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Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. There are over 100 different known cancers that affect humans.
It is Also called: Carcinoma, Malignancy, Neoplasms, Tumor. Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don’t need them, and old cells don’t die when they should. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. Benign tumors aren’t cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body.. There are more than 100 different types of cancer. Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis. Symptoms and treatment depend on the cancer type and how advanced it is. Most treatment plans may include surgery, radiation and/or chemotherapy. Some may involve hormone therapy, biologic therapy, or stem cell transplantation.
Cancers can be grouped according to the type of cell they start in. There are 5 main categories

  • Carcinoma – cancer that begins in the skin or in tissues that line or cover internal organs. There are a number of subtypes, including adenocarcinoma, basal cell carcinoma, squamous cell carcinoma, and transitional cell carcinoma
  • Sarcoma – cancer that begins in the connective or supportive tissues such as bone, cartilage, fat, muscle, or blood vessels
  • Leukaemia – cancer that starts in blood forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and go into the blood
  • Lymphoma and myeloma – cancers that begin in the cells of the immune system
  • Brain and spinal cord cancers – these are known as central nervous system cancers

Causes of Cancer

Cancer is a complex group of diseases with many possible causes. The known causes of cancer, includes genetic factors; lifestyle factors such as tobacco use, diet, and physical activity; certain types of infections; and environmental exposures to different types of chemicals and radiation.

Genetics and Cancer

Some types of cancer run in certain families, but most cancers are not clearly linked to the genes we inherit from our parents

Tobacco and Cancer

cigarette, cigar, and smokeless tobacco use affects different groups of people.

Diet and Physical Activity

diet, physical activity, excess body weight, and alcohol use may affect your risk of cancer.

Sun and UV Exposure

Too much sun exposure also cause cancer.

Radiation Exposure and Cancer Risk

The different types of radiation exposure also have cancer risk

Other Carcinogens

The environmental causes of cancer that may lurk in our homes, at work, in pollution, and even in some medical tests and treatments. some types of infections are linked to cancer.
It has also been seen that not all tumors are cancerous; they are either malignant or benign.
Benign tumors aren’t cancerous. They can often be removed, and, in most cases, they do not come back. Cells in benign tumours do not spread to other parts of the body.
Malignant tumors are cancerous and are made up of cells that grow out of control. Cells in these tumours can invade nearby tissues and spread to other parts of the body. Sometimes cells move away from the original (primary) cancer site and spread to other organs and bones where they can continue to grow and form another tumour at that site. This is known as metastasis or secondary cancer. Metastases keep the name of the original cancer location. e.g. pancreatic cancer that has spread to the liver is still called pancreatic cancer.

Symptoms of Cancer

15 Cancer Symptoms for Women

  • Cancer Symptoms for Men
  • Problems When You Pee
  • Changes in Your Testicles
  • Blood in Your Pee or Stool
  • Skin Changes
  • Changes in Lymph Nodes
  • Trouble Swallowing
  • Heartburn
  • Mouth Changes
  • Weight Loss Without Trying
  • Fever
  • Breast Changes
  • Fatigue
  • Cough
  • Pain
  • Belly Pain and Depression
  • Stages of Cancer
  • Staging is a way of describing the size of a cancer and how far it has grown. When doctors first diagnose a cancer, they carry out tests to check how big the cancer is and whether it has spread into surrounding tissues. Staging is important because it helps your treatment team to know which treatments you need.Stage 1 usually means that a cancer is relatively small and contained within the organ it started in.
    Stage 2 usually means the cancer has not started to spread into surrounding tissue but the tumour is larger than in stage 1. Sometimes stage 2 means that cancer cells have spread into lymph nodes close to the tumour. This depends on the particular type of cancer.
    Stage 3 usually means the cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area.
    Stage 4 means the cancer has spread from where it started to another body organ. This is also called secondary or metastatic cancer.
    Sometimes doctors use the letters A, B or C to further divide the number categories – for example, stage 3B cervical cancer. 

    Cancer Treatment Options

    Treatment Types

    Find out what you need to know about the most common types of cancer treatment, such as surgery, chemotherapy, radiation therapy, and many others. Learn how they work and why they are used, and get an idea of what to expect and how they might affect you if you’re getting them.

    Surgery

    Surgery can be used to diagnose, treat, or even help prevent cancer in some cases. Most people with cancer will have some type of surgery. It often offers the greatest chance for cure, especially if the cancer has not spread to other parts of the body. Learn more about surgery here.

    Chemotherapy

    Chemotherapy (chemo) is the use of medicines or drugs to treat cancer. The thought of having chemotherapy frightens many people. But knowing what chemotherapy is, how it works, and what to expect can often help calm your fears. It can also give you a better sense of control over your cancer treatment.

    Radiation Therapy

    Radiation therapy uses high-energy particles or waves to destroy or damage cancer cells. It is one of the most common treatments for cancer, either by itself or along with other forms of treatment..

    Targeted Therapy

    Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to more precisely identify and attack cancer cells, usually while doing little damage to normal cells. Targeted therapy is a growing part of many cancer treatment regimens.

    Immunotherapy

    Immunotherapy is treatment that uses your body’s own immune system to help fight cancer. There are different types of immunotherapy to treat different types of cancer.

    Hyperthermia

    The idea of using heat to treat cancer has been around for some time, but early attempts had mixed results. Today, newer tools allow more precise delivery of heat, and hyperthermia is being studied for use against many types of cancer.

    Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants)

    bone marrow transplants and other types of stem cell transplants that are used to treat cancer.

    Photodynamic Therapy

    Photodynamic therapy or PDT is a treatment that uses special drugs, called photosensitizing agents, along with light to kill cancer cells. The drugs only work after they have been activated or “turned on” by certain kinds of light.

    Lasers in Cancer Treatment

    Lasers, which are very powerful, precise beams of light, can be used instead of blades (scalpels) for very careful surgical work, including treating some cancers.

    Alternative and Complementary Therapy:

    This therapy involves homeopathy and acupuncture

    Cancer Recurrence

    Cancer recurrence is defined as the return of cancer after treatment and after a period of time during which the cancer cannot be detected. (The length of time is not clearly defined.) The same cancer may come back where it first started or somewhere else in the body.
    There are different types of cancer recurrence:

    • Local recurrence means that the cancer has come back in the same place it first started.
    • Regional recurrence means that the cancer has come back in the lymph nodes near the place it started.
    • Distant recurrence means the cancer has come back in another part of the body, some distance from where it started (often the lungs, liver, bone marrow, or brain).

    Care After Cancer Treatment

    After your cancer treatment, as a cancer survivor you’re eager to return to good health. But beyond your initial recovery, there are ways to improve your long-term health so that you can enjoy the years ahead as a cancer survivor.
    The recommendations for cancer survivors are no different from the recommendations for anyone who wants to improve his or her health: Exercise, eat a balanced diet, maintain a healthy weight, avoid tobacco and limit the amount of alcohol you drink
    Aftercare also involves the review of physical exam and medical history of a patient that include endoscopy, imaging procedures and blood work. This aftercare is very important as it helps in determining the changes in health of a patient.

    Breast Cancer Treatment in India

    Breast Cancer

    Breast cancer usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. A breast cancer that started off in the lobules is known as lobular carcinoma, while one that developed from the ducts is called ductal carcinoma. Breast cancer is cancer that develops from breast tissue.[ Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, or a red scaly patch of skin.In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.

    Symptoms of Breast Cancer

    Signs and symptoms of breast cancer include:

    • a lump in the breast – the most common first sign. The woman usually finds the lump. …
    • a lump in the armpit (axilla) …
    • changes in breast shape or size.
    • skin changes. …
    • nipple changes.

    Advanced Breast Cancer Symptoms

    • Weight loss
    • Bone pain
    • Welling in the armpit
    • Skin ulcers
    • Discomfort or breast pain

    Types of Breast Cancer

    Ductal Carcinoma in situ

    Ductal Carcinoma in Situ (DCIS) is a non-invasive breast cancer where abnormal cells have been contained in the lining of the breast milk duct.

    Invasive Ductal Carcinoma

    Invasive Ductal Carcinoma means that abnormal cells that originated  in the lining of the breast milk duct have invaded surrounding tissue

    Triple Negative Breast Cancer

    Triple negative breast cancer means that the cells in the tumor are negative for progesterone, estrogen, and HER2/neu receptors

    Inflammatory Breast Cancer

    Inflammatory breast cancer is a less common form of breast cancer that may not develop a tumor and often affects the skin.

    Metastatic Breast Cancer

    Metastatic breast cancer is cancer that has spread beyond the breast, sometimes into the lungs, bones, or brain

    Breast Cancer during Pregnancy

    Women who are diagnosed with breast cancer during pregnancy may face tremendous additional strain due to concern for the safety of the unborn child

    Other Types

    Less common types of breast cancer include Medullary Carcinoma, Tubular Carcinoma, and Mucinous Carcinoma

    Stages of Breast Cancer

    The stage is based on the following factors:

    • The size of the tumor within the breast
    • The number of lymph nodes affected
    • The nearest lymph nodes are found under the arm, known as the axillary area
    • Signs indicating whether or not the breast cancer cancer has invaded other organs within the body

    If breast cancer has spread, or metastasized, evidence be may found in the bones, liver, lungs, or brain.

    Stage 0 & 1

    These lowest numbered stages represent the earliest detection of breast cancer development. At Stage 0 and 1, the cancer cells are confined to a very limited area. Stage 1 breast cancer is split into 2 stages
    Stage 1A means that the tumour is 2cm or smaller and has not spread outside the breast
    Stage 1B means that small areas of breast cancer cells are found in the lymph nodes close to the breast and either

    • No tumour is found in the breast or
    • The tumour is 2cm or smaller

    Stage 2 (II) and Stage 2A (IIA)

    Stage 2 breast cancer is still in the earlier stages, but there is evidence that the cancer has begun to grow or spread.  It is still contained to the breast area and is generally very effectively treated. his is divided into two groups
    Stage 2A means

    • There is no tumour or a tumour 2cm or smaller in the breast and cancer cells are found in 1 to 3 lymph nodes in the armpit or in the lymph nodes near the breastbone
    • The tumour is larger than 2cm but not larger than 5cm and there is no cancer in the lymph nodes

    Stage 2B means

    • The tumour is larger than 2cm but not larger than 5cm and small areas of cancer cells are in the lymph nodes
    • The tumour is larger than 2cm but not larger than 5cm and the cancer has spread to 1 to 3 lymph nodes in the armpit or to the lymph nodes near the breastbone
    • The tumour is larger than 5cm and has not spread to the lymph nodes

    Stage 3 (III) A, B, and C

    Stage 3 breast cancer is considered advanced cancer with evidence of cancer invading surrounding tissues near the breast.
    Stage 3 breast cancer is divided into 3 groups
    Stage 3A means

    • No tumour is seen in the breast or the tumour may be any size and cancer is found in 4 to 9 lymph glands under the arm or in the lymph glands near the breastbone
    • The tumour is larger than 5cm and small clusters of breast cancer cells are in the lymph nodes
    • The tumour is more than 5cm and has spread into up to 3 lymph nodes in the armpit or to the lymph nodes near the breastbone

    Stage 3B means

    • The tumour has spread to the skin of the breast or to the chest wall, and made the skin break down (an ulcer) or caused swelling – the cancer may have spread to up to 9 lymph nodes in the armpit or to the lymph glands near the breastbone

    Stage 3C means
    The tumour can be any size, or there may be no tumour, but there is cancer in the skin of the breast causing swelling or an ulcer and it has spread to the chest wall. It has also spread to

    • 10 or more lymph nodes in the armpit
    • Lymph nodes above or below the collar bone
    • Lymph nodes in the armpit and near the breastbone

    Stage 4 (IV)

    Stage 4 breast cancer indicates that cancer has spread beyond the breast to other areas of the body.
    In stage 4 breast cancer

    • The tumour can be any size
    • The lymph nodes may or may not contain cancer cells
    • The cancer has spread (metastasised) to other parts of the body such as the bones, lungs, liver or brain

    Diagnosis of Breast Cancer

    Mammogram

    A mammogram is an x-ray that allows a qualified specialist to examine the breast tissue for any suspicious areas.  In a diagnostic mammogram, more x-rays are taken, providing views of the breast from multiple vantage points.

    Ultrasound

    A breast ultrasound is a scan that uses penetrating sound waves that do not affect or damage the tissue and cannot be heard by humans

    MRI

    During a breast MRI, a magnet connected to a computer transmits magnetic energy and radio waves (not radiation) through the breast tissue. It scans the tissue, making detailed pictures of areas within the breast

    Biopsy

    A breast biopsy is a test that removes tissue or sometimes fluid from the suspicious area. The removed cells are examined under a microscope and further tested to check for the presence of breast cancer.

    There are different ways of taking biopsies. These include

    CT Scan
    CT scan is done for checking the spread of the cancer
    PET scan for checking the spread of the cancer

    Types of Breast Cancer Surgery

    The first step and most common form of treatment for breast cancer is surgery. Surgery involves removing the tumor and nearby margins. The margin is the surrounding tissue that might be cancerous. The goal of surgery is to remove not only the tumor, but also enough of the margin to be able to test for the spread of the cancer. Once the removed tissue is checked, your post-operative report should tell you if you had “clear margins,” (meaning the tissue farthest away from the breast was free of any cancer cells.)

    Lumpectomy (Breast-Conserving Surgery)

    Partial Mastectomy

    Total Mastectomy

    Modified Radical Mastectomy

    Radical Mastectomy

    Breast Cancer Treatment

    here are several ways to treat breast cancer, depending on its type and stage.
    Local treatments: Some treatments are called local therapies, meaning they treat the tumor without affecting the rest of the body. Types of local therapy used for breast cancer include:

    These treatments are more likely to be useful for earlier stage (less advanced) cancers, although they might also be used in some other situations.
    Systemic treatments: Breast cancer can also be treated using drugs, which can be given by mouth or directly into the bloodstream. These are called systemic therapies because they can reach cancer cells anywhere in the body. Depending on the type of breast cancer, several different types of drugs might be used, including:

    Many women will get more than one type of treatment for their cancer

    Oral Cancer Treatment in India

    Oral Cancer

    Oral cancer is a cancer that develops in the tissues of the mouth or throat. Most develop in the squamous cells found in your mouth, tongue, and lips. Oral cancers are most often discovered after they have spread to the lymph nodes of the neck. Early detection is key to surviving this cancer. Oral cancer appears as a growth or sore in the mouth that does not go away. Oral cancer, which includes cancers of the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat)

    Types of Oral Cancer

    In the head and neck region, two of the most common types of cancer are cancer of the oral cavity (mouth and tongue) and cancer of the oropharynx (the middle of the throat from the tonsils to the tip of the voice box). The oral cavity and oropharynx, along with other parts of the head and neck, contribute to the ability to chew, swallow, breathe, and talk.

    A cancer that develops on the inside or outside layer of the body is called a carcinoma and these types of cancer are categorised by the type of cells the cancer starts in.
    Squamous cell carcinoma is the most common type of mouth cancer, accounting for nine out of 10 cases. Squamous cells are found in many places around the body, including the inside of the mouth and under the skin.
    Less common types of mouth cancer include:

    • oral malignant melanoma – where the cancer starts in cells called melanocytes, which help give skin its colour
    • adenocarcinomas – cancers that develop inside the salivary glands

    Causes of Oral Cancer

    Risk factors for the development of oral cancer include:

    • Smoking . Cigarette, cigar, or pipe smokers are six times more likely than nonsmokers to develop oral cancers.
    • Smokeless tobacco users. Users of dip, snuff, or chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips.
    • Excessive consumption of alcohol. Oral cancers are about six times more common in drinkers than in nondrinkers.
    • Family history of cancer.
    • Excessive sun exposure, especially at a young age.
    • HPV infection (a sexually transmitted virus)

    Symptoms of Oral Cancer

    The most common symptoms of oral cancer include:

    • Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
    • The development of velvety white, red, or speckled (white and red) patches in the mouth
    • Unexplained bleeding in the mouth
    • Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
    • Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks
    • A soreness or feeling that something is caught in the back of the throat
    • Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
    • Hoarseness, chronic sore throat, or change in voice
    • Ear pain
    • A change in the way your teeth or dentures fit together
    • Dramatic weight loss

    Stages of Oral Cancer

    There are four main stages in this system – stages 1 to 4. Some doctors also refer to stage 0.

    Stage 0 or carcinoma in situ (CIS)

    If you have CIS or stage 0 cancer of the mouth or oropharynx, you have a very early stage cancer. Some doctors prefer to call this pre cancer. There are cancer cells but they are all contained within the lining of the mouth or oropharynx. So they have not spread. As the cells have not spread, this is not yet a true cancer. If the pre cancer is not treated, there is a high chance of this condition going on to develop into an invasive cancer.

    Stage 1

    This is the earliest stage of invasive cancer. It means that cancer has begun to grow through the tissues lining the mouth or oropharynx and into the deeper tissues underneath. The cancer is no more than 2 cm across and has not spread to nearby tissues, lymph nodes or other organs.

    Stage 2

    If you have stage 2 cancer, the tumour is larger than 2cm across, but less than 4cm. The cancer has not spread to lymph nodes or any other organs.

    Stage 3

    Having stage 3 mouth or oropharynx cancer can mean one of two things. Either the cancer is bigger than 4cm but has not spread to any lymph nodes or other parts of the body. Or the tumour is any size but has spread to one lymph node on the same side of the neck as the cancer. In this case the lymph node involved is no more than 3cm across.

    Stage 4

    Stage 4 means the cancer is advanced. It is divided into 3 stages

    • Stage 4a means the cancer has grown through the tissues around the lips and mouth – lymph nodes in the area may or may not contain cancer cells
    • Stage 4b means the cancer is any size and has spread to more than 1 lymph node on the same side of the neck as the cancer, or to lymph nodes on both sides of the neck, or any lymph node is bigger than 6cm
    • Stage 4c means the cancer has spread to other parts of the body such as the lungs or bones

    Diagnosis of Oral Cancer

    Biopsy

    To make a definite diagnosis of any mouth or oropharyngeal cancer your doctor needs to take a sample of tissue from the affected area (a biopsy) and look at it under a microscope for signs of cancer. If the area is easy to get at (for example, in your mouth) your doctor will be able to remove a very small amount of tissue and send it to the laboratory. There are different ways of taking a biopsy to diagnose mouth and oropharyngeal cancers. They include scalpel biopsy and panendoscopy. If you have a lump in your neck, your doctor may take a sample of cells using fine needle aspiration.

    Scalpel biopsy

    A scalpel biopsy means cutting out a small piece of tissue from the affected area. Your doctor will inject some local anaesthetic into the area to numb it. Then the doctor cuts round the biopsy area, gently lifts the piece of tissue using a pair of tweezers and cuts it off. This is uncomfortable but only lasts a short time. For many people, the most uncomfortable part is the local anaesthetic injection

    Nasoendoscopy

    A nasoendoscopy (sometimes spelt nasendoscopy) or laryngoscopy allows your specialist to look at all your upper air passages. This includes the back of your throat (the pharynx).

    The specialist passes a narrow, flexible telescope (a nasoendoscope) up your nose and down your throat. It can be a bit uncomfortable, so your doctor may use an anaesthetic spray to numb your throat first. But if you have the anaesthetic spray you can’t eat or drink until it wears off so you may choose not to have it. If the specialist sees any abnormal area in your throat, they will need to take a biopsy from that area.

    Fine needle aspiration

    Fine needle aspiration is also called FNA. If your doctor can feel a lump in your neck, you may need to have a fine needle aspiration. This means putting a thin needle into the lump. The specialist will first feel the lump, so that they know where to put the needle. Once the needle is in the lump, the doctor draws out cells and fluid. The doctor sends the cells to the laboratory, where a specialist called a pathologist examines them to see if they are cancerous.

    Your doctor may also use a fine needle biopsy to see if the cancer has spread to the lymph nodes in your neck. The doctor puts the needle into one of the large lymph nodes and draws out fluid and cells for testing.

    Panendoscopy

    Your doctor may ask you to go into hospital to have a panendoscopy. This is usually if they can’t get a good view using the mirror or nasoendoscope, or if they see something abnormal and need to take a biopsy. The nasoendoscope is too fine to use for a biopsy. But a panendoscope is thicker so your specialist can use it to remove a sample of the affected tissue. A panendoscope is a series of connected tubes that a head and neck surgeon uses to look at your upper airways. There is a camera and light at one end, and an eyepiece at the other.

    You have this test while you are under general anaesthetic. The doctor gently puts the panendoscope up your nose and down into your throat. They will look at all parts of your pharynx, as well as the larynx (voice box), food pipe (oesophagus), windpipe (trachea) and breathing tubes (bronchi). This is because people with mouth and oropharyngeal cancers are at a greater risk of developing cancers in other areas of the head and neck.

    Chest X-ray

    You need to have a routine chest X-ray if you are going to have surgery under general anaesthetic

    CT scan

    MRI scan

    Orthopantomogram (OPG or OPT)

    This type of X-ray takes pictures of the area around the upper jawbone (maxilla) and lower jawbone (mandible) and the surrounding area. It can pick up any signs of cancer in and around these bones. It is also a useful way of seeing if you need any dental work done before treatment starts. Your doctor may call this test a Panorex scan

    PET-CT Scan

    Barium swallow

    A barium swallow is a type of X-ray investigation. This is not a very common test but you may have it if you are having difficulty swallowing solid food.
    You swallow a liquid that contains barium. Barium shows up the outline of the inside of the digestive system very clearly on X-ray

    Treatment of Oral Cancer

    Oral cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments.
    At any stage of disease, people with oral cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care

    Surgery

    Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. Patients may have surgery alone or in combination with radiation therapy.

    Non-surgical Treatments

    Radiation therapy

    Radiation therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area

    Chemotherapy

    Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body. A new targeted therapy called cetuximab, which blocks a growth factor upon which cancer cells may depend, is being used today, either alone or in combination with radiation and older chemotherapy drugs.
    Chemotherapy is usually given by injection

    Biological Therapy:

    Biological therapy is treatment designed to stimulate or restore the ability of the body’s immune (natural internal defense) system to fight infection and disease. Biological therapy is also called biotherapy or immunotherapy. Biological therapies are treatments that act on processes in cells. They may

    • Stop cancer cells from dividing and growing
    • Seek out cancer cells and kill them
    • Encourage the immune system to attack cancer cells

    There are many different types of biological therapy and they may be called

    • Biological Response Modifiers (BRMs)
    • Biologic agents or biologics
    • Targeted therapies
    • Immunotherapy

    Pancreatic Cancer Treatment and Surgery in India

    Pancreatic Cancer

    Pancreatic cancer arises when cells in the pancreas, a glandular organ behind the stomach, begin to multiply out of control and form a mass. These cancerous cells have the ability to invade other parts of the body. There are a number of types of pancreatic cancer. Pancreatic cancer is a disease in which malignant (cancerous) cells form in the tissues of the pancreas. The pancreas is a gland located behind the stomach and in front of the spine. The pancreas produces digestive juices and hormones that regulate blood sugar. Cells called exocrine pancreas cells produce the digestive juices, while cells called endocrine pancreas cells produce the hormones. The majority of pancreatic cancers start in the exocrine cells. This cancer may metastasize or spread top surrounding organs and lymph nodes such as lungs and liver.

    Types of Pancreatic Cancer

    Pancreatic cancers are grouped into two main types:

    Endocrine tumors

    Tumors of the endocrine pancreas are uncommon, making up less than 4% of all pancreatic cancers. As a group, they are sometimes known as pancreatic neuroendocrine tumors (NETs) or islet cell tumors.
    Pancreatic NETs can be benign or malignant (cancer). Benign and malignant tumors can look alike under a microscope, so it isn’t always clear whether or not a pancreatic NET is cancer. Sometimes the diagnosis only becomes clear when the tumor spreads outside of the pancreas.
    There are many types of pancreatic NETs
    Functioning tumors: About half of pancreatic NETs make hormones that are released into the blood and cause symptoms. These are called functioning tumors. Each one is named for the type of hormone-making cell it starts in.

    • Gastrinomas come from cells that make gastrin. About half of gastrinomas are cancers.
    • Insulinomas come from cells that make insulin. Most insulinomas are benign (not cancers).
    • Glucagonomas come from cells that make glucagon. Most glucagonomas are cancers.
    • Somatostatinomas come from cells that make somatostatin. Most somatostatinomas are cancers.
    • VIPomas come from cells that make vasoactive intestinal peptide (VIP). Most VIPomas are cancers.
    • PPomas come from cells that make pancreatic polypeptide. Most PPomas are cancers.

    The most common types of functioning NETs are gastrinomas and insulinomas. The other types occur very rarely

    . Exocrine tumors

    Exocrine tumors are by far the most common type of pancreas cancer. When someone says that they have pancreatic cancer, they usually mean an exocrine pancreatic cancer.
    Pancreatic adenocarcinoma: An adenocarcinoma is a cancer that starts in gland cells. About 95% of cancers of the exocrine pancreas are adenocarcinomas. These cancers usually begin in the ducts of the pancreas. But sometimes they develop from the cells that make the pancreatic enzymes, in which case they are called acinar cell carcinomas.
    Less common types of cancers: Other cancers of the exocrine pancreas include adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, and undifferentiated carcinomas with giant cells. These types are distinguished from one another based on how they look under the microscope.
    Solid pseudopapillary neoplasms (SPNs): These are rare, slow-growing tumors that almost always occur in young women. Even though these tumors tend to grow slowly, they can sometimes spread to other parts of the body, so they are best treated with surgery. The outlook for people with these tumors is usually very good.
    Ampullary cancer (carcinoma of the ampulla of Vater): This cancer starts in the ampulla of Vater, which is where the bile duct and pancreatic duct come together and empty into the small intestine. Ampullary cancers aren’t technically pancreatic cancers, but they are included in this document because their treatments are very similar.
    Ampullary cancers often block the bile duct while they are still small and have not spread far. This blockage causes bile to build up in the body, which leads to yellowing of the skin and eyes (jaundice) and can turn urine dark. Because of this, these cancers are usually found at an earlier stage than most pancreatic cancers, and they usually have a better prognosis (outlook) than typical pancreatic cancers

    Symtons of Pancreatic cancer

    the three most common symptoms are:

    • pain in the stomach or back
    • jaundice
    • weight loss

    Other possible symptoms of pancreatic cancer include:

    • itching (if you have jaundice)
    • nausea and vomiting
    • bowel changes
    • fever and shivering
    • indigestion
    • blood clots

    Causes of Pancreatic Cancer

    Age

    • Smoking
    • Diabities

    Chronic pancreatitis and hereditary pancreatitis

    Helicobacter pylori infection

    There are also a number of other factors that have been associated with an increased risk of pancreatic cancer. These are:

    Stages of Pancreatic Cancer

    here are 4 stages in this system – stage 1 to 4.

    Stage 1

    Stage 1 means the cancer is completely inside the pancreas and has not spread to the lymph nodes. It is divided into

    Stage 1A means the cancer is completely inside the pancreas and is smaller than 2 cm. There is no cancer in the lymph nodes or other areas of the body. In TNM staging, this is the same as T1, N0, M0.

    Stage 1B means the cancer is completely inside the pancreas but is bigger than 2cm. There is no cancer in the lymph nodes or other areas of the body. In TNM staging, this is the same as T2, N0, M0.

    Stage 2

    Stage 2 is divided into

    Stage 2A means the cancer has started to grow into nearby tissues around the pancreas. It may be in the duodenum or the bile duct. But there is no cancer in the nearby large blood vessels or lymph nodes. This means that, although the cancer has been growing locally, there is a chance that it may not have spread through the blood or lymph systems. In TNM staging, this is the same as T3, N0, M0.

    Stage 2B means the cancer can be any size and may have grown into the tissues surrounding the pancreas. Cancer is also found in the nearby lymph nodes, but not the large blood vessels. In TNM staging, this is the same as T1, 2 or 3, N1, M0.

    Stage 3

    The cancer is growing outside the pancreas, into the nearby large blood vessels. It may or may not have spread into the lymph nodes. It has not spread to other areas of the body. Your doctor may call this locally advanced cancer. In TNM staging, this is the same as T4, Any N, M0.

    Stage 4

    The cancer has spread to other areas of the body such as the liver or lungs. Your doctor may call this advanced cancer. In TNM staging, this is the same as Any T, Any N, M1.

    Diagnosis of Pancreatic Cancer

    The diagnosis of pancreatic cancer involves performing a number of imaging studies that include –

    Computerised tomography (CT) scan

    computerised tomography (CT) scan produces a detailed image of the inside of your body using a series of X-ray images

    Magnetic resonance imaging (MRI) scan

    magnetic resonance imaging (MRI) scan also produces an image of the inside of your body, but it uses strong magnetic and radio waves instead of X-rays.

    Positron emission tomography (PET) scan

    A positron emission tomography (PET) scan can help to show where the cancer is and whether it has spread to other parts of the body

    Endoluminal ultrasonography (EUS)

    If a small shadow is seen on a CT or MRI scan but it’s not obvious what it is, another test called endoluminal ultrasonography (EUS) can be carried out.

    Endoscopic retrograde cholangiopancreatography (ERCP)

    Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to insert a plastic tube or stent into the bile duct if someone has jaundice.

    During ERCP, an endoscope is passed through your mouth and guided towards your stomach. The endoscope can then be used to inject a special dye into your bile and pancreatic ducts.

    After the dye has been injected, an X-ray will be taken. The dye will show up on the X-ray and will highlight any tumour that’s blocking the bile and pancreatic ducts.

    Laparoscopy

    laparoscopy is a surgical procedure that allows the surgeon to access the inside of your abdomen and pelvis.

    During the procedure, a small incision will be made in your abdomen, and a laparoscope (a thin, flexible microscope) will be inserted.

    Biopsy

    biopsy involves taking a sample from a suspected tumour, which can then be tested to see if it’s cancerous (malignant) or non-cancerous (benign).

    A biopsy can be carried out during an EUS, ERCP or laparoscopy using a small instrument attached to the endoscope to collect a number of cells.

    Ultrasound scan

    An ultrasound scan is a painless procedure that uses high-frequency sound waves to produce an image of the inside of your body.

    Treatment of Pancreatic Cancer

    Treatment for pancreatic cancer depends on the type, location and stage of your cancer (how far it’s spread).

    Your age, general health and personal preferences will also be taken into consideration when deciding on your treatment plan.

    The first aim will be to completely remove the tumour and any other cancerous cells in your body.

    There are 2 general types of surgery used for pancreatic cancer:

    • Potentially curative surgery is used when the results of exams and tests suggest that it is possible to remove all the cancer.
    • Palliative surgery may be done if imaging tests show that the tumor is too widespread to be removed completely. This surgery is done to relieve symptoms or to prevent certain complications like a blocked bile duct or intestine, but it is not meant to try to cure the cancer.

