine how to continue the treatment.
Radio iodine
Papillary and follicular carcinomas capture
iodine-131, and radioiodine administration is used to facilitate the
removal of the thyroid remains after surgery.
Treatment with thyroid hormones
The administration of thyroid hormones is mandatory after the removal of the thyroid gland.In patients who underwent anaplastic, medullary or lymphoma carcinoma, hormone therapy is used to avoid a possible hypothyroidism, however, in the papillary and follicular is also used to suppress the pituitary TSH secretion (will have to administer higher doses that in previous cases).
Normally only when external radiotherapy (and on selected occasions) purposes, palliative, since it has no effect to destroy tumors. Yes you can have curative effect if associated with chemotherapy in lymphomas thyroid; However, in the Medullary carcinomas usually prove ineffective. See more about radiation therapy
Follow-up of thyroid cancer
The different types of thyroid cancer require a concrete follow-up by the medical specialist:
Papillary and follicular carcinomas
A few weeks after the surgery is performed
"body iodine uptake" and, based on the result, shown the doses of iodine
131 to manage; Once administered radioiodine
treatment with thyroid hormone begins, and after a few months, are
determinations of thyroid hormone, TSH, thyroglobulin, antithyroglobulin
antibody and another scan with iodine.If the disease is not detected in these tests, evolutionary controls pautarán every 4-6 months. In addition, it is usually performed an annual chest x-ray. And as recurrences tend to occur in the first 10 years they tend to determine thyroid hormone, TSH, thyroglobulin and antithyroglobulin antibody annually, until the sixth year, when the determination will be biennial until age 10, and tracking with iodine will be five, seven and nine years.
Anaplastic Carcinoma
Treatment is palliative, so the main track will be to control the symptoms which cause the tumor.
Medullary carcinoma
He is determination of plasma calcitonin
every 6-12 months, since the increase in its levels often indicate
metastases, so if there is no evidence of disease, but the calcitonin is
increased, tests are carried out to locate the tumor. Other
markers are also determined as CEA (carcinoembryonic Antigen), because
although it is not so specific, it increases when there is a tumor. Where a tumor is detected, it will be necessary again with the greater possible removal surgery.
Thyroid Lymphoma
Tests are performed to determine other possible locations of the tumor.21. Bladder Cancer
This disease is four times more common in men over 60 years, and is more prevalent in urban areas. There are also some racial differences, since it appears most frequently in the races white and Hispanic.
80% of bladder tumors are still superficial at the time of the diagnosis, but the big problem is the great tendency to recur in areas adjacent to the primary lesion.
Causes of bladder cancer
What is the exact cause of the presence of this type of cancer has not been shown, however, several risk factors have been linked to his appearance:
• Smoking is the most important risk factor and, in fact, is the reason for this type of cancer is more common in males, and so has also increased its incidence in women who smoke. It is carcinogenic substances containing tobacco are filtered by the kidneys and are concentrated in the urine, where contact with the bladder. The continuous contact of the tissues of the bladder with urine contaminated by carcinogenic is what predisposes to the development of the tumor.
• Exposure to certain toxic industrial workplace (rubber, leather, paint and oil, dyes...), which may enter the body by inhalation, ingestion or skin absorption.
• Abuse of analgesics.
• Excessive consumption of tea, coffee and artificial sweeteners (although there is no scientific evidence at present showing that these products cause this type of cancer).
• Suffer chronic cystitis (such as people carriers of catheters for a long time).
• Suffer from schistosomiasis, an infection caused by parasites which is very uncommon in Europe, and that can lead to the development of bladder cancer.
• Personal history, when the patient has already had a bladder cancer.
• Occasionally has been associated with urinary tract infections of repetition that, to irritate the tissues that form the bladder, may favor the appearance of neoplasia.
Symptoms of bladder cancer
Most bladder cancers debut with hematuria
(blood in urine), which is often accompanied by discomfort with
urination (dysuria), but never in pain during urination. The
amount of blood in the urine will vary according to the infiltration of
the tumor, and can seen from slightly dark urine, until completely red
urine. In many cases the initial, as pain during
urination symptoms, and a frequent and urgent need to do so, can
simulate a urine infection.The presence of severe perineal pain is usually associated with most pervasive forms in which the tumor has infiltrated all the bladder wall. When the disease progresses it can cause obstruction and anuria (lack of emission of urine).
This tumor causes metastasis as late, so it is usually diagnosed before the start of the symptoms in other organs.
Diagnosis of bladder cancer
To diagnose a bladder cancer is llevana conducted the following tests:• Urinalysis: with the blood and, in some cases cells will be detected, it is possible to also identify some malignant cells. The initial test that must be done to, subsequently, is carry out a more detailed study.
• Rectal or vaginal touch to assess the consistency of the bladder.
• Intravenous urography: detect the vast majority of large tumors. This test is usually performed on all patients who consult for hematuria, to detect early cancer, in the case that this is the cause.
• Ultrasound of the urinary tract: is used to determine the size and the degree of tumor invasion.
• Endoscopic examination (cystoscopy): is performed under anesthesia. It allows you to see the actual appearance of the lesion, and determine its size and exact location.
• CT/MRI: to define the tumor stage and check if the cancer has spread to other areas of the body.
• Biopsy: it is performed to determine the type of tumor and the aggressiveness with which we are confronted. Normally this is done at the same time as endoscopy, to cause minimum possible discomfort to the patient.
Stages of bladder cancer
The evolution of bladder tumor is classified according to the following stages:• Stage 0: or early-stage, where the tumor is very superficial and only affects the inner lining of the bladder.
• Stage I: but it has been extended by the internal tissue of the bladder, does not affect still muscular wall.
• Stage II: cancer also affects the muscles of the bladder.
• Stage III: the disease has spread to the muscular wall of the bladder, surrounding tissue and, even, the reproductive system.
• Stage IV: Cancer cells reach the wall of the abdomen or nearby lymph nodes. It may be metastasis in organs more remote as the liver, lungs, or bones.
• Recurrent: is when the disease recurrence following treatment. It may recur in the bladder or in another area of the body.
Treatment and prognosis of bladder cancer
The treatment of bladder cancer depends on the stadium in which the tumor is at the time of diagnosis:• Surgery: provided that the tumor is not very large and it has not infiltrated all the bladder wall will be his removal. You will be a radical cystectomy (with this are removed so the bladder as the tissues surrounding it and, at times, even the urethra) or partial, depending on the tumor stage. As this tumor has enough risk of return, in cases in which it opts for surgery, then instillations Urol. of immunotherapy or chemotherapy are made to prevent recurrence.
• Immunotherapy: it is a very effective technique, since it decreases to half the risk of recurrence of the tumor. It can be some side effects such as flu-like syndrome and cystitis.
• Chemotherapy: used in cases in which there is distant metastasis. Sometimes also used as adjuvant to surgery to remove cancerous debris and reduce the risk of cancer from coming back.
