Cancer - The Beast Within

  1. General

Statistics tell us that 1 in 2 men and 1 in 3 women will be affected by cancer during their life. There are a myriad of reasons why some people are more prone to getting cancer than others such as use of tobacco, diet, lack of exercise, genetics, family history, workplace issues, and environmental issues to name a few. Some of the risk factors can be controlled totally or at least to a certain degree. Others are totally out of our control-genetics and family history for example. In any event, if one sees his doctor often and obtains appropriate screenings, the early warning signs of cancer can be seen and treatment started in order to avoid future severe consequences where possible.

Most physicians will agree that stopping smoking is one of the most significant things one can do in order to help prevent cancer. Not only can smoking cause direct cancer to the larynx, lungs, mouth and esophagus, but it can also lead to cancers in other parts of a patient’s body. Some statistic show that a person who smokes two packs of cigarettes a day is 20 times more likely to develop cancer that someone who does not smoke. Indeed, stopping smoking also leads to longer lives according to statistical analysis.

Clearly, choices people make with lifestyles and food also can assist in cancer prevention. A low fat diet with fiber is considered the optimum way to avoid cancer caused by dietary issues. A good personal exercise program assists in keeping a person in good physical shape and helps ward off certain cancers as well. For example, it is suggested that a person should exercise 30-50 minutes 4-6 times per week in order to stay in good physical shape.

There are certain cancers that tend to run in families because of race or ethnicity. Being aware of family history and telling your doctor about such history will assist the physician to be observant about any predispositions for cancer.

Sometimes, a person can be susceptible to cancer because of their work environment. Clearly, exposure to asbestos is a cancer risk. Exposure to too much sun can cause skin cancer. Smoking or being exposed to second hand smoke can lead to lung cancer. Exposure to dangerous solvents or chemicals or fumes from merely existing or burning chemicals or solvents can lead to cancer. A good way to determine whether you are exposed to workplace dangers is to ask your employer for a copy of their material safety data sheet for all substances that are available or inherently present in the workplace.

It is normal for cells to grow, divide and die. However, sometimes cells mutate or change and divide more quickly than normal cells. These cells can lump together and cause tumors. Sometimes the tumors are cancerous or malignant. Malignant tumors can invade the remaining tissues in the body and can spread to other areas of the body by a process known as metastasizing and cause formation of tumors in other parts of the body. Usually, tumors that are not malignant do not metastasize. Essentially, cancers are the product of cells growing out of control.

Cancer staging is a process where the physician determines how serious the cancer is in the body. Stage I, for example, means the cancer is usually only within the specific layer of tissue involved and has not spread to other parts of the body. Stage II would mean that the cancer has become more invasive. Stage III means that the cancer has spread to the lymph nodes and the risk is quite high at that point. Stage IV means the cancer has spread to other parts of the body. This spread is what is known as metastasis. A metastasized cancer cannot be cured.

  1. Standard of Care for Different Cancers

It is important that your physician recognize cancer signs at the earliest opportunity. Many cancers are far more susceptible to early treatment regimens. The most severe consequences of cancers develop when the cancer cells grow out of control because of failure to detect the cancer signs early. The longer a tumor is allowed to grow, the more likely it will spread to other parts of the body or become much more difficult, if not impossible, to control or eliminate. Moreover, cancer that has grown for a long time is much more difficult to successfully treat.

Women are susceptible to breast cancer. Therefore, early screening of potential issues with breast cancer is paramount. Certainly, the first step would be for the physician to test by clinical exam for any lumps in the breast. Most physicians indicate that once a woman reaches 40 years of age, she should obtain a mammogram every 1-2 years in addition to a clinical breast examination for lumps. A woman with family history of breast cancer might even have mammograms started earlier and have them more often than someone without a family history. Earlier detection of breast cancer has substantially reduced the death rate among women that contract the disease since it is often successfully treated.

Most tumors that develop in the breast are not malignant. Although some are cancerous, they often are non invasive and have not spread to other parts of the body. These types of breast cancer are very treatable. Breast cancers are the second most common cancers contracted by women. Skin cancer is the first most common.

Similarly, women are susceptible to cervical cancer. Most physicians would agree that a Pap smear every three years would be the standard of care. By testing cells from Pap smear, the physician can determine whether the woman has what is referred to as human papiloma virus (HPV). Several types of HPV are associated with cervical cancers. Locating and treating abnormal cells before they develop can help avid later more significant problems.