    Palliative Surgery

    Palliative surgery is meant to treat the symptoms of the cancer and prevent problems that may potentially arise as a result of the cancer.

    One problem palliative surgery may be able to treat is blockage of the bile duct. Having a blocked bile duct can not only be painful, it can also interfere with digestion and cause jaundice.

    The two main options to relieve blockage are stent placement and bypass surgery.

    Endoscopic Stent Placement

    Stent placement is the most common procedure used to relieve blockage in the bile ducts. For this less invasive procedure, the gastroenterologist uses an endoscope to place small plastic or metal stents into the duct to relieve blockage. Larger stents can be used to relieve intestinal blockage.

    Operative Biliary and Intestinal Bypass

    Instead of bile flowing from the common bile duct through the pancreas, bypass surgery redirects the flow of bile from the common bile duct into the small intestine. Additionally, if the duodenum or stomach is blocked by the tumor, a loop of intestine can be sewn to the stomach further up to allow food to be more easily digested.

    Medical Therapy

    Medical therapy uses drugs to destroy cancer cells.

    Chemotherapy

    For patients with early pancreatic cancer, chemotherapy is generally given after surgery (called adjuvant therapy), though in some cases, it may be given before (called neoadjuvant therapy). For patients with advanced disease, chemotherapy may be given alone or in combination with other treatments

    Targeted Therapy

    Targeted therapy targets specific genes in cancer cells, causing less damage to healthy cells. Targeted therapy drugs for pancreatic cancer help stop the growth and spread of the cancer

    Radiation Therapy

    Radiation therapy uses high-energy rays (such as x-rays) to destroy cancer cells. It can be given before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy). It can also be given in combination with other types of treatment.

    Radiation therapy can be combined with chemotherapy to treat pancreatic cancer patients whose cancers are too widespread to be treated with surgery

    Curative Surgeries for pancreatic cancer

    Most curative surgery is designed to treat cancers at the head of the pancreas. Because these cancers are near the bile duct, some of them cause jaundice and are found early enough to be removed. Surgeries for other parts of the pancreas are typically only done when complete removal of the cancer will be possible.

    There are several procedures used to remove tumors of the pancreas:

    Pancreaticoduodenectomy (Whipple procedure)

    This is the most common operation to remove a cancer of the exocrine pancreas. It involves removing the head of the pancreas and sometimes the body of the pancreas as well. At times, part of the stomach, small intestine, and lymph nodes near the pancreas are also removed. The gallbladder and part of the common bile duct are removed, and the remaining bile duct is attached to the small intestine so that bile from the liver can continue to enter the small intestine. Removal of tissue called the mesopancreas (RMP) may also be combined with the Whipple procedure. This tissue which contains cancer cells or cells that secrete compounds that may help the cancer grow, prevent it from dying or inhibit some chemotherapy.

    Distal pancreatectomy

    This operation removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. The spleen is usually removed as well. This operation is used more often with islet cell tumor and less often, adenocarcinoma of the pancreas found in the tail and body of the pancreas. Another name for this surgery is radical antegrade pancreatosplenectomy or RAMPS procedure. This operation may sometimes be completed laparoscopically.

    Total pancreatectomy

    This operation was once used for tumors in the body or head of the pancreas. It removes the entire pancreas and often the spleen. It is now seldom used to treat exocrine cancers of the pancreas because there does not seem to be any advantage to removing the whole pancreas. It is possible to live without a pancreas, but when the entire pancreas is removed, people are left without any islet cells, the cells that make insulin. These people develop diabetes, which can be hard to manage because they become totally dependent on insulin. Total pancreatectomy is now done primarily for IPMN when the entire duct is at risk. If this is the case, the patient sees an endocrinologist pre-surgery to learn how to manage their diabetes. It is never done for adenocarcinoma unless there are unusual compelling reasons

    Ablative Techniques for pancreatic cancer

    Ablation refers to treatments that destroy tumors, usually with extreme heat or cold. This type of treatment typically does not require a hospital stay. There are different kinds of ablative treatments:

    Radiofrequency ablation (RFA): This procedure uses high-energy radio waves for treatment. The doctor inserts a thin, needle-like probe into the tumor. A high-frequency current is then passed through the tip of the probe, which heats the tumor and destroys the cancer cells. This treatment is used mainly for small tumors.

    Microwave thermotherapy: This procedure is similar to RFA, except microwaves are used to heat and destroy the abnormal tissue.

    Cryosurgery (cryoablation): This procedure destroys a tumor by freezing it using a thin metal probe. The probe is guided into the tumor, and very cold gasses are passed through the probe to freeze the tumor, killing the cancer cells. This method can be used to treat larger tumors than the other ablation techniques, but it sometimes requires general anesthesia (where you are deeply asleep and not able to feel pain).

    Lung Cancer Treatment In India

    Lung Cancer

    Lung cancer, also known as lung carcinoma,is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung.If left untreated, this growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body. These abnormal cells do not grow into a healthy lung tissue and as a result of this, they divide for forming tumors. These innumerable and large tumors weaken the lungs and due to this they cannot provide the bloodstream with oxygen.Most cancers that start in the lung, known as primary lung cancers, are carcinomas.

    Types of Lung Cancer

    There are two major types of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Staging lung cancer is based on whether the cancer is local or has spread from the lungs to the lymph nodes or other organs. Because the lungs are large, tumors can grow in them for a long time before they are found. Even when symptoms—such as coughing and fatigue—do occur, people think they are due to other causes. For this reason, early-stage lung cancer (stages I and II) is difficult to detect.

    Non-Small Cell Lung Cancer

    Non-small cell lung cancer accounts for about 85 percent of lung cancers and includes:

    • Adenocarcinoma, the most common form of lung cancer in the United States among both men and women;
    • Squamous cell carcinoma, which accounts for 25 percent of all lung cancers;
    • Large cell carcinoma, which accounts for about 10 percent of NSCLC tumors.

    Stages of Non-Small Cell Lung Cancer

    Stage I: The cancer is located only in the lungs and has not spread to any lymph nodes.

    Stage II: The cancer is in the lung and nearby lymph nodes.

    Stage III: Cancer is found in the lung and in the lymph nodes in the middle of the chest, also described as locally advanced disease. Stage III has two subtypes:

    • If the cancer has spread only to lymph nodes on the same side of the chest where the cancer started, it is called stage IIIA.
    • If the cancer has spread to the lymph nodes on the opposite side of the chest, or above the collar bone, it is called stage IIIB.

    Stage IV: This is the most advanced stage of lung cancer, and is also described as advanced disease. This is when the cancer has spread to both lungs, to fluid in the area around the lungs, or to another part of the body, such as the liver or other organs.

    Small Cell Lung Cancer

    Small cell lung cancer accounts for the remaining 15 percent of lung cancers in the United States. They tend to grow more quickly than NSCLC tumors. Usually, SCLC is more responsive to chemotherapy than NSCLC.

    Stages of Small Cell Lung Cancer

    Limited stage: In this stage, cancer is found on one side of the chest, involving just one part of the lung and nearby lymph nodes.

    Extensive stage: In this stage, cancer has spread to other regions of the chest or other parts of the body.

    The American Joint Commission on Cancer implemented a more detailed staging system in which the stages of small cell lung cancer are described using Roman numerals and letters (for example, Stage IIA). This is the same method that is used for non-small cell lung cancer in describing the growth and spread of the cancer

    Symptoms of Lung Cancer

    The most common symptoms of lung cancer are:

    • A cough that does not go away or gets worse.
    • Coughing up blood or rust-colored sputum (spit or phlegm)
    • Chest pain that is often worse with deep breathing, coughing, or laughing.
    • Hoarseness.
    • Weight loss and loss of appetite.
    • Shortness of breath.
    • Feeling tired or weak.

    Diagnosis of Lung Cancer

    In addition to a physical examination, the following tests may be used to diagnose and stage lung cancer:

    • A biopsy is the removal of a small amount of tissue for examination under a microscope.
    • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor.

    Imaging tests

    • CT scan. A CT scan produces images that allow doctors to see the size and location of a lung tumor and/or lung cancer metastases.
    • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body.
    • Magnetic resonance imaging (MRI) scan. An MRI also produces images that allow doctors to see the location of a lung tumor and/or lung cancer metastases and measure the tumor’s size. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.
    • Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer

    Lung Cancer Treatment

    Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

    Surgery

    he goal of surgery is the complete removal of the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of healthy lung tissue. A “negative margin” means that when the pathologist examines the lung, or piece of lung that has been removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor.

    The following types of surgery may be used:

    • The lungs have five lobes, three in the right lung and two in the left lung. The removal of an entire lobe of the lung in a procedure called a lobectomy is currently thought to be the most effective type of surgery, even when the lung tumor is very small.
    • A wedge resection. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of healthy lung.
    • This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed.
    • If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.
    • Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumor to destroy the cancer with an electrical current. It is sometimes used for a lung tumor that cannot be removed with the other types of surgery listed above.

    Radiation therapy

    Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks.

    Chemotherapy

    Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. It has been shown to improve both the length and quality of life for people with lung cancer of all stages. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). Most chemotherapy used for lung cancer is given by IV injection.

    Targeted therapy

    Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

    Thyroid Cancer

    Thyroid cancer is a disease that you get when abnormal cells begin to grow in your thyroid gland . The thyroid gland is shaped like a butterfly and is located in the front of your neck. It makes hormones that regulate the way your body uses energy and that help your body work normally. The most common symptom of cancer of the thyroid is a painless lump or swelling that develops in the neck

    Types of Thyroid Cancer

    here are several different types of thyroid cancer, which are classified based on how similar they look to normal thyroid cells under a microscope and by the type of cell from which they develop.

    • Papillary carcinoma is the most common type of thyroid cancer, accounting for approximately 80 percent of cases. Papillary carcinomas are slow growing, differentiated cancers that develop from follicular cells and can develop in one or both lobes of the thyroid gland. This type of cancer may spread to nearby lymph nodes in the neck, but it is generally treatable with a good prognosis (outlook for survival).
    • Follicular carcinoma is the second most common type of thyroid cancer, and accounts for approximately one out of 10 cases. It is found more frequently in countries with an inadequate dietary intake of iodine. Follicular carcinoma is also a differentiated form of thyroid cancer. In most cases, it is associated with a good prognosis, although it is somewhat more aggressive than papillary cancer. Follicular carcinomas do not usually spread to nearby lymph nodes, but they are more likely than papillary cancers to spread to other organs, like the lungs or the bones.
    • Hürthle cell carcinoma, also known as oxyphil cell carcinoma, is a subtype of follicular carcinoma, and accounts for approximately 3 percent of all thyroid cancers.
    • Medullary thyroid carcinoma develops from C cells in the thyroid gland, and is more aggressive and less differentiated than papillary or follicular cancers. Approximately 4 percent of all thyroid cancers will be of the medullary subtype. These cancers are more likely to spread to lymph nodes and other organs, compared with the more differentiated thyroid cancers. They also frequently release high levels calcitonin and carcinoembryonic antigen (CEA), which can be detected by blood tests.
    • Anaplastic carcinoma is the most undifferentiated type of thyroid cancer, meaning that it looks the least like normal cells of the thyroid gland. As a result, it is a very aggressive form of cancer that quickly spreads to other parts of the neck and body. It occurs in approximately 2 percent of thyroid cancer cases.

    Causes of Thyroid cancer

    The main risk factors for developing thyroid cancer are:

    • having a thyroid condition
    • having a family history of thyroid cancer (in the case of medullary thyroid cancer)
    • having a bowel condition known as familial adenomatous polyposis (FAP)
    • acromegaly (a rare condition where the body produces too much growth hormone)
    • having previous benign (non-cancerous) breast conditions
    • weight and height
    • radiation exposure

    Symptoms of Thyroid Cancer

    The most common early sign of thyroid cancer is an unusual lump, nodule or swelling in the neck.

    Other possible symptoms of thyroid cancer include:

    • Neck pain: In many cases, neck pain starts in the front. In some cases the neck pain may extend all the way to the ears.
    • Voice changes: Experiencing hoarseness or other voice changes that do not go away could be a sign of thyroid cancer.
    • Breathing problems: Sometimes thyroid cancer patients say it feels like they are breathing through a straw. This breathing difficulty is often a symptom of the disease.
    • Coughing: A cough that continues and is not related to a cold.
    • Trouble swallowing: A growth or nodule on the thyroid gland may interfere with swallowing

    Stages of Thyroid cancer

    The number staging depends on the type of thyroid cancer you have. There are different systems for:

    Papillary and follicular thyroid cancer

    The number stages for papillary and follicular thyroid cancer are the same. These types are classed as differentiated thyroid cancers. There are 4 number stages. These cancers are staged differently depending on your age. These types of thyroid cancer tend to respond well to treatment, particularly if you are younger.

    If you are under 45

    Stage 1 means you have thyroid cancer which may or may not have spread to nearby lymph nodes. The tumour can be any size but has not spread to distant areas of the body. In TNM staging, this is the same as Any T, Any N, M0.

    Stage 2 means your cancer has spread to other parts of the body (Any T, Any N, M1).

    If you are over 45

    Stage 1 means your cancer is only inside the thyroid and is less than 2cm across (T1, N0, M0).

    Stage 2 means your cancer is between 2cm and 4cm across, and is only inside the thyroid (T2, N0, M0).

    Stage 3 means the tumour is

    • larger than 4 cm or has grown slightly outside the thyroid, but it has not spread to nearby lymph nodes or other parts of the body (T3, N0, M0)
    • any size within the thyroid gland or has started to grow slightly outside the thyroid. It has spread to lymph nodes close to the thyroid in the neck but not to other parts of the body (T1-T3, N1a, M0)

    Stage 4 is divided into 3 groups from A to C

    Stage 4A means the tumour

    • has grown beyond the thyroid gland and into nearby tissues in the neck. It may or may not have spread to nearby lymph nodes but has not spread to other parts of the body (T4a, N0 or N1a, M0) OR
    • is any size and may have grown into nearby tissues in the neck. It has spread to certain lymph nodes in the neck (cervical nodes) or to lymph nodes in the upper chest (the superior mediastinal nodes) or behind the throat (retropharyngeal nodes) but not to other parts of the body (T1-T4a, N1b, M0)

    Stage 4B means the tumour has grown into the area surrounding the bones of the spine or into nearby large blood vessels. It may or may not have spread to nearby lymph nodes, but it has not spread to other parts of the body (T4b, Any N, M0).

    Stage 4C means the cancer has spread to other parts of the body (Any T, Any N, M1).

    Medullary thyroid cancer

    There are 4 number stages for people of any age with medullary thyroid cancer.

    Stage 1 means that the tumour is 2 cm or less across and has not grown outside the thyroid. It has not spread to nearby lymph nodes or other parts of the body. In TNM staging, this is the same as T1, N0, M0.

    Stage 2 means the tumour is

    • between 2 cm and 4cm across and has not grown outside the thyroid at all (T2, N0, M0) OR
    • larger than 4 cm or has grown slightly outside the thyroid, but has not spread to nearby lymph nodes or other parts of the body (T3, N0, M0)

    Stage 3 means that the tumour is any size within the thyroid gland or has started to grow slightly outside the thyroid. It has spread to lymph nodes close to the thyroid in the neck but not to other parts of the body (T1-T3, N1a, M0).

    Stage 4 is divided into 3 groups from A to C

    Stage 4A means the tumour

    • has grown beyond the thyroid gland and into nearby tissues of the neck. It may or may not have spread to nearby lymph nodes but has not spread to other parts of the body (T4a, N0 or N1a, M0) OR
    • is any size and may have grown into nearby tissues in the neck. It has spread to the cervical lymph nodes in the neck or to nodes in the upper chest (the superior mediastinal nodes) or behind the throat (retropharyngeal nodes), but not to other parts of the body (T1 to T4a, N1b, M0)

    Stage 4B means the tumour has grown into the area surrounding the bones of the spine or into nearby large blood vessels. It may or may not have spread to nearby lymph nodes, but it has not spread to other parts of the body (T4b, Any N, M0).

    Stage 4C means the cancer has spread to other parts of the body.

    Anaplastic (undifferentiated) thyroid cancer

    All anaplastic thyroid cancers are considered to be stage 4 when they are diagnosed. This stage is divided into 3 groups from A to C.

    Stage 4A means the tumour is still within the thyroid gland. It may or may not have spread to nearby lymph nodes, but has not spread to other parts of the body (T4a, Any N, M0).

    Stage 4B means the tumour has grown outside the thyroid gland. It may or may not have spread to nearby lymph nodes, but has not spread to other parts of the body (T4b, Any N, M0).

    Stage 4C means the cancer has spread to other parts of the body (Any T, Any N, M1).

    Diagnosis of Thyroid Cancer

    Apart from Physical and Medical examination , following test are also conducted

    Biopsy

    The actual diagnosis of thyroid cancer is made with a biopsy, in which cells from the suspicious area are removed and looked at under a microscope

    Imaging tests

    Imaging tests may be done for a number of reasons, including to help find suspicious areas that might be cancer, to learn how far cancer may have spread, and to help determine if treatment is working

    Ultrasound

    Ultrasound uses sound waves to create images of parts of your body. For this test, a small, wand-like instrument called a transducer is placed on the skin in front of your thyroid gland. It gives off sound waves and picks up the echoes as they bounce off the thyroid. The echoes are converted by a computer into a black and white image on a computer screen. You are not exposed to radiation during this test.

    This test can help determine if a thyroid nodule is solid or filled with fluid. (Solid nodules are more likely to be cancerous.) It can also be used to check the number and size of thyroid nodules

    Radioiodine scan

    Radioiodine scans can be used to help determine if someone with a lump in the neck might have thyroid cancer. They are also often used in people who have already been diagnosed with differentiated (papillary, follicular, or Hürthle cell) thyroid cancer to help show if it has spread

    Chest x-ray

    If you have been diagnosed with thyroid cancer (especially follicular thyroid cancer), a plain x-ray of your chest may be done to see if cancer has spread to your lungs

    Computed tomography (CT) scan

    The CT scan is an x-ray test that produces detailed cross-sectional images of your body. It can help determine the location and size of thyroid cancers and whether they have spread to nearby areas, although ultrasound is usually the test of choice. A CT scan can also be used to look for spread into distant organs such as the lungs.

    Magnetic resonance imaging (MRI) scan

    Like CT scans, MRI scans can be used to look for cancer in the thyroid, or cancer that has spread to nearby or distant parts of the body

    Positron emission tomography (PET) scan

    For a PET scan, a radioactive substance (usually a type of sugar related to glucose, known as FDG) is injected into the blood. The amount of radioactivity used is very low. Because cancer cells in the body grow quickly, they absorb more of the sugar than normal cells. After waiting about an hour, you lie on a table in the PET scanner for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body

    Blood tests

    Blood tests alone can’t tell if a thyroid nodule is cancerous. But they can help show if the thyroid is working normally, which may help the doctor decide what other tests may be needed.

    Thyroid-stimulating hormone (TSH)

    Tests of blood levels of thyroid-stimulating hormone (TSH or thyrotropin) may be used to check the overall activity of your thyroid gland. Levels of TSH, which is made by the pituitary gland, may be high if the thyroid is not making enough hormones

    T3 and T4 (thyroid hormones)

    These are the main hormones made by the thyroid gland. Levels of these hormones may also be measured to get a sense of thyroid gland function. The T3 and T4 levels are usually normal in thyroid cancer.

    Thyroglobulin

    Thyroglobulin is a protein made by the thyroid gland. Measuring the thyroglobulin level in the blood can’t be used to diagnose thyroid cancer, but it can be helpful after treatment

    Calcitonin: For the body to use calcium efficiently, calcitonin hormone is released in the thyroid gland. On examining the levels of Calcitonin, possible detection of Medullary thyroid cancer can be done. Recurrence of the cancer after treatment can also be checked by testing the levels of Calcitonin.

    Other tests

    Vocal cord exam (laryngoscopy)

    Thyroid tumors can sometimes affect the vocal cords. If you are going to have surgery to treat thyroid cancer, a procedure called a laryngoscopy will probably be done first to see if the vocal cords are moving normally. For this exam, the doctor looks down the throat at the larynx (voice box) with special mirrors or with a laryngoscope, a thin tube with a light and a lens on the end for viewing.

    Treatment of Thyroid Cancer

    After thyroid cancer is found and staged, your cancer care team will discuss your treatment options with you. It is important to take the time to consider each of your options. In choosing a treatment plan, factors to consider include the type and stage of the cancer and your general health. The treatment options for thyroid cancer might include.

    Surgery

    Surgery is the main treatment in nearly every case of thyroid cancer, except for some anaplastic thyroid cancers. If thyroid cancer is diagnosed by a fine needle aspiration (FNA) biopsy, surgery to remove the tumor and all or part of the remaining thyroid gland is usually recommended.

    Lobectomy

    This operation is sometimes used to treat differentiated (papillary or follicular) thyroid cancers that are small and show no signs of spread beyond the thyroid gland. First, the surgeon makes an incision (cut) a few inches long across the front of the neck and exposes the thyroid. The lobe containing the cancer is then removed, usually along with the isthmus (the small piece of the gland that acts as a bridge between the left and right lobes).

    Thyroidectomy

    Thyroidectomy is surgery to remove the thyroid gland. As with lobectomy, this is typically done through an incision a few inches long across the front of the neck

    Lymph node removal

    If cancer has spread to nearby lymph nodes in the neck, these will be removed at the same time surgery is done on the thyroid. This is especially important for treatment of medullary thyroid cancer and for anaplastic cancer (when surgery is an option).

    Radioactive iodine (radioiodine) therapy

    Thyroid gland absorbs nearly all of the iodine in your body. When radioactive iodine (RAI), also known as I-131, is taken into the body in liquid or capsule form, it concentrates in thyroid cells. The radiation can destroy the thyroid gland and any other thyroid cells (including cancer cells) that take up iodine, with little effect on the rest of your body.

    Thyroid hormone therapy

    Taking daily pills of thyroid hormone (thyroid hormone therapy) can serve 2 purposes:

    • It can help maintain the body’s normal metabolism (by replacing missing thyroid hormone after surgery).
    • It can help stop any remaining cancer cells from growing (by lowering TSH levels).

    After a thyroidectomy, the body can no longer make the thyroid hormone it needs, so patients must take thyroid hormone (levothyroxine) pills to replace the loss of the natural hormone.

    Taking thyroid hormone may also help prevent some thyroid cancers from returning.

    External beam radiation therapy

    External beam radiation therapy uses high-energy rays (or particles) to destroy cancer cells or slow their growth. A carefully focused beam of radiation is delivered from a machine outside the body. Generally, this type of radiation treatment is not used for cancers that take up iodine (that is, most differentiated thyroid cancers), which are better treated with radioiodine therapy. It is more often used as part of the treatment for medullary thyroid cancer and anaplastic thyroid cancer.

    Chemotherapy

    Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or muscle, or are taken by mouth. Chemotherapy is systemic therapy, which means that the drug enters the bloodstream and travels throughout the body to reach and destroy cancer cells.

    Targeted therapy

    Targeted therapy is a type of treatment that uses dru Tyrosine kinase inhibitor therapy is a type of targeted therapy that blocks signals needed for tumors to grow gs or other substances to identify and attack specific cancer cells without harming normal cells.

    Head and Neck Cancer Treatment in India

    Head and Neck Cancers

    Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat). These squamous cell cancers are often referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, but salivary gland cancers are relatively uncommon. Salivary glands contain many different types of cells that can become cancerous, so there are many different types of salivary gland cancer.

    Types of Head and Neck Cancer

    Cancers of the head and neck are further categorized by the area of the head or neck in which they begin. These areas are described below and labeled in the image of head and neck cancer regions.

    Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor (bottom) of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.

    Pharynx: The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx (the upper part of the pharynx, behind the nose); the oropharynx (the middle part of the pharynx, including the soft palate [the back of the mouth], the base of the tongue, and the tonsils); the hypopharynx (the lower part of the pharynx).

    Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.

    Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.

    Salivary glands: The major salivary glands are in the floor of the mouth and near the jawbone. The salivary glands produce saliva.

    Symptoms of Head and neck Cancer

    The symptoms of head and neck cancers may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing, and a change or hoarseness in the voice.

    Oral cavity. A white or red patch on the gums, the tongue, or the lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.

    Pharynx. Trouble breathing or speaking; pain when swallowing; pain in the neck or the throat that does not go away; frequent headaches, pain, or ringing in the ears; or trouble hearing.

    Larynx. Pain when swallowing or ear pain.

    Paranasal sinuses and nasal cavity. Sinuses that are blocked and do not clear; chronic sinus infections that do not respond to treatment with antibiotics; bleeding through the nose; frequent headaches, swelling or other trouble with the eyes; pain in the upper teeth; or problems with dentures.

    Salivary glands. Swelling under the chin or around the jawbone, numbness or paralysis of the muscles in the face, or pain in the face, the chin, or the neck that does not go away

    causes of head and neck cancer

    • Smoking cigarettes, cigars or pipes.
    • Chewing tobacco or betel quid (paan)
    • Alcohol.
    • Human papilloma virus (HPV) infection.
    • Diet.
    • Sunlight.
    • Exposure to chemicals.
    • Pre-cancerous conditions

    Staging of Head and Neck Cancer

    Staging involves using the letters T, N and M to assess tumors by:

    • the size of the primary tumor (T);
    • the degree to which regional lymph nodes (N) are involved. Lymph nodes are small organs located along the channels of the body’s lymphatic system which store special cells that fight infection and other diseases); and
    • the absence or presence of distant metastases (M) – cancer that has spread from the original (primary) tumor to distant organs or distant lymph nodes.

    Each of these is categories is further classified with a number 1 through 4 to give the total stage. Thus a T1-N1-M0 cancer would describe a T1 tumor, N1 lymph node involvement, and no metastases.

    Once the T, N and M are determined, a “stage” of I, II, III or IV is assigned:

    • Stage I cancers are small, localized and usually curable.
    • Stage II and III cancers typically are locally advanced and/or have spread to local lymph nodes.
    • Stage IV cancers usually are metastatic (have spread to distant parts of the body) and generally are considered inoperable.

    Diagnosis of Head and Neck Cancer

    Diagnosing a head and neck cancer includes one or more of the following tests

    Medical History & Physical Examination: the doctor or nurse will take a complete medical history, noting all symptoms and risk factors. The doctor will thoroughly examine the head and neck area, feeling for abnormalities, looking at the inside of the mouth and throat, and using mirrors and lights to examine hard-to-see areas.

    Endoscopy
    In some cases, the doctor may use a flexible, lighted tube called an endoscope to examine areas of the head and neck that are less accessible. This tube may be inserted through the nose or mouth, using a topical anesthetic (a medication applied directly to the nose and throat) to make the examination more comfortable.

    Urine and blood test /Physical examination: Lumps in the cheeks, lips, neck and gums are examined by performing a physical examination of a patient. Abnormalities are also noticed by inspecting throat, nose, tongue and mouth. Cancer can be diagnosed by performing urine and blood tests.

    Imaging Tests
    Imaging tests such as CT, MRI, or ultrasound may be required to gain more information about the location and extent of the tumor. Doctors also use PET scans to help diagnose head and neck cancers. PET scans are often combined with CT to determine whether the cancer has spread to lymph nodes in the neck or other areas of the body. Additional imaging tests may include panorex (a special x-ray of the jaws), barium swallow (which helps to image abnormalities in the esophagus), dental x-rays, chest x-rays, and radionuclide bone scanning (a sensitive method of measuring bone activity).

    Biopsy
    A biopsy involves removing a small amount of tissue or fluid for examination under a microscope. Depending on the size and location of the nodule or lesion, a biopsy can be performed with either a small scalpel or needle in an outpatient setting, or in the hospital while the patient is under general anesthesia.

    Head and Neck Cancer Treatment

    Many cancers of the head and neck can be cured, especially if they are found early. Treatment varies according to the type, location, and extent of the cancer, and often includes a combination of surgery, radiation therapy, and chemotherapy.

    Surgery

    Surgery is the primary (first) treatment for most cancers of the head and neck. Improvements in surgical techniques allow surgeons to remove many more tumors while preserving nearby structures involved in sensory and physical functioning. New techniques allow surgeons to remove these lymph nodes while sparing nerves that are important for shoulder function. Complex surgery to remove tumors at the base of the skull once considered nearly impossible can now be safely performed.

    Minimally Invasive Surgery

    Minimally invasive surgical techniques are used when possible to remove tumors that are located near structures involved in sensory and physical functioning. In many cases, patients can recover more quickly when treated with minimally invasive surgery compared with traditional, open surgery.This surgery includes

    Endoscopic Laser Surgery

    This technique may be used to remove tumors in the larynx (voice box) or pharynx (throat) while preserving the structures involved in speech and swallowing. The surgeon inserts a thin, lighted tube called an endoscope through the patient’s mouth and into the throat. Surgeons remove the tumor using a special laser that is attached to the endoscope.

    Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)

    A tiny video camera that is attached to an endoscope is used to remove thyroid tumors through a small incision.

    Robotic Surgery

    Tumors of the tongue and tonsils can be removed with the aid of small robotic arms that are placed in the mouth, avoiding the need to make a large incision or to split the jawbone

    Radiation Therapy

    Radiation therapy alone or in combination with chemotherapy is standard curative treatment for many patients with head and neck cancers. Which approach is used depends on the extent of the tumor; radiation and chemotherapy are used in combination when treating more advanced disease. In select situations, such as oral cavity tumors, the patient undergoes surgery followed by radiation therapy and/or chemotherapy. .

    Patients may be treated with one or both of the following types of radiation therapy:

    External-beam radiation therapy

    a type of external-beam radiation therapy called intensity-modulated radiation therapy (IMRT), which uses highly sophisticated computer software and three-dimensional images from CT scans to deliver radiation to tumors with greater precision than conventional radiation therapy

    Brachytherapy

    Tiny, radioactive seeds are implanted into the tumor site, where they deliver the highest dose of radiation possible with minimal effect on nearby healthy tissue.

    Proton Therapy

    Proton therapy,is  an advanced form of radiation therapy, to deliver high doses of radiation to tumors that may be resistant to conventional forms while minimizing exposure to the surrounding healthy tissues. Proton therapy directs its cancer-fighting energy to precise locations within the body

    Chemotherapy

    Increasingly, chemotherapy — in combination with radiation therapy — is used to treat head and neck cancers that are difficult to reach surgically or that cannot be cured by surgery alone. This approach is also used to treat patients for whom surgery would cause significant functional or cosmetic disability, such as loss of the larynx (voice box), with its associated loss of natural voice and the need for a permanent stoma (hole) in the front of the neck.