• Radiation therapy: its objective is to destroy the tumor cells using radiation high energy X. Radiation therapy is especially useful when there are several tumors of small size in the inner surface of the bladder. It can also be used after surgery to decrease the chances of recurrence, or to alleviate symptoms in those cases in which the cancer is incurable.
Prognosis of bladder cancer
Risk of recurrence in this type of tumor in the years following the treatment. Therefore, perform cystoscopy and cytology after removal of tumor: every three months during the first two years, every six months for three years, and once a year until the 10 years after surgery.
However, this cancer has a good survival rate, reaching almost 80% after the five years after the diagnosis. This rate may vary depending on the tumor stage the patient present to detect pathology.
Prevention of bladder cancer
It is difficult to prevent bladder cancer
because, except for tobacco, or exposure to certain toxic, causes that
cause its appearance do not know safely. However, you can take measures such as:• Drink more than 1.5 litres of water a day.
• Avoid the use of tobacco. It is estimated that smokers have twice the risk of developing the disease than the rest of the population. It is ideal to not start the habit ever since they needed 20 years without smoking to return to baseline of normal risk.
• A balanced, without abusing the coffee diet, contain abundant fruits and vegetables.
• See a doctor to diagnose and treat any infection of urine properly.
• Meet the occupational safety standards to limit exposure to chemicals that are associated with the occurrence of this pathology (see causes section).
22 oral Cancer
The oral cavity extends from the union of the skin in the anterior part of the lips to the junction of palates hard and soft (at the top) and the line of papillae attends (at the bottom). It is divided into labial mucosa, the anterior two-thirds of the tongue, the jugal mucosa (inner part of the cheeks), floor of the mouth, gums, retromolar trigone and hard palate.
This area has a rich lymphatic vascularization (except the lips) and near the midline tumors tend to drain bilaterally. Diagnostic lymph node involvement is usually 30% (although it varies by locations) and when this tumor spreads to distance it is usually do to the lungs and much less frequently to the bone or liver.
Most tumors of the oral cavity are squamous histology and often come preceded of premalignant lesions. We can also meet with tumors lymphoid, soft tissue, bone, cartilage, etc.
Risk factors for oral cancer
As we mentioned previously, oral cancer is directly related to smoking and the habit of smoking or chewing tobacco other. Smoking pipe, for example, can be a special risk in cancers of the lip area. So it is with the consumption of large amounts of alcohol. However, there are other risk factors that can be considered causes or triggers of carcinoma of the oral cavity:• Infection by the virus of human papillomavirus (HPV), the risk of oral HPV infection is often associated with sexual behaviour like oral sex.
• A deficient oral hygiene.
• Continuous or chronic irritation of the oral area, either by the friction of the dentate, rough teeth or dentures badly positioned.
• Some immunosuppressive drugs.
• Exposure continued to ultraviolet light (in lip cancers, most common in people who work outdoors).
• Poor diet (low in fruits and vegetables).
• Graft versus host, which can occur after a stem cell transplant.
• Suffering from Fanconi anemia, Congenital Dyskeratosis.
Symptoms of cancer of the oral cavity
Oral cavity tumors significantly affect very basic
functions: breathing, chewing, swallowing, altered sense of taste,
voice and physical appearance.Carcinoma of the oral cavity symptoms tend to be the onset of a chronic injury that no improvement with standard treatments, or pain or bleeding from it, either an oral ulcer, or with what is known as Leukoplakia (a patch or whitish plate that appears in the mouth or inside of the cheeks).
This type of injury can occur in a painless way to top, and refer to the burning sensation when the tumor starts to grow.
Other common symptoms of oral cancer are dysphagia (swallowing pain), dysarthria (alteration to pronounce words), and even halitosis (bad breath). The affected patient can also appreciate a weight loss or feel the swollen lymph nodes in the neck.
Diagnosis and staging of cancer of the oral cavity
Diagnosis and staging of cancer of the oral
cavity is done through inspection and a biopsy of the suspicious lesion
(gum, of the language...). The extension study is
completed with a good physical examination where the doctor or the
dentist can see if there are sores or ulcers in the area; recommending
a dental and nutritional assessment of the patient, and
skull-cervico-thoracic (CT or MRI) imaging, as well as a study of high
airway and esophagus.As in all tumors of this location (head and neck) PET-TAC is one proves very useful for staging, since it is very effective to realize the existence of non-palpable cervical nodes.
Once fact the study is classified according to the AJCC oral tumor (American Joint Comitee on Cancer) which sets the TNM classification (this system represents the extent of the primary tumor (T), spread to the lymph nodes (N) and the spread (metastasized) to other organs (M)):
TX
|
The primary tumor cannot be assessed. |
T0
|
There is no proof of a primary tumor. |
Tis
|
In situ carcinoma. |
T1
|
Tumor ≤2 cm in its greatest dimension. |
T2
|
Tumor > 2 cm, but ≤4 cm in greatest dimension. |
T3
|
Tumor > 4 cm in greatest dimension. |
T4a
|
Moderately advanced local disease. |
| (LIP) The tumor invades through the cortical bone, the inferior alveolar nerve, the floor of the mouth or the skin of the face; i.e. the Chin or nose. | |
| (Oral cavity) The tumor invades adjacent structures (for example, through the cortical bone [mandible or maxilla] toward [extrinsic] deep muscle of the tongue [Genioglossus, hyoglossus, palatoglossus and estilogloso], maxillary sinus or skin of the face). | |
T4b
|
Local disease is very advanced. |
| The tumor invades the masticatory space, the pterygoid plates or the base of the skull, or involves the internal carotid artery. |
Regional lymph nodes (N)
| NX | Regional lymph nodes cannot be assessed. |
| N0 | There are no metastases in regional lymph nodes. |
| N1 | A single ipsilateral lymph node metastasis, ≤3 cm in its greatest dimension. |
| N2 | A single ipsilateral lymph node metastases, > 3 cm, but ≤6 cm in greatest dimension. |
| Metastases to multiple lymph nodes ipsilateral, none > 6 cm in greatest dimension. | |
| Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension. | |
| N2a | A single ipsilateral lymph node metastases, > 3 cm, but ≤6 cm in greatest dimension. |
| N2b | Metastases to multiple lymph nodes ipsilateral, none > 6 cm in greatest dimension. |
| N2c | Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension. |
| N3 | Metastasis in lymph node > 6 cm in greatest dimension. |
Distant metastasis
| M0 | There is no distant metastasis. |
| M1 | Distant metastasis. |
Stadium forecast anatomical/groups
Stadium
|
T
|
N
|
M
|
| 0 | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| II | T2 | N0 | M0 |
| III | T3 | N0 | M0 |
| T1 | N1 | M0 | |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| VAT | T4a | N0 | M0 |
| T4a | N1 | M0 | |
| T1 | N2 | M0 | |
| T2 | N2 | M0 | |
| T3 | N2 | M0 | |
| T4a | N2 | M0 | |
| IVB | Any T | N3 | M0 |
| T4b | Any N | M0 | |
| IVC | Any T | Any N | M1 |
Prognosis of oral cavity cancer
Among the factors that allow to establish
the prognosis of the affected cancer of the oral cavity are TNM
classification, the resectability of the tumor, the degree of tumor
differentiation (differentiated or undifferentiated), the general
condition of the patient, the weight loss of the East and co-morbidities
(the presence and effect of other diseases) from the patient. The depth of tumor invasion conditions the risk of lymph nodes metastases and a worse prognosis.If detected in time, and the tumor is in the early stages, the cure rate can exceed 90%. However, it's a type of tumor that if not caught in time spreads quickly to other areas (mainly throat and neck), which gets much worse survival rates.
