DIAGNOSIS OF CANCER
Diagnosis of Cancer
The Diagnosis of Cancer involves three sets of investigations
Confirmation of Diagnosis, by biopsy which we discussed in the last issue
Staging workup, to see the extent of disease locally, its spread and the operability
General Investigations, to assess the general fitness of the patient to undertake the treatment
The routine investigations to asses the general fitness of the patient include blood tests for hemoglobin, white cell count, sugar, liver function tests, kidney function tests, proteins and electrolyte(to detect nutritional deficiencies) and blood grouping
X Rays
X-ray chest to see the state of the lungs and any spread to the lungs
X-rays of the limbs, head, spine are done when cancers of the bone are suspected, or in cancers of muscles, to see the involvement of bones
Ultrasound
Ultrasound of the Abdomen -This is a simple OPD procedure, which is cheap, painless, fast and very informative. Besides giving details of the cancers of the abdominal organs (digestive system, kidneys, liver, gall bladder and female organs like uterus, ovary etc) it is helpful in showing the spread to the liver and the nodes.
Ultrasound of the neck is done to see the nodes in the neck and for glands like the thyroid
Ultrasound of the breast and other swellings on the limbs are done too to see if the swelling contains water or is solid
Scopy
Scopy is an investigation where the inside of a hollow organ is seen by an instrument which has fiber optic light. It not only shows the cancer or the disease but also can be used to take a biopsy, stop bleeding, and put stents to bypass blocks and perform other procedures
Usually done without anesthesia
Upper Gastrointestinal Scopy
This is for the stomach and the upper intestines. This is done through the mouth and can also be used to see the pancreatic duct and the bile duct. ERCP(Endoscopic Retrograde Cholangio Pancreatico graphy) is done by this too
Broncoscopy is done through the nose to see the air passage and the lungs
Nasopharyngoscopy is done to see the inside of the nose, through the nose
Laryngoscopy is done to see the Larynx (Voice Box) through the nose
Colonoscopy is done through the rectum to see the large intestines
Doppler
Doppler is done over blood vessels (artery and veins) to see the blood flow in them, and to find the involvement of the vessels or any compression on them by the tumor. This is like the ultrasound and done externally
Computerized Axial Tomography
Commonly called CAT scan or CT scan, this is a very common investigation done to see the extent of the cancer. It gives a very good picture of the cancer, the organs involved, and the local and distant spread. It is however a little expensive and not available in all the hospitals in our country. It is very helpful in cancers of the chest, abdomen and brain and is a great help in deciding the extent of surgery and the treatment for the patient
MRI (Magnetic Resonance Imaging)
Like Tuscan, MRI is a very helpful investigation to see the internal organs, specially the bones, spine, limbs and the head
Radioactive Scans
These are done by injecting radioactive dyes specific for particular organ and subsequently picking up the radio sensitivity by special cameras. They help to see the involvement of various organs and the functioning. Commonly done scans are for bone, liver, kidney and thyroid gland
Tumor Markers
These are tests done on blood. Tumor Markers are substances which are normally not found in the blood or found in very small quantities. The presence or rise of these in the blood is an indicator of cancer. It is very good investigation to see the response to treatment in which situation it will fall to normal and for follow-up of cancer patients, where rise in the levels after treatment indicates relapse. Following are some common tumor markers
CA-125 for cancer of ovary
PSA (Prostates Specific Antigen) for cancer prostate
CEA (Carcinoma Embryonic Antigen) for cancer of large intestines and rectum
AFP (Alpha Fetor Protein) for cancer of testis and liver
BHCG (Beta Human Chronic Gonadotropin) for cancer of testis and ovary
Calcitonin for Medullary carcinoma of thyroid
Thyroglobulin for cancer of thyroid
Sunday, August 9, 2009
KNOW MORE ABOUT CANCER
KNOW MORE ABOUT CANCER
Myths and Facts About Cancer
Though cancer has existed since very long, its detailed knowledge is just over a century old in the history of medicine. And in spite of its significant prevalence and adequate efforts to spread cancer awareness amongst the common man, by all concerned, there are still a large number of myths existing, regarding cancer even in the mind of educated people.
· Age:- Cancer is not the disease of old age only, it can occur in any age and at times .Even a baby can be born with cancer.
· Survival and Cure Diagnosis of Cancer does not mean a death warrant. Cancer can be cured if detected early and a large number of patients survive several years and at times even normal life after having cancer
· Spread:- Cancer is not contagious, It does not spread by staying in the same house or by touch .
· Use of Knife:- People feel that use of knife for biopsy or surgery can spread cancer, but it is not so. Biopsy is essential to diagnose most cancers and plan treatment and surgery where ever possible is the most effective method of treatment in majority of cancers. It removes or decreases the diseased part and makes chemotherapy and radiotherapy more effective
·
Early signs of Cancer:-
Early detection of cancer is the most important way of curing it. So we must all be very careful of early signs of Cancer. They can be summarized as follows
C hange in bowel or bladder habits
A sore that does not heal
U nusual bleeding or discharge
T hickening or lump in breast or elsewhere
I ndigestion or difficulty in swallowing
Obvious change in an existing wart or mole
N agging cough or hoarseness of voice
Besides the above Cancer warning signals, one should consult a doctor in the eventuality of unexplained weight loss, continuous prolonged fever, or general weakness. Patients with family history of cancer or those who have had cancer in the past ,or who have had exposure to radiation or are working in an industry where they are in contact with chemicals are at high risk for