    Blood Cancer Treatment in India

    Blood Cancer

    Blood cancer is an umbrella term for cancers that affect the blood, bone marrow and lymphatic system. Blood is a parts of the body. Blood has different components sch as red blood cells, white blood cells, platelets and plasma. The red blood cells (rbc), platelets also called monocytes because it is belong to the “myeloid” group and other white blood cells belong to the “lymphoid” group. Lymphoid cells are affected. Disease progresses quickly. Blood cancer or Leukaemia is actually a group of diseases, each of which impede with the normal functioning of blood cells and progressively weaken the system.leukaemia is classified as either Acute or Chronic. Blood and urine samples may also be tested for various substances, called tumor markers, which may indicate cancer.

    Types of blood cancers

    Common types of blood cancer include:

    • Leukemia: Cancer that originates in blood-forming tissue.
    • Non-Hodgkin lymphoma: Cancer that develops in the lymphatic system from cells called lymphocytes, a type of white blood cell that helps the body fight infections.
    • Hodgkin lymphoma: Cancer that develops in the lymphatic system from cells called lymphocytes. Hodgkin lymphoma is marked by the presence of an abnormal lymphocyte called the Reed-Sternberg cell (or B lymphocyte).
    • Multiple myeloma: Cancer that begins in the blood’s plasma cells, a type of white blood cell that is made in the bone marrow.

    Blood cancer symptoms

    Some common blood cancer symptoms include:

    • Fever, chills
    • Persistent fatigue, weakness
    • Loss of appetite, nausea
    • Unexplained weight loss
    • Night sweats
    • Bone/joint pain
    • Abdominal discomfort
    • Headaches
    • Shortness of breath
    • Frequent infections
    • Itchy skin or skin rash
    • Swollen lymph nodes in the neck, underarms, groin

    Some of the serious symptoms include –

    • Heavy and uncontrolled bleeding
    • Bluish coloration of the fingernails or lips
    • Seizure
    • Rapid heart rate
    • Severe abdominal pain
    • Change in the level of alertness or consciousness that include unresponsiveness or passing out
    • Breathing or respiratory problems like wheezing, shortness of breath, labored breathing and difficulty in breathing
    • High fever
    • Sudden behavior or mental status change such as delusions, confusion, hallucinations, lethargy and delirium
    • Palpitations, chest tightness, chest pain and chest pressure

    Causes of Blood Cancer

    1. Exposure to radiation.

    2. Exposure to chemicals.

    3. Human T-cell Leukaemia Virus (HTLV)

    4. Genetic factors (chromosomal abnormalities).

    Stages of Blood Cancer

    Doctors combine the T,N,M results to determine the stage of cancer for each person. Most cancers have four stages: stages I (one) to IV (four). Some cancers also have a stage 0 (zero).

    • Stage 0. This stage describes cancer in situ, which means “in place.” Stage 0 cancers are still located in the place they started and have not spread to nearby tissues. This stage of cancer is often highly curable, usually by removing the entire tumor with surgery.
    • Stage I. This stage is usually a small cancer or tumor that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.
    • Stage II and III. These stages indicate larger cancers or tumors that have grown more deeply into nearby tissue. They may have also spread to lymph nodes but not to other parts of the body.
    • Stage IV. This stage means that the cancer has spread to other organs or parts of the body. It may also be called advanced or metastatic cancer.

    Diagnosis of Blood Cancer

    Biopsy : The presence of cancer cells is determined by taking a sample of a bone marrow while performing a biopsy. This can be done through a bone needle biopsy or bone marrow aspiration.

    Urine Test : High level of protein known as Bence Jones protein is determined by taking urine samples. Some specific cancers may have high level of protein.

    Blood Test : The number of some specific blood cells is determined by performing a blood test

    Chest X-ray : This x-ray helps in determining the presence of swollen lymph nodes, bone damage or tumors growing in the bone marrow.

    Cytogenetics : The change in the genetic material is determined by this test.

    Spinal Tap : Certain amount of clear fluid is taken that surrounds the spinal cord and brain. This test is done for checking the presence of cancer cells.

    Physical Exam : Swollen lymph nodes can be determined with the help of this test. Growth of tumors in the bone marrow or damage to the bone can also be determined with the help of a physical examination.

    Treatment of Blood Cancer

    Treatment for blood cancer depends on the type of cancer, your age, how fast the cancer is progressing, where the cancer has spread and other factors. Some common blood cancer treatments include:

    • Stem cell transplantation: A stem cell transplant infuses healthy blood-forming stem cells into the body. Stem cells can be collected from the bone marrow, circulating (peripheral) blood and umbilical cord blood.
    • Chemotherapy: Chemotherapy is the use of anticancer drugs designed to interfere with and halt the growth of cancer cells in the body. Chemotherapy for blood cancer sometimes consists of giving several drugs together in a set regimen. It may also be given before a stem cell transplant.
    • Radiation therapy: Radiation therapy may be used to destroy cancer cells or to relieve pain or discomfort. It may also be given before a stem cell transplant.

    Biological therapy is treatment designed to stimulate or restore the ability of the body’s immune (natural internal defense) system to fight infection and disease. Biological therapy is also called biotherapy or immunotherapy

    Prostate Cancer Treatment in India

    Prostate Cancer

    Prostate cancer is a disease which only affects men. Cancer begins to grow in the prostate – a gland in the male reproductive system. Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer – it is only when an autopsy is done that doctors know it was there. he prostate is below the bladder and in front of the rectum. The size of the prostate changes with age. In younger men, it is about the size of a walnut, but it can be much larger in older men. Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the center of the prostate.

    Types of prostate cancer

    Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen).

    Other types of prostate cancer include:

    • Sarcomas
    • Small cell carcinomas
    • Neuroendocrine tumors (other than small cell carcinomas)
    • Transitional cell carcinomas

    Causes of Prostate Cancer

    ·        Family history

    ·        Gene changes

    ·         Diet

    ·         Obesity

    ·         Smoking

    ·         Chemical exposures

    ·         Inflammation of the prostate

    ·         Sexually transmitted infections

    ·         Vasectomy

    Symptoms of Prostate Cancer?

    There are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen:

    • A frequent need to urinate, especially at night
    • Difficulty starting or stopping a stream of urine
    • A weak or interrupted urinary stream
    • Leaking of urine when laughing or coughing
    • Inability to urinate standing up
    • A painful or burning sensation during urination or ejaculation
    • Blood in urine or semen

    Symptoms of Advanced Prostate Cancer

    • Paralysis or weakness in the lower limbs, usually with constipation
    • Stiffness, deep or dull pain in the upper thighs, pelvis, lower back or ribs.  This is often followed by pain in the bones of those areas
    • Swelling of the lower extremities
    • Fatigue, vomiting or nausea
    • Loss of appetite and weight

    Stages of Prostate Cancer

    Stage Stage grouping Stage description
    I T1, N0, M0

    Gleason score 6 or less

    PSA less than 10

    The doctor can’t feel the tumor or see it with an imaging test such as transrectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA) [T1]. The cancer is still within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10.
    OR
    T2a, N0, M0

    Gleason score 6 or less

    PSA less than 10

    The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound and is in one half or less of only one side (left or right) of the prostate [T2a]. The cancer is still within the prostate and has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 6 or less and the PSA level is less than 10.
    IIA T1, N0, M0

    Gleason score of 7

    PSA less than 20

    The doctor can’t feel the tumor or see it with imaging such as transrectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA level) [T1]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumor has a Gleason score of 7. The PSA level is less than 20.
    OR
    T1, N0, M0

    Gleason score of 6 or less

    PSA at least 10 but less than 20

    The doctor can’t feel the tumor or see it with imaging such as transrectal ultrasound (it was either found during a transurethral resection or was diagnosed by needle biopsy done for a high PSA) [T1]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumor has a Gleason score of 6 or less. The PSA level is at least 10 but less than 20.
    OR
    T2a or T2b, N0, M0

    Gleason score of 7 or less

    PSA less than 20

    The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound and is in only one side of the prostate [T2a or T2b]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. It has a Gleason score of 7 or less. The PSA level is less than 20.
    IIB T2c, N0, M0

    Any Gleason score

    Any PSA

    The tumor can be felt by digital rectal exam or seen with imaging such as transrectal ultrasound and is in both sides of the prostate [T2c]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumor can have any Gleason score and the PSA can be any value.
    OR
    T1 or T2, N0, M0

    Any Gleason score

    PSA of 20 or more

    The cancer has not yet spread outside the prostate. It may (or may not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumor can have any Gleason score. The PSA level is at least 20.
    OR
    T1 or T2, N0, M0

    Gleason score of 8 or higher

    Any PSA

    The cancer has not yet spread outside the prostate. It may (or may not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The Gleason score is 8 or higher. The PSA can be any value.
    III: T3, N0, M0

    Any Gleason score

    Any PSA

    The cancer has grown outside the prostate and may have spread to the seminal vesicles [T3], but it has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumor can have any Gleason score and the PSA can be any value.
    IV T4, N0, M0

    Any Gleason score

    Any PSA

    The cancer has grown into tissues next to the prostate (other than the seminal vesicles), such as the urethral sphincter (muscle that helps control urination), rectum, bladder, and/or the wall of the pelvis [T4]. The cancer has not spread to nearby lymph nodes [N0] or elsewhere in the body [M0]. The tumor can have any Gleason score and the PSA can be any value.
    OR
    Any T, N1, M0

    Any Gleason score

    Any PSA

    The tumor may or may not be growing into tissues near the prostate [any T]. The cancer has spread to nearby lymph nodes [N1] but has not spread elsewhere in the body [M0]. The tumor can have any Gleason score and the PSA can be any value.
    OR
    Any T, any N, M1

    Any Gleason score

    Any PSA

    The cancer may or may not be growing into tissues near the prostate [any T]and may or may not have spread to nearby lymph nodes [any N]. It has spread to other, more distant sites in the body [M1]. The tumor can have any Gleason score and the PSA can be any value.

    Diagnosis of Prostate Cancer

    Most prostate cancers are first found during screening with a prostate-specific antigen (PSA) blood test or a digital rectal exam (DRE).A number of tests are performed for diagnosing prostate cancer that include

    Medical history and physical exam

    If your doctor suspects you might have prostate cancer, he or she will ask you about any symptoms you are having, such as any urinary or sexual problems, and how long you have had them. You might also be asked about possible risk factors, including your family history.

    PSA blood test

    The prostate-specific antigen (PSA) blood test is used mainly to screen for prostate cancer in men without symptoms). It’s also one of the first tests done in men who have symptoms that might be caused by prostate cancer.

    Transrectal ultrasound (TRUS)

    For this test, a small probe about the width of a finger is lubricated and placed in your rectum. The probe gives off sound waves that enter the prostate and create echoes. The probe picks up the echoes, and a computer turns them into a black and white image of the prostate. The procedure often takes less than 10 minutes

    Prostate biopsy

    If certain symptoms or the results of tests such as a PSA blood test or DRE suggest that you might have prostate cancer, your doctor will do a prostate biopsy.A biopsy is a procedure in which small samples of the prostate are removed and then looked at under a microscope. A core needle biopsy is the main method used to diagnose prostate cancer.

    Suspicious results

    Sometimes when the prostate cells are seen, they don’t look like cancer, but they’re not quite normal, either. These results are often reported as suspicious.

    Prostatic intraepithelial neoplasia (PIN): In PIN, there are changes in how the prostate cells look, but the abnormal cells don’t look like they’ve grown into other parts of the prostate (like cancer cells would). PIN is often divided into 2 groups:

    • Low-grade PIN: the patterns of prostate cells appear almost normal
    • High-grade PIN: the patterns of cells look more abnormal

    Imaging tests to look for prostate cancer spread

    Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body.

    Bone scan

    If prostate cancer spreads to distant sites, it often goes to the bones first. A bone scan can help show whether cancer has reached the bones.

    Computed tomography (CT) scan

    A CT scan uses x-rays to make detailed, cross-sectional images of your body

    Magnetic resonance imaging (MRI)

    Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium may be injected into a vein before the scan to better see details.

    Lymph node biopsy

    In a lymph node biopsy, also known as lymph node dissection or lymphadenectomy, one or more lymph nodes are removed to see if they have cancer cells. This isn’t done very often for prostate cancer, but can be used to find out if the cancer has spread from the prostate to nearby lymph nodes.

    Treatment of Prostate Cancer

    Depending on the situation, the treatment options for men with prostate cancer might include:

    Because prostate cancer often grows very slowly, some men (especially those who are older or have other serious health problems) might never need treatment for their prostate cancer. Instead, their doctors may recommend approaches known as watchful waiting or active surveillance

    Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland. The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles. A radical prostatectomy can be done in different ways.

    Open approaches to radical prostatectomy

    In the more traditional approach to doing a prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery, sometimes referred to as an open approach. There are 2 main ways to do this operation.

    Radical retropubic prostatectomy

    For this operation, the surgeon makes an incision (cut) in your lower abdomen, from the belly button down to the pubic bone. You will either be under general anesthesia (asleep) or be given spinal or epidural anesthesia (numbing the lower half of the body) along with sedation during the surgery.

    Radical perineal prostatectomy

    In this operation, the surgeon makes the incision in the skin between the anus and scrotum

    Laparoscopic approaches to radical prostatectomy

    Laparoscopic approaches use several smaller incisions and special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years.

    Laparoscopic radical prostatectomy

    For a laparoscopic radical prostatectomy (LRP), the surgeon inserts special long instruments through several small incisions to remove the prostate. One of the instruments has a small video camera on the end, which lets the surgeon see inside the abdomen.

    Robotic-assisted laparoscopic radical prostatectomy

    In this approach, also known as robotic prostatectomy, the laparoscopic surgery is done using a robotic interface (called the da Vinci system). The surgeon sits at a control panel in the operating room and moves robotic arms to operate through several small incisions in the patient’s abdomen. Robotic prostatectomy has advantages over the open approach in terms of less pain, blood loss, and recovery time

    Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation may be used:

    • As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
    • As part of the first treatment (along with hormone therapy) for cancers that have grown outside the prostate gland and into nearby tissues.
    • If the cancer is not removed completely or comes back (recurs) in the area of the prostate after surgery.
    • If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.

    The 2 main types of radiation therapy used for prostate cancer are:

    • External beam radiation

    In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

    • Brachytherapy (internal radiation)

    Brachytherapy (also called seed implantation or interstitial radiation therapy) uses small radioactive pellets, or “seeds,” each about the size of a grain of rice. These pellets are placed directly into your prostate

    Cryotherapy (also called cryosurgery or cryoablation) is the use of very cold temperatures to freeze and kill prostate cancer cells. Despite it sometimes being called cryosurgery, it is not actually a type of surgery.

    Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. The goal is to reduce levels of male hormones, called androgens, in the body, or to stop them from affecting prostate cancer cells

    Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or given by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment potentially useful for cancers that have spread (metastasized) to distant organs.

    Unlike traditional vaccines, which boost the body’s immune system to help prevent infections, this vaccine boosts the immune system to help it attack prostate cancer cells. The vaccine is used to treat advanced prostate cancer that is no longer responding to initial hormone therapy but that is causing few or no symptoms.

    Gallbladder Cancer Treatment in India

    Gallbladder Cancer

    Gallbladder cancer is a rare disease in which malignant (cancer) cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.

    Types of Gallbladder Cancer

    The two types of gallbladder cancer that occur most frequently are:

    • Adenocarcinoma is the most common type of gallbladder cancer, and accounts for 90 percent of cases. Adenocarcinomas are a specific type of cancer that begin in the gland-like cells that line organs of the digestive tract.
    • Papillary adenocarcinoma is a special subtype of adenocarcinoma that has a better prognosis, or outlook, compared with other types of gallbladder cancers. It is much less likely to spread to nearby lymph nodes or other organs like the liver.

    Other much less common types of gallbladder cancers are adenosquamous carcinomas, squamous cell carcinomas, small cell carcinomas and sarcomas.

    Causes of Gallbladder Cancer

    GENERAL

    • Gender: Gallbladder cancer occurs twice as frequently in women as in men, and this may be related to the increased frequency of gallstones and chronic inflammation.
    • Age: Gallbladder cancer occurs mainly in individuals over the age of 65, and the average age at diagnosis is 73.
    • .

    BODY

    • Obesity: Being overweight or obese is a risk factor for gallbladder cancer, and may be related to the increased risk for developing gallstones.

    GENETICS

    • Family history: Although the genetic cause is unknown, the risk of gallbladder cancer seems to increase in families with a history of the disease.

    LIFESTYLE

    • Chemical exposure: Some studies have shown that exposure to certain industrial chemicals, particularly those used in the rubber and textile industries, may be linked to an increased risk of gallbladder cancer.

    OTHER CONDITIONS

    • Gallstones: The leading gallbladder cancer risk factor is the presence of gallstones, which are found in over 75 percent of patients with gallbladder cancer.
    • Porcelain gallbladder: This is a condition where calcium deposits cover the wall of the gallbladder, and some but not all studies have suggested a link between this condition and the development of gallbladder cancer. There may be a link between chronic inflammation and the calcification of the gallbladder.
    • Choledochal cysts: Bile-filled cysts may develop along the common bile duct that leads from the gallbladder and liver to the small intestine. Sometimes the lining of the cysts may develop pre-cancerous cells, increasing the risk of cancer.
    • Bile duct abnormalities: Other conditions that cause the bile duct to backup or result in inflammation of the gallbladder may also be potential risk factors.
    • Gallbladder polyps: These are abnormal growths that form on the gallbladder. They may be caused by cholesterol deposits or by inflammation. Larger polyps (bigger than a centimeter) have a greater chance of being cancerous, and doctors often recommend removing the gallbladder when larger polyps are found.
    • Typhoid: Individuals with a chronic salmonella infection, which is the bacterium that causes typhoid, may be at increased risk for gallbladder cancer,

    Sysmtons of Gallbladder Cancer

    Stages of Gallbladder Cancer

    Stage 0: Tis, N0, M0: There is a small cancer only in the epithelial layer of the gallbladder (Tis). It has not spread outside the gallbladder.

    Stage I: T1 (a or b), N0, M0: The tumor has grown into the lamina propria (T1a) or the muscle layer (T1b). It has not spread outside the gallbladder.

    Stage II: T2, N0, M0: The tumor has grown into the perimuscular fibrous tissue (T2). It has not spread outside the gallbladder.

    Stage IIIA: T3, N0, M0: The tumor extends through the serosa (outer layer of the gallbladder) and/or directly grows into the liver and/or one other nearby structure (T3). It has not spread to nearby lymph nodes (N0) or to tissues or organs far away from the gallbladder (M0).

    Stage IIIB: T1 to T3, N1, M0: The tumor has not grown into the main blood vessels leading into the liver or reached more than one nearby organ other than the liver (T1 to T3), but it has reached nearby lymph nodes (N1). It has not spread to tissues or organs far away from the gallbladder (M0).

    Stage IVA: T4, N0 or N1, M0: The tumor has grown into the main blood vessels leading into the liver or has reached more than one nearby organ other than the liver (T4). It may or may not have spread to nearby lymph nodes (N0 or N1). It has not spread to tissues or organs far away from the gallbladder (M0).

    Stage IVB: Either of the following is true:

    Any T, N2, M0: The main tumor may or may not have grown outside the gallbladder. It has spread to lymph nodes further away from the gallbladder (N2). It has not spread to tissues or organs far away from the gallbladder (M0).

    OR

    Any T, any N, M1: The main tumor might or might not have grown outside the gallbladder. It might or might not have spread to lymph nodes. The tumor has spread to tissues or organs far away from the gallbladder (M1).

    Diagnosis of Gallbladder Cancer

    Blood tests

    Your specialist will arrange blood tests called liver function tests. This series of tests shows if the liver and gallbladder are working normally. Included is a test for a chemical called bilirubin

    Ultrasound scan

    Your doctor may use this type of scan to look at your gallbladder. Ultrasound can pick up about 1 in 2 gallbladder cancers. This scan uses sound waves to create pictures of your body.

    CT scan

    A CT is a computerised scan using X-rays. Your specialist may suggest you have a CT scan of your tummy (abdomen). CT scans of the gallbladder can pick up a growth inside the gallbladder, or one that is growing outside the gallbladde

    X-ray of the gallbladder using an endoscope (ERCP)

    ERCP stands for endoscopic retrograde cholangiopancreatography. You swallow a long, flexible tube so your doctor can look at the inside of your small bowel (duodenum) and take biopsies of anything that looks abnormal.

    Type of MRI scan of the gallbladder, pancreas and bile ducts (MRCP)

    MRCP is short for magnetic resonance cholangiopancreatography. It’s a type of MRI scan. It uses radio signals to give detailed pictures of your pancreas, gallbladder and bile ducts

    Biopsy and fine needle aspiration (FNA)

    A biopsy means removing a sample of tissue and looking at it under a microscope. This is the only certain way to tell whether a growth is a cancer or not

    Treatment of Gallbladder Cancer

    The main types of treatments for gallbladder cancer include:

    There are 2 general types of surgery for cancer of the gallbladder:

    • Potentially curative surgery

    Potentially curative surgery is done when imaging tests or the results of earlier surgeries show there is a good chance that the surgeon can remove all of the cancer

    • Palliative surgery

    Palliative surgery is done to relieve pain or prevent complications, such as blockage of the bile ducts, if the tumor is too widespread to be removed completely. Palliative surgery is not expected to cure the cancer, but it can sometimes help relieve symptoms and/or prolong a person’s life. Palliative surgery is described in more detail in “Palliative therapy for gallbladder cancer.”

    Radiation therapy uses high-energy rays (such as x-rays) or atomic particles to destroy cancer cells. There are different kinds of radiation therapy.For gallbladder cancer, a machine is used to create a beam of x-rays or particles that are aimed at the cancer. This is known as external beam radiation therapy (EBRT).

    Chemotherapy (chemo) is treatment with anti-cancer drugs that are usually given into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers that have spread beyond where they started. Chemo can help some people with gallbladder cancer, but so far its effects against this type of cancer has been found to be limited. .For resectable gallbladder cancers, chemo may be used after surgery

    Palliative therapy is treatment given to help control or reduce symptoms caused by advanced cancer. It does not try to cure the cancer. If the cancer has spread too far to be removed completely by surgery, doctors may advise palliative operations, radiation, chemotherapy, or other treatments to help make you feel better or to help prevent possible complications from the cancer. Because gallbladder cancers tend to advance quickly, doctors try to use palliative therapies that are less likely to affect a person’s quality of life, when possible. f

    Biliary stent or biliary cathete

    cancer is blocking a duct that carries bile from the gallbladder or liver to the small intestine, it can lead to jaundice and other problems. The doctor may insert a small tube (either a stent or a catheter) into the bile duct or the gallbladder to help the bile drain out. during surgery.

    • A stent is a small metal or plastic tube that keeps the duct open to allow the bile to drain into the small intestine.
    • A catheter is a thin, flexible tube that drains into a bag outside the body through a small hole in the skin of the abdomen. The bag can be emptied when needed. If you have a catheter, your doctor or nurse will teach you how to care for it.

    These procedures are often done to help relieve or prevent symptoms from more advanced cancers

    Photodynamic Therapy : A laser and a light sensitive medicine are used in this therapy for destroying the cancer cells. The different gallbladder symptoms can also be relieved by the means of this therapy. The injection of the medicine is done into a vein that will travel through the body which is then taken up by the cells. A laser is then passed over the cells for activating the drug that will eventually kill all the cancer cells.

    Ovarian Cancer Treatment in India

    Ovarian Cancer

    Ovarian cancer happens when cells that are not normal grow in one or both of your ovaries. The ovaries are two small glands, located on either side of your uterus. They produce female sex hormones and store and release eggs (ova).

    Treatments for ovarian cancer are more successful when the cancer is found early. But most of the time, cancer has already spread by the time it is found.

    Types of Ovarian Tumors

    There are more than 30 different types of ovarian cancer which are classified according to the type of cell from which they start. Cancerous ovarian tumors can start from three common cell types:

    • Surface Epithelium – cells covering the lining of the ovaries
    • Germ Cells – cells that are destined to form eggs
    • Stromal Cells – Cells that release hormones and connect the different structures of the ovaries

    Causes of Ovarian Cancer

    Ovarian cancer is considered as one of the most common cancer among women. Some of its major causes include –

    • The usage of hormone replacement therapy for more than five years especially when only estrogen is used
    • Inherited gene mutation
    • Women who are 50 years or above
    • Obesity
    • Family history of breast cancer or ovarian cancer
    • Having never been pregnant
    • Having had cancer before such as colon, breast or uterine

    Symptoms

    In some cases, ovarian cancer may cause early symptoms. The most common symptoms of ovarian cancer include:

    • Frequent bloating.
    • Pain in your belly or pelvis.
    • Trouble eating, or feeling full quickly.
    • Urinary problems, such as an urgent need to urinate or urinating more often than usual.

    Other symptoms that affect some women with ovarian cancer include:

    Stages of Ovarian Cancer

    Stage 1

    Stage 1 ovarian cancer means the cancer is only in the ovaries. It is divided into 3 groups

    • Stage 1a – the cancer is completely inside one ovary
    • Stage 1b – the cancer is completely inside both ovaries
    • Stage 1c – as well as cancer in one or both ovaries, there is some cancer on the surface of an ovary or there are cancer cells in fluid taken from inside your abdomen during surgery or the ovary ruptures (bursts) before or during surgery

    Stage 2

    Stage 2 means the cancer has grown outside the ovary or ovaries and is growing within the area circled by your hip bones (the pelvis). There may also be cancer cells in the abdomen.  So stage 2 cancer can be

    • 2a – the cancer has grown into the fallopian tubes or the womb
    • 2b – the cancer has grown into other tissues in the pelvis, for example the bladder or rectum
    • 2c – the cancer has grown into other tissues in the pelvis and there are cancer cells in fluid taken from inside your abdomen

    Stage 3

    Stage 3 cancer of the ovary means the cancer has spread outside the area surrounded by your hip bones (the pelvis) into the abdominal cavity. Your cancer is also stage 3 if cancer is found in the lymph nodes in your upper abdomen (tummy), groin or behind the womb. So stage 3 cancer can be

    • 3a – using a microscope, cancer growths can be seen in tissue taken from the lining of the abdomen
    • 3b – there are visible tumour growths on the lining of the abdomen that are 2cm across or smaller
    • 3c – there are tumour growths larger than 2cm on the lining of the abdomen, or cancer in lymph nodes in the upper abdomen, groin or behind the womb, or both

    Stage 4

    Stage 4 ovarian cancer means the cancer has spread to other body organs some distance from the ovaries, such as the liver or lungs. But if ovarian cancer is only found on the surface of the liver and not within the liver itself, then the cancer is still stage 3.

    Diagnosis of Ovarian Cancer

    Some exams and tests that are done to look for or diagnose ovarian cancer include:

    • A biopsy, which is the only way to know for sure if a woman has ovarian cancer. This usually is done with a laparotomy, through a cut (incision) in the belly.
    • A physical exam, including a pelvic exam and Pap test. An ovarian lump may be felt during a pelvic exam. A rectovaginal exam may also be done to feel the pelvic organs.
    • Blood test: A cancer antigen 125 (CA-125) level, to measure a protein found on the surface of many ovarian cancer cells.
    • A pelvic and transvaginal ultrasound, to look for an ovarian lump.
    • A pelvic or abdominal CT scan or MRI, to check for the spread of cancer.
    • Exploratory Surgery : This surgery is performed for confirming the diagnosis of ovarian cancer.
    • Positron Emission Tomographic Scan (PET) : This test helps in defining those areas that altered blood supply and also helps in identifying cancer.
    • Magnetic Resonance Imaging (MRI): Magnetic energy is used for generating highly detailed images of the anatomy such as tumors.

    Treatment of Ovarian Cancer

    The main treatments for ovarian cancer are surgery and chemotherapy.

    Almost all women with ovarian cancer will need surgery. The amount and type of surgery you have will depend on your stage and type of cancer

    For most women with stage 1 ovarian cancer, you will have surgery to remove your

    • Ovaries
    • Fallopian tubes
    • Womb (including the cervix)

    Advanced ovarian cancer

    Stage 2, 3 and 4 ovarian cancers are classed as advanced. This means the cancer has spread away from the ovary.

    Surgery: Three types of surgeries are involved in treating ovarian cancer such as –

    • Laparoscopy: The use of this minimally invasive surgery depends on the extent of the cancer.
    • Frozen Section Tissue Analysis: The rapid analysis of the tissue is done under a microscope. The nature of the tumor is determined as whether it is cancerous or non-cancerous that also helps surgeons to perform a suitable procedure during the first surgery.
    • Laparotomy: This procedure is used by making a large abdominal incision. This incision is done for removing uterus, ovaries, Fallopian tubes surrounding lymph glands, omentum (a fold of fatty tissue) and tumor. Cytoreductive or debulking surgery is another name for this surgery.

    Chemotherapy

    After you have recovered from surgery, you will have chemotherapy. If the surgeon was able to remove all your cancer, the aim of chemotherapy is to reduce the risk of the cancer coming back. If the surgeon couldn’t take out all the cancer, then the aim of chemotherapy is to shrink the cancer that has been left behind. Some women may then have further surgery.

    Biological therapy

    For some advanced cancers, you may have a type of biological therapy called bevacizumab with chemotherapy.Bevacizumab targets a cancer cell protein called vascular endothelial growth factor (VEGF). This protein helps cancers to grow blood vessels, so they can get food and oxygen from the blood. All cancers need a blood supply to be able to survive and grow. Bevacizumab blocks this protein and stops the cancer from growing blood vessels, so it is starved and can’t grow

    Gastric Cancer Treatment in India

    Gastric Cancer

    Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Stomach cancer, also called gastric cancer, is a cancer that starts in the stomach, the disease usually grows slowly over many years. Men are more likely to suffer from stomach cancer as compared to women. This cancer has also been seen in older people who are above 55 years of age.

    Types of stomach cancers

    Different types of stomach cancer include:

    Adenocarcinoma

    About 90% to 95% of cancers of the stomach are adenocarcinomas. When the term stomach cancer or gastric cancer is used, it almost always refers to an adenocarcinoma. These cancers develop from the cells that form the innermost lining of the stomach (known as the mucosa).

    Lymphoma

    These are cancers of the immune system tissue that are sometimes found in the wall of the stomach. About 4% of stomach cancers are lymphomas. The treatment and outlook depend on the type of lymphoma.

    Gastrointestinal stromal tumor (GIST)

    These are rare tumors that start in very early forms of cells in the wall of the stomach called interstitial cells of Cajal. Some of these tumors are non-cancerous (benign); others are cancerous. Although GISTs can be found anywhere in the digestive tract, most are found in the stomach.

    Carcinoid tumor

    These are tumors that start in hormone-making cells of the stomach. Most of these tumors do not spread to other organs. About 3% of stomach cancers are carcinoid tumors.

    Other cancers

    Other types of cancer, such as squamous cell carcinoma, small cell carcinoma, and leiomyosarcoma, can also start in the stomach, but these cancers are very rare.