Treatment of cancer of the oral cavity
Surgery and radiation therapy are the
standard treatment in the early stages of cancer of the oral cavity, in
an attempt to preserve such basic functions that you can see affected in
this tumor such as chewing, swallowing, articulation of the word... With this choice of treatment survivals are achieved at age 5 of 70%.For unresectable locally advanced lesions (when can not be a functional or aesthetic reconstruction, or injury resulting in trismus - inability to open the mouth-, injuries that cross the midline of the pharyngeal wall, lymph node involvement, and so on) the treatment of choice is chemoradiotherapy (RQT) with rescue surgery if necessary. The 5-year survival obtained with these techniques is 25-40%.
For relapsed or recurrent disease if it is not radiated previously you can try to rescue surgery or a RQT may arise.
If you have already been irradiated can pose a re-irradiation or chemotherapy alone. If the disease is remote (metastatic), treatment is chemo always with palliative, never curative intent.
Complications of cancer of the oral cavity
If the chosen treatment has been surgery aesthetic
complications arising from the operation, in the area of the face, head
or neck may occur, as well as affecting any of their functions.Radiation therapy can also cause dry mouth on the affected by this cancer, and difficulties to swallow and eat, especially at the beginning of the recovery.
The biggest complication, however, is the possibility of metastasis to other parts of the body, as the adjacent areas, the larynx, esophagus, or lung. Therefore, it is necessary that these patients carry out periodic reviews of their State of health to detect them in time if it were the case.
23. Bone Cancer
Lesions are usually classified according to the tissue that predominates in its composition, and whether they are benign or malignant. Both the malignant and benign tumors are likely to grow and compress healthy bone tissue and replace it with defective tissue, but benign tumors do not spread and are not usually dangerous to the life of the patient.
The most common benign bone tumor is osteochondroma, which is usually diagnosed in childhood, although it can go undetected until adulthood. Usually stops growing when it completes the development of the patient so that, if it does not produce symptoms (which would be compression of surrounding structures), does not require treatment. If, on the contrary, it causes symptoms, growth is treated by resection once finished. If adult continues to grow, the possibility of that is malignizado should be assessed.
In the event that the tumor is malignant, must distinguish between cancer that originated in the bone (primary bone cancer), and the one who started in another part of the body, and then spreads to the bone (secondary bone cancer). The second, which is the most common metastasis from other cancers such as breast, lung and prostate is more frequent.
In general:
• The most common benign bone tumor is osteochondroma.
The tumor bone most frequent malignant metastases constitute •.
• The most frequent primary malignant bone tumor is osteosarcoma, followed by chondrosarcoma and Ewing's sarcoma.
Types and characteristics of bone cancer
Among the existing types of bone cancer are osteosarcoma, chondrosarcoma, Ewing's sarcoma, and metastasis. See them in more detail:
Osteosarcoma
The most common bone cancer is osteosarcoma,
which has its origin in osteoblasts, which are the bone cells that
generate new bone. Osteosarcoma is a malignant bone tumor that destroys normal bone tissue.• Age: it usually appears in the second decade of life.
• Location: distal femur and proximal tibia, which are bones forming the knee joint. It is also frequent to appear in the proximal femur (near the hip) and the proximal humerus (near the shoulder).
• Clinic: The most common symptoms are pain, which is accentuated with movement, and the enlargement of a part of the bone, which can interfere with the function of the nearest joint (almost always the knee). In addition, bone, weakened by the action of the tumor, is more susceptible to fracture.
• Evolution: it is an aggressive tumor can metastasize, mainly lung
• Treatment: surgical resection with wide margins associated with chemotherapy, before and after the surgery.
• Forecast: in adults it has worse prognosis than children and young people. It is also worse if develops in bones who have received radiation therapy, or after a previous bone alteration such as Paget's disease. Advances in the treatment of this type of cancer have managed to improve the survival of patients, and, at age 5, 80% of them are cured.
Chondrosarcoma
Chondrosarcoma, the second most common type of bone cancer, and is formed of cartilage producing cells. In most cases it's primary tumors, but they can also be due to previous benign lesions that have malignizado.• Age: occurs between the fifth and the seventh decade of life, and is very rare, affecting less than 20 years.
• Locations: pelvis, femur proximal and proximal humerus.
• Clinic: they tend to cause local pain that is worse at night.
• Evolution: growth slow but with a strong tendency to recurrence.
• Treatment: these tumors are resistant to radiation therapy and chemotherapy, so the treatment of choice is surgical resection.
• Prognosis: it is difficult to predict their clinical course, and depends on the aggressiveness of the tumor and its location (when it is located in the pelvis, for example, it can take longer to diagnose and is more difficult to eradicate).
Ewing's Sarcoma
It's a very aggressive malignant tumor, especially affecting children.• Age: it affects people aged between 10 and 30 years, though usually develops during puberty because when bones are growing rapidly
• Location: develops in the bones or soft tissues near them, and particularly affects the bones of the arms and legs, although it also appears in the pelvis in 25% of cases (which means worst prognosis). Sometimes the tumor spreads to other bones and lungs (metastasis).
• Clinic: pain, palpable mass and often systemic impact (fever, malaise).
• Treatment: surgical resection associated to chemotherapy, before and after surgery, and radiation therapy if it gets a wide resection.
• Forecast: influences especially the location (the worst prognosis is for patients with tumor located in the sacrum and pelvis), the size, the presence or absence of metastasis, age (children under 15 years old have better prognosis) and sex (worst prognosis in boys), among other factors.
Metastasis
The skeleton is the most frequent sites of
metastases, and in addition, metastases are the bone most frequent tumor
in patients older than 50 years. Bone metastases
are developed as a result of the spread of malignant cells from the
primary tumor, entering the bone tissue through lymph and blood vessels.• Classification in order of frequency: breast cancer in women, prostate cancer in men, and cancer of the lung, kidney and thyroid in both sexes.