Endometrial where the lining of the uterus has cancer is most often found in women who have gone through menopause. Bleeding or spotting from the vagina is an early warning sign of this type of cancer. Ovarian cancer involves one or both ovaries. Ovarian cancer can be more difficult to detect. Usually, the treating Ob/Gyn will check the ovaries during a normal pelvic exam to determine whether they appear to be normal. However, if the tumor is small, it can be more difficult to detect. Unfortunately, the Pap smear which is good tool for checking for cervical cancer, is not effective in determining whether endometrial or ovarian cancer exists.

A woman with high levels of estrogen or a woman over 50 years of age may be more susceptible to endometrial cancer. If a woman is put on estrogen therapy without using progestin it may increase the risk of endometrial cancer. If a woman has used the medicine known as tamoxifen, she may also be more susceptible to endometrial cancer.

If there is a suspicion of endometrial cancer, the physician should perform a biopsy to test for cancerous or pre cancerous cells. Similarly, performing a dilation and curettage (D&C) where the cervix is widened and the uterine wall is scraped or suctioned is also utilized to collect and test tissue. Where a patient has diabetes, high blood pressure, is very obese or who may have other cancer, often the procedure of choice should be utilization of imaging tests such as an MRI, CT Scan or ultrasound to help diagnose possible cancer of the uterus.

If endometrial cancer is found, the physician should remove the uterus, the fallopian tubes and the ovaries. Progestin therapy may be necessary as well to balance the estrogen levels. As with many cancers, this cancer is very treatable if found early.

One of the more common cancers in men is prostate cancer. By a digital rectal exam a trained physician can determine if your prostate is firm and rubbery which is considered normal or whether there are any hard spots on the prostate which are considered abnormal. If there are any suspicions because of an abnormal digital rectal exam, a biopsy would likely be suggested to determine if there are abnormal cells on the prostate. Similarly, regular blood testing for protein specific antigen (PSA) is recommended. If the PSA is elevated, it can be suggestive of possible prostate issues that need to be further explored. Total reliance on PSA levels, however, is not recommended since infection can cause elevated levels and/or the levels themselves may be misleading. Prostate cancer can metastasize to other parts of the body if not checked regularly. The treating physician should be alert to symptoms such as frequent urination, less urinating force, blood or pus in the urine, pain while urinating, pain with ejaculation, hip and low back pain, pelvis pain, weight loss.

There are various modalities of treating prostate cancer. If it is suspected that there is chance of metastasis, a radical prostatectomy should be performed. A procedure called DaVinci laproscopic prostatectomy is used by some skilled urologists because it is considered to be more able to save the nerve bundles surrounding the prostate which means there is less likelihood of incontinence and/or impotency.

Colorectal cancer is another very treatable cancer if discovered early. Colon cancer originates in the large intestine. Rectal cancer originates in the rectum. Usually, colorectal cancer starts as a polyp in the colon. Eventually, the polyp can get larger and grow into a cancer and spread throughout the body. A physician should be very careful to determine if the patient has symptoms such as cramping in the lower stomach, urge to have bowel movement when there is no need, significant unexpected weight loss, blood discharge from the rectum, blood in the toilet after bowel movement, prolonged change in stools or long term constipation. If one or more of these symptoms appear, the physician will likely order a fecal occult blood test to determine the existence of non visible blood in the stool, examine the colon by sigmoidoscopy, conduct a barium enema test where x-rays are taken to observe any possible spots that are suspicious, or observe the entire colon by performing a colonoscopy. Colon cancer is rare in younger people so screening usually begins more rigorously after age 50.

Skin cancer is non discriminatory. It can happen to anyone at any age. It is particularly important for the physician to look at moles to determine whether there is any abnormality present. The physician should look for discoloration, abnormal growth pattern, the size of the mole, and the edges of the mole. Often, skin screening involves use of what is commonly referred to as the ABCDE rule. A stands for asymmetry where the physician looks for a mole that might be divided and does not look the same on both sides. B stands for border where the physician checks the borders of moles to determine whether the edges are irregular. C stands for color. Discoloration, darkening, loss of color or multiple colors raise the suspicion index for the physician. D. stands for diameter. If a mole is larger than ¼ inch in diameter, a physician should be very careful with any such mole. E stands for elevation. A physician should be very suspicious of any mole that is raised above the skin and which contains an uneven surface.

Melanoma is a type of skin cancer that is very dangerous and life threatening. It can spread to through the whole body. If diagnosed early it is treatable. If not diagnosed early it can be fatal. A physician should be particularly aware that in men a melanoma is frequently found on the chest or back and in women it is frequently found on the legs. Often, the melanoma does not look threatening at first. It is thought that children who had sunburns at an early age are most likely susceptible to melanoma. These cancers must be removed immediately. Often this involves what is known a Moh’s surgery where the physician, aided by a pathologist during the procedure, removes the smallest portion of skin surrounding the melanoma as possible and tests the margins to determine if enough was removed. If not, cutting our more of the surrounding area is performed until the margins are safe. Sometimes, more radical surgery is required, depending on how invasive it is believed that the melanoma is.