    Causes of stomach cancer

    • Smoking
    • Being overweight or obese
    • A diet high in smoked, pickled, or salty foods
    • Stomach surgery for an ulcer
    • Type-A blood
    • Epstein-Barr virus infection
    • Certain genes
    • Working in coal, metal, timber, or rubber industries
    • Exposure to asbestos

    Symptoms

    Early on, stomach cancer may cause:

    As stomach tumors grow, you may have more serious symptoms, such as:

    Stages of Stomach Cancer

    Stage 0: Tis, N0, M0

    This is stomach cancer in its earliest stage. It has not grown beyond the inner layer of cells that line the stomach (Tis). The cancer has not spread to any lymph nodes (N0) or anywhere else (M0). This stage is also known as carcinoma in situ.

    Stage IA: T1, N0, M0

    The cancer has grown beneath the top layer of cells in the mucosa into tissue below, such as the connective tissue (lamina propria), the thin muscle layer (muscularis mucosa), or the submucosa (T1). The cancer has not spread to any lymph nodes (N0) or anywhere else (M0).

    Stage IB: Any of the following:

    T1, N1, M0: The cancer has grown into the layer of connective tissue (lamina propria), and may have grown into the thin layer of muscle beneath it (muscularis mucosa) or deeper into the submucosa (T1). Cancer has also spread to 1 or 2 lymph nodes near the stomach (N1), but not to any distant tissues or organs (M0).

    OR

    T2, N0, M0: The cancer has grown into the main muscle layer of the stomach wall, called the muscularis propria (T2). It has not spread to nearby lymph nodes (N0) or to any distant tissues or organs (M0).

    Stage IIA: Any of the following:

    T1, N2, M0: The cancer has grown beneath the top layer of cells of the mucosa into the layer of connective tissue (lamina propria), thin muscle layer (muscularis mucosa), or the submucosa (T1). It has spread to 3 to 6 nearby lymph nodes (N2). It has not spread to distant sites (M0).

    OR

    T2, N1, M0: The cancer has grown into the main muscle layer of the stomach called the muscularis propria (T2). It has spread to 1 or 2 nearby lymph nodes (N1), but has not spread to distant sites (M0).

    OR

    T3, N0, M0: The cancer has grown through the main muscle layer into the subserosa, but has not grown through all the layers to the outside the stomach (T3). It has not spread to any nearby lymph nodes (N0) or to distant tissues or organs (M0).

    Stage IIB: Any of the following:

    T1, N3, M0: The cancer has grown beneath the top layer of cells of the mucosa into the layer of connective tissue (lamina propria), the thin muscle layer, or the submucosa (T1). It has spread to 7 or more nearby lymph nodes (N3). It has not spread to distant tissues or organs (M0).

    OR

    T2, N2, M0: The cancer has grown into the main muscle layer, called the muscularis propria (T2). It has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant tissues or organs (M0).

    OR

    T3, N1, M0: The cancer has grown into the subserosa layer, but not through all the layers to the outside of the stomach (T3). It has spread to 1 or 2 nearby lymph nodes (N1), but has not spread to distant tissues or organs (M0).

    OR

    T4a, N0, M0: The cancer has grown completely through all the layers of stomach wall into the outer covering of the stomach (the serosa), but it has not grown into nearby organs or tissues, such as the spleen, intestines, kidneys, or pancreas (T4a). It has not spread to any nearby lymph nodes (N0) or distant sites (M0).

    Stage IIIA: Any of the following:

    T2, N3, M0: The cancer has grown into the main muscle layer, called the muscularis propria (T2). It has spread to 7 or more nearby lymph nodes (N3), but has not spread to distant tissues or organs (M0).

    OR

    T3, N2, M0: The cancer has grown into the subserosa layer, but not through all the layers to the outside of the stomach (T3). It has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant tissues or organs (M0).

    OR

    T4a, N1, M0: The cancer has grown completely through all the layers of the stomach wall into the outer covering of the stomach (the serosa), but it has not grown into nearby organs or tissues (T4a). It has spread to 1 or 2 nearby lymph nodes (N1), but it has not spread to distant sites (M0).

    Stage IIIB: Any of the following:

    T3, N3, M0: The cancer has grown into the subserosa layer, but not through all the layers to the outside of the stomach (T3). It has spread to 7 or more nearby lymph nodes (N2), but it has not spread to distant sites (M0).

    OR

    T4a, N2, M0: The cancer has grown completely through all the layers of the stomach wall into the serosa (the outer covering of the stomach), but it has not grown into nearby organs or tissues (T4a). It has spread to 3 to 6 nearby lymph nodes (N2), but it has not spread to distant sites (M0).

    OR

    T4b, N0 or N1, M0: The cancer has grown through the stomach wall and into nearby organs or structures such as the spleen, intestines, liver, pancreas, or major blood vessels (T4b). It may also have spread to up to 2 nearby lymph nodes (N0 or N1). It has not spread to distant sites (M0).

    Stage IIIC: Any of the following:

    T4a, N3, M0: The cancer has grown completely through all the layers of the stomach wall into the serosa, but it has not grown into nearby organs or tissues (T4a). It has spread to 7 or more nearby lymph nodes (N3), but it has not spread to distant sites (M0).

    OR

    T4b, N2 or N3, M0: The cancer has grown through the stomach wall and into nearby organs or structures such as the spleen, intestines, liver, pancreas, or major blood vessels (T4b). It has spread to 3 or more nearby lymph nodes (N2 or N3). It has not spread to distant sites (M0).

    Stage IV: Any T, any N, M1

    The cancer has spread to distant organs such as the liver, lungs, brain, or bones (M1)

    Diagnosis of Stomach Cancer

    • Blood tests to look for signs of cancer in your body.
    • Upper endoscopy. Your doctor will put a thin, flexible tube with a small camera down your throat to look into your stomach.
    • Upper GI series test. You’ll drink a chalky liquid with a substance called barium. The fluid coats your stomach and makes it show up more clearly on X-rays.
    • CT scan . This is a powerful X-ray that makes detailed pictures of the inside of your body.
    • Biopsy . Your doctor takes a small piece of tissue from your stomach to look at under a microscope for signs of cancer cells. He might do this during an endoscopy.

    Treatment for Stomach Cancer

    The main treatments for stomach cancer are:

    Surgery is part of the treatment for many different stages of stomach cancer if it can be done. If a patient has a stage 0, I, II, or III cancer and is healthy enough, surgery (often along with other treatments) offers the only realistic chance for cure at this time. The type of operation usually depends on what part of the stomach the cancer is in and how much cancer is in the surrounding tissue. Different kinds of surgery can be used to treat stomach cancer:

    Endoscopic resection

    Endoscopic mucosal resection and endoscopic submucosal resection can be used only to treat some very early-stage cancers, where the chance of spread to the lymph nodes is very low.

    These procedures do not require a cut (incision) in the skin. Instead, the surgeon passes an endoscope (a long, flexible tube with a small video camera on the end) down the throat and into the stomach. Surgical tools can be passed through the endoscope to remove the tumor and part of the normal stomach wall around it.

    Subtotal (partial) gastrectomy

    This operation is often recommended if the cancer is only in the lower part of the stomach. It is also sometimes used for cancers that are only in the upper part of the stomach.

    Only part of the stomach is removed, sometimes along with part of the esophagus or the first part of the small intestine (the duodenum)

    Total gastrectomy

    This operation is done if the cancer has spread throughout the stomach. It is also often advised if the cancer is in the upper part of the stomach, near the esophagus.

    The surgeon removes the entire stomach, nearby lymph nodes, and omentum, and may remove the spleen and parts of the esophagus, intestines, pancreas, or other nearby organs. The end of the esophagus is then attached to part of the small intestine. This allows food to move down the intestinal tract. But people who have had their stomach removed can only eat a small amount of food at a time. Because of this, they must eat more often.

    Lymph node removal

    In either a subtotal or total gastrectomy, the nearby lymph nodes are removed. This is a very important part of the operation. Many doctors feel that the success of the surgery is directly related to how many lymph nodes the surgeon removes.

    Chemotherapy

    Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond where it started.

    Radiation therapy

    Radiation therapy uses high-energy rays or particles to kill cancer cells in a specific area of the body. External beam radiation therapy is the type of radiation therapy often used to treat stomach cancer. This treatment focuses radiation on the cancer from a machine outside the body.

    Cervical Cancer Treatment in India

    Cervical Cancer

    Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it’s found early. It is usually found at a very early stage through a Pap test.

    Cervical cancer is one of the most common cancers in women worldwide

    Types of Cervical Cancer

    here are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Each one is distinguished by the appearance of cells under a microscope.

    • Squamous cell carcinomas begin in the thin, flat cells that line the bottom of the cervix. This type of cervical cancer accounts for 80 to 90 percent of cervical cancers.
    • Adenocarcinomas develop in the glandular cells that line the upper portion of the cervix. These cancers make up 10 to 20 percent of cervical cancers.

    Sometimes, both types of cells are involved in cervical cancer. Other types of cancer can develop in the cervix, but these are rare.

    • Metastatic cervical cancer is cancer that has spread to other parts of the body.

    Causes of Cervical Cancer

    GENERAL

    • Pregnancy: Women who have had three or more full-term pregnancies, or who had their first full-term pregnancy before age 17, are twice as likely to get cervical cancer.

    GENETICS

    • Family history: Women with a sister or mother who had cervical cancer are two to three times more likely to develop cervical cancer.

    LIFESTYLE

    • Sexual history: Certain types of sexual behavior are considered risk factors for cervical cancer and HPV infection. These include: sex before age 18, sex with multiple partners and sex with someone who has had multiple partners. Studies also show a link between chlamydia infection and cervical cancer.
    • Smoking: A woman who smokes doubles her risk of cervical cancer.
    • Oral contraceptive use: Women who take oral contraceptives for more than five years have an increased risk of cervical cancer, but this risk returns to normal within a few years after the pills are stopped.

    OTHER CONDITIONS

    • Weakened immune system: In most people with healthy immune systems, the HPV virus clears itself from the body within 12-18 months. However, people with HIV or other health conditions or who take medications that limit the body’s ability to fight off infection have a higher risk of developing cervical cancer.
    • Diethylstilbestrol (DES): Women whose mothers took DES, a drug given to some women to prevent miscarriage between 1940 and 1971, have a higher risk of developing cervical cancer.
    • HPV: Though HPV causes cancer, having HPV does not mean you will get cancer. The majority of women who contract HPV clear the virus or have treatment so the abnormal cells are removed. HPV is a skin infection, spread through skin-to-skin contact with a person who has the virus

    Symptoms of Cervical Cancer

    Common symptoms of cervical cancer may include:

    • Vaginal bleeding: This includes bleeding between periods, after sexual intercourse or post-menopausal bleeding.
    • Unusual vaginal discharge: A watery, pink or foul-smelling discharge is common.
    • Pelvic pain: Pain during intercourse or at other times may be a sign of abnormal changes to the cervix, or less serious conditions.

    .

    Signs of advanced stages of cervical cancer

    Cervical cancer may spread (metastasize) within the pelvis, to the lymph nodes or elsewhere in the body. Signs of advanced cervical cancer include:

    • Weight loss
    • Fatigue
    • Back pain
    • Leg pain or swelling
    • Leakage of urine or feces from the vagina
    • Bone fractures

    Stages of Cervical Cancer

    Stage 0: Stage 0 cervical cancer means that the cancer cells are confined to the surface of the cervix. This stage is also called carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN) grade III (CIN III).

    Stage 1: In stage I cervical cancer, the cancer has grown deeper into the cervix, but has not spread beyond it. This stage is further separated into two subcategories:

    • Stage IA: There is a very small amount of cancer, less than 5 mm deep and less than 7 mm wide, that can only be seen under a microscope.
    • Stage IB: The cancer can be seen and measures 4 cm or less; or the cancer can only be seen under a microscope and measures more than 5 mm deep and 7 mm wide.

    Stage II : Stage II cervical cancer means that the cancer has grown beyond the cervix and uterus, but has not reached the walls of the pelvis or the lower part of the vagina. In this stage of cervical cancer, the disease has not spread to lymph nodes or distant sites. Stage II has two additional subcategories:

    • Stage IIA: The cancer has not spread into the tissues next to the cervix, the parametria, but it may have grown into the upper part of the vagina.
    • Stage IIB: The cancer has spread into the tissues next to the cervix, the parametria.

    Stage III:

    Stage III cervical cancer means that the cancer has spread to the lower part of the vagina or the walls of the pelvis, but not to nearby lymph nodes or other parts of the body. This stage is separated into two subcategories:

    • Stage IIIA: The cancer has spread to the lower third of the vagina, but not to the walls of the pelvis.
    • Stage IIIB: The cancer has grown into the walls of the pelvis and/or has blocked both ureters, but has not spread to the lymph nodes or distant sites. Or the cancer has spread to the lymph nodes in the pelvis, but not to distant sites.

    Stagr IV

    In this cervical cancer stage, the disease has spread to nearby organs or other parts of the body. Stage IV is separated into two subcategories:

    • Stage IVA: The cancer has spread to the bladder or rectum, but not to the lymph nodes or distant sites.
    • Stage IVB: The cancer has spread to organs beyond the pelvis, such as the lungs or liver.

    Diagnosis of Cervical Cancer

    ·         Medical history and physical exam

    ·         Colposcopy

    If you have certain symptoms that suggest cancer or if your Pap test shows abnormal cells, you will need to have a test called colposcopy

    ·         Cervical biopsies

    Several types of biopsies can be used to diagnose cervical pre-cancers and cancers

    Colposcopic biopsy

    For this type of biopsy, first the cervix is examined with a colposcope to find the abnormal areas. Using a biopsy forceps, a small (about 1/8-inch) section of the abnormal area on the surface of the cervix is removed.

    Endocervical curettage (endocervical scraping)

    Sometimes the transformation zone (the area at risk for HPV infection and pre-cancer) cannot be seen with the colposcope and something else must be done to check that area for cancer. This means taking a scraping of the endocervix by inserting a narrow instrument (called a curette). The curette is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the laboratory for examination.

    Cone biopsy

    In this procedure, also known as conization, the doctor removes a cone-shaped piece of tissue from the cervix. A cone biopsy can also be used as a treatment to completely remove many pre-cancers and some very early cancers.

    ·         Cystoscopy, proctoscopy, and examination under anesthesia

    These are most often done in women who have large tumors. They are not necessary if the cancer is caught early.

    In cystoscopy a slender tube with a lens and a light is placed into the bladder through the urethra. This lets the doctor check your bladder and urethra to see if cancer is growing into these areas. Biopsy samples can be removed during cystoscopy for pathologic (microscopic) testing. Cystoscopy can be done under a local anesthetic, but some patients may need general anesthesia. Proctoscopy is a visual inspection of the rectum through a lighted tube to check for spread of cervical cancer into your rectum.

    • XRay,PET,CT scan

    Treatment of Cervical Cancer

    Common types of treatments for cervical cancer include:

    variety of procedures are performed  depending on the type and stage of cervical cancer, as well as individual fertility concerns.

    • Hysterectomy: During this type of cervical cancer surgery, the uterus and cervix are removed.
    • Radical hysterectomy: For all but a very small percentage of women with early cervical cancer, a radical hysterectomy will be necessary. This involves removing the uterus and cervix, as well as all of the surrounding tissue (the parametria) and the upper part of the vagina. During this cervical cancer surgery, the lymph nodes in the pelvis are also removed. For young women, the ovaries are left behind to preserve ovarian function. For older women, they are removed.
    • Pelvic extenteration: For women with recurrent or advanced cervical cancer, pelvic extenteration may be an option. During this surgery for cervical cancer, the uterus, cervix, vagina, ovaries, bladder, rectum and nearby lymph nodes are removed. Tissue from elsewhere in the body is used to reconstruct the vagina, and urine and stool are passed into external bags.
    • Radiation therapy

    Some radiation therapy delivery methods include:

    • External beam radiation therapy – radiation is directed from a machine outside the body onto cancerous cells within the body. (Examples: 3D conformal radiation therapy, IMRT, IGRT, TomoTherapy, stereotactic radiosurgery)
    • Internal radiation therapy – radioactive material is placed (via a catheter or other carrier) directly into or near a tumor. (Example: high-dose rate brachytherapy)
    • Systemic radiation therapy – a radioactive substance (that is swallowed or injected) travels through the blood to locate and destroy cancerous cells. (Example: radioactive iodine therapy)
    • Chemotherapy

    Systemic chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and can reach all areas of the body, making this treatment useful for killing cancer cells in most parts of the body. Chemo is often given in cycles, with each period of treatment followed by a recovery period.

    Lymphoma Cancer Treatment in India

    Lymphoma Cancer

    Lymphoma is cancer that begins in infection-fighting cells of the immune system, called lymphocytes. These cells are in the lymph nodes, spleen, thymus, bone marrow, and other parts of the body. When you have lymphoma, lymphocytes change and grow out of control.

    There are two main types of lymphoma:

    • Non-Hodgkin: Most people with lymphoma have this type.
    • Hodgkin

    Non-Hodgkin and Hodgkin lymphoma each affect a different kind of lymphocyte. Every type of lymphoma grows at a different rate and responds differently to treatment.

    Non-Hodgkin

    Non-Hodgkin lymphoma (also known as non-Hodgkin’s lymphoma, NHL, or sometimes just lymphoma) is a cancer that starts in cells called lymphocytes, which are part of the body’s immune system. Lymphocytes are in the lymph nodes and other lymphoid tissues (such as the spleen and bone marrow).

    Hodgkin

    Hodgkin disease (Hodgkin lymphoma) is a type of lymphoma, a cancer that starts in white blood cells called lymphocytes. Lymphocytes are part of the immune system.

    Symptoms of Hodgkin Lymphoma

    Warning signs that you might have lymphoma include:

    • Swollen glands (lymph nodes), often in the neck, armpit, or groin
    • Cough
    • Shortness of breath
    • Fever
    • Night sweats
    • Stomach pain
    • Fatigue
    • Weight loss
    • Itching

    Causes of Hodgkin Lymphoma

    • Are in your 60s or older
    • Are male
    • Have a weak immune system from HIV/AIDS, an organ transplant, or because you were born with an immune disease
    • Have an immune system disease such as rheumatoid arthritis, Sjögren’s syndrome, lupus, or celiac disease
    • Have been infected with a virus such as Epstein-Barr, hepatitis C, human T-cell leukemia/lymphoma (HTLV-1), or human herpesvirus 8 (HHV8)
    • Have a close relative who had lymphoma
    • Were exposed to benzene or chemicals that kill bugs and weeds
    • Were treated for Hodgkin or non-Hodgkin lymphoma in the past
    • Were treated for cancer with radiation
    • Are overweight

    Types of Hodgkin Lymphoma

    Classical types

    There are 4 types of classical Hodgkin lymphoma. All these types contain abnormal cells called Reed-Sternberg cells that can be seen under the microscope. Reed-Sternberg cells are a type of white blood cell (B lymphocyte) that has become cancerous

    The 4 types of classical Hodgkin lymphoma are

    Nodular lymphocyte predominant type

    Only about 1 in 20 cases (5%) of Hodgkin lymphoma are the nodular lymphocyte predominant type. It is more common in older people but can occur in young people. The main difference between this type and classical Hodgkin lymphoma is that in the nodular lymphocyte predominant type there are very few Reed-Sternberg cells. But there are other abnormal cells that doctors call popcorn cells. This type of Hodgkin lymphoma is often only in one group of lymph nodes when it is diagnosed (localised disease). It tends to be slower growing than classical Hodgkin lymphoma and the treatment is different.

    Hodgkin Lymphoma Stages

    • Stage 1 means there is Hodgkin lymphoma in only 1 group of lymph nodes or lymphoma in 1 body organ only
    • Stage 2 means Hodgkin lymphoma in 2 or more groups of lymph nodes or an organ and 1 or more group of lymph nodes. In both cases, the 2 sites of lymphoma must be on the same side of the diaphragm
    • Stage 3 means Hodgkin lymphoma on both sides of the diaphragm
    • Stage 4 means that many groups of lymph nodes contain Hodgkin lymphoma and it has spread to body organs such as the liver, bones or lungs

    Diagnosis of Hodgkin Lymphoma

    • Blood test. It checks the number of certain cells in your blood.
    • Bone marrow aspiration or biopsy. Your doctor uses a needle to remove fluid or tissue from your bone marrow — the spongy part inside bone where blood cells are made — to look for lymphoma cells.
    • Chest X-ray. It uses radiation in low doses to make images of the inside of your chest.
    • MRI. It uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
    • PET scan. It uses a radioactive substance to look for cancer cells in your body.
    • Molecular test. It looks for changes to genes, proteins, and other substances in cancer cells to help your doctor figure out which type of lymphoma you have.

    Treatment of Hodgkin Lymphoma

    Several types of treatment can be used for Hodgkin disease

    Chemotherapy

    Chemotherapy (chemo) is the use of drugs to kill cancer cells. Chemotherapy for Hodgkin disease is usually injected into a vein under the skin or taken as a pill. Chemo drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.

    Radiation therapy

    Radiation therapy uses high-energy rays (or particles) to destroy cancer cells. To treat Hodgkin disease, a carefully focused beam of radiation is delivered from a machine outside the body. This is known as external beam radiation. Radiation therapy is most useful when Hodgkin disease is only in one part of the body. For classic Hodgkin disease, radiation is often given after chemotherapy, especially when there is a large or bulky tumor mass (usually in the chest)

    Monoclonal antibodies

    Antibodies are proteins made by your immune system to help fight infections. Man-made versions, called monoclonal antibodies (mAbs), can be designed to attack a specific target, such as a substance on the surface of lymphocytes (the cells in which Hodgkin disease starts).

    High-dose chemotherapy and stem cell transplant

    Stem cell transplants (SCTs) are sometimes used for hard-to-treat Hodgkin disease, such as disease that doesn’t go away completely after chemotherapy (chemo) and/or radiation or that comes back after treatment.

    The doses of chemo drugs given to patients normally are limited by the side effects these drugs cause. Higher doses can’t be used, even if they might kill more cancer cells, because they would severely damage the bone marrow, where new blood cells are made.

    A stem cell transplant lets doctors give higher doses of chemo (sometimes along with radiation therapy). This is because after getting high-dose chemo treatment, the patient receives a transplant of blood-forming stem cells to restore the bone marrow.

    Non-Hodgkin Lymphoma

    Non-Hodgkin lymphoma (sometimes called NHL, or just lymphoma) is a cancer that starts in cells called lymphocytes, which are part of the body’s immune system. Here we will discuss NHL in adults.

    Types of Non-Hodgkin Lymphoma

    T-cell or B-cell lymphomas are categorized under lymphomas that depends on whether these lymphomas have began from T-cell lymphocytes or B-cell lymphocytes. B-cell lymphomas are considered as the most common that include –

    • Follicular lymphoma
    • Diffuse large B-cell lymphoma

    Some of the not so common types are –

    • Lymphoplasmacytic lymphoma
    • Extranodal marginal zone lymphoma of mucosa-associated tissue
    • Small lymphocytic lymphoma (SLL)
    • Mediastinal large B-cell lymphoma
    • Mantle cell lymphoma
    • Nodal marginal zone lymphoma
    • Burkitt lymphoma

    T-cell lymphoma types include –

    • Lymphoblastic lymphoma
    • Peripheral T-cell lymphoma
    • Anaplastic large cell lymphoma
    • Skin (cutaneous) lymphoma

    Symptoms of Non-Hodgkin Lymphoma

    Non-Hodgkin’s lymphoma symptoms may include:

    • Painless, swollen lymph nodes in your neck, armpits or groin.
    • Abdominal pain or swelling.
    • Chest pain, coughing or trouble breathing.
    • Fatigue.
    • Fever.
    • Night sweats.
    • Weight loss.

    Stages of Non-Hodgkin Lymphoma

    Stage 1 

    This means you have lymphoma

    • In one group of lymph nodes or
    • In just one organ or area of the body outside the lymphatic system (extranodal lymphoma)

    Stage 2

    This means you have lymphoma

    •  In 2 or more groups of lymph nodes on the same side of your diaphragm, or
    •  In 1 or more groups of lymph nodes and also in one nearby organ or area of body, all on the same side of the diaphragm

    Stage 3

    This means you have lymphoma

    • In lymph nodes on both sides of the diaphragm, or
    • In lymph nodes on both sides of the diaphragm and a nearby organ or area of body is affected

    Stage 4

    This means you have lymphoma

    • Throughout one or more organs that are not part of the lymphatic system, or
    • In an organ that is not part of the lymphatic system, and it has also spread to organs or lymph nodes far away from the organ, or
    • In your liver, bone marrow, cerebrospinal fluid (CSF) or lung (unless it has spread to your lung from nearby lymph nodes)

    Diagnosis of Non-Hodgkin Lymphoma

    A tissue biopsy is done for diagnosing Non-Hodgkin lymphoma. When there is painless and enlarged lymph node that does not have any infection then a biopsy is required. Other tests include –

    • Spinal tap that depends on the location, stage and type of the Non-Hodgkin lymphoma
    • Blood tests
    • Chest x-ray
    • PET scan
    • MRI scans for epidural or spinal lymphoma
    • Bone marrow biopsy
    • Upper GI endoscopy
    • Computed tomography (CT) scans of the pelvis, chest, neck and abdomen
    • Testicular ultrasound is done for evaluating the opposite testicle for a testicular lymphoma primary site
    • Upper GI series and small bowel x-rays
    • Head and neck examination

    Treatment of Non-Hodgkin Lymphoma

    The treatment of Non-Hodgkin lymphoma depends on its stage, symptoms and the type. The aim of the treatment is to eliminate the lymphoma without causing any damage to the surrounding cells. The common treatment options for Non-Hodgkin lymphoma include –

    Chemotherapy

    Chemotherapy (chemo) is the use of drugs to kill cancer cells. Chemotherapy for Hodgkin disease is usually injected into a vein under the skin or taken as a pill. Chemo drugs enter the bloodstream and travel throughout the body to reach and destroy cancer cells wherever they may be.

    Radiation therapy

    Radiation therapy uses high-energy rays (or particles) to destroy cancer cells. To treat Hodgkin disease, a carefully focused beam of radiation is delivered from a machine outside the body. This is known as external beam radiation. Radiation therapy is most useful when Hodgkin disease is only in one part of the body. For classic Hodgkin disease, radiation is often given after chemotherapy, especially when there is a large or bulky tumor mass (usually in the chest)

    Monoclonal antibodies

    Antibodies are proteins made by your immune system to help fight infections. Man-made versions, called monoclonal antibodies (mAbs), can be designed to attack a specific target, such as a substance on the surface of lymphocytes

    Radioimmunotherapy: This treatment uses a monoclonal antibody that also combines a radioactive particle to it. This helps in destroying the lymphoma cells and simultaneously it also destroys many more cells that are in the radiation path.

    Retinoblastoma (Eye Cancer) Treatment in India

    Retinoblastoma

    Retinoblastoma is a rare type of eye cancer that usually develops in early childhood, typically before the age of 5. This form of cancer develops in the retina, which is the specialized light-sensitive tissue at the back of the eye that detects light and color.

    In most children with retinoblastoma, the disease affects only one eye. However, one out of three children with retinoblastoma develops cancer in both eyes. The most common first sign of retinoblastoma is a visible whiteness in the pupil called “cat’s eye reflex” or leukocoria. This unusual whiteness is particularly noticeable in photographs taken with a flash. Other signs and symptoms of retinoblastoma include crossed eyes or eyes that do not point in the same direction (strabismus); persistent eye pain, redness, or irritation; and blindness or poor vision in the affected eye(s).

    Types of Retinoblastoma

    Unilateral Retinoblastoma : This type of retinoblastoma accounts for almost 75% of cases and it usually affects only one eye. Unilateral retinoblastoma can be either sporadic or hereditary. Sporadic generally happens in those children who are over age 1 and accounts for almost 75-80% of unilateral retinoblastoma cases.

    Bilateral Retinoblastoma : Bilateral retinoblastoma is an indication of a genetic influence and it affects not one but both the eyes. This disease can be inherited from a parent who are having it but at the same time does not show any symptoms. This condition can be diagnosed early at a young age as compared to unilateral disease.

    Trilateral Retinoblastoma : Intracranial tumor also develops in those children who have inherited retinoblastoma. This tumor originates in primitive nerve cells and is considered as rare that accounts for only 5% of patients having bilateral retinoblastoma.

    Causes of Eye Cancer

    It’s not clear exactly why this occurs, but the following factors may increase the risk of it happening:

    • lighter eye colour – if you have blue, grey or green eyes, you have a higher risk of developing eye melanoma compared with people who have brown eyes
    • white or pale skin – eye melanoma mostly affects white people and is more common in those with fair skin
    • unusual moles – if you have irregularly shaped or unusually coloured moles, you’re more at risk of developing skin cancer and eye melanoma
    • use of sunbeds – there’s some evidence to suggest that exposing yourself to ultraviolet (UV) radiation from sunbeds, for example, can increase your risk of eye melanoma
    • overexposure to sunlight – this increases your risk of skin cancer, and may also be a risk factor for eye melanoma

    Symptoms

    Symptoms of eye cancer can include:

    • shadows, flashes of light, or wiggly lines in your vision
    • blurred vision
    • a dark patch in your eye that’s getting bigger
    • partial or total loss of vision
    • bulging of one eye
    • a lump on your eyelid or in your eye that’s increasing in size
    • pain in or around your eye, although this is rare

    Stages of Retinoblastoma

    • Intraocular. This means that cancer occurs in one or both eyes, but has not spread into surrounding tissues or other parts of the body.
    • Extraocular. The cancer has spread to tissues around the eye or to other parts of the body.
    • Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis

    Diagnosis of Retinal Cancer

    • Ultrasound. An ultrasound uses sound waves to create pictures of the internal organs. A transmitter that emits sound waves is moved over the child’s body. A tumor generates different echoes of the sound waves than normal tissue does, so when the waves are bounced back to a computer and changed into images, the doctor can locate a mass inside the body. The procedure is painless.
    • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the child’s body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors
    • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the brain and spinal column. MRI can also be used to measure the tumor’s size.
    • MRI or CT scan of the brain. These tests may be recommended to find out if there is an abnormality of the pineal gland, which is a small gland in the brain that regulates the body’s response to light
    • Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a doctor takes a sample of cerebral spinal fluid (CSF) to look for cancer cells, blood, or tumor markers, which are substances found in higher than normal amounts in the blood, urine, or body tissues of people

    ·        Bone marrow aspiration and biopsy. These two procedures are performed to determine if any retinoblastoma cells have spread to the bone marrow and are often done at the same Treatment of Retinoblastoma Cancer

    Treatment of Retinoblastoma Cancer

    Surgery

    Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery to remove the eye is called enucleation. A surgeon removes the eyeball and places an eye implant into the eye socket. This eye implant is then attached with the eye muscles. The implanted eyeball will be moved by the eye muscles just like it moves the natural eye. This implanted eye cannot see. The placement of a custom-made artificial eye is done on the eye implant after some weeks of the surgery. This artificial eye is matched with the healthy eye of a child. Gradually, it sits at the back of the eyelids and is clipped on the eye implant. When the eye implant is moved by the eye muscles then it will look as if the child is moving this artificial eye.