• Location: settle most of metastases in the spine, proximal femur and the proximal humerus.
• Clinic: the initial and most frequent symptom is pain, progressive and constant, that is accentuated with the night's rest and hardly responds to common painkillers. Sometimes, patients do not refer pain and metastasis is discovered by a pathological fracture.
• Treatment: bisphosphonates for the symptoms and delay the onset of bone complications, especially in metastasis caused by breast cancer. Metastases that occur as a result of thyroid cancer respond to pharmacological treatment used against this type of cancer. In patients who are at risk of imminent split (the intensity of the pain and the radiological appearance of metastasis determine this risk) and in those with pathological fractures, gets to improve survival and quality of life of the patient by the surgical treatment, associated with postoperative radiotherapy and tumor specific cancer treatment. The therapeutic possibilities for treating bone metastases include: chemotherapy, radiotherapy, surgery, hormone therapy, techniques of vascular excision of the tumor, immunotherapy, and medical treatment of pain and bone destruction. The combined use of these techniques increases the chances of success.
Diagnosis of bone cancer
Bone cancer diagnosis is performed using the following techniques:
Simple Radiology
Simple Radiology is the imaging technique more useful for the diagnosis of bone tumors; In addition, the radiological image usually guide on the benignity or malignancy of the lesions.Benign lesions tend to have a well-defined pattern (called geographic), however, in the malignant mixed the healthy tissue with the sick (permeative pattern) or there is an alteration of the fabric (destructive pattern). Some aggressive tumors can also cause the formation of bone, appearing thin overlapping slices (Onion layers image), or calcifications.
Often, you can set a diagnosis based on the location and the radiological appearance of the lesion.
CT and MRI
Computed axial tomography is used in some
cases, but that more information brings and, therefore, which is more
used, is magnetic resonance imaging. Often this test is diagnostic; for this purpose should obtain images of all of the affected bone. In
addition, it is the technique of choice for the study and planning of
surgical intervention of aggressive or malignant tumor lesions.
Biopsy
In many cases no one gets to the definitive diagnosis until a biopsy is performed. The
sample can be obtained by aspiration or surgical biopsy (it can be a
sign, or by removal of the entire tumor at the same time, but this last
single is done in the case of benign tumors).
Extension studies
The lung is the most frequent site of
metastasis of malignant bone tumors, therefore, in all patients are made
plain x-ray and CT of the chest and, in some cases, abdominal and
pelvic CT. The scan can also be useful in certain cases.
Treatment of bone cancer
These are the treatment options for bone cancer:
Surgery
Benign bone tumors are generally treated by local resection; However,
the wicked are treated more aggressively, through wide resection and
reconstruction in the area, either with grafts, prostheses... The
advances in this field have made possible that patients with bone
tumors in arms or legs to avoid total limb amputation, although later
require reconstructive surgery to improve the functionality of the
operated area.
Chemotherapy
Chemotherapy, before and after surgical
resection, has been the factor that has contributed most to improve the
survival of patients with osteosarcoma and Ewing's sarcoma. See more about chemotherapy
Radiotherapy
It is used primarily after surgical resection of the tumor/Ewing and sarcomas, as well as in cases of metastasis. Also can be used in combination with surgery or replacing this in patients who prefer to avoid the surgery. See more about radiation therapy
Cryosurgery
Sometimes you can use this technique, based on the use of liquid nitrogen to destroy cancer cells by freezing.
Bone cancer prognosis
For the set of existing bone cancer data indicate that the relative 5-year survival rate is approximately 70%. In
particular, chondrosarcoma, which is the most common bone cancer in
adults, the relative 5-year survival rate is approaching 80%.In some cases cancer of bone may lead to metastasis, mainly to the lungs or may recur, in the same area or in different body bones. Children and patients younger than bone cancer are more likely to suffer from other types of cancer, such as leukemia. Therefore, it is very important to make timely follow-up and diagnostic tests necessary to keep track of these patients.
You must also remember that the programs of rehabilitation and physical therapy in these patients are usual to regain lost mobility and autonomy.
24 leukemia
As the disease progresses, the malignant cells interfere with the production of another type of blood, such as red blood cells and platelets cells, which has resulted in the development of anemia and increased the risk of infections.
Leukemias have an approximate incidence of two or three cases per 100,000 inhabitants per year. Neoplasms are more frequent in children (around 25% of children's cancers are leukemias), and affect males more often.
There seems to be substantial differences in the prevalence of leukaemia among the different races or geographic areas, rural or urban, environment or between different social classes. However, depending on the type of leukemia, his appearance at certain ages is more frequent. For example, in the case of leukemia Acute Lymphocytic (lymphoblastic), usually occurs in children aged between three and five years, and although it also affects teenagers, is uncommon in adults.
Causes of leukemia
Although the cause of the leukemia is not known
exactly, is known that there are different factors that can cause the
onset of this disease.• Genetic.
• Immunodeficiencies.
• Environmental factors.
Regarding the relationship of genetic factors to the development of leukemia, it is known that the disease is more common in twins than in the rest of the population, and suffer from genetic disorders such as Down syndrome and Fanconi syndrome is a factor of risk associated with the emergence of leukemia.
People with immune system weakened by the administration of chemotherapy or immunosuppressant (which are supplied to patients who have had an organ transplant), are also more likely to develop leukemia.
One of the most studied factors are environmental factors, especially exposure to ionizing radiation, chemicals like benzene and certain drugs, and viruses.
The relationship between ionizing radiation and leukemia was discovered from nuclear accidents (explosions or incidents at nuclear power stations).
Various chemical products are also related to the emergence of the disease, especially some pesticides, and other substances such as mustard gas used in World War I.
Some viruses are also associated with the development of leukemias, especially Epstein-Barr virus, related to African Burkitt Lymphoma or lymphomas in immunosuppressed patients.
Types of leukemia
There are several criteria to classify leukemias. A form of classification is based on its natural history:• De novo: occur unless there is a previous process that triggers the disease.
• Secondary: whenever there is a previous process leading to leukemia, like for example a blood disease.
Another way to classify them based on the type of blood cell that starts the malignant transformation, and the speed of progression of the disease. In the case of acute leukemias, its development is very fast, while the chronic leukaemias progress slowly. In addition, leukemias can be:
• Lymphoblastic: when affect lymphocytes (white blood cells of the bone marrow variety).
• Myeloblastic or mielociticas: affecting series precursor cell myeloid or series red (red blood cells, and platelets).
Acute Lymphocytic Leukemia
In acute lymphatic leukemia cells that
should be transformed into cells become cancerous and replace normal
cells in the bone marrow, and spread to other organs (liver, spleen,
kidneys, brain, lymph nodes...) where they continue to proliferate and
cause diseases such as meningitis, anemia, renal and liver failure, etc.
It is the most common cancer in children.