Lung cancers can either be non small cell and small cell. Non small cell lung cancer is more common in adults. It usually grows more slowly and metastasizes more slowly. Most experts agree that small lung cell cancer is almost always caused by smoking.

Multiple myeloma involves cancer in the bone marrow. Plasma cells are over produced and form tumors which kill the bone cells around them. It also prevents other blood cells from being made that the body needs. The physician must recognize the symptoms of multiple myeloma which include bone pain, bone fractures frequently occurring, weakness and fatigue, confusion, constipation or increased urination.

If a physician suspects possible multiple myeloma he should order an x-ray to determine if there is any areas of bone loss. Similarly, blood tests should be performed to determine of there are adequate iron levels in the blood or whether the calcium levels are heightened, Moreover, blood tests can also assist in determining whether the kidneys are working appropriately. One of the gold standards fro determining whether multiple myeloma has invaded the spine is an MRI. A conclusive test to determine whether multiple myeloma is present is called a bone marrow aspiration where a needle is inserted into the bone to obtain a small sample of tissue.

Although there is presently no effective cure for multiple myeloma, one can be treated for pain (often prednisone) and chemotherapy (often melphalan) to destroy abnormal cells or slow the progress of the disease. Other treatment modalities can include radiation or bone marrow transplant.

Nasopharyngeal cancer is a malignant tumor that invades the nasopharynx which is located near the back part of the nose near the throat and where the tubes from the ears open into the throat. Although this type of cancer is rare in America, Chinese men and men from Southeast Asia seem more susceptible to it. A lump in the neck is an early possible sign of this cancer which should be identified by the physician. Problems with an ear, nosebleeds, headaches, ringing in the ear, or neurological deficits on one side of the face might also be suggestive of a problem worthy of further consideration. If this type of cancer is suspected, the physician should perform and endoscopy to determine whether the cancer can be visualized. A biopsy sample should be taken and tested as well. Moreover, an MRI should likely be pursued to determine the size of the tumor. Treament can involve radiation and chemotherapy. Like many cancers, if the treating physician is alert and catches this cancer early, it is very treatable.

Osteosarcoma is a bone cancer that is found most often in children and teenagers. It frequently originates in the leg bone or shoulder and metastasizes to other areas. If the patient complains of a dull aching pain in the bone or joint, swelling or a lump, muscle atrophy on one side of the body, the physician must consider osteosarcoma as part of the differential diagnosis. An x-ray will usually demonstrate whether an osteosarcoma is present. An MRI or CT Scan is further demonstrative as to whether bone destruction has occurred as a result of the tumor or whether there has been any invasion by the tumor into the surrounding muscles or other soft tissues. The treating physician should order a biopsy when the differential diagnosis either does or should include an osteosarcoma. Unfortunately, some infections and osteosarcomas can look similar by these diagnostic tests and should be confirmed by biopsy. Moreover, a CT Scan should be ordered to determine whether the osteosarcoma has spread to the lungs. The treatment regimen should usually involve chemotherapy and/or surgery. Statistics reveal that if this type of tumor is caught early, treatment can be quite successful. Joint replacement may be necessary at times but with therapy, many normal activities can be performed thereafter.

Testicular cancer often occurs in young men. A treating physician should determine if the medical history of the patient involved surgery at a young age to remove an undescended testicle or has other predispositions to testicular cancer. The physician should palpate the testicle to determine whether there is a hard painless lump on the testicle. He should also ask the patient if he has pain in the scrotum or whether the scrotum feels heavy. This type of cancer is very treatable if found early. The physician will likely recommend the removal of the cancerous testicle and some type of chemotherapy, especially if the cancer has metastasized.

Stomach cancer or what is sometimes referred to as gastric cancer, involves growth of cancer cells along the wall of the stomach. The treating physician must be aware that symptoms of this type of cancer involve indigestion, nausea and loss of appetite, feeling tired, blood in the stools, vomiting after meals, stomach pain and a bloated feeling. Because many of these symptoms are also not symptoms of just cancer, the careful physician should include caner as part of the differential diagnosis until proven otherwise. A complete [physical exam would be a necessity. Similarly, any significant suspicions should suggest the need for an endoscopy along with a biopsy sample and lab testing of the suspicious area involved. Treatment modalities would include possible surgery, chemotherapy and radiation. This cancer can metastasize and thus should be diagnosed and treated at the earliest time possible.

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