    Radiation Therapy

    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, plaques, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated

    Cryotherapy

    Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. More than one freezing may be needed.

    Laser therapy

    Laser therapy uses heat in the form of a laser to shrink a smaller tumor. It may be called thermotherapy or TTT for transpupillary thermotherapy. It may be used alone or in addition to cryotherapy or radiation therapy

    Chemotherapy

    Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide and may be used to shrink an eye tumor. The injection of these drugs is done into a vein that travels in the entire body. It also helps in shrinking the tumor of retinoblastoma that has spread to the other areas of the body or outside the eyeball.

    Bone Cancer/ Bone Tumor Treatment in India

    Bone Cancer

    cancer can occur in any part of any bone. Cancer begins when normal cells in the bone change and grow uncontrollably, forming a mass called a tumor. A bone tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread. Even though a benign tumor does not spread outside the bone, it can grow large enough to press on surrounding tissue and weaken the bone. A malignant tumor can destroy the cortex and spread to nearby tissue. If bone tumor cells get into the bloodstream, they can spread to other parts of the body, especially the lungs, through a process called metastasis

    There are different types of bone cancer, including:

    • Osteosarcoma and Ewing sarcoma. These are two of the most common types of bone cancer and mainly occur in children and young adults.
    • Chondrosarcoma. Chondrosarcoma is cancer of the cartilage and is more common in adults.
    • Chordoma. This is a type of bone cancer that typically starts in the lower spinal cord.

    Benign Bone Tumors

    Osteochondromas :

    Osteochondromas develop in adolescents and teenagers.

    These tumors form near the actively growing ends of long bones, such as arm or leg bones. Specifically, these tumors tend to affect the lower end of the thighbone (femur), the upper end of the lower leg bone (tibia), and the upper end of the upper arm bone (humerus).

    These tumors are made of bone and cartilage. Osteochondroma has been considered to be an abnormality of growth

    Nonossifying Fibroma Unicameral

    Nonossifying fibroma unicameral is a simple solitary bone cyst. It’s the only true cyst of bone. It’s usually found in the leg and occurs most often in children and adolescents.

    Giant Cell Tumors

    Giant cell tumors grow aggressively. They occur in adults, and they’re found in the rounded end of the bone and not in the growth plate. These are very rare tumors.

    Enchondroma

    An enchondroma is a cartilage cyst that grows inside the bone marrow. When they occur, they begin in children and persist as adults

    Fibrous Dysplasia

    Fibrous dysplasia is a gene mutation that makes bones fibrous and vulnerable to fracture.

    Aneurysmal Bone Cyst

    An aneurysmal bone cyst is an abnormality of blood vessels that begins in the bone marrow. It can grow rapidly and can be particularly destructive because it affects growth plates.

    Causes of Bone Cancer

    The cause of bone tumors isn’t known. The tumors often occur when parts of the body are growing rapidly. A few possible causes are genetics, radiation treatment, and injuries to the bones. Osteosarcoma has been linked to radiation treatment (particularly high doses of radiation) and other anticancer drugs, especially in children. However, a direct cause hasn’t been identified. People who have had bone fractures repaired with metal implants are also more likely to develop osteosarcoma later.

    Symptoms of Bone Tumors

    You may have no symptoms of a bone tumor. This is common. Your doctor may find a tumor when looking at an X-ray of another problem, such as a sprain. But symptoms of a bone tumor may include pain that:

    • Is in the area of the tumor
    • Is often felt as dull or achy
    • May get worse with activity
    • Often awakens people at night

    Trauma does not cause a bone tumor, but a bone that is weakened by a tumor may be more easily broken. This may then cause severe pain.

    Other symptoms related to bone tumors may include:

    Stages of Bone Cancer

    Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.

    Stage IA: The tumor is low grade (G1 or G2) and 8 cm or smaller (T1). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

    Stage IB: The tumor is low grade (G1 or G2) and larger than 8 cm (T2). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

    Stage IIA: The tumor is high grade (G3 or G4) and 8 cm or smaller (T1). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

    Stage IIB: The tumor is high grade (G3 or G4) and larger than 8 cm (T2). It has not spread to any lymph nodes or to other parts of the body (N0, M0).

    Stage III: There are multiple high-grade (G3 or G4) tumors in the primary bone site (T3), but they have not spread to any lymph nodes or to other parts of the body (N0, M0).

    Stage IVA: The tumor is of any size or grade and has spread to the lung(s) (any G, any T, N0, and M1a).

    Stage IVB: The tumor is of any size or grade and has spread to the lymph nodes (any G, any T, N1, and any M), or the tumor is of any size or grade and has spread to another organ besides the lung (any G, any T, any N, and M1b).

    Recurrent: Recurrent cancer is cancer has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above

    Diagnosis of Bone Cancer

    n addition to a physical examination, the following tests may be used to diagnose bone cancer:

    Blood tests. Some laboratory tests may help detect bone cancer. Alkaline phosphatase and lactate dehydrogenase levels in the blood may be higher in patients with osteosarcoma or Ewing sarcoma..

    X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

    Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancerous cells, appear dark.

    Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

    Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRI scans are used to check for any tumors in nearby soft tissue.

    Positron emission tomography (PET) scan. A PET scan is a way to create picture of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

    Integrated PET-CT scan. This scanning method collects images from both a CT and a PET scan at the same time and then combines the images. This technique helps the doctor look at both the structure and how energy is used by the tumor and healthy tissue. This information can help doctors plan treatment and determine the benefits of different treatments.

    Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis..

    Treatment of Bone Cancer

    Treatment options depend on the type, size, location, and stage of the cancer, as well as the person’s age and general health. Treatment options for bone cancer include surgery, chemotherapy, radiation therapy, and cryosurgery.

    • Surgery is the usual treatment for bone cancer. The surgeon removes the entire tumor with negative margins (no cancer cells are found at the edge or border of the tissue removed during surgery). The surgeon may also use special surgical techniques to minimize the amount of healthy tissue removed with the tumor.

    There are different types of surgery for treating bone cancer such as –

    • Surgery for cancer that does not affect the limbs : The surgical procedure is performed for removing bone and some nearby tissue if the bone cancer takes place in the bones apart from legs and arms. This removed bone is then replaced with a part of bone from a different area of the body or can also be replaced with the help of special metal prosthesis.
    • Surgery for removing the cancer while sparing the limb : The surgical procedure can be performed for removing the bone cancer while sparing the limb if the bone cancer can be separated from other tissue and nerves. The lost bone is then replaced with some other bone from a different area of the body or can also be replaced with the help of a special prosthesis.
    • Surgery for removing a limb : The surgical procedure is required for removing a part or all part of a limb when the bone cancer is very large and is located on a complicated point on the bone.
    • Chemotherapy is the use of anticancer drugs to kill cancer cells. Patients who have bone cancer usually receive a combination of anticancer drugs. However, chemotherapy is not currently used to treat chondrosarcoma
    • Radiation therapy, also called radiotherapy, involves the use of high-energy x-rays to kill cancer cells. This treatment may be used in combination with surgery. It is often used to treat chondrosarcoma, which cannot be treated with chemotherapy, as well as ESFTs . It may also be used for patients who refuse surgery.
    • Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells. This technique can sometimes be used instead of conventional surgery to destroy the tumor

    Skin Cancer Treatment in India

    Skin Cancer

    Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. It is the uncontrolled growth of abnormal skin cells. It occurs when unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors.

    Causes of Skin Cancer

    • Sun exposure. Ultraviolet (UV) light from the sun is the main environmental cause of most skin cancers. …
    • Sunbeds. Reguarly using sunlamps and sunbeds can increase the risk of developing some skin cancers. …
    • Previous skin cancers. …
    • Previous radiotherapy treatment. …
    • Lowered immunity. …
    • Exposure to chemicals. …
    • Genetic conditions.

    Symptoms of Skin Cancer

    Symptoms of basal cell carcinoma

    Basal cell cancers may:

    • be smooth and pearly
    • look waxy
    • appear as a firm, red lump
    • bleed sometimes
    • develop a crust or scab
    • begin to heal but never completely heal
    • be itchy
    • look like a flat, red spot which is scaly and crusty
    • develop into a painless ulcer.

    Symptoms of squamous cell carcinoma

    Squamous cell cancers usually develop in areas that have been damaged by sun exposure. They are mainly found on the face, neck, bald scalps, arms, backs of hands and lower legs. Squamous cell cancers may:

    • look scaly
    • have a hard, horny cap
    • make the skin raised in the area of the cancer
    • feel tender to touch
    • bleed sometimes.

    Some of the symptoms of melanoma include –

    • Bruise on the foot that does not heal
    • A mole on the skin which is changing in shape or color and is also growing
    • Black or brown streak underneath toenail or fingernail
    • Appearance of new dark spot that looks like a mole and also grows quickly
    • Bleeding, pain or itch in a new spot on the skin
    • A bleeding and scaly mole on the skin

    Stages of Skin Cancer

    Stage 0

    Stage 0 is also called Bowen’s disease or carcinoma in situ. Carcinoma means there are cancer cells there. In situ means the cells are still in the place where they started to develop. So the cells have started to turn into cancer, but they have not yet spread or grown into surrounding areas of the skin. If it is not treated, Bowen’s disease can develop into a squamous cell skin cancer.

    Stage 1

    Stage 1 means the cancer is 2cm across or less and has 1 or no high risk features.

    High risk features mean the cancer

    • Is more than 2mm thick
    • Has grown into the lower dermis
    • Has grown into the space around a nerve (perineural invasion)
    • Started on the ear or lip
    • Looks very abnormal under the microscope (the cells are poorly differentiated or undifferentiated)

    Stage 2

    Stage 2 means the cancer is more than 2cm across, or has 2 or more high risk features.

    Stage 3

    Stage 3 means the cancer

    • Has grown into the bones in the face, such as the jaw bone or the bone around the eye, OR
    • Has spread to a nearby lymph node (or lymph gland) on the same side of the body (and is less than 3cm)

    Stage 4

    Stage 4 means the cancer

    • Has grown into the spine, ribs or lower part of the skull, OR
    • Has spread to a lymph node that is more than 3cm OR to an internal organ, such as the lungs

    Diagnosis of Skin Cancer

    Treatment of Skin Cancer

    Surgery

    Most basal cell and squamous cell skin cancers can be successfully treated with surgery. In most cases the surgery is minor. The affected area is completely removed, usually under local anaesthetic

    Radiotherapy

    Radiotherapy can be used to treat basal cell or squamous cell skin cancers

    Chemotherapy

    Chemotherapy tablets or injections are only used in certain circumstances for skin cancer. More often, chemotherapy creams are used

    • To treat actinic keratosis
    • For skin cancers that are only on the top layer of the skin

    Immunotherapy

    Interferon stimulates your body’s immune system to pick out and fight cancer cells. Interferon is sometimes used to treat advanced squamous cell cancers that started in the nose, mouth or elsewhere inside the head and neck area

    Photodynamic therapy (PDT)

    This is a relatively new type of treatment. It is another alternative to surgery. PDT uses a drug that makes skin cells sensitive to light. The area of skin that needs treating is exposed to a special type of light, and the cancer cells are destroyed

    Liver Cancer Treatment in India

    Liver Cancer

    he liver continuously filters blood that circulates through the body, converting nutrients and drugs absorbed from the digestive tract into ready-to-use chemicals. The liver performs many other important functions, such as removing toxins and other chemical waste products from the blood and readying them for excretion. Because all the blood in the body must pass through it, the liver is unusually accessible to cancer cells traveling in the bloodstream. The liver can be affected by primary liver cancer, which arises in the liver, or by cancer which forms in other parts of the body and then spreads to the liver. Most liver cancer is secondary or metastatic, meaning it started elsewhere in the body. Primary liver cancer, which starts in the liver, accounts for half of all cancers in some undeveloped countries. This is mainly due to the prevalence of hepatitis, caused by contagious viruses, that predisposes a person to liver cancer.

    The more common benign tumors of the liver include:

    • Hemangioma
    • Hepatic adenoma
    • Focal nodular hyperplasia
    • Cysts
    • Lipoma
    • Fibroma
    • Leiomyoma

    None of these tumors are treated like liver cancer. They may need to be removed surgically if they cause pain or bleeding

    Types of Liver Cancer

    The place where a cancer starts is called the primary site, so cancers that start in the liver are known as primary liver cancers.

    Hepatocellular carcinoma (HCC)

    This is the most common form of liver cancer in adults. It begins in the hepatocytes, the main type of liver cell. About 4 out of 5 cancers that start in the liver are this type.

    Bile duct cancer (cholangiocarcinoma)

    Bile duct cancers account for 1 or 2 out of every 10 cases of liver cancer. These cancers can start in the small tubes (called bile ducts) that carry the bile that is made in the liver to the gallbladder or from the gallbladder to the intestines

    Rare types of primary liver cancers

    Angiosarcomas and hemangiosarcomas are rare cancers that start in the cells lining the blood vessels of the liver. These tumors grow quickly. Often by the time they are found they are too widespread to be removed. Treatment may help slow the disease, but these cancers are usually very hard to treat.

    Hepatoblastoma is a very rare kind of liver cancer that is usually found in children younger than 4 years old. About 2 out of 3 children with these tumors have good outcomes with surgery and chemotherapy, although the tumors are harder to treat if they have spread outside the liver.

    Cancers that spread to the liver (secondary liver cancers)

    If a cancer starts somewhere else and then spreads to the liver, it is called secondary liver cancer. Secondary liver cancer is much more common than cancer that starts in the liver (primary liver cancer). Many common types of cancer, including colon, rectum, lung, and breast, spread (metastasize) to the liver.

    Causes of Liver Cancer

    • Gender: this cancer is more common in men than women
    • . Hepatitis C and Hepatitis B long-term infections are associated with liver cancer as they often result in cirrhosis. Hepatitis B can cause liver cancer without cirrhosis.
    • Long-term infections with hepatitis B and/or C
    • Cirrhosis
    • Heavy alcohol use
    • Being obese (very overweight)
    • Type 2 diabetes
    • Certain inherited conditions, such as hereditary hemochromatosis
    • Arsenic exposure, which can come from drinking water
    • Exposure to the solvent vinyl chloride
    • Using anabolic steroids
    • Tobacco use

    Symptoms of Liver Cancer

    Most of the time liver cancer does not cause symptoms in its early stages. The symptoms below could be caused by liver cancer, but they can also be caused by other cancers or conditions. Weight loss (when you’re not trying to lose weight)

    • Lack of appetite
    • Feeling very full after a small meal
    • Nausea or vomiting
    • Fever
    • A swollen liver or a mass that can be felt under the ribs on the right side
    • A swollen spleen, felt as a mass under the ribs on the left side
    • Pain in the belly (abdomen) or near the right shoulder blade
    • Swelling in your belly
    • Itching
    • Yellowing of the skin and eyes (jaundice)
    • Swollen veins on the belly that can be seen through the skin
    • Becoming sicker if you have chronic hepatitis or cirrhosis

    Some liver tumors make hormones that act on organs other than the liver. These hormones may cause:

    • High blood calcium levels that can cause nausea, confusion, constipation, weakness, or muscle problems
    • Low blood sugar levels, which can make you feel very tired or faint
    • Breast enlargement and/or shrinking of the testicles in men
    • High counts of red blood cells which can cause someone to look red and flushed
    • High cholesterol levels

    Stages of Liver Cancer

    Stage I: This is the earliest stage of HCC. The tumor has not spread to the blood vessels, lymph nodes, or other parts of the body (T1, N0, M0).

    Stage II: The tumor involves nearby blood vessels, but it has not spread to the regional lymph nodes or other parts of the body (T2, N0, M0).

    Stage IIIA: The cancer has not spread beyond the liver, but the area of the cancer is larger than stage I or II (T3a, N0, M0).

    Stage IIIB: The cancer involves a major vein around the liver, but it has not spread to nearby lymph nodes or other parts of the body (T3b, N0, M0).

    Stage IIIC: Any tumor that has spread to the organs near the liver (except the gallbladder), or if the tumor has broken through the visceral peritoneum. There is no spread to nearby lymph nodes or other parts of the body (T4, N0, M0).

    Stage IVA: Any tumor that has spread to the regional lymph nodes but not to other parts of the body (any T, N1, M0).

    Stage IVB: Any tumor that has spread to other parts of the body (any T, any N, M1).

    Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer has returned, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

    Diagnosis of Liver Cancer

    The following tests may be used to diagnose. This list describes options for diagnosing this type of cancer, but not all tests listed will be used for every person.

    • Physical examination. If a person has symptoms of HCC, the doctor will feel the abdomen to check the liver, spleen, and other nearby organs for lumps, swelling, or other changes. The doctor will also look for an abnormal buildup of fluid in the abdomen and for signs of jaundice, which include yellowing of the skin and whites of the eyes.
    • Blood tests. At the same time as the physical examination, the doctor will most likely do a blood test to look for a substance called alpha-fetoprotein (AFP). The doctor will also test the patient’s blood to see if he or she has hepatitis B or C. Other blood tests can show how well the liver is working.

    In addition, other tests are commonly needed to diagnose HCC and to find where the tumor is located in the liver and if it has spread to other parts of the body. After the physical examination and blood tests, the doctor may recommend one or more of the following tests:

    • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. The sound waves bounce off the liver, other organs, and tumors. Each creates a different picture on a computer monitor.
    • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow..
    • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.
    • An angiogram is an x-ray picture of the blood vessels. A dye is injected into the bloodstream so the blood vessels of the liver show up on an x-ray.
    • Laparoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called a laparoscope. The person is sedated as the tube is inserted through a small incision in the abdomen. Local anesthetic to numb the area is also used.
    • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.
    • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy

    Treatment of Liver Cancer

    Disease-directed treatments to eliminate HCC

    These treatments are generally recommended when the tumor has been found at an early stage. Many doctors will not use these treatments if the tumor is larger than 5 cm.

    Surgery

    Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is likely to be the most successful disease-directed treatment, particularly for patients with a tumor smaller than 5 cm

    Two types of surgery are used to treat HCC:

    • When a portion of the liver is removed, the surgery is called a hepatectomy. A hepatectomy can be done only if the cancer is in one part of the liver, and the liver is working well. The remaining section of liver takes over the functions of the entire liver and may regrow to its normal size within a few weeks. A hepatectomy may not be possible if the patient has advanced cirrhosis, even if the tumor is small.
    • Liver transplantation. Sometimes, a liver transplantation can be done. This procedure is possible only when the cancer has not spread outside the liver, a suitable donor is found, and very specific criteria are met in terms of tumor size and number
    • Thermal ablation

    Radiofrequency ablation (RFA) and microwave therapy both use heat to destroy cancer cells. They may be given through the skin, through laparoscopy, or during a surgical operation while a patient is sedated

    Percutaneous ethanol injection

    Percutaneous ethanol injection uses alcohol injected directly into the liver tumor to destroy it. The procedure is simple, safe, and particularly effective for a tumor smaller than 3 cm

    Disease-directed treatments to improve survival

    Chemoembolization

    This is a type of chemotherapy treatment that is similar to hepatic arterial infusion,. During this procedure, drugs are injected into the hepatic artery, and the flow of blood through the artery is blocked for a short time so the chemotherapy stays in the tumor longer. Blocking the blood supply to the tumor also destroys cancer cells.

    Radiation therapy

    Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells.

    There are two types of radiation therapy used to treat HCC:

    • Stereotactic body radiation therapy (SBRT). SBRT is a term that describes several methods of delivering high doses of radiation to a tumor while limiting the amount of radiation exposure to healthy tissues. This is important because healthy liver tissue can be damaged by radiation as well. SBRT effectively treats tumors that are approximately 5 cm or smaller
    • During radioembolization, a doctor places radioactive beads into the artery that supplies the tumor with blood in a way that’s similar to chemoembolization . The beads deliver radiation directly into the tumor when they become trapped in the small blood vessels of the tumor.

    Targeted therapy

    Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

    Kidney Cancer Treatment in India

    Kidney Cancer

    Every person has two kidneys, which are located above the waist on both sides of the spine. These reddish-brown, bean-shaped organs are each about the size of a small fist. They are located closer to the back of the body than to the front.

    The kidneys filter blood to remove impurities, excess minerals and salts, and extra water. Every day, the kidneys filter about 200 quarts of blood to generate two quarts of urine. The kidneys also produce hormones that help control blood pressure, red blood cell production, and other bodily functions.

    Kidney cancer begins when healthy cells in one or both kidneys change and grow uncontrollably, forming a mass called a tumor. A tumor can be malignant, indolent, or benign. A malignant tumor is cancerous, meaning it can grow and spread to other parts of the body. An indolent tumor is also cancerous, but this type of tumor rarely spreads to other parts of the body. A benign tumor means the tumor can grow but will not spread.

    Types of Kidney Cancer

    There are several types of kidney cancer:

    • Renal cell carcinoma. Renal cell carcinoma is the most common type of adult kidney cancer, making up about 85% of diagnoses. This type of cancer develops in the proximal renal tubules that make up the kidney’s filtration system. There are thousands of these tiny filtration units in each kidney.
    • Transitional cell carcinoma. This is also called urothelial carcinoma and accounts for 10% to 15% of the kidney cancers diagnosed in adults. Transitional cell carcinoma begins in the area of the kidney where urine collects before moving to the bladder, called the renal pelvis. This type of kidney cancer is similar to bladder cancer and is treated in a similar way.
    • Sarcoma of the kidney is rare. This type of cancer develops in the soft tissue of the kidney; the thin layer of connective tissue surrounding the kidney, called the capsule; or surrounding fat. Sarcoma of the kidney is usually treated with surgery. However, sarcoma commonly comes back in the kidney area or spreads to other parts of the body. More surgery or chemotherapy may be recommended after the first surgery.
    • Wilms tumor. Wilms tumor is most common in children and is treated differently than kidney cancer in adults. This type of tumor is more likely to be successfully treated with radiation therapy and chemotherapy than the other types of kidney cancer when combined with surgery. This has resulted in a different approach to treatment.

    Causes of Kidney Cancer

    The following factors may raise a person’s risk of developing kidney cancer:

    • Smoking.Smoking tobacco doubles the risk of developing kidney cancer and is believed to cause about 30% of kidney cancers in men and approximately 25% in women.
    • Men are two to three times more likely to develop kidney cancer than women.

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    • Kidney cancer is typically found in adults and is usually diagnosed between the ages of 50 and 70.
    • Nutritionand weight. Research has often shown a link between kidney cancer and obesity, which is generally caused by many years of eating a high-fat diet.
    • High blood pressure.Men with high blood pressure, also called hypertension, may be more likely to develop kidney cancer.
    • Overuse of certain medications.Painkillers containing phenacetin have been banned in the United States since 1983 because of their link to transitional cell carcinoma. Diuretics and analgesic pain pills, such as aspirin, acetaminophen, and ibuprofen, have also been linked to kidney cancer.
    • Exposure to cadmium.Some studies have shown a connection between exposure to the metallic element cadmium and kidney cancer. Working with batteries, paints, or welding materials may increase a person’s risk as well. This risk is even higher for smokers who have been exposed to cadmium.
    • Long-term dialysis.People having dialysis for a long time may develop cancerous cysts in their kidneys. These growths are usually found early and can often be removed before the cancer spreads.
    • Family history of kidney cancer.People who have first-degree relatives, such as parents, brothers, sisters, or children, with kidney cancer have an increased risk of developing the disease

    Symptoms of Kidney Cancer

    • Blood in the urine
    • Pain or pressure in the side or back
    • A mass or lump in the side or back
    • Swelling of the ankles and legs
    • High blood pressure
    • Anemia, which is a low red blood cell count
    • Fatigue
    • Loss of appetite
    • Unexplained weight loss
    • Recurrent fever that is not from cold, flu, or other infection
    • For men, a rapid development of a cluster of enlarged veins, known as a varicocele, around a testicle

    Stages of Kidney Cancer

    Stage I: The tumor is 7 cm or smaller and is only located in the kidney. It has not spread to the lymph nodes or distant organs (T1, N0, M0).

    Stage II: The tumor is larger than 7 cm and is only located in the kidney. It has not spread to the lymph nodes or distant organs (T2, N0, M0).

    Stage III: Either of these conditions:

    • A tumor of any size is located only in the kidney. It has spread to the regional lymph nodes but not to other parts of the body (T1, T2; N1; M0).
    • The tumor has grown into major veins or perinephric tissue and may or may not have spread to regional lymph nodes. It has not spread to other parts of the body (T3; any N; M0).

    Stage IV: Either of these conditions:

    • The tumor has spread to areas beyond Gerota’s fascia and extends into the adrenal gland on the same side of the body as the tumor, possibly to lymph nodes, but not to other parts of the body (T4; any N; M0).
    • The tumor has spread to any other organ, such as the lungs, bones, or the brain (any T, any N, M1)

    Recurrent: Recurrent cancer is cancer that has come back after treatment. It may be found in the kidney area or in another part of the body.

    Diagnosis of Kidney Cancer

    n addition to a physical examination, the following tests may be used to diagnose kidney cancer:

    • Blood and urine tests. The doctor may recommend having a blood test to check the number of red blood cells and a urine test to find blood, bacteria, or cancer cells. These tests may suggest that kidney cancer is present but cannot make a definite diagnosis.
    • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis

    Imaging tests

    • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation.
    • Intravenous pyelogram (IVP). A dye is injected into the patient’s bloodstream to highlight the kidney, urethra, and bladder when an x-ray is taken. The picture produced can show changes in these organs and in the nearby lymph nodes.
    • Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer or a fracture (break), appear dark.
    • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. If a benign angiomyolipoma is suspected, a special dye called a contrast medium is given during the scan to provide better detail on the image. This dye is injected into a patient’s vein.
    • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called gadolinium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein.
    • Cystoscopy and nephro-ureteroscopy. Occasionally, special tests called a cystoscopy and nephro-ureteroscopy may be done for renal pelvic cancer. They are not used for renal cell carcinoma. During these procedures, the patient is sedated while a tiny, lighted tube is inserted into the bladder through the urethra and up into the kidney. Sedation is giving medication to become more relaxed, calm, or sleepy. The device can remove samples of cells and, in some cases, small tumors.

    Treatment of Kidney Cancer

    Surgery

    Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. If the cancer has not spread beyond the kidneys, surgery to remove the tumor, part or all of the kidney, and possibly nearby tissue and lymph nodes, may be the only treatment necessary.

    The types of surgery used for kidney cancer include the following procedures:

    • Radical nephrectomy. Surgery to remove the tumor, the entire kidney, and surrounding tissue is called a radical nephrectomy. If nearby tissue and surrounding lymph nodes are also affected by the disease, a radical nephrectomy and lymph node dissection is performed.. A radical nephrectomy is usually recommended to treat a large tumor when there is little healthy tissue remaining.
    • Partial nephrectomy. A partial nephrectomy is the surgical removal of a tumor. This type of surgery preserves kidney function and lowers the risk of developing chronic kidney disease after surgery..
    • Laparoscopic and robotic surgery. During laparoscopic surgery, the surgeon makes several small incisions rather than the one larger incision in the abdomen used during a traditional surgical procedure. The surgeon then inserts telescoping equipment into these small, keyhole incisions to remove the kidney completely or perform a partial nephrectomy. Sometimes, the surgeon may use robotic instruments to perform the operation.

    Sometimes surgery is not recommended because of characteristics of the tumor or the patient’s overall health. The following procedures may be recommended instead:

    • Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumor to destroy the cancer with an electrical current.
    • Cryoablation, also called cryotherapy or cryosurgery, is the freezing of cancer cells with a metal probe inserted through a small incision..
    • Immunotherapy: Immunotherapy, also known as biologic therapy, helps in boosting the natural defenses of the body to fight against cancer

    Targeted therapies

    These drugs are often used as the first line of treatment against advanced kidney cancers. They can often shrink or slow the growth of the cancer.

    Bladder Cancer Treatment in India

    Bladder Cancer

    The bladder is an expandable, hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra. Bladder cancer begins when healthy cells in the bladder lining, most commonly urothelial cells, change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

    Types of Bladder Cancer

    The type of bladder cancer depends on how it looks under the microscope. The three main types of bladder cancer are:

    • Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It begins in the urothelial cells found in the lining the bladder. Urothelial carcinoma is the common term for this type of bladder cancer; however, it was previously called transitional cell carcinoma or TCC.
    • Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.
    • Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.

    ·         Papillary cancer

    Papillary bladder cancer is a form of early bladder cancer. It appears as mushroom-like growths or is leaf-shaped like seaweed (fronds). Some people may have both papillary cancer and CIS.

    ·         Carcinoma in situ (CIS)

    This is a type of non-invasive bladder cancer that appears as a flat, red area in the bladder. CIS can grow quickly, and if it’s not treated effectively, there’s a high risk that CIS will develop into an invasive bladder cancer.

    Causes of Bladder Cancer

    • Tobacco use. The most common risk factor is cigarette smoking, although smoking cigars and pipes can also raise the risk of developing bladder cancer. Smokers are four to seven times more likely to develop bladder cancer than nonsmokers.
    • The likelihood of being diagnosed with bladder cancer increases with age. More than 70% of people with bladder cancer are older than 65 years old.
    • Men are three to four times more likely to develop bladder cancer than women, but women are more likely to die from bladder cancer than men. Before smoking rates for women increased, men were five to six times more likely to develop bladder cancer than women.
    • Chemicals used in the textile, rubber, leather, dye, paint, and print industries; some naturally occurring chemicals; and chemicals called aromatic amines can increase the risk of bladder cancer.
    • Chronic bladder problems. Bladder stones and infections may increase the risk of bladder cancer. Bladder cancer may be more common for people who are paralyzed from the waist down and have had many urinary infections.
    • Cyclophosphamide (Cytoxan, Clafen, Neosar) use. People who have taken the chemotherapy drug cyclophosphamide have a higher risk of developing bladder cancer.

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    • Personal history. People who have already had bladder cancer once are more likely to develop bladder cancer again.
    • People who have some forms of this parasitic disease, which is found particularly in parts of Africa and the Mediterranean region, are more likely to develop bladder cancer.
    • Arsenic exposure. Arsenic is a naturally occurring substance that can cause health problems if consumed in large amounts. When found in drinking water, it has been associated with an increased risk of bladder cancer..