Chronic lymphocytic leukemia
Chronic lymphocytic leukemia affects especially people older than 60 years, and more to men than to women. Cancerous cells increase in lymph nodes, then spread to the liver and spleen, and then invade the bone marrow. The
disease progresses slowly, and depends on factors such as the number of
lymphocytes in the blood and bone marrow, the severity of the anemia,
and the capacity of the patient's immune system to fight infections that
can get.
Acute myeloid leukemia
Acute myeloid leukemia is characterized
because they are myeloid cells (the cells that should become
granulocytes) that become cancerous and replace normal cells in the bone
marrow. As in the previous case, the Leukemic
cells travel through the bloodstream and settle in other organs, where
are still growing and dividing, causing various conditions (tumours,
anaemia, meningitis...) and damaging other organs. This
type of leukemia affects people of any age, but especially to adults,
and is related to the exposure to large doses of radiation and the use
of chemotherapy to treat other conditions.
Chronic myeloid leukemia
Chronic myeloid leukemia, which affects
people of all ages and sexes (although it is not common in children),
presents with anemia and thrombocytopenia (lack of platelets in the
blood). The Leukemic cells originate primarily in the bone marrow, but also in the spleen and liver. With
the progress of the disease, patients frequently have fever, fatigue,
weakness, loss of appetite and weight, increased size of lymph nodes,
and hemorrhage.
Symptoms of leukemia
The clinic's leukemia depends, on the one hand,
bone marrow failure caused by the growth of cancer cells, which inhibits
the growth of other cells, and on the other hand, the infiltration of
these abnormal cells in organs and tissues.The beginning is almost always acute, suddenly (except in chronic types), and the time between the onset of symptoms and the diagnosis usually does not exceed three months.
It is normal that patients show symptoms at the time of diagnosis, but sometimes they remain asymptomatic (without symptoms) and leukemia is diagnosed by performing a blood test. They frequently refer asthenia (fatigue), anorexia (lack of appetite) and weight loss. Half of the patients have a fever and sweating, especially night. In 50% of patients can be seen Diathesis cutaneous or mucosal (bleeding into the skin or mucous membranes).
There may be pain joints and bone, especially in children. The most frequent is that the Leukemic cells invade the liver, spleen and lymph nodes, causing Lymphadenopathy and hepatosplenomegaly (increase in the size of liver and spleen). Sometimes can affect the nervous system, paralysis of nerves or increased intracranial pressure (within the skull). The involvement of other organs is rare, although in relapses can affect the breast, testicles and skin or mucous membranes.
Diagnosis of leukemia
Anemia is a practically constant in the patient with leukemia. Usually the number of leukocytes is increased (Leukocytosis), although in some cases it may be decreased (leukopenia). The number of platelets is lower than normal (thrombocytopenia).Symptoms that may indicate the presence of leukemia include weakness and feeling of breathlessness (due to anemia), infection and fever (by the shortage of white blood cells), and hemorrhage (bleeding from the nose and gums).
When it examines a sample of blood from the patient to the microscope, are observed very immature white blood cells (blasts). A bone marrow biopsy will help to confirm the diagnosis and determine what kind of leukemia the patient suffers.
Biochemical disorders that occur more frequently are hyperuricemia (high uric acid), hypocalcemia (low calcium), hyperphosphatemia (high phosphorus), hyperkalemia (high potassium) and increase serum activity of the lactic dehydrogenase (LDH). These alterations are seen especially in cases with Leukocytosis, large visceromegalias, or lymph nodes, and reflect the high cell turnover. Hypogammaglobulinemia (low gamma globulin) is detected in some patients.
Treatment of leukemia
Leukemia treatment aims to destroy the cancer cells, to get back normal cells grow in the bone marrow, and prevent recurrence. In general the treatment of leukemia is based on chemotherapy and bone marrow transplants. The guidelines of chemotherapy vary depending on the type of leukemia, so it must be individualized for each patient.During the treatment, it may be necessary to perform transfusions to the patient to correct anemia and bleeding, and give you antibiotics to treat infections.
Chemotherapy is commonly used combinations of drugs, and if Leukemic cells reappear within time, bone marrow transplantation may be the best alternative for healing for the patient. However, to make this possible, it is necessary to obtain bone marrow from a compatible person (HLA-compatible) with the patient, usually a close family member. See more about chemotherapy
Prognosis of leukemia
The prognosis depends on the type of leukemia and the age and personal circumstances of the patient. Acute
Lymphatic leukemia, especially in children whose ages range between 3
and 7 years old, has a good prognosis, because at least 50% of the
children is leukaemia-free five years after treatment. Also
a high percentage of patients of leukemia, acute myeloid (between 50%
and 85%) respond well to treatment, although adults older than 50 years
who have contracted the disease after receiving chemotherapy and
radiation as a treatment for other diseases have worse prognosis.In the case of chronic lymphocytic leukemia, the disease progresses slowly, by what the prognosis is associated with the degree of development of leukemia at the time of diagnosis, although it is worse in those patients are very anemic.
Current treatment of chronic myeloid leukemia does not cure the disease, only to delay their advance, and most patients die in the two years following diagnosis. His only chance of a complete cure is transplantation of bone marrow, which is particularly effective in the early stages of the disease.
25 melanoma
What is melanoma?
Melanoma is a type of cancer that forms from cells called melanocytes. Melanocytes produce a substance called melanin, which is responsible for the color of skin, hair and eyes. Melanin also protects from the harmful UV rays of the Sun. If
the skin receives too many UV rays, the melanocytes may begin to divide
without control and thus begins the cutaneous melanoma.However, melanocytes are found in various areas of the body, there may be melanomas on other sites such as the eye, the digestive or nervous system.
Melanoma can appear in normal skin or in a mole, and is the most serious of skin cancers because it extends very quickly through the lymph system or blood vessels, reaching produce metastases in lymph nodes and other areas of the human body like liver, lungs, bones and brain.
Types of melanoma
The most frequent types of melanoma are four:• Lentigo maligno-melanoma: 5-10% of cases of melanoma. It appears almost always older than 60 years, in the face and on Sun-damaged skin. It has a slow growth surface and takes long to penetrate in depth; metastases, therefore, are late and are limited to the cervical lymph nodes.
• Superficial spreading melanoma: is the most common, around 70% of cases of melanoma. It is most common in people aged 40-60 years and its usual location is the aforementioned: males in the trunk and women legs. Its surface growth lasts less than type Maligna maligno-melanoma, may still take months or years to penetrate deeply and spread.
• Melanoma acral lentiginous: they represent 10% of all melanomas and are located mainly on the palms, plants, under the nail and on the lips. Its surface growth is short and quickly grows in depth, without typical signs of bleeding, itching, or pain. It is more frequent in people black and Asian.
• Nodular melanoma: 10-15% of cutaneous melanomas. Its color is homogeneous and their size does not increase much; grows deep quickly and is difficult to do early detection. It is the most aggressive type.