    Symptoms of Gallbladder Cancer

    • Blood or blood clots in the urine
    • Pain or burning during urination
    • Frequent urination
    • Feeling the need to urinate many times throughout the night
    • Feeling the need to urinate, but not being able to pass urine
    • Lower back pain on one side of the body

    Symptoms that may indicate more advanced bladder cancer include:

    • Pain in the lower back around the kidneys (flank pain).
    • Swelling in the lower legs.
    • A growth in the pelvis near the bladder (pelvic mass).

    Other symptoms that may develop when bladder cancer has spread include:

    Stages of Bladder Cancer

    Stage 0a: This is an early cancer that is only found on the surface of the inner lining of the bladder. Cancer cells are grouped together and can often be easily removed. The cancer has not invaded the muscle or connective tissue of the bladder wall. This type of bladder cancer is also called noninvasive papillary urothelial carcinoma (Ta, N0, M0).

    Stage 0is: This stage of cancer, also known as flat or carcinoma in situ, is found only on the inner lining of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder (Tis, N0, M0). This is always a high-grade cancer (see Grades, below).

    Stage I: The cancer has grown through the inner lining of the bladder into the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).

    Stage II: The cancer has spread into the thick muscle wall of the bladder. It is also called invasive cancer or muscle-invasive cancer. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs (T2, N0, M0).

    Stage III: The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder. It may also have spread to the prostate in a man or the uterus and vagina in a woman. It has not spread to the lymph nodes or other organs (T3 or T4a, N0, M0).

    Stage IV: Any of these conditions:

    • The tumor has spread to the pelvic wall or the abdominal wall but not to the lymph nodes or other parts of the body (T4b, N0, M0).
    • The tumor has spread to one or more regional lymph nodes but not to other parts of the body (any T, N1-3, M0).
    • The tumor may or may not have spread to the lymph nodes but has spread to other parts of the body (any T, any N, M1).

    Recurrent cancer: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence

    Diagnosis of Bladder Cancer

    The following tests may be used to diagnose

    • Urine tests. The doctor tests a urine sample to find out if it contains tumor cells. If a patient is undergoing a cystoscopy, an additional test may be performed that involves rinsing the bladder and collecting the liquid through the cystoscope or through another small tube that is inserted into the urethra.
    • Cystoscopy. This is the key diagnostic procedure for bladder cancer. It allows the doctor to see inside the body with a thin, lighted, flexible tube called a cystoscope.
    • Transurethral resection of bladder tumor (TURBT). If abnormal tissue is found during a cystoscopy, the doctor will do a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. This surgical procedure is called a transurethral bladder tumor resection or TURBT

    The following imaging tests may be used to find out if the bladder cancer has spread and to help with staging.

    • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. A CT scan can also be used to measure the tumor’s size.
    • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.
    • Positron emission tomography (PET) scan. PET scan may help find bladder cancer that has spread better than a CT scan or MRI alone. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

    Treatment of Bladder Cancer

    Surgery

    Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. There are different types of surgery for bladder cancer, and the most beneficial option usually depends on the stage and grade of the disease. Surgical options to treat bladder cancer include:

    • Transurethral bladder tumor resection (TURBT). This procedure is used for diagnosis and staging, as well as treatment. During TURBT, a surgeon inserts a cystoscope through the urethra into the bladder. The surgeon then removes the tumor using a tool with a small wire loop, a laser, or fulguration (high-energy electricity).
    • A radical cystectomy is the removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. In addition, lymph nodes in the pelvis are removed for both men and women. This is called a pelvic lymph node dissection. A thorough pelvic lymph node dissection is the most accurate way to find cancer that has spread to the lymph nodes. Rarely, for some specific cancers, it may appropriate to remove only part of the bladder, which is called partial cystectomy.
    • During a laparoscopic or robotic cystectomy, the surgeon makes several small incisions (cuts) instead of the one larger incision used for traditional surgery. The surgeon then uses telescoping equipment with or without robotic assistance to remove the bladder.
    • Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

    Chemotherapy: This therapy involves the combination of two or more drugs for destroying cancer cells in the case of bladder cancer. These drugs can be directly given to the bladder by passing a tube through the urethra or can also be given through a vein in the arm. Chemotherapy is also sometimes combined with radiation therapy.

    Immunotherapy

    Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function

    Radiation therapy

    Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells

    Colon Cancer Treatment in India

    Colon Cancer

    Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.

    Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body

    Types of Colon Cancer

    Adenocarcinoma is the most common type of colorectal cancer. Other colorectal cancers include gastrointestinal carcinoid tumors, gastrointestinal stromal tumors, primary colorectal lymphoma, leiomyosarcoma, melanoma and squamous cell carcinoma.

    There are two main subtypes of adenocarcinoma:

    • Mucinous adenocarcinoma is made up of approximately 60 percent mucus. The mucus can cause cancer cells to spread faster and become more aggressive than typical adenocarcinomas. Mucinous adenocarcinomas account for 10 to 15 percent of all colon and rectal adenocarcinomas.
    • Signet ring cell adenocarcinoma accounts for less than one percent of adenocarcinomas. Named for its appearance under a microscope, signet ring cell adenocarcinoma is typically aggressive and may be more difficult to treat.
    • Gastrointestinal carcinoid tumors: This slow-growing cancer forms in the neuroendocrine cell (a nerve cell that also creates hormones) in the lining of the gastrointestinal tract. These tumors account for just 1 percent of all colorectal cancers, but half of all of the cancers found in the small intestine.
    • Primary colorectal lymphomas: A type of non-Hodgkin lymphoma (NHL), lymphomas are cancers that develop in the lymphatic system from cells called lymphocytes. Lymphocytes are a type of white blood cell that helps the body fight infections. NHL can develop in many parts of the body, including the lymph nodes, bone marrow, spleen, thymus and the digestive tract..
    • Gastrointestinal stromal tumors: Also known as GISTs, this is a rare type of colorectal cancer that starts in a special cell found in the lining of the gastrointestinal (GI) tract called interstitial cells of Cajal (ICCs).
    • Leiomyosarcomas: Another form of sarcoma, leiomyosarcomas essentially means “cancer of smooth muscle.” The colon and rectum have three layers of the type of muscle that can be affected, which all work together to guide waste through the digestive tract. This rare type of colorectal cancer accounts for about 0.1 percent of all colorectal cases.
    • Melanomas: Though most commonly associated with the skin, melanomas can occur anywhere, including the colon or rectum.
    • Squamous cell carcinomas: Some parts of the GI tract, like the upper part of the esophagus and the end of the anus, are lined with flat cells called squamous cells. These are the same type of cells that are found on the surface of the skin. Cancers starting in these cells are called squamous cell carcinoma

    Causes of Colon Cancer

    • The risk of colorectal cancer increases as people get older. Colorectal cancer can occur in young adults and teenagers,
    • Men have a slightly higher risk of developing colorectal cancer than women.
    • Family history of colorectal cancer. Colorectal cancer may run in the family if first-degree relatives (parents, brothers, sisters, children) or many other family members (grandparents, aunts, uncles, nieces, nephews, grandchildren, cousins) have had colorectal cancer.

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    • Physical inactivity and obesity. People who lead an inactive lifestyle, meaning no regular exercise and a lot of sitting, and people who are overweight and obese may have an increased risk of colorectal cancer.
    • While various dietary factors have been looked at as possibly affecting the risk of developing colorectal cancer, the current research most consistently links eating more red and processed meat to a higher risk of the disease.
    • Recent studies have shown that smokers are more likely to die from colorectal cancer than nonsmokers.

    Symptoms of Colon Cancer

    • A change in bowel habits
    • Diarrhea, constipation, or feeling that the bowel does not empty completely
    • Bright red or very dark blood in the stool
    • Stools that look narrower or thinner than normal
    • Discomfort in the abdomen, including frequent gas pains, bloating, fullness, and cramps
    • Weight loss with no known explanation
    • Constant tiredness or fatigue
    • Unexplained iron-deficiency anemia, which is a low number of red blood cells

    Sometimes bleeding happens when the colon cancer progresses. Gradually, there will be not enough red blood cells in the body that is called as anemia. Following are some of the symptoms of anemia –

    • Breathlessness
    • Fatigue

    Also obstruction is caused by the colon cancer that include following symptoms –

    • Vomiting
    • A feeling of bloating, especially near the belly button
    • Constipation
    • Abdominal pain

    Stages of Colon Cancer

    Stage 0: This is called cancer in situ. The cancer cells are only in the mucosa, or the inner lining, of the colon or rectum.

    Stage I: The cancer has grown through the mucosa and has invaded the muscular layer of the colon or rectum. It has not spread into nearby tissue or lymph nodes (T1 or T2, N0, M0)

    Stage IIA: The cancer has grown through the wall of the colon or rectum and has not spread to nearby tissue or to the nearby lymph nodes (T3, N0, M0).

    Stage IIB: The cancer has grown through the layers of the muscle to the lining of the abdomen, called the visceral peritoneum. It has not spread to the nearby lymph nodes or elsewhere (T4a, N0, M0

    Stage IIC: The tumor has spread through the wall of the colon or rectum and has grown into nearby structures. It has not spread to the nearby lymph nodes or elsewhere (T4b, N0, M0).

    Stage IIIA: The cancer has grown through the inner lining or into the muscle layers of the intestine and spread to one to three lymph nodes, or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph nodes but has not spread to other parts of the body (T1 or T2; N1 or N1c, M0 or T1, N2a, M0).

    Stage IIIB: The cancer has grown through the bowel wall or to surrounding organs and into one to three lymph nodes or to a nodule of tumor in tissues around the colon or rectum that do not appear to be lymph nodes, but it has not spread to other parts of the body (T3 or T4a, N1 or N1c, M0; T2 or T3, N2a, M0; or T1 or T2, N2b, M0).

    Stage IIIC: The cancer of the colon, regardless of how deep it has grown, has spread to four or more lymph nodes but not to other distant parts of the body (T4a, N2a, M0; T3 or T4a, N2b, M0; or T4b, N1 or N2, M0)

    Stage IVA: The cancer has spread to a single distant part of the body, such as the liver or lungs (any T, any N, M1a).

    Stage IVB: The cancer has spread to more than one part of the body (any T, any N, M1b).

    Recurrent: Recurrent cancer is cancer that has come back after treatment. The disease may be found in the colon, rectum, or in another part of the body

    Diagnosis of Colon Cancer

    In addition to a physical examination, the following tests may be used to diagnose colorectal cancer. The doctor will also ask about your medical and family history.

    • As described in Screening, a colonoscopy allows the doctor to look inside the entire rectum and colon while a patient is sedated. If colorectal cancer is found, a complete diagnosis that accurately describes the location and spread of the cancer may not be possible until the tumor is surgically removed.
    • A biopsy is the removal of a small amount of tissue for examination under a microscope. A biopsy may be performed during a colonoscopy, or it may be done on any tissue that is removed during surgery. Sometimes, a CT scan or ultrasound is used to help perform a needle biopsy. A needle biopsy removes tissue through the skin with a needle that is guided into the tumor.
    • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy).
    • Blood tests. Because colorectal cancer often bleeds into the large intestine or rectum, people with the disease may become anemic. A test of the number of red cells in the blood, which is part of a complete blood count (CBC), can indicate that bleeding may be occurring.
    • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. In a person with colon cancer, a CT scan can check for the spread of cancer in the lungs, liver, and other organs. It is often done before surgery.
    • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow. MRI is the best imaging test to find where the colorectal cancer has grown.
    • Ultrasound is a procedure that uses sound waves to create a picture of the internal organs to find out if cancer has spread. Endorectal ultrasound is commonly used to find out how deeply rectal cancer has grown and can be used to help plan treatment; however, this test cannot accurately detect cancer that has spread to nearby lymph nodes or beyond the pelvis. Ultrasound can also be used to view the liver, although CT scans or MRIs are preferred because they are better for finding tumors in the liver.
    • Chest x-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. An x-ray of the chest can help doctors find out if the cancer has spread to the lungs.
    • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
    • Carcinoembryonic Antigen (CEA) Assay : CEA levels in the blood are measured in this test. The normal as well as cancer cells release CEA in the bloodstream. When these CEA is found in large amounts then it indicates colon cancer.
    • Proctoscopy: A proctoscope (a thin and tube-like instrument having light and lens for viewing) is inserted into the rectum in this rectum test. Sometimes removal of the tissue is also done by using a tool in order to check the presence of a disease by examining under a microscope.
    • Reverse-Transcription Polymerase Chain Reaction (RT-PCR) Test : Function of genes or the changes in the structure in a tissue sample are examined by using certain types of chemicals

    . Treatment of Colon Cancer

    Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. This is the most common treatment for colorectal cancer and is often called surgical resection. Part of the healthy colon or rectum and nearby lymph nodes will also be removed. In addition to surgical resection, surgical options for colorectal cancer include

    Laparoscopic surgery. Some patients may be able to have laparoscopic colorectal cancer surgery. With this technique, several viewing scopes are passed into the abdomen while a patient is under anesthesia. The incisions are smaller and the recovery time is often shorter than with standard colon surgery.

    Colostomy for rectal cancer. Less often, a person with rectal cancer may need to have a colostomy. This is a surgical opening, or stoma, through which the colon is connected to the abdominal surface to provide a pathway for waste to exit the body; such waste is collected in a pouch worn by the patient

    Radiofrequency ablation. Some patients may be able to have surgery on the liver or lungs to remove tumors that have spread to those organs. Another way is to use energy in the form of radiofrequency waves to heat the tumors, called radiofrequency ablation or RFA.

    Radiation therapy

    Radiation therapy is the use of high-energy x-rays to destroy cancer cells. It is commonly used for treating rectal cancer because this tumor tends to recur near where it originally started

    Chemotherapy

    Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is usually given by a medical oncologist, a doctor who specializes in treating cancer with medication.

    Targeted therapy

    Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

    Esophageal Cancer Treatment in India

    Esophagus cancer

    Esophageal cancer occurs when cancer cells develop in the esophagus, a tube-like structure that runs from your throat to your stomach. Food goes from the mouth to the stomach through the esophagus. The cancer starts at the inner layer of the esophagus and can spread throughout the other layers of the esophagus and to other parts of the body

    Esophageal cancer has been categorized into two types that include –

    Adenocarcinoma: This type of esophageal cancer starts in the glandular tissue in the lower part of the esophagus. The stomach and the esophagus appear together in this lower part of esophagus.

    Squamous Cell Carcinoma: Squamous cell carcinoma begins in the squamous cells lining the esophagus. This type of esophageal cancer typically occurs in the middle and upper part of the esophagus.

    Causes of Esophageal Cancer

    There are a number of factors which increase a person’s risk of developing esophageal cancer. They include:

    • Gastroesophageal reflux disease (GERD), in which contents and acid from the stomach back up into the esophagus, significantly increase the risk of adenocarcinoma of the esophagus.
    • Smoking or other use of tobacco.
    • Heavy alcohol use.
    • Barrett’s esophagus, a condition that affects the lower part of the esophagus and can lead to esophageal cancer

    Symptoms of Esophageal Cancer

    Early on there may be no symptoms. In more advanced cancers, symptoms of esophageal cancer include:

    Stages of Esophageal Cancer

    Staging of squamous cell carcinoma of the esophagus

    . There are separate staging systems for the two most common types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. The staging system for each is described below.

    Stage 0: This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

    Stage IA: This is the same as T1 cancer, in which the cancer is located in only the 2 inside layers of the esophagus (T1, N0, M0, G1).

    Stage IB: Either of these conditions:

    • The cancer is located in only the 2 inside layers of the esophagus, but the tumor cells are less differentiated (T1, N0, M0, G2 or G3).
    • The tumor is located in the lower part of the esophagus, and the cancer has spread to either of the 2 outer layers of the esophagus, but not to the lymph nodes or other parts of the body (T2 or T3, N0, M0, G1).

    Stage IIA: Either of these conditions:

    • The tumor is located in the upper or middle part of the esophagus, and the cancer is in either of the 2 outer layers of the esophagus (T2 or T3, N0, M0, G1).
    • The tumor is located in the lower part of the esophagus, and the cancer is in either of the 2 outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).

    Stage IIB: Either of these conditions:

    • The tumor is located in the upper or middle part of the esophagus, and cancer is in either of the 2 outer layers of the esophagus. The tumor cells are less differentiated (T2 or T3, N0, M0, G2 or G3).
    • Cancer is in the inner layers of the esophagus and has spread to 1 or 2 lymph nodes near the tumor (T1 or T2, N1, M0, any G).

    Stage IIIA: Any of these conditions:

    • Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor (T1 or T2, N2, M0, any G).
    • Cancer is in the outside layer of the esophagus and has spread to 1 or 2 lymph nodes (T3, N1, M0, any G).
    • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

    Stage IIIB: Cancer is in the outside layer of the esophagus and in 3 to 6 lymph nodes (T3, N2, M0, any G).

    Stage IIIC: Any of these conditions:

    • Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in 6 or less lymph nodes (T4a, N1 or N2, M0, any G).
    • Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).
    • Cancer has spread to 7 or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

    Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

    Staging of adenocarcinoma of the esophagus

    For adenocarcinoma, doctors use the T, N, and M classifications, as well as the grade (G).

    Stage 0: This is the same as Tis cancer, in which cancer is found in only the top lining of the esophagus (Tis, N0, M0, G1).

    Stage IA: This is the same as T1 cancer, in which the cancer is located in either of the 2 inside layers of the esophagus only (T1, N0, M0, G1 or G2).

    Stage IB: Either of these conditions:

    • The cancer is located in either of the 2 inside layers of the esophagus only, and the tumor cells are poorly differentiated (T1, N0, M0, G3).
    • The cancer has spread to an outer layer of the esophagus but not to the lymph nodes or other parts of the body (T2, N0, M0, G1 or G2).

    Stage IIA: Cancer is in an outer layer of the esophagus, and the cells are poorly differentiated (T2, N0, M0, G3).

    Stage IIB: Either of these conditions:

    • Cancer is in the outside layer of the esophagus but not beyond (T3, N0, M0, any G).
    • Cancer is in an inner layer or the muscularis propria of the esophagus and has spread to 1 or two lymph nodes (T1 or T2, N1, M0, any G).

    Stage IIIA: Any of these conditions:

    • Cancer is in the inner layers of the esophagus and has spread to 3 to 6 lymph nodes near the tumor (T1 or T2, N2, M0, any G).
    • Cancer is in the outside layer of the esophagus and has spread to 1 or 2 lymph nodes (T3, N1, M0, any G).
    • Cancer has spread beyond the esophagus to nearby tissue but not to lymph nodes or other areas of the body (T4a, N0, M0, any G).

    Stage IIIB: Cancer is in the outside layer of the esophagus and in 3 to 6 lymph nodes (T3, N2, M0, any G).

    Stage IIIC: Any of these conditions:

    • Cancer has spread beyond the esophagus into nearby tissue. Cancer is also in 6 or less lymph nodes (T4a, N1 or N2, M0, any G).
    • Cancer has spread beyond the esophagus into nearby tissue and cannot be removed by surgery (T4b, any N, M0, any G).
    • Cancer has spread to 7 or more lymph nodes but not to distant parts of the body (any T, N3, M0, any G).

    Stage IV: Cancer has spread to another part of the body (any T, any N, M1, any G).

    Recurrent: Recurrent cancer is cancer that has come back after treatment. It may come back in the esophagus or in another part of the body

    Diagnosis of Esophageal Cancer

    In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:

    • Barium swallow, also called an esophagram. The patient swallows a liquid containing barium and then a series of x-rays are taken.. Barium coats the surface of the esophagus, making a tumor or other unusual changes easier to see on the x-ray. If there is an abnormal looking area, your doctor may recommend an upper endoscopy and biopsy to find out if it is cancerous.
    • Upper endoscopy, also called esophagus-gastric-duodenoscopy, or EGD. An upper endoscopy allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus while the patient is sedated.. If there is an abnormal looking area, a biopsy will be performed to find out if it is cancerous. An endoscopy using an inflatable balloon to stretch the esophagus can also help widen the blocked area so that food can pass through until treatment begins.
    • Endoscopic ultrasound. This procedure is often done at the same time as the upper endoscopy. During an ultrasound, sound waves provide a picture of the wall of the esophagus and nearby lymph nodes and structures. The ultrasound is used to find out if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer has spread to the lymph nodes or other nearby structures.
    • Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a patient’s tumor is located in the upper two-thirds of the esophagus to find out if the tumor is growing into the person’s airway.
    • Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A biopsy is the removal of a small amount of tissue from the suspicious area for examination. A pathologist then analyzes the sample(s).
    • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy.
    • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail. This dye is generally injected into a patient’s vein.
    • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A contrast medium is usually injected into a patient’s vein to create a clearer picture.
    • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

    Treatment of Esophageal Cancer

    Treatment of esophageal cancer depends on many factors, including the stage of the cancer and the overall health of the patient.

    • Surgery . Part or all of the esophagus may be removed.

    Surgery for palliative care

    In addition to surgery to treat the disease, surgery may be used to help patients eat and relieve symptoms caused by the cancer. This is called palliative surgery. To do this, surgeons and gastroenterologists (doctors who specialize in the gastrointestinal tract) can:

    • Put in a percutaneous gastrostomy or jejunostomy, also called a feeding tube, so that a person can receive nutrition directly into the stomach or intestine. This may be done before chemotherapy and radiation therapy is given to make sure that the patient can eat enough food to maintain his or her weight and strength during treatment.
    • Create a bypass, or new pathway, to the stomach if a tumor blocks the esophagus but cannot be removed with surgery; this procedure is rarely used.
    • Radiation therapy. Kills cancer cells with radiation.
    • Chemotherapy. Powerful drugs that target cancer cells throughout the body. Typically used in combination with radiation therapy and/or surgery.

    ·         Endoscopic therapy

    The following treatments use an endoscope (see Diagnosis) to treat esophageal cancer and to manage side effects caused by the tumor.

    • Endoscopy and dilation. This procedure expands the esophagus. It may have to be repeated if the tumor grows.
    • Endoscopy with stent placement. This procedure uses an endoscopy to insert a stent in the esophagus. An esophageal stent is a metal, mesh device that is expanded to keep the esophagus open.
    • Photodynamic therapy. Photodynamic therapy is a palliative or supportive care option used to make swallowing easier, especially for people who cannot or choose not to have surgery, radiation therapy, or chemotherapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor and stays longer in cancer cells than in healthy cells. A light is then aimed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a short period of time, it does not cure esophageal cancer.
    • This type of palliative treatment helps kill cancer cells by heating them with an electric current. This is sometimes used to help relieve symptoms by removing a blockage caused by the tumor.
    • This is a type of palliative treatment that uses an endoscope with a probe attached that can freeze and remove tumor tissue. It can be used to reduce the size of a tumor to help a patient swallow better

    ·         Targeted therapy

    Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

    Uterine (Endometrial) Cancer Treatment in India

    Uterine Cancer

    The pear-shaped uterus is hollow and located in the pelvis of a woman between the bladder and rectum. The uterus is also known as the womb, where a baby grows when a woman is pregnant. It has three sections: the narrow, lower section called the cervix, the broad section in the middle called the isthmus, and the dome-shaped top section called the fundus.

    Endometrial cancer is the growth of abnormal cells in the lining of the uterus . The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.Endometrial cancer usually occurs in women older than 50

    There are two major types of uterine cancer:

    Adenocarcinoma. This makes up more than 80% of uterine cancers. It develops from cells in the lining of the uterus called the endometrium. This cancer is also commonly called endometrial cancer. A common type of endometrial adenocarcinoma is called endometrioid carcinoma, and treatment varies depending on the grade of the tumor, how far it goes into the uterus, and the stage or extent of disease. A less common type is called endometrial serous carcinoma, and this form is treated in a fashion similar to ovarian cancer which is also commonly of the serous type.

    Sarcoma. This type of uterine cancer develops in the supporting tissues of the uterine glands or in the myometrium, which is the uterine muscle. Sarcoma accounts for about 2% to 4% of uterine cancers. Sarcomas are treated differently than adenocarcinomas in most situations.  Types of endometrial cancers with some elements of sarcoma include leiomyosarcoma, endometrial stromal sarcoma or carcinosarcoma.

    . Symptoms of Uterine Cancer

    The most common symptom of endometrial cancer is abnormal vaginal bleeding, ranging from a watery and blood-streaked flow to a flow that contains more blood. Vaginal bleeding during or after menopause is often a sign of a problem.

    • Unusual vaginal bleeding, spotting, or discharge. For premenopausal women, menorrhagia, or abnormal uterine bleeding (AUB).
    • Difficulty or pain when urinating
    • Pain during sexual intercourse
    • Pain in the pelvic area

    Causes of Uterine Cancer

    • Being obese. Fat cells make extra estrogen, but the body doesn’t make extra progesterone to balance it out.
    • Taking estrogen without taking a progestin.
    • Taking tamoxifen. Tamoxifen reduces your risk for breast cancer but can increase your risk for endometrial cancer.
    • Polycystic ovary syndrome. This can cause you to produce too much estrogen and not enough progesterone.
    • Having naturally high levels of estrogen. This can cause women to start their periods before age 12 and delay menopause until after they are 52.

    Other things that increase your risk include:

    Stages of Uterine Cancer

    Stage 0: The tumor is called carcinoma in situ, which means it is very early stage cancer. It is found only in one layer of cells and has not spread (Tis, N0, M0).

    Stage I: The cancer is found only in the uterus or womb, and it has not spread to other parts of the body (T1, N0, M0).

    Stage IA: The cancer is found only in the endometrium or less than one-half of the myometrium (T1a, N0, M0).

    Stage IB: The tumor has spread to one-half or more of the myometrium (T1b, N0, M0).

    Stage II: The tumor has spread from the uterus to the cervical stroma but not to other parts of the body (T2, N0, M0).

    Stage III: The cancer has spread beyond the uterus, but it is still only in the pelvic area (T3, N0, M0).

    Stage IIIA: The cancer has spread to the serosa of the uterus and/or the tissue of the fallopian tubes and ovaries but not to other parts of the body (T3a, N0, M0).

    Stage IIIB: The tumor has spread to the vagina or next to the uterus (T3b, N0, M0).

    Stage IIIC1: The cancer has spread to the regional pelvic lymph nodes (T1 to T3, N1, M0).

    Stage IIIC2: The cancer has spread to the para-aortic lymph nodes with or without spread to the regional pelvic lymph nodes (T1 to T3, N2, M0).

    Stage IVA: The cancer has spread to the mucosa of the rectum or bladder (T4, any N, M0).

    Stage IVB: The cancer has spread to lymph nodes in the groin area, and/or it has spread to distant organs, such as the bones or lungs (any T, any N, M1).

    Diagnosis of Uterine Cancer

    An endometrial biopsy is needed to confirm a diagnosis of endometrial cancer. A biopsy removes a small sample of the lining of the uterus (endometrium) to be looked at under a microscope.

    Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily done to evaluate for cervical cancer.  However, sometimes a Pap test may occasionally find abnormal glandular cells, which are caused by uterine cancer

    Other tests may include:

    Treatment of Uterine Cancer

    reatments include:

    Surgery to remove the uterus (and cervix), ovaries, and fallopian tubes (hysterectomy with bilateral salpingo-oophorectomy). Common surgical procedures for uterine cancer include:

    Hysterectomy. Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, the upper part of the vagina, and nearby tissues)

    Lymph node dissection. At the same time as a hysterectomy, the surgeon may remove lymph nodes near the tumor to determine if the cancer has spread beyond the uterus.

    Sentinel lymph node biopsy. Sometimes a sentinel lymph node biopsy is performed. A sentinel lymph node biopsy is a procedure that helps the doctor find out whether cancer has spread to the lymph nodes

    • Hormone therapy
    • Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have receptors to the hormones on them. These tumors are generally adenocarcinomas and are grade 1 or 2 tumors.  Hormone therapy for uterine cancer often involves the sex hormone progesterone, given in a pill form

    Brachytherapy in India

    Brachytherapy

    Brachytherapy is an advanced cancer treatment. Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues. The term “brachy” is Greek for short distance. Brachytherapy is radiation therapy given at a short distance: localized, precise, and high-tech. The different types of cancers throughout the body are treated by Brachytherapy that may include –

    • Eye
    • Prostate
    • Vagina
    • Head and Neck
    • Rectum
    • Uterus
    • Skin
    • Gallbladder
    • Cervix
    • Breast
    • Lung

    Some of the tumors which can treat with brachytherapy are:

    • Prostate cancer
    • Breast cancer
    • Lung cancer
    • Esophageal cancer
    • Gynecologic cancers
    • Anal/Rectal tumors
    • Sarcomas
    • Head and neck cancers

    Equipments used in Brachytherapy

    For permanent implants, radioactive material (which is enclosed within small seeds or pellets) is placed directly in the site of the tumor using a specialized delivery device. For temporary implants, needles, plastic catheters or specialized applicators are placed in the treatment site. Different types of radioactive material may be used according to the type of brachytherapy; some types of radiation sources used in brachytherapy are: Iodine, Palladium, Cesium and Iridium. In all cases of brachytherapy, the source of radiation is encapsulated which means that the radioactive material is enclosed within a non-radioactive metallic capsule. This prevents the radioactive materials from entering the patient’s body.

    Brachytherapy Types

    • Internal radiation therapy

    Internal radiation therapy uses a radiation source that’s usually sealed in a small holder called an implant. The implant is placed very close to or inside the tumor, so that it harms as few normal cells as possible. Internal radiation therapy allows a higher dose of radiation in a smaller area than might be possible with external radiation treatment.

    • Intracavitary (IN-truh-KAV-uh-tair-ee) radiation, the radioactive source is placed in a cavity (space) in the body, such as the rectum or uterus.
    • interstitial (IN-ter-STIH-shul) radiation, the implants are placed in or near the tumor, but not in a body cavity.

    Types of Brachytherapy Implant

    Temporary Brachytherapy : This type involves the removal of the implants after the completion of the treatment. Balloons filled with fluid, hollow needles and catheters are the different types of implants that are used at the time of treatment that are removed after the completion of the treatment. Low dose or high dose Brachytherapy can also be used.

    Permanent Brachytherapy : Seeds or pellets small size implants are used in permanent Brachytherapy. The insertion of these implants is then done in the tumor through the hollow needles. The small-sized implants are then left in place as they do not result in any discomfort or pain.

    Brachytherapy Techniques

    There are three types of brachytherapy which can be used to treat cervical cancer:1

    • Low dose rate (LDR) brachytherapy
    • High dose rate (HDR) brachytherapy
    • Pulsed dose rate (PDR) brachytherapy

    All three types provide effective radiotherapy for cervical cancer, by placing a source of radiation directly next to the cancer. The difference between them is how often the radiation is delivered and how ‘intense’ the radiation is.