Risk factors for melanoma
These are the most common risk factors that predispose to suffer a melanoma:
Exposure to Sun's rays
The continuous and regular sun exposure is
probably not a risk factor so important in the formation of melanoma
such as sunburn. The most damaging burns are the
mild/moderate (which cause pain for less than two days and end up in a
peeling of the skin) and the serious (pain or blisters for more than two
days). The most serious burns for the development of melanoma are occurring in childhood and adolescence; that occur in adulthood increases the risk of melanoma over the next 10 years.
Sensitive skin
Skin types are divided into phototypes from I to VI, according to the greater or less ease of Tan or burns. Skin types I and II are the most sensitive to sunlight; It's clear skin that often suffers burns and hard Tan, and melanoma can arise more frequently in these people. However,
people with higher skin types have darker skin and tanning appears very
soon, thus protecting from the Sun's ultraviolet rays.
Multiple moles
Moles, also known as nevus, are confined
dark spots, and can be congenital (existing since birth) or acquired
(appear throughout life, mainly since puberty). The
total number of nevi, which a person has is linked to genetics, but is
also closely related to the amount of solar radiation that is exposed
during childhood.People with 50 or more nevi have an added risk factor for developing melanoma, so it should be evaluated by a dermatologist.
Atypical Mole
They are nevus that alone already constitute a risk factor for melanoma. They are flat, like spots, and meet at least three of the following characteristics:• Jagged edges in the form.
• Fuzzy edges on the boundary.
• Various colours.
• More than 5 mm in diameter.
• Redness.
Family history
Melanoma is associated with a genetic
predisposition as in other cancers, so that a melanoma risk will be
higher if a family member has suffered it. The
risk will be greater the more nearby is the familiar, younger has
suffered from the disease, and more number of affected family has.
Weakened immune system
The consumption of drugs, transplant patients,
those infected with HIV/AIDS, cancer or autoimmune diseases, patients
are causes of depression of the immune system, which facilitates the
development of cancers, including melanoma.
Diagnosis of a melanoma
How can I identify a melanoma?
Early detection of melanoma is essential to prevent the spread of cancer for the rest of the human body. In
the early stages the survival of the patient is 90-95%, while in the
case of advanced Melanoma Survival drops to 20% and treatment options
are reduced. For this reason, it is advisable to
examine the entire length of the skin with the help of mirrors once a
month and go to the dermatologist to the discovery of a cutaneous macha
with warning signs.There are several simple and rapid methods to detect warning signs that indicate the possible development of a melanoma. No method is foolproof and they should be used in unison.
Rule ABCDE
Melanoma will have the following characteristics:• Asymmetry.
• Irregular, Scalloped edges.
• Heterogeneous coloration (2 or more tones: black, Brown, reddish...).
• Diameter greater than 5 mm.
• Evolution with bleeding, itching, redness, hardening...
Seven criteria of Glasgow
Consists of three major criteria that are each worth 2 points and four minor criteria that are each 1 point. A lesion is suspected of melanoma if you add 3 or more points:Major criteria:
• Resizing.
• Change of form.
• Color changing.
Minor criteria:
• 7mm or more in diameter.
• Inflammation.
• Bleeding.
• Itching or pain.
"The ugly duckling" or "The ugly duckling"
It is a very simple method that is detected in a
group of moles that look different from the rest and examine it
thoroughly applying the methods described.Where are shown more often?
Man melanoma usually occur more frequently in the trunk, between the shoulders and hips, and the head and neck. On the other hand, in women it appears most frequently at the bottom of the legs.
In the persons of black race melanoma usually arises under the nails of the feet or hands, in the palms of the hands and soles of the feet.
Tests to diagnose melanoma
In addition to the physical examination by
dermatologists, there are other diagnostic tests that can help to
identify more clearly the presence of a melanoma. The
most well known or used is the digital dermoscopy, which allows
photographing the suspicious area and expand it to see it in detail to
analyze and even be able to keep track of the patient. This
test can detect skin cancers at early stages, rule out a tumor lesion
or orient the specialist to find out if it is necessary to request a
skin biopsy. Cutaneous biopsy involves removing a skin sample to analyse in the laboratory and thus confirm whether it's a cancerous lesion or a pathology of autoimmune skin.
Treatment of melanoma
The ideal treatment is excision in the
operating room of the melanoma, and the survival of the patient depends
on the degree of invasion having the tumor. It is usually removed with a margin of 0'5 - 3cm, but there are also more thorough techniques such as Mohs surgery. Mohs
surgery involves removing all of the melanoma, preserving the maximum
healthy tissue surrounding it, thanks to the implementation of
systematic intraoperative biopsies.Lymph nodes are removed only if it is shown that there is tumor metastasis through palpation (indurated swollen little mobile and painless), or through the technique of Sentinel lymph node. Sentinel lymph node is the node that receives a cancerous metastasis before any other, if this is not affected, none more it will be. It is detected thanks to the injection of a radioactive substance in melanoma, that seeps up to a first node, which is the Sentinel node, which is extracted and analysed microscopically.
To ensure the effects of surgery is used with interferon-α immunotherapy; radiation therapy is only used on Lentigo Maligna maligno-melanoma, and is sometimes the only option in very elderly or unfit for surgery. See more about radiation therapy
Prevention of melanoma
There are two essentials in the prevention of melanoma: self-examination and protection from UV rays.Self-examination should be performed once a month; in it the whole body with the help of mirrors, should be inspected without forgetting the bottom of nail, the folds between the fingers and the scalp. Each mole or unusual spot must conform to the rules which have been cited above, and in case of doubt, always consult a specialist in dermatology. We must remember that an early diagnosis of melanoma can be lifesaving.
UV protection should include certain measures:
• Avoid exposure to the Sun between 1100 h to 16.00.
• Always use protective cream with an index suitable for the skin phototype. Repeat the application of cream every two hours, and after a bath or a lot of sweat, even if the product indicates resistance to water.
• Dry thoroughly after a bath prevents burns due to the"magnifying glass" water droplets.
• Wear protective clothing if you were to be exposed too long to the Sun and has a sensitive skin phototype. This includes a hat or CAP, sunglasses and light long sleeve.
• Taken all these measures in places where the light is reflected in the environment (sea, snow, desert).
• Avoid UV rays booths; been shown that their use increases the risk of developing melanoma and other skin cancers.
• Monitor medication that increases the sensitivity to sunlight, so consult your doctor and read the prospectuses.
• Children under 6 months should not be exposed to the sun never, and children under 3 years may only do so with a very high protection.
Finally, insist on consultation dermatologist before any suspect hint on a patch of skin; with more than 50 moles or with a direct family history of melanoma patients should see regular dermatologist for a full test.
26 mesothelioma
Pleural localization is the most common (80%), affecting the pleura of diffuse form. The pleura is the membrane that covers the surface of the lungs and rib cage.
A tumor is rare. It occurs between the 5th and 7th decades of life due to occupational exposure to asbestos or asbestos (a mineral) in youth. The incidence is higher in Australia, Belgium and Great Britain (with over 20 cases per million population); in Spain, the incidence is less than 22 cases per million, and mesothelioma represents 0.3% of deaths by cancer. The incidence is higher in men than in women.
The average survival of those affected by malignant mesothelioma is between six and 18 months.
Causes of mesothelioma
Asbestos - brandname of a mineral formed by
silica, magnesium, lime and ferrous oxide - is the main cause of
mesothelioma, having demonstrated its ability to carcinogenic in
animals. In humans found that risk is
proportional to the exposure, being miners and workers of the
shipbuilding industry, of construction, the textile and plumbers, higher
risk groups. Indeed, it is estimated that up to
10% of workers at risk develop mesothelioma, and 80% of cases of
mesothelioma have a history of exposure to this mineral, whose use in
the building began to restrict for decades and it has been banned in
many developed countries (in Spain in 2001), but it is still present in
many of the buildings that surround us. Currently, there are several court cases and associations of victims claiming compensation for those affected by its use.The latency period (the time between exposure and the onset of the disease) can be between 14 and 75, and other factors that may influence the time of exposure, the intensity and environmental exposure are, and there are even cases of mesothelioma family.
Other causes of mesothelioma are ionizing radiation (increase in incidence in patients previously treated with radiotherapy) or the SV40 virus, present between 60 and 86% of mesothelioma samples (although not conclusive results in studies can be extracted).
Symptoms of mesothelioma
The initial symptoms of mesothelioma usually occur
months prior to diagnosis in the form of chest pain (non-pleuritic, as a
prick, but dull and poorly localized), as well as Dyspnea (shortness of
breath sensation) variable in relation to the quantity of pleural
effusion.Dry cough, fever and night sweats, asthenia (fatigue) and weight loss can also appear. Occurs most often in a unilateral way (95%), and especially in the area of the right hemithorax (60%), probably in relation to its greater volume.
The progression of the disease produces shortness of breath, and the invasion of neighbouring structures can lead to dysphagia (difficulty swallowing), dysphonia, brachial plexopathy (involvement of the nervous Plexus), or superior vena cava syndrome (when there is compression of the main vein is produce symptoms such as dyspnea, swelling on the face and arm, cough, chest pain, dysphagia, cyanosis, congestion headache and dizziness).
Mesothelioma can also be accompanied by symptoms of Paraneoplastic syndromes (it's different groups of symptoms suffered by cancer patients, and that cannot be explained by the local tumor invasion or its metastases, they are associated with the release of biologically active substances by the tumor, that exert their effects at a distance. In fact, may be the first sign that warn of the presence of a tumor).
Diagnosis and staging of mesothelioma
Because the symptoms of this tumor are very
nonspecific, suspicion of mesothelioma finds appear with radiology,
after checking history of exposure to asbestos. The
various radiological tests: CT and MRI are useful for the study of
extension or for determining resectability (operability) whether or not
the injury. The PET is superior to the TAC setting remote disease, but has its limitations in locoregional staging.Obtaining a specimen for the histopathological diagnosis of mesothelioma can be by thoracentesis (pleural fluid obtaining) for cytological study, but the profitability of this test is not more than 33%. Pleural biopsy to obtain a cylinder of tissue can be blind (50% return), or open by videothorascopy (VATS), or by Thoracotomy, reaching up to a 95% return; in addition, reports of the spread of the disease to the diaphragm, pericardium, chest wall and lymph nodes. This biopsy involves a risk of dissemination by the chest wall up to in 10% of patients.
For the staging of mesothelioma is used TNM system, in its update of 2002.
Many factors forecasts that influence survival (in stages) such as: the general condition of the patient, chest pain, dyspnea, the thrombocytosis (platelets > 400000), loss of weight, elevated LDH (> 500 IU/l), pleural involvement (compared with pericardium or peritoneum), anemia, leukocytosis, over 75 years of age, etc.
Treatment of mesothelioma
Mesothelioma treatment depends on the stage
in which the disease is, and one can say that there is no standard
treatment because of the low incidence. Currently the following therapies are used:
Surgery
Surgery with curative intent is, in theory,
the best option for the treatment of mesothelioma, however, complete
resection (with broad and negative margins) rare time is achieved. Less than 25% of those operated remain alive at 5 years.We have the following options:
1 extrapleural neumonectomy: consists of the en bloc resection of the parietal and visceral, pleura along with lung infiltrated by tumor, lymph nodes Mediastinal, diaphragm and pericardium. All this is reconstructed with mesh. It is a very complicated technique which is not at all centers and has a high perioperative morbidity-mortality (in very selected cases and expert hands is 4%). It has an average of between 9 and 19 months, and a survival survival at two years between 9% and 37%.
2 Pleurectomy (decorticate): consists of resection of the parietal pleura, including the portion of the mediastinum, pericardium and diaphragm, and part of the visceral pleura. This technique is less aggressive than the previous and, above all, more functional for the patient; the mortality of intervention varies between 1.5% and 5%, what happens is that with this technique in 80% of cases remains viable tumor. This technique does not lengthen survival, but better control recurrent Pleural effusions, of more effectively than pleurodesis with TALC (paste the visceral pleura to the parietal introducing talcum powder between the two pleural "leaves"). Median survival is between 9 and 20 months
3 Videothorascopy (VATS) and pleurodesis: is considered the symptomatic treatment of choice.
Radiotherapy
Even though mesothelioma is a tumor
radiosensitive, indications of radiotherapy are limited due to the
proximity with the heart, esophagus, liver and spinal cord (more
radiosensitive structures).Can be used in
1 radiation therapy prophylactic instead of biopsy or puncture, to prevent the spread of the tumor.
2. palliative radiotherapy: relieves pain in 50% of patients, no influence on survival.
3 (supplementary) Adjuvant radiotherapy with or without chemotherapy after surgery (although there are no studies showing benefit).
Chemotherapy
Approximately 85-90% of patients
mesotheliomas presents as unresectable disease (locally advanced or
metastatic), so the treatment intended to be palliative. We have already seen this scenario for surgery and radiotherapy.Chemotherapy gets between 10 and 20% of responses on its own. The agents employed are the Platinum (cis or carboplatin), anthracycline (ADRIAMYCIN) and antimetabolites (pemetrexed). In schemes of polychemotherapy, responses are higher (up to 48%). The most active scheme is cisplatin-pemetrexed, what can be considered the standard treatment in unresectable disease. Another drug to take into account in combination with Platinum (even with Oxaliplatin) is the raltitrexed.
The new agents antidiana (anti-angiogenics or inhibiting tyrosine kinase) have not shown, for now, its utility.