    Low dose rate (LDR) brachytherapy uses sources that give out a low level of radiation. To deliver the total dose of radiation, the sources have to remain next to the cancer for an extended period of time. Therefore, treatment is usually spread out over the course of one week and requires a stay in hospital.1

    high dose rate (HDR) brachytherapy uses sources that give out a higher level of radiation. The total dose of radiation can therefore be given in shorter sessions than LDR brachytherapy.1 As such, patients can often receive treatment on an outpatient basis (i.e. you may not need an overnight stay in hospital).
    Pulsed dose rate (PDR) brachytherapy is a cross between LDR and HDR brachytherapy. It provides short pulses of radiation to the cancer using a source that gives out a high level of radiation. However these pulses are spread out (e.g. one short pulse every hour) so that it simulates LDR brachytherapy

    Procedure of Brachytherapy

    Brachytherapy may be given on a permanent or temporary basis. In permanent brachytherapy, seeds containing the radioactive material are implanted either inside or nearby the tumor. Low dose radiation is gradually absorbed over time and eventually fades after six months.

    For temporary brachytherapy, a catheter or applicator is a used to deliver the radioactive material to a target site. In cases of low dose radiotherapy, this material is usually placed in the delivery device for 12 to 24 hours before being removed, while high dose radiation may only be administered for a few minutes. Various different radioactive sources are used in brachytherapy. Some examples include:

    • Radioactive iodine
    • Radioactive palladium
    • Radioactive cesium
    • Radioactive iridium

    Once the material is selected, it is delivered to the target site using one of two methods:

    • Hot loading – The radioactive material is placed manually and directly into the target tissue.
    • Afterloading – A delivery device is placed into position using imaging studies and then loaded with the radioactive material by hand (manual afterloading) or by an automated machine (automatic remote afterloading).

    Benefits of Brachytherapy

    • is very effective in treating cancer, as the radiation is delivered with a high level of accuracy
    • Has a minimized risk of side effects, due to the targeted and precise nature of delivering the radiotherapy from inside the body
    • Is a minimally invasive technique – i.e. it doesn’t involve extensive surgery
    • Can be performed on an outpatient basis – avoiding the need for an overnight stay in hospital in many cases
    • Requires very short treatment times (typically from 1 to 5 days)
    • Has short recovery times (typically 2 to 5 days) – people can usually return to everyday activities very quickly
    • Requires fewer visits to the hospital and overnight stays than other options
    • The benefits of brachytherapy can enable you to get back to your everyday life sooner with minimal disruption.

    How does brachytherapy compare to other treatments?

    In terms of the effectiveness of treatment, studies have shown that brachytherapy is comparable to external beam radiotherapy and surgery when treating many types of cancer. For some cancers, more than one type of treatment may be given. Brachytherapy can be used in combination with external beam radiotherapy (EBRT). This can help improve the overall effectiveness of the radiotherapy and limit the side effects from the radiation dose.

    Treatment Effectiveness Safety profile Treatment time
    Brachytherapy Effective in treating many types of cancer as the radiation is delivered with a high degree of precision from within the body. Radiation is precisely delivered from within the body reducing the risk of unnecessary damage to healthy tissues and organs close to the tumor. This helps reduce the risk of potential side effects. Can be completed in 1-5 days in total; often on an outpatient basis. Quick recovery times (typically 2 to 5 days).
    External beam radiotherapy (EBRT) ERBT is effective in treating a wide variety of cancers, as it can be used almost anywhere in the body. EBRT delivers radiation from outside the body. The radiation has to travel through healthy tissue to reach the tumor. Therefore more healthy tissues and organs may be exposed to the radiation. Typically completed over 6-8 weeks of small daily doses. As the radiation passes through healthy tissues, treatment has to be spaced out to limit damage to healthy cells.
    Surgery Surgery is very effective in treating tumors that are accessible and have not spread to other parts of the body. Surgery only affects the immediate area being operated on. It can cause scarring and often requires longer recovery times whilst the wound heals. Surgery is usually a one time procedure. It usually requires a stay in hospital and there is often a period of recovery time.
    Chemotherapy Chemotherapy is effective in treating many types of cancer. As the treatment (drug) is administered to the whole body it is effective in treating cancer that has spread. The chemotherapy drug is circulated throughout the whole body. Therefore a range of side effects are often experienced. Chemotherapy is usually given in cycles. This allows the cancer cells to be attacked at their most vulnerable time, and gives the body’s normal cells time to recover. Each treatment cycle could last minutes, hours, or days, depending on the cancer being treated.

    Hormone Therapy in India

    Hormone Therapy

    What hormones are

    Hormones are natural substances made by glands in our bodies. The network of glands that make hormones is called the endocrine system. Hormones are carried in our bloodstream and act as messengers between one part of our body and another. They have lots of effects and one of these is controlling the growth and activity of certain cells and organs

    What hormone therapy is

    Cancers that are hormone sensitive or hormone dependent need hormones to grow or develop. Hormone therapies can slow down or stop the growth of cancer by either

    • Stopping hormones being made or
    • Preventing hormones from making cancer cells grow and divide

    Some cancers use these hormones to grow. Hormone therapy for cancer is the use of medicines to block the effects of hormones. It does not work for all types of cancer. Doctors use hormone therapy for people with cancers that are hormone sensitive or hormone dependent.

    Cancers that can be hormone sensitive include

    Types of Hormone Therapy

    There are a number of different types of hormone therapy. The type you have depends on a number of factors, including your type of cancer. There is information below about

    Back to top

    Breast cancer hormone therapy

    The female hormones oestrogen and progesterone affect some breast cancers. Doctors describe these cancers as oestrogen receptor positive (ER+) or progesterone receptor positive (PR+) or both. Hormone treatment for breast cancer works by stopping these hormones getting to the breast cancer cells. There are different types of hormone therapies for breast cancer, such as

    • Tamoxifen : is one of the most common hormone therapies used for breast cancer. Both premenopausal women and postmenopausal women can take tamoxifen. It works by stopping the hormone oestrogen from reaching cancer cells. Some breast cancer cells have areas called receptors. When oestrogen locks onto the receptors, it can encourage the breast cancer cells to divide so that the cancer grows. Tamoxifen blocks these receptors
    • Aromatase inhibitors: You may have an aromatase inhibitor if you have been through the menopause. After menopause, your ovaries stop producing oestrogen. But your body still makes a small amount by changing other hormones (called androgens) into oestrogen. We need an enzyme called aromatase to make this change happen. Aromatase inhibitors block this enzyme so that it can’t change androgens into oestrogen.
    • Luteinising hormone (LH) blockers: A gland in the brain, called the pituitary gland, controls the amount of sex hormones made by the ovaries. In women, LH blockers are drugs that stop the ovaries making oestrogen or progesterone. They do this by blocking the signal from the pituitary gland to the ovaries

    Prostate cancer hormone therapy

    Prostate cancer depends on the male hormone testosterone for its growth. Hormone therapy aims to reduce or stop the body making testosterone to slow down or stop the growth of the cancer. There are different types of hormone therapy, including

    luteinising hormone (LH) blockers : A gland in the brain called the pituitary gland produces luteinising hormone (LH) that controls the amount of testosterone made by the testicles. LH blockers are drugs that stop the production of luteinising hormone. So the testicles stop making testosterone.

    anti androgens : Prostate cancer cells have areas called receptors. Testosterone attaches to these receptors and that can encourage the cells to divide so that the cancer grows. Anti androgen drugs work by attaching themselves to these receptors. So these drugs stop testosterone reaching prostate cancer cells. There are a few different types of anti androgen, including bicalutamide (Casodex), cyproterone acetate (Cyprostat) and flutamide (Drogenil)

    gonadotrophin releasing hormone (GnRH) blockers.: Gonadotrophin releasing hormone (GnRH) blockers stop messages from a part of the brain called the hypothalamus that tell the pituitary gland to produce luteinising hormone. Luteinising hormone tells the testicles to produce testosterone. So blocking GnRH stops the testicles producing testosterone. There is currently only one GnRH blocker and it is called degarelix (Firmagon).

    Womb cancer hormone therapy

    The female hormones oestrogen and progesterone affect the growth and activity of the cells that line the womb. Doctors give the hormone progesterone to help shrink larger womb cancers. Or it can treat womb cancers that have come back.

    There are different types of progesterone treatment, including medroxyprogesterone acetate (Provera) and megestrol (Megace).

    Hormone Replacement Therapy (HRT)

    Hormone replacement therapy (HRT) is a treatment used to relieve symptoms of the menopause. It replaces female hormones that are at a lower level as you approach the menopause. The menopause, sometimes referred to as the “change of life”, is when a woman’s ovaries stop producing an egg every four weeks.

    Symptoms of a drop in the Estrogen Levels

    One of the main symptoms of low estrogen in menopausal women is sleep disturbances. Not being able to sleep well can lead to extreme fatigue during the day, which is another typical sign of low estrogen.

    Because of sleep disturbances, women may also experience night sweats, heart palpitations and weight gain. In some cases, they may even have cold sweats. Other signs may include:

    • Drier skin, eyes and vagina
    • Joint pain
    • Headaches
    • Bladder and vaginal infections.
    • Decreased sex drive is another sign.
    • Depression which can result from symptoms

    Who Shouldn’t Take Hormone Replacement Therapy?

    If you have these conditions, you may want to avoid HRT:

    Indications for hormone replacement therapy

    Current indications for the use of HRT are:

    • For the treatment of menopausal symptoms where the risk:benefit ratio is favourable, in fully informed women.
    • For women with early menopause until the age of natural menopause (around 51 years), even is they are asymptomatic.
    • For those women under 60 years who are at risk of an osteoporotic fracture in whom non-oestrogen treatments are unsuitable.

    How Hormone Replacement Therapy is taken

    • This therapy can be taken in the form of an implant. The insertion of the small pellets of estrogen is done under the skin of thigh, tummy or buttock. This is done under local anesthesia.
    • This therapy can be taken in the form of tablets either through the mouth or can also be directly placed into the vagina for treating dryness.
    • HRT is given as a patch that will stick to the skin.
    • A gel or cream can also be applied either to the vagina for treating vaginal dryness or can also be applied to the skin.

    Benefits of Hormone Replacement Therapy (HRT)

    Perhaps the largest benefit women receive from hormone therapy is relief from:

    • Hot flashes
    • Night sweats
    • Sleep difficulties
    • Vaginal dryness
    • Anxiety

    Neuro Oncology in India

    Neuro-Oncology

    Neuro-oncology is the study of brain and spinal cord neoplasms, many of which are (at least eventually) very dangerous and life-threatening (astrocytoma, glioma, glioblastoma multiforme, ependymoma, pontine glioma, and brain stem tumors are among the many examples of these). Following are several objectives of neuro-oncology –

    • To know the prognostic factors that are influencing glioma outcome.
    • To treat primary peripheral and central nervous system tumors
    • Careful study of typical radiological appearance, prognosis and treatment options for the neurological complications of cancer such as epidural spinal cord compression and brain metastases.
    • Careful study of signs and symptoms of brain tumors in children and adults
    • Neurological complications associated with systemic cancer
    • Careful study of typical radiological appearance, prognosis and treatment options for primary brain tumors such as brain stem glioma, lowgrade glioma, medulloblastoma and glioblastoma.

    Brain Cancer

    Brain tumors are abnormal growths of cells in the brain.

    • Although such growths are popularly called brain tumors, not all brain tumors are cancer. Cancer is a term reserved for malignant tumors.
    • Malignant tumors can grow and spread aggressively, overpowering healthy cells by taking their space, blood, and nutrients. They can also spread to distant parts of the body. Like all cells of the body, tumor cells need blood and nutrients to survive.
    • Tumors that do not invade nearby tissue or spread to distant areas are called benign.
    • In general, a benign tumor is less serious than a malignant tumor. But a benign tumor can still cause many problems in the brain by pressing on nearby tissue.

    Symptoms of Brain Cancer

    The following symptoms are most common:

    Other nonspecific symptoms and signs include the following:

    • Altered mental status — changes in concentration, memory, attention, or alertness
    • Nausea, vomiting
    • Abnormalities in vision
    • Difficulty with speech
    • Gradual changes in intellectual capacity or emotional response

    Symptoms that may be specific to the location of the tumor include:

    • Pressure or headache near the tumor
    • Loss of balance and difficulty with fine motor skills is linked with a tumor in the cerebellum.
    • Changes in judgment, including loss of initiative, sluggishness, and muscle weakness or paralysis is associated with a tumor in the frontal lobe of the cerebrum.
    • Partial or complete loss of vision is caused by a tumor in the occipital lobe or temporal lobe of the cerebrum.
    • Changes in speech, hearing, memory, or emotional state, such as aggressiveness and problems understanding or retrieving words can develop from a tumor in the frontal and temporal lobe of the cerebrum.
    • Altered perception of touch or pressure, arm or leg weakness on one side of the body, or confusion with left and right sides of the body are linked to a tumor in the frontal or parietal lobe of the cerebrum.
    • Inability to look upward can be caused by a pineal gland tumor.
    • Lactation, which is the secretion of breast milk and altered menstrual periods in women, and growth in hands and feet in adults are associated with a pituitary tumor.
    • Difficulty swallowing, facial weakness or numbness, or double vision is a symptom of a tumor in the brain stem.
    • Vision changes, including loss of part of the vision or double vision can be from a tumor in the temporal lobe, occipital lobe, or brain stem.

    Brain tumor symptoms when the tumor is in the front of the brain (cerebrum)

    • Seizures
    • Visual changes
    • Slurred speech
    • Paralysis or weakness on half of the body or face
    • Increased intracranial pressure
    • Drowsiness and/or confusion
    • Personality changes

    Symptoms of a brain tumor in the brainstem (middle of brain) may include:

    • Seizures
    • Endocrine problems (diabetes and/or hormone regulation)
    • Visual changes or double vision
    • Headaches
    • Paralysis of nerves/muscles of the face or half of the body
    • Respiratory changes
    • Increased intracranial pressure

    Symptoms of a brain tumor in the cerebellum (back of brain) may include:

    • Increased intracranial pressure
    • Vomiting (usually occurs in the morning without nausea)
    • Headache
    • Uncoordinated muscle movements
    • Problems walking (ataxia)

    Brain Tumor Causes
    Primary brain tumor causes are largely unknown. Researchers believe most brain tumors are caused by a combination of events. Current areas of investigation focus on:

    • Genetic cell mutations
    • Defects
    • Viruses
    • Injury
    • Chemicals
    • Hormones
    • Environmental factors
    • Occupational factors

    Brain tumors are not contagious. It is clear, however, that a large portion of brain tumors result from other cancers, these are called secondary brain tumors

    Brain Tumor Diagnosis
    In addition to a complete medical history and physical examination, following tests to diagnose a brain tumor:

    • Angiogram is a procedure in which a dye allows a close inspection of all the blood vessels in the brain to aid in detecting certain types of tumors.
    • Bone Scan detects tumors and bone abnormalities. In a bone scan, a dye is injected and then absorbed by bone tissue so that X-rays can be taken.
    • Computed Tomography Scan (CT or CAT scan) is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal and vertical cross-sectional images (often called slices) of the body. A CAT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CAT scans are more detailed than general X-rays.
    • Functional Magnetic Resonance Imaging (fMRI) is used to map the functional area of a patient’s brain. This technique provides an added degree of precision in guidance and navigation during surgery and maximizes tumor resection while minimizing the possibility of weakness, blindness and speech loss.
    • Magnetic Resonance Imaging (MRI) is a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body.
    • MR SPECT is a highly effective method of scanning the brain that can detect tumors that other brain scans might miss. It is a noninvasive test that offers results in real time, decreasing the need for biopsies and other surgeries.
    • Neurological exam in which a physician tests reflexes, muscle strength, eye and mouth movement, coordination and alertness.
    • Stereotactic Biopsy is a procedure that obtains a specimen of the tumor so that a neuropathologist can analyze it. The goal of the biopsy is to confirm a diagnosis. This minimally invasive approach can be used to obtain a diagnosis either before proceeding with a craniotomy or instead of a larger procedure.

    Brain Tumor Treatment Options

    ·         Surgery

    Removing a growing brain tumour is important because as the tumour gets bigger it increases the pressure inside the head. It is this increased pressure that causes some of the symptoms of brain tumours. The surgeon is sometimes able to remove the whole tumour but often this is not possible and they can only remove part of it

    Radiation therapy: X-rays and other forms of radiation can destroy tumor cells or delay tumor growth. Some of the new methods are developed for delivering radiation therapy –

    Hyperfractionation: In this, small doses of radiation therapy are given 2-3 times a day instead of one.

    Radiosensitizers: In this, drugs are used for making cancer cells further sensitive to radiation. When radiosensitizers and radiation are combined together then it can damage more tumor cells.

    Stereotactic Radiosurgery: This type of therapy damages less healthy tissues and the radiation is delivered directly to the tumor. The exact location of the tumor is diagnosed with the help of MRI or CT scan.

    • Chemotherapy: The use of drugs to kill rapidly dividing cells. It can be taken orally or intravenously.
    • Targeted therapy: The focus on a specific element of a cell, such as molecules or pathways required for cell growth, in order to use them as a target.
    • Tumor Treating Fields: (A wearable device) locally or regionally delivered treatment that produces electric fields to disrupt the rapid cell division exhibited by cancer cells by creating alternating, “wave-like” electric fields that travel across their region of usage in different directions. Because structures within dividing cells have an electric charge, they interact with these electric fields.
    • Biological Therapy: In this therapy, the immune system of a patient is used in order to fight with cancer. The natural defenses of the body are restored to fight against cancer by using substances that are either made in the laboratory or are made by the body itself. This entire procedure is known as immunotherapy or biotherapy.
    • Hyperthermia Therapy: During this therapy, the tissue of the body is exposed to high temperatures to kill and damage cancer cells or these cancer cells can also be made more sensitive to the effects of radiation.
    • Gamma Knife Radiosurgery: Neurological diseases or disorders can be treated with the help of this surgery. In this non-invasive method, the brain is operated without using general anesthesia or by making any type of incisions.

    Cost of Brain Cancer Surgery

    The cost of brain cancer surgery in India is relatively lower than other developed countrie due to latest technology used in hospital and higly experienced and certified doctors for brain tumors…

    Novalis Tx Radiosurgery System in India

    Novalis Tx radiosurgery system

    Novalis Tx is a radiosurgery system that is one of the most advanced cancer treatments available. Radiosurgery is a highly precise form of radiation therapy that uses a beam of energy shaped to match the outline of the tumor. It delivers energy precisely where it is needed.

    The Novalis Tx uses a radiation beam that rotates around the patient. It can send energy anywhere in the body, from almost any direction.

    Because the Novalis Tx is so precise, your doctor can be confident that the best possible treatment dose is delivered while healthy tissue is protected. The focused beam can even adapt to your breathing, making it effective for treating some lung cancers.

    Other radiosurgery systems use a circular beam. Because most tumors have an irregular shape, the circular beam cannot cover them completely. Radiation treatment is not as precise.

    Novalis Tx radiation therapy for cancer

    Novalis Tx radiosurgery is used to treat brain, spine and other cancers.

    Brain tumors treated with Novalis Tx include:

    • Craniopharyngiomas
    • Gliomas
    • Skull base meningiomas
    • Brain tumors in children
    • Brain cancer that has recurred (come back) after treatment
    • Other types of cancer that have spread to the brain.

    Other tumors treated with Novalis Tx radiosurgery include:

    • Lung, liver and prostate cancer
    • Spinal cancer
    • Pituitary gland tumors
    • Acoustic neuromas

    Novalis Tx radiation therapy can also treat seizures, Parkinson’s disease and other non-cancerous conditions.

    Procedure of Novalis Tx Radiosurgery System

    High-tech radiation delivery system is used by Novalis Tx radiosurgery that makes use of motion management and image-guidance tools. A patient is required to lie down on a table and the machine then starts to rotate around the patient. The cancer-fighting shaped beams are then delivered from various angles for treating tumors located at different areas. The aim of Novalis Tx is to shape the radiation beam so as to match the tumor shape. This radiation beam destroys the tumor while sparing the nearby healthy tissue. The shape, size and location of the tumor are the factors that determine the number of treatments.

    Benefits of Novalis Tx radiosurgery

    Precise radiation therapy

    Using advanced imaging and computer systems, the Novalis Tx radiosurgery system shapes the radiation beam around your tumor. Novalis Tx radiation therapy even adapts to breathing and other body movements.

    Benefits of shaped beam treatment include:

    • The best possible treatment dose for the entire tumor
    • Healthy tissue is protected
    • Radiation treatments are safe, complete and accurate

    With Novalis Tx, the shaped radiation beam moves around you, and the radiosurgery treatment bed is fully adjustable. Both the beam and your position can be adjusted so radiation only reaches the area needing treatment.

    Faster radiation treatments

    Because the Novalis Tx radiosurgery system is so precise, treatment can often be delivered faster than with other forms of radiation therapy.

    • Treatment time can be as little as 15 to 20 minutes
    • More comfortable than other radiosurgery treatment options
    • Less chance of body movement, making treatment more accurate
    • Treatment can be as short as a single day

    .

    Personalized cancer treatment

    The Novalis Tx radiosurgery system can be used to deliver a wide range of treatments. This ensures that you get the best treatment for your condition. Other radiosurgery devices only deliver one type of treatment.

    • Novalis Tx can deliver a more powerful dose to treat tumors deep inside the body or brain
    • Some tumors previously considered untreatable can be helped with Novalis Tx

    Novalis Tx radiosurgery is a comfortable, non-invasive treatment

    With some forms of radiation therapy, patients wear a frame to keep the head still during treatment. The Novalis Tx system offers frameless radiosurgery, which is more comfortable for most patients. Depending on the area needing radiosurgery, you might wear a custom-fit mask to keep your head in the best position for treatment.In most cases, treatment with Novalis Tx is not painful.

    Cyberknife Radiation Therapy

    CyberKnife

    The CyberKnife Robotic Radiosurgery System is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. The treatment – which delivers beams of high dose radiation to tumors with extreme accuracy – offers new hope to patients worldwide.

    Though its name may conjure images of scalpels and surgery, the CyberKnife treatment involves no cutting. In fact, the CyberKnife System is the world’s first and only robotic radiosurgery system designed to treat tumors throughout the body non-invasively. It provides a pain-free, non-surgical option for patients who have inoperable or surgically complex tumors, or who may be looking for an alternative to surgery. These high dose radiation beams can be given from any angle by precisely concentrating on the tumor while causing minimum damage to the nearby healthy tissue and significant structures such as optic nerve or spinal cord.

    Types of Conditions Treated by the CyberKnife Surgery

    yberKnife treats intracranial (skull base) benign and malignant tumors, as well as spine tumors and lesions of the cervical, thoracic and lumbar regions.

    Some intracranial (head and brain) tumors and lesions that can be treated by CyberKnife are-

    • Acoustic neuroma
    • Anaplastic astrocytoma
    • Arteriovenous malformation (AVM)
    • Craniopharyngioma
    • DNET
    • Ependymoma
    • Gangliocytoma
    • Germinoma
    • Glioblastoma multiforme
    • Glioma
    • Glomus jugulare tumor
    • Hemangioblastoma
    • Hemangiopericytoma
    • Meningioma
    • Neurocytoma
    • Neurofibronna
    • Neurofibronnatosis
    • Oligodendroglioma
    • PNET
    • Pituitary adenoma
    • Schwannoma
    • Trigeminal neuralgia
    • Vestibular schwannoma

    Some, extracranial (outside of the head and brain) tumors and lesions that can be treated by CyberKnife are-

    • Colon cancer
    • Hepatocellular carcinoma
    • Nasopharyngeal carcinoma
    • Non-small cell lung cancer
    • Osteosarcoma
    • Ovarian cancer
    • Pancreatic cancer
    • Prostate cancer
    • Renal cell carcinoma
    • Squamous cell carcinoma
    • Small-cell lung cancer
    • Uterine cancer

    Additionally, CyberKnife is capable of full-body targeting for-

    • Thoracic surgery (lung)
    • General surgery (liver, pancreas and breast)
    • Head and Neck surgery (laryngeal, nasopharyngeal, glossal)
    • Urological surgery

    Benefits of Cyberknife Surgery

    • Painless
    • Non-invasive
    • No incisions
    • No recovery time
    • Zero or minimal side effects
    • Fewer treatments required
    • Outpatient procedure
    • Reduced risk of complications
    • Can treat recurrent tumors
    • Comfortable, fast and flexible –

    Cyberknife Treatment Procedures

    The CyberKnife system uses the combination of a robotics and image guidance to deliver concentrated and accurate beams of radiation to intracranial and extracranial targets, many of which are inoperable with sub- millimeter accuracy. The robotic arm is highly flexible, allowing access to tumors in difficult-to-reach locations.

    Step 1: Treatment Setup

    Imaging
    A special CT scan (called CT/Simulation) is acquired for every patient, and a MRI, if needed,  is also acquired.  Your physicians use the scans to identify the size, shape and location of the lesion/tumor along with the surrounding vital structures to be avoided.

    Making a Mask or Body Mold
    Depending on the need for treatment, a custom soft mask (for head/neck treatments) or body mold is formed and used to help minimize movement during the treatment and ensure your comfort.  The process is simple and painless.

    Fiducial Placement
    The treatment of body (non-head) lesion/tumor using the CyberKnife System requires the implantation of gold seeds referred to as fiducial markers.  These fiducial markers require a short outpatient procedure to implant 3-6 seeds in and/or around the tumor.  This will enable CyberKnife System to track the tumor  throughout the treatment. Lesions in the head and spine do not need this placement.

    Step 2: Treatment Planning

    Your previously obtained CT and MRI data are sent to the CyberKnife treatment-planning computer where the physicians’ team will use advanced  software to customize the radiation beams that the robot will deliver to the tumor or lesion during your treatment.  You do not need to be present during this step.

    Step 3: Treatment Delivery

    .

    Positioning
    You will be asked to lie on the treatment table and will be fitted with the custom mask or body mold made for you earlier during the set-up process.  In some cases a mild sedative will be given to you to help you relax, along with any other medication that may be needed during treatment.  In some cases anesthesia may be required; this evaluation will be done prior to treatment.

    Painless Treatment
    During treatment, you will need to lie still. You may sleep during the procedure.  The length of treatment varies depending on the location of your lesion/tumor. The image guidance system periodically compares x-ray images to the CT scan to ensure the radiation is targeted accurately at the tumor.

    Completion
    When your treatment session is completed, our nursing staff will do an assessment. When the nursing assessment has been completed, you will be released to home and may resume normal activity within 24 hours. Your physician will prescribe between 1 to 5 treatments.   To maximize your healing, we might insert rest days between the treatment days, depending on the treatment site.

    Follow-up
    As with any radiosurgery or radiation therapy procedure, your progress is likely to be monitored by follow up exams and imaging.

    When is Cyberknife a Suitable Treatment Option?

    Radiation therapy, surgery or chemotherapy are some of the traditional therapies that are used in combination with Cyberknife stereotactic radiosurgery. Following are the circumstances that requires Cyberknife system –

    • When a patient does not want to go through a traditional surgery
    • When a patient is unable to undergo a surgery
    • Recurrence of a tumor close to a significant structure like the spine, that previously received maximum dose of radiation
    • When surgery is not able to remove the entire diseased tissue
    • When tumor is located near to a significant structure like optic nerves where performing a traditional surgery can increase the risk of damage to these structures
    • When a surgical procedure is difficult to perform

    What is image-guided stereotactic radiosurgery?

    The CyberKnife system uses a distinctive radiosurgery device with a linear accelerator (Linac), which produces radiation mounted on a robotic arm. Through the use of image guided cameras, CyberKnife locates the position of the tumor. The Linac attached to the robotic arm is then used to deliver multiple beams of radiation while minimizing exposure to surrounding normal tissue. With sub-millimeter accuracy, CyberKnife is used to treat vascular abnormalities, tumors, functional disorders, and cancers of the body.

    Is CyberKnife safe?

    CyberKnife, does not present problems associated with traditional surgery. Mainly, there is no anesthesia or anesthesia after effects, the risk of infection and hemorrhaging are minimized. CyberKnife offers accurate precision within sub-millimeter distances and spares healthy tissues surrounding the targeted area.

    Through the use of continuous imaging, CyberKnife is able to compensate for patient movement, making uncomfortable head frames obsolete. Also, CyberKnife® uses a robotic arm as a radiation source, enabling many different body parts to be treated. This makes CyberKnife® much more convenient than the gamma knife, or other methods of stereotactic radiosurgery.

    After Treatment, when will my tumor or lesion disappear?
    The effects of radiosurgery occur gradually and over a period of time.  The timeframe can range from days, months or even years depending on the medical condition targeted.  Some tumors change slower than others and eventually disappear.  Others simply stop growing and present no further cell growth or activity.  After treatments patients typically are asked to get periodic images ( CT Scan or MRI) of their tumor(s) so that their physician can monitor the effectiveness of the radiation.

    . How is a CyberKnife “Radiosurgery” treatment different from a traditional Radiation therapy treatment?

    Traditional Radiation therapy typically delivers Radiation to a wide field of tissues in the body resulting in the treatment of both the Tumor and a large amount of surrounding healthy tissues. This is necessary because traditional Radiation therapy systems do not account for Tumor motion and are therefore less accurate. These wide radiation fields often increase the possibility of damaging the normal tissues and increasing the risk of side effects following the radiation treatment. To reduce the number of side effects, clinicians were forced to rethink the way traditional Radiation therapy was delivered. As a result, overall Radiation dose was reduced and number of treatments was divided into 30 – 40 sessions, delivered over a period.

    Radiosurgery devices, such as CyberKnife Robotic Radiosurgery System, are designed to deliver Radiation with extreme accuracy, targeting Tumor with minimal damage to the surrounding healthy tissues. The accuracy of the CyberKnife system allows clinicians to deliver very high doses of Radiation safely because the size of the Radiation field is small and includes only the Tumor and a small amount of surrounding tissue. This allows for less damage to surrounding healthy tissue and for clinicians to complete treatment in 1 to 5 days as compared to weeks it takes in traditional radiation therapy.

    Through the use of continuous imaging, CyberKnife is able to compensate for patient movement, making uncomfortable head frames obsolete. Also, CyberKnife uses a Robotic arm as a radiation source, enabling many different body parts to be treated. This makes CyberKnife much more convenient than the Gamma Knife, or other methods of Stereotactic Radiosurgery.

    How does CyberKnife System differ from other radiosurgery systems?

    Unprecedented targeting accuracy Many tumors have proven to move during treatment delivery – even when the patient is immobilized. Using advanced robotic technology and the ability to track tumor motion throughout the treatment, CyberKnife system can deliver radiation with extreme accuracy by automatically correcting tumor movement in real-time. While other technologies rely on static images taken prior to treatment, CyberKnife system automatically tracks, detects, and corrects for even the slightest motion that might occur during treatment delivery.

    Unrivaled conformality& dose gradient

    Unconstrained by the clockwise / counterclockwise rotations of conventional radiotherapy systems, the robotic mobility of the CyberKnife system enables beams to be delivered from a very wide array of unique angles. By approaching the target from hundreds of different angles, CyberKnife system sculpts delivered dose precisely to the unique contours of the target, while limiting exposure to surrounding critical structures.