27. brain tumors
Metastatic tumors are much more frequent than the primary, since between 20 and 40% of cancer patients may develop brain metastases. The incidence of tumors intracranial primary is 1-8 cases per 100,000 inhabitants per year. This incidence shows a peak in childhood, where brain tumors are the second most frequent cause of cancer after leukemia, and increases the age of 40.
The different types of tumors play a role different depending on the age of the patient. Thus, in childhood are frequent infratentorial tumors (located in the lower part of the brain) as medulloblastoma and cerebellar Astrocytoma, while adults predominate glioblastoma multiforme and anaplastic Astrocytoma (both malignant and with poor prognosis due to its high rate of recurrence after surgery). Meningioma is the most common benign primary brain tumor, and originates in the meninges, which are the layers of tissue covering the brain.
Causes of brain tumors
The causes of intracranial tumours are unknown. We
know that in some types of brain tumors are important inheritance and
genetic factors, but in the majority of patients there is no evidence of
a family history
Symptoms of brain tumors
Brain tumors produce symptoms and neurological signs that are divided into General and focal. These symptoms vary according to the location of the tumor. Thus, the fast-growing tumors present clinical manifestations much before the slow-growing.(Local) focal symptoms include seizures, paresis (paralysis), aphasia (difficulty to understand and produce language), apraxias (inability to perform movements), agnosias (alteration of the memory), cranial (cerebral nerves) condition, etc. These focal symptoms are caused by the tumor mass and peritumoral edema (fluid that surrounds the tumor).
General symptoms are attributed to an increased intracranial pressure. Intracranial hypertension may be produced by own tumor mass, by peritumoral edema, by obstruction of the flow of CSF (cerebrospinal fluid, in which the central nervous system is immersed), by obstruction of the cerebral venous system, or by a blockage of CSF absorption. These general symptoms include mental disorders, headaches, nausea and vomiting, dizziness, generalized convulsions and papilledema (fluid in the eye). It is also common to see alterations of the personality, headaches (sometimes night or morning dominance), dizziness and nausea, in initial stages.
In patients with intracranial hypertension are frequently symptoms and known as focal signs of false location, due to the displacement of the brain tissue of an intracranial compartment to another. The most common symptoms are: apathy (emotional indifference), urinary incontinence, and imbalance of the March, unilateral or bilateral paralysis of cranial VI, ptosis (fall of the upper eyelid of the eye), Mydriasis (dilation of the pupil), hemiparesis (paralysis of half the body) ipsilateral and bilateral Babinski (infant, abnormal reflex in adults, which consists of open fan the toes after rubbed firmly of the same plant) , focal or generalized seizures, and signs of corticospinal involvement.
Other symptoms that may cause to suspect the presence of a tumor are:
• Drowsiness and changes in alertness.
• Difficulty in swallowing.
• Trembling hands.
• Weakness, numbness or tingling on one side of the body.
• Lack of balance and coordination in the movements.
• Vertigo.
• Disorders of the senses and the ability to perceive certain stimuli (temperature changes, pain...).
• Loss of bladder or bowel control.
• Changes in mood, personality, and behavior.
• Problems to read or write.
Diagnosis of brain tumors
The diagnosis of an intracranial tumor is
established by clinical and complementary examinations which confirm the
presence of the tumor, its location, and even, at times, provide
specific information about its characteristics. The
most useful test is magnetic resonance imaging (MRI), which defines, as
computed axial tomography (CT), the tumor itself and differentiates it
from circulating edema. Other tests are
angiography (test diagnostic imaging which scans blood vessels), evoked
potentials (test which consists of recording and processing brain
responses to different sensory stimuli), and CSF studies.The definitive diagnosis is established with a biopsy (taking a sample of tissue for study) of the tumor, which should be (except medical indication against), even if the tumor is not susceptible of surgery.
Differential diagnosis
Intracranial tumors must be differentiated from other processes capable of producing focal neurological symptoms. Therefore,
other non-tumor expansive intracranial disorders such as bleeding,
should be excluded cysts, vascular malformations, etc.
Complications of brain tumors
Any other location (not brain) cancer patients
often have neurological complications of the disease, which sometimes
can be serious and irreversible consequences, therefore they need early
diagnosis that allows them to maintain the quality of life.
Brain metastases
It consists of the extension of a cancer within the brain. It is the most common complication. Tumors that more often produce brain metastases include lung, breast and melanoma skin cancer. Often
patients with lung cancer and melanoma perform an MRI before starting
treatment, in order to rule out the presence of metastases to the brain.The clinic consists of the emergence, in days or weeks, a neurological defect (which depends on the location of the metastasis), seizures or headaches. The diagnostic method of choice is the MRI.
Brain metastases have a poor prognosis, since they indicate the presence of disseminated cancer. Depending on whether or not the primary tumor (tumor that has spread) is controlled, and the number of intracranial metastasis (single or multiple) applies a treatment or another (radiation or surgery).
Neoplastic meningitis
It consists of the involvement of the meninges (brain covers) by a systemic cancer. The most frequent causes are lymphomas and leukemias, as well as lung and breast cancer.The clinic consists of the appearance of various symptoms, as intracranial hypertension or paralysis of cranial nerves, especially the oculomotor (responsible for the movement of the eyes), facial and the auditory.
The diagnosis is made by a CSF examination, where you will discover malignant cells.
Neoplastic meningitis does depends on the type of tumor arising from the condition, and from the moment of appearance in relation to cancer. In general, it is bad. Treatment can consist of chemotherapy and/or radiation therapy.
Cerebrovascular complications
The incidence, type, and the mechanism of cerebral vascular injury vary depending on the tumor. In general, bruising and cerebral infarcts occur. The main cause of the bruising is bleeding from the tumor metastasis, while attacks are produced by a coagulation or a thrombus.
Treatment of brain tumors
The treatment of brain cancer depends on the type, degree, the extension and the location of the tumor. The therapeutic possibilities include surgery to remove the tumor, chemotherapy and radiotherapy. It is common to use several of these techniques, combining them to obtain greater benefit against cancer. The treatment guidelines should be monitored by a medical expert.In high-grade gliomas treatment has achieved better results and a higher rate of survival of patients, has been the combination of surgery (when possible), radiation therapy, and chemotherapy. He is recommended in these cases radiotherapy after the operation with techniques allowing to delimit the zone as much as possible to radiate to avoid damaging healthy brain tissue.
Some drugs that have demonstrated efficacy in postoperative treatment of these tumours are temozolomide, taxanes, and irinotecan.
You must be regular monitoring of patients, performing a brain resonance, every six months when it's low grade gliomas, and every three months in the high-grade. In cases in which the resonance offers questions, another test called emission tomography (PET) Positron, which consists of evaluating the behavior more or less aggressive tumor, according to the incorporation of glucose or other labelled molecules can be.