    Unparalleled healthy tissue sparing

    As the only system capable of delivering beams that move real-time with 3D respiratory motion, CyberKnife system significantly reduces treatment margins. With smaller treatment margins, CyberKnife system focuses the prescribed dose to the intended target — not the surrounding healthy tissue.

    Can the elderly and children be treated with the CyberKnife?

    Since CyberKnife is less risky than traditional surgery it can be a suitable option for the elderly or for pediatric cases. Age is not a crucial factor in excluding patients from CyberKnife treatments. In the case of young children, a pediatrician, anesthesiologist and nurse anesthesiologist may be consulted to ensure the safety and comfort of the child during treatment.

    How many times can one receive a CyberKnife treatment?

    The frequency of treatments depends on where the tumor is located and what type of tumor is being treated. Most cases receive multi-treatments or can be re-treated with the CyberKnife system.

    Is CyberKnife Radiosurgery cost effective?

    Cost studies have shown radiosurgery to be less expensive than conventional surgery because it eliminates lengthy post-surgical hospital stays, expensive medication and sometimes months of rehabilitation.

    Stereotactic Radiosurgery and Radiotherapy in India

    Stereotactic Radiosurgery

    Stereotactic radiosurgery (SRS) is a form of radiation therapy that focuses high-power energy on a small area of the body. Despite its name, radiosurgery is a treatment, not a surgical procedure. Incisions (cuts) are not made on your body. Stereo means 3-dimensional (3-D) and tactic means to probe. Stereotactic radiation therapy allows radiation beams to be given to a very specific area, usually the brain.

    There are 2 ways to deliver stereotactic radiation therapy treatment.

    • Stereotactic radiosurgery (SRS) delivers a single high dose of radiation to the tumour (called a single fraction). This treatment doesn’t involve surgery. An incision (cut) is not made and tissue is not surgically removed.
    • Stereotactic radiotherapy (SRT) gives smaller doses of radiation over a number of treatment sessions (called multiple fractions), until the desired total dose is given.

    Diseases and Conditions Treated by Stereotactic Radiosurgery
    ·  rigeminal Neuralgia

    • Brain Metastases
    • Parkinson’s Disease
    • Some causes of Epilepsy
    • Acoustic Neuroma and other Head and Neck Cancers
    • Movement Disorders
    • Spinal Cord Tumors
    • Neurological Problems
    • Pituitary Tumors
    • Movement Disorders
    • Cancer of the Eye (Uveal Melanoma)
    • Blood Vessel Problems like Arteriovenous Malformations

    Types of Stereotactic Radiation

    Stereotactic Body Radiation Therapy (SBRT) also known as stereotactic ablative radiotherapy, administers very high doses of radiation, using several beams of various intensities aimed at different angles to precisely target the tumor. SBRT is used for treating:

    • Pediatric Cancers
    • Bladder Cancer
    • Lung Cancer
    • Head and Neck Cancers
    • Pancreatic Cancer
    • Liver Cancer
    • Kidney Cancer

    Stereotactic Radiosurgery (SRS) is a non-invasive treatment that uses dozens of tiny radiation beams to accurately target brain tumors with a single high dose of radiation. Despite its name, SRS is not a surgical procedure and does not require an incision or anesthesia. However, the radiation beams are as small and precise as a scalpel. SRS is primarily used for treating spinal and brain cancers.

    Equipments used for Stereotactic Radiosurgery

    Stereotactic radiation delivery (Equipment) systems include:

    Gamma Knife

    The Gamma Knife is not a knife. It is a machine that precisely focuses about 200 beams of gamma radiation (usually cobalt) at a tumour. The radiation is delivered at the point where the beams cross or intersect. It is usually given as a single high-dose treatment. The technique is sometimes called Gamma Knife surgery (GKS).

    Linear accelerator (LINAC)

    The LINAC machine delivers radiation in several x-ray beams that follow arcs. The treatment may be given over several sessions. Each session may take 30 minutes or longer.

    CyberKnife

    CyberKnife is an advanced type of linear accelerator. A robotic system points the linear accelerator in a variety of positions. Several x-ray cameras (or imaging devices) and computers are used to track the person’s position. If a person moves slightly, the robotic system can adjust. by repositioning the linear accelerator before the beam of radiation is delivered. This type of treatment may need to be given over a period of days.

    The use of CyberKnife is not limited to brain tumours. It can be used for tumours in other parts of the body, such as the spine or lung. Small, local tumours seem to benefit most from this treatment. A stereotactic frame is not needed, but other immobilization devices or special markers may be used.

    Procedure of Stereotactic Radiosurgery

    Stereotactic Radiosurgery by using Linear Accelerator (LINAC) :  This procedure is considered same as Gamma Knife procedure and has been categorized into 4 phases-

    • Imaging
    • Computerized Dose Planning
    • Head Frame Placement
    • Radiation Delivery

    Radiation beams are delivered from many angles using gantry (a part of the LINAC machine) that rotates around the patient. Large tumors can be effectively treated with less repositioning and more uniformity as it delivers larger x-ray beam.

    Stereotactic Radiosurgery Using the Gamma Knife: Four phases are involved in this procedure –

    • Placement of the Head Frame : Pins are used for attaching the skull with a box-shaped light- weight aluminum head frame. These pins prevent the movement of the skull till the treatment session finishes. This frame is primarily used for focusing gamma rays on the specific site where the treatment is required.
    • Imaging of the Tumor Location: Magnetic Resonance Imaging (MRI) or a computed tomography (CT) scan is performed for locating the precise location of the tumor in respect to the head frame.
    • Computerized Dose Planning : The tumor is then radiated by performing a computer-aided treatment plan.
    • Radiation Delivery : Radiation beams are then targeted on a specific area of the brain. These beams enter from the different holes in the helmet that is attached with the head frame so as to enable these beams to target the exact site in the brain. The treatment then starts and the patient talks to the physician by using a microphone present inside the helmet. A physician can see the patient during the procedure through a camera which is also there in the helmet. A click and a chime is then heard when the helmet locks into the radiation source. The entire procedure takes about 2-4 hours and the head frame is removed after the completion of the procedure.

    Intensity Modulated Radiation Therapy (IMRT) in India

    Radiotherapy

    Radiotherapy is a treatment involving the use of high-energy radiation. It’s commonly used to treat cancer.

    Almost half of all people with cancer have radiotherapy as part of their treatment plan.

    Radiotherapy is also sometimes used to treat benign (non-cancerous) tumours and other conditions, such as thyroid disease and some blood disorders.

    Radiotherapy can be used, alone or in combination with chemotherapy (chemoradiotherapy), to try to cure cancers.

    For people with incurable cancers, radiotherapy is a very effective way of controlling symptoms.

    Radiotherapy can also be used before surgery to shrink a tumour so it’s easier to remove (known as neoadjuvant treatment), or after surgery to destroy small amounts of tumour that may be left (known as adjuvant treatment).

    The calculation of the amount and type of radiation is done carefully so as to destroy cancer or abnormal cells. This entire procedure properly divides these cells for destroying them and causes little or no damage to the surrounding healthy cells.

    IMRT Radiation Therapy

    Intensity modulated radiotherapy (IMRT) is a type of conformal radiotherapy. Conformal radiotherapy shapes the radiation beams to closely fit the area of the cancer. Each radiotherapy beam is divided into many small beamlets that can vary their intensity. This allows different doses of radiation to be given across the tumour.

    IMRT can also create a U shaped (concave) area at the edge of the radiotherapy field. This avoids high radiation doses to structures that would otherwise be damaged by the radiotherapy. So IMRT can reduce the risk of long term side effects. It is very helpful in areas such as the head and neck, for example to avoid the spinal cord or salivary glands.

    The intensity of the radiation in IMRT can be changed during treatment to spare more adjoining normal tissue than is spared during conventional radiation therapy. Because of this an increased dose of radiation can be delivered to the tumor using IMRT. Intensity modulated radiation therapy is a type of conformal radiation, which shapes radiation beams to closely approximate the shape of the tumor.

    When IMRT is used?

    It’s mainly used  to treat breast, head and neck, prostate, bladder and lung cancers.

    Because IMRT can reduce the risk of damaging healthy tissue near the cancer, it’s sometimes used in situations where the tumour is very close to important organs or structures. For example,

    Intensity-modulated radiotherapy (IMRT).when IMRT is used to treat pelvic tumours, it can reduce the risk of long-term bowel problems.

    When it’s used for head and neck tumours, it can reduce damage to the salivary glands and the risk of permanent mouth dryness. It may also allow higher doses of radiotherapy to be given to the tumour

    Types of Cancer Treated with IMRT

    • Spinal Cord Cancer
    • Bone Cancer
    • Prostate Cancer
    • Head and Neck Cancer
    • Gastrointestinal Cancer
    • Brain Tumors
    • Lung Cancer
    • Gynecologic Cancer
    • Breast Cancer

    Procedure of IMRT

    The key behind IMRT is the use of inverse planning. Unlike standard approaches, the target and normal tissues are first contoured on a planning computed tomography (CT) scan. Computerized optimization programs are used to generate the intensity profile of each radiation beam (typically 7-9 are used).

    During this process, beams are divided into small “beamlets” and the intensity of each beamlet is individually optimized to satisfy pre-determined planning goals.

    When cast into the patient, these modulated beams produce highly conformal treatment plans. Rapid dose gradients outside the target result in considerable sparing of nearby normal tissues.

    Such plans are almost always superior to conventional plans, particularly in patients with complex-shaped targets.

    Facilitating the delivery of IMRT is a device known as a Multi-Leaf Collimator (MLC). Positioning in the machine head, the MLC has leaves which move in and out of the beam’s path under computer control.

    The longer the leaves are open, the higher the intensity; the longer they are closed, the lower the intensity.

    Treatment sessions : The painless IMRT treatment sessions begins that takes 10-30 minutes to complete. The type of cancer determines the number of treatment sessions.

    Benefits of IMRT

    • Improved target conformity, particularly for concave target volumes
    • Can produce intentional dose inhomogeneity—dose-painting
    • Increases normal tissue sparing
    • Enables dose escalation
    • Can compensate for missing tissue.

    Pet CT Scan in India

    PET (Positron Emission Tomography) scan

    A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning. A PET scan uses a radioactive drug (tracer) to show this activity.

    The tracer may be injected, swallowed or inhaled, depending on which organ or tissue is being studied by the PET scan. The tracer collects in areas of your body that have higher levels of chemical activity, which often correspond to areas of disease. On a PET scan, these areas show up as bright spots.

    A PET scan is useful in revealing or evaluating several conditions, including some cancers, heart disease and brain disorders.

    What does a PET scan show?

    • It can show the difference between active cancer tissue and scar tissue
    • The presence of a cancer can also be seen
    • It can also decide an appropriate treatment for cancer
    • It can also determine the stage of cancer
    • It can show the spread of the cancer to different parts of the body
    • It can show how the treatment for cancer is working
    • The presence of a lump in cancer can also be seen

    The use of PET scan for Doctors

    Doctors also use PET-CT scans to:

    conditions That can be examined with the help of PET scans include

    PET scans must be interpreted carefully because noncancerous conditions can look like cancer, and many types of cancer do not appear on PET scans. The types of cancer most likely to show up on PET scans include:

    • Brain
    • Breast
    • Cervical
    • Colorectal
    • Esophageal
    • Head and neck
    • Lung
    • Lymphoma
    • Melanoma
    • Pancreatic
    • Prostate
    • Thyroid

    Heart disease

    PET scans can reveal areas of decreased blood flow in the heart. This information can help you and your doctor decide, for example, whether you might benefit from a procedure to open clogged heart arteries (angioplasty) or coronary artery bypass surgery.

    Brain disorders

    PET scans can be used to evaluate certain brain disorders, such as:

    • Tumors
    • Alzheimer’s disease
    • Seizures
    • ·  Parkinson’s disease (a progressive disease of the nervous system in which a fine tremor, muscle weakness, and a peculiar type of gait are seen)
    • Huntington’s disease (a hereditary disease of the nervous system which causes increasing dementia, bizarre involuntary movements, and abnormal posture)
    • Epilepsy (a brain disorder involving recurrent seizures)
    • Stroke
    • To locate the specific area to be reached during brain surgery
    • To evaluate the brain after injury to look for a blood clot or bleeding in, or blood and oxygen flow to the brain tissue
    • To detect the spread of cancer to other parts of the body from the original cancer site
    • To see how well cancer treatment is working
    • To evaluate blood flow heart muscle to determine if treatment is needed to improve blood flow to the heart  and to determine the effects of a heart attack
    • To further identify lung lesions or masses seen on chest X-ray and/or chest CT
    • To look for cancers that have come back after treatment and find them earlier than can be done with other diagnostic tests

    How does a PET scan work

    Radiotracer : The first step before beginning a PET scan is to use a machine named cyclotron that helps in producing a radioactive medicine. A natural chemical that can be ammonia, glucose or water is tagged with the radioactive medicine. The name given to this tagged natural chemical is radiotracer. The insertion of this tracer is then done into the human body. The radiotracer will then travel to different areas within the body that makes use of the natural chemical. Fluorodeoxyglucose or FDG is a type of radioactive drug that shows the presence of cancers as cancers use glucose differently from normal tissue.

    Detecting Positrons : The energy emitted by a positron (a positively charged particle) can be detected by a PET scan. Positrons are made when the radiotracer is broken down within the body of patient. This looks like a 3-dimensional image on a computer screen.

    PET scan Images : The image will reveal the functioning of the different parts of the body when they are breaking down the radiotracer. The various levels of positrons will be displayed according to color and brightness by a PET image. The examination of the complete image is the done by a radiologist.

    Procedure of PET scans

    PET scans may be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

    Generally, a PET scan follows this process:

    1. You will be asked to remove any clothing, jewelry, or other objects that may get in the way of the scan. A bracelet with your name and an identification number may be put on your wrist. You may get a second bracelet if you have allergies.
    2. If you are asked to remove your clothing, you will be given a gown to wear.
    3. You will be asked to empty your bladder before starting the procedure.
    4. An intravenous (IV) line will be started in your hand or arm for injection of the radioactive tracer. (Depending on the type of PET scan you may inhale or swallow the tracer.)
    5. Certain types of scans of the abdomen (belly) or pelvis may require that a urinary catheter be put into the bladder to drain urine during the procedure.
    6. In some cases, an initial scan may be done before the radioactive tracer is injected, depending on the type of study being done.
    7. You will be in a chair or on a table in a quiet room.
    8. The radioactive tracer will be injected into your vein. The tracer will be allowed to concentrate in the organ or tissue for about 45 to 60 minutes. You will stay in the facility during this time and will be asked to rest quietly. You will not be hazardous to other people, as the tracer emits less radiation than a standard X-ray.
    9. After the tracer has been absorbed for a certain length of time, you will be positioned on a padded table inside the scanner ring and the scan will begin. The scanner will move slowly over the body part being studied.
    10. When the scan has been completed, the IV line will be removed. If a urinary catheter has been inserted, it will be removed, too.

    While the PET scan itself causes no pain, having to lie still for the length of the procedure might cause some discomfort or pain, particularly if you have recently had surgery or a joint injury. The technologist will use all possible comfort measures and complete the procedure as quickly as possible to minimize any discomfort or pain.

    Cost of a PET scan

    A PET scans has proved itself as an effective tool for diagnosing the cancer. The cost of a PET scan in India varies from Rs 6000 in case of government set-up and Rs 11,550 in case of private set-up. The radioactive material FDG determines the cost of PET scan.

    Surgical Oncology

    Surgical oncology is the branch of surgery applied to oncology; it focuses on the surgical management of tumors, especially cancerous tumors. Surgery is used to diagnose, stage and treat cancer, and to manage certain cancer-related symptoms.

    Conditions Treated by Surgical Oncology

    • Neuroendocrine Tumors of the Gastrointestinal Tract
    • Endocrine Cancer
    • Multiple Endocrine Neoplasia Types 1 and 2
    • Adrenal Gland
    • Thyroid
    • Stomach
    • Breast cancer
    • Pancreas
    • Liver
    • Rectum and Colon
    • Endocrine Cancer
    • Soft tissue sarcomas
    • Gastrointestinal cancer
    • Head and neck cancers
    • Parathyroid
    • Esophagus
    • Melanoma

    Surgical Oncology Procedures

    Thyroidectomy: The thyroid is a gland located at the base of your neck that produces hormones that affect your metabolism. When a person has a thyroid disorder, such as hyperthyroidism or cancer, a thyroidectomy may be performed to remove the thyroid. In this procedure, most or all of the thyroid gland is surgically removed.

    Pancreatico duodenectomy or Whipple: The Whipple Procedure, or pancreaticoduodenectomy, is the most commonly performed surgery to remove tumors in the pancreas. The Whipple procedure involves removal of the “head” (wide part) of the pancreas next to the first part of the small intestine (duodenum). It also involves removal of the duodenum, a portion of the common bile duct, gallbladder, and sometimes part of the stomach. Afterward, surgeons reconnect the remaining intestine, bile duct, and pancreas.

    Breast Surgery: Breast surgery is a form of surgery performed on the breast. Types include:

    Melanoma Excision: It Is a Surgery to remove a melanoma . The surgery removes the entire melanoma along with a border (margin) of normal-appearing skin. The width of the border of normal skin removed depends on the depth of the melanoma . More tissue, usually skin and fat, is also removed from under the melanoma.

    Rectal or Colon Resection: Bowel resection, also called partial colectomy, for colorectal cancer removes the tumor and part of the colon or rectum on either side.

    The goal of bowel resection is to take out the part of the colon or rectum where the cancer is. Nearby lymph nodes are taken out and tested for cancer. Then healthy parts of the colon or rectum are sewn back together. Bowel resection is done either by opening the abdomen (open resection) or by laparoscopy.

    Distal Pancreatectomy: A distal pancreatectomy is where the bottom half of the pancreas is removed by a surgical procedure. The most frequent reason for performing a distal pancreatectomy is the presence of a tumor in the body or tail of the pancreas. njury, pancreatic cancer, pancreatic pseudocysts and chronic pancreatitis can be treaded.

    Gastrectomy: Stomach cancer is often treated with a total gastrectomy, a complex surgery performed to remove the entire stomach.

    Liver Resection: A liver resection, or partial hepatectomy, is a surgical procedure to remove tumors in the liver. Removing the cancerous portion of the liver may help to prevent the disease from spreading more. To perform a liver resection surgery, the surgeons make an incision below the ribcage, across the right side of the upper abdomen. An ultrasound device is used to find the liver tumor(s). The diseased portion of the liver is then removed, along with some adjoining healthy liver tissue.

    Lymph Node Dissection: Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. n a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.[

    Esophagectomy: Open esophagectomy is surgery to remove part or all of the esophagus. This is the tube that moves food from your throat to your stomach. After it is removed, the esophagus is rebuilt from part of your stomach or part of your large intestine.

    Most of the time, esophagectomy is done to treat cancer of the esophagus or a severely damaged stomach.

    Surgical Oncology Techniques

    Minimally Invasive Surgery:

    Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgeryLaparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs . Laparoscopy is used to find problems such as cysts, adhesions, fibroids , and infection. Tissue samples can be taken for biopsy through the tube (laparoscope).

    Anal sphincter preserving surgery

    Anal sphincter preserving surgery is used on tumors that affect the lower portion of the rectum. This surgery helps selected patients to avoid a colostom

    Chemoembolization

    Chemoembolization is a two-step procedure. First, chemotherapy is delivered directly to the tumor using narrow tubes called catheters, which reach the treatment area using a tiny skin puncture. Next, embolization may be used to cut off blood supply to the tumor. This starves the tumor of oxygen and nutrients and at the same time, traps the anticancer drug at the treatment site, allowing for a greater therapeutic effect.

    Cryosurgery

    Cryosurgery is the use of extreme cold to destroy abnormal tissue

    Particle breast treatment

    Particle breast treatment is a five-day treatment alternative to breast radiation for women with certain smaller, early-stage breast cancers

    Radiofrequency ablation

    Radiofrequency ablation is an image-guided technique that uses heat to destroy cancer cells. A needle electrode is guided to the tumor and high frequency electrical currents are applied. Most often used to treat liver disease, this technique may be used in combination with chemotherapy or radiation therapy.

    Robotic surgery

    Robotic surgery is one of the most recent advances in minimally invasive surgery. During robotic surgery, the use of the surgical robot helps our surgeons to operate with greater precision, leading to improved surgical outcomes.

    Sentinel Lymph Node (SLN) Biopsy :

    A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present.

    Medical Oncology in India

    Medical Oncology

    The treatment of cancer with the help of certain agents and drugs that travels in the entire system of the body for destroying cancer cells and simultaneously also helps the body to defend itself is the main focus of both medical oncology and hematology. This is assumed as a systemic treatment as compared to radiation oncology that only focuses on treating a particular part of the body. Chemotherapy, drugs and certain other related therapies such as hormone therapies and biological response modifiers are used in medical oncology for treating cancers.
    Hormone Therapy : This therapy is considered as a systemic treatment and is also known as endocrine-based therapy. Hormone therapy interferes with certain hormones (natural body chemicals) that help in stimulating the growth of the cancer. Some cancers use these hormones to grow. Hormone therapy for cancer is the use of medicines to block the effects of hormones. It does not work for all types of cancer. Doctors use hormone therapy for people with cancers that are hormone sensitive or hormone dependent. Hormone therapies can slow down or stop the growth of cancer by either

    • Stopping hormones being made or
    • Preventing hormones from making cancer cells grow and divide

    Chemotherapy: Chemotherapy literally means drug treatment. In cancer treatment, the term chemotherapy means treatment with cell killing (cytotoxic) drugs. You may have just one chemotherapy drug or a combination of different chemotherapy drugs. There are more than 100 different drugs currently available and new ones are being developed all the time. You may have chemotherapy with other types of cancer drugs. These drugs can be injected into a vein (intravenously) that enters into the bloodstream and travels through the entire body. Chemotherapy can also be administered in pill form. Whether chemotherapy is a suitable treatment for you, and which drugs you might have, depends on many things. These include

    • The type of cancer you have
    • Where in your body the cancer started
    • What the cancer cells look like under the microscope (the grade)
    • Whether the cancer has spread
    • Your general health

    There are different types of chemotherapy drugs that include

    Alkylating agents

    Alkylating agents directly damage DNA (the genetic material in each cell) to keep the cell from reproducing. These drugs work in all phases of the cell cycle and are used to treat many different cancers, including leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma, as well as cancers of the lung, breast, and ovary

    Antimetabolites

    Antimetabolites interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells during the S phase, when the cell’s chromosomes are being copied. They are commonly used to treat leukemias, cancers of the breast, ovary, and the intestinal tract, as well as other types of cancer

    Anti-tumor antibiotics

    These drugs are not like the antibiotics used to treat infections. They work by altering the DNA inside cancer cells to keep them from growing and multiplying.

    Anthracyclines

    Anthracyclines are anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle. They are widely used for a variety of cancers.

    Topoisomerase inhibitors

    These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied during the S phase. (Enzymes are proteins that cause chemical reactions in living cells.) Topoisomerase inhibitors are used to treat certain leukemias, as well as lung, ovarian, gastrointestinal, and other cancers

    Mitotic inhibitors

    Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products. They work by stopping mitosis in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell reproduction

    Corticosteroids

    Corticosteroids, often simply called steroids, are natural hormones and hormone-like drugs that are useful in the treatment of many types of cancer, as well as other illnesses. When these drugs are used as part of cancer treatment, they are considered chemotherapy drugs

    How chemo is given

    Examples of regional chemo include drugs given into these parts of the body:

    Intra-arterial – injected into an artery that goes to a certain area of the

    body

    Intravesical – put into the bladder

    Intrapleural – put into the chest cavity between the lung and chest wall

    Intraperitoneal – put into the belly (abdomen) around the intestines and other organs

    Intrathecal – put into the central nervous system (brain and spinal cord)

    Intralesional/intratumoral – injected right into the tumor

    Topical – applied to the skin as a cream or lotion

    Reasons for giving Chemotherapy Drugs

    1. Chemotherapy drugs controls the cancer and enhances the quality of life
    2. The drugs helps in treating those cancers that react well to chemotherapy
    3. The resistance of cancer cells can be overcome by giving these drugs in higher dosages
    4. The size of the tumors is decreased with the help of these drugs that also provides for a safer removal.
    5. The cancer-killing effectiveness is also increased of other treatments like radiation therapy

    Molecular or Targeted Therapy

    Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules (“molecular targets”) that are involved in the growth, progression, and spread of cancer. Targeted cancer therapies are sometimes called “molecularly targeted drugs,” “molecularly targeted therapies,” “precision medicines,” or similar names.

    What is Hematology?

    Hematology is the science or study of blood, blood-forming organs and blood diseases. The medical aspect of hematology is concerned with the treatment of blood disorders and malignancies, including types of hemophilia, leukemia, lymphoma and sickle-cell anemia. Hematology is a branch of internal medicine that deals with the physiology, pathology, etiology, diagnosis, treatment, prognosis and prevention of blood-related disorders. Hematology science involves the five types of white blood cells — neutrophils, monocytes, lymphocytes, eosinophils and basophils. Red blood cells are also known as erythrocytes. Following tools are used for managing the blood diseases –

    • Stem cell transplant and bone marrow transplant
    • Removal and addition of blood components as required
    • Chemotherapy
    • Immunosuppressive drugs
    • Biological therapy for malignant and benign blood disorders
    • Growth factor drugs

    Common Conditions of Blood Diseases

    • Thrombocytopenia
    • Anemia
    • Multiple Myeloma
    • Leukemias
    • Primary Amyloidosis
    • Immune Cytopenias
    • Porphyria
    • Clotting and bleeding disorders
    • Myeloproliferative disorders
    • Hematologic Malignancies
    • Myelofibrosis with Myeloid Metaplasia
    • Immune Cytopenias
    • Monoclonal Gammopathies of Undetermined Significance
    • Enlarged Lymph Nodes or Spleen
    • Myelodysplastic Syndromes
    • Lymphoproliferative disorders
    • Hypercoagulable States and Platelet Disorders

    Radiation Oncology

    Radiation oncology is a medical specialty that involves treating cancer with radiation. Doctors who specialize in treating cancer with radiation (radiation oncologists) use radiation therapy to treat a wide variety of cancers.

    Radiation therapy uses carefully targeted and regulated doses of high-energy radiation to kill cancer cells. Radiation causes some cancer cells to die immediately after treatment, but most die because the radiation damages the chromosomes and DNA so that the cells can no longer divide and the tumor can’t grow.

    The type of radiation therapy prescribed by a radiation oncologist depends on many factors, including:

    • The type of cancer.
    • The size of the cancer.
    • The cancer’s location in the body.
    • How close the cancer is to normal tissues that are sensitive to radiation.
    • How far into the body the radiation needs to travel.
    • The patient’s general health and medical history.
    • Whether the patient will have other types of cancer treatment.
    • Other factors, such as the patient’s age and other medical conditions.

    Radiation Therapy Treatment Options

    Radiation can come from a machine outside the body (external-beam radiation therapy) or from radioactive material placed in the body near cancer cells (internal radiation therapy, more commonly called brachytherapy)

    External-beam radiation therapy

    Intensity-modulated radiation therapy (IMRT): IMRT uses hundreds of tiny radiation beam-shaping devices, called collimators, to deliver a single dose of radiation (2). The collimators can be stationary or can move during treatment, allowing the intensity of the radiation beams to change during treatment sessions. This kind of dose modulation allows different areas of a tumor or nearby tissues to receive different doses of radiation.

    Image-guided radiation therapy (IGRT): In IGRT, repeated imaging scans (CT, MRI, or PET) are performed during treatment. These imaging scans are processed by computers to identify changes in a tumor’s size and location due to treatment and to allow the position of the patient or the planned radiation dose to be adjusted during treatment as needed.

    Tomotherapy: Tomotherapy is a type of image-guided IMRT. A tomotherapy machine is a hybrid between a CT imaging scanner and an external-beam radiation therapy machine (6). The part of the tomotherapy machine that delivers radiation for both imaging and treatment can rotate completely around the patient in the same manner as a normal CT scanner.

    Stereotactic radiosurgery: Stereotactic radiosurgery (SRS) can deliver one or more high doses of radiation to a small tumor (5, 8). SRS uses extremely accurate image-guided tumor targeting and patient positioning. Therefore, a high dose of radiation can be given without excess damage to normal tissue.

    Stereotactic body radiation therapy: Stereotactic body radiation therapy (SBRT) delivers radiation therapy in fewer sessions, using smaller radiation fields and higher doses than 3D-CRT in most cases. By definition, SBRT treats tumors that lie outside the brain and spinal cord. Because these tumors are more likely to move with the normal motion of the body, and therefore cannot be targeted as accurately as tumors within the brain or spine.

    Proton therapy: External-beam radiation therapy can be delivered by proton beams as well as the photon beams described above. Protons are a type of charged particle.

    Other charged particle beams: Electron beams are used to irradiate superficial tumors, such as skin cancer or tumors near the surface of the body, but they cannot travel very far through tissue (1). Therefore, they cannot treat tumors deep within the body.

    Internal radiation therapy

    Internal radiation therapy (brachytherapy) is radiation delivered from radiation sources (radioactive materials) placed inside or on the body . Several brachytherapy techniques are used in cancer treatment. Interstitial brachytherapy uses a radiation source placed within tumor tissue, such as within a prostate tumor. Intracavitary brachytherapy uses a source placed within a surgical cavity or a body cavity, such as the chest cavity, near a tumor. Episcleral brachytherapy, which is used to treat melanoma inside the eye, uses a source that is attached to the eye.

    In brachytherapy, radioactive isotopes are sealed in tiny pellets or “seeds.” These seeds are placed in patients using delivery devices, such as needles, catheters, or some other type of carrier. As the isotopes decay naturally, they give off radiation that damages nearby cancer cells.

    The placement of brachytherapy sources can be temporary or permanent (1, 12):

    • For permament brachytherapy, the sources are surgically sealed within the body and left there, even after all of the radiation has been given off. The remaining material (in which the radioactive isotopes were sealed) does not cause any discomfort or harm to the patient. Permanent brachytherapy is a type of low-dose-rate brachytherapy.
    • For temporary brachytherapy, tubes (catheters) or other carriers are used to deliver the radiation sources, and both the carriers and the radiation sources are removed after treatment. Temporary brachytherapy can be either low-dose-rate or high-dose-rate treatment.

    Systemic Radiation Therapy

    Systemic radiation therapy is a type of radiation therapy in which radioactive material travels through the bloodstream to reach cells all over the body. Systemic radiation is used to treat certain types of cancer, such as thyroid cancer, or to relieve pain when cancer has spread (metastasized) to the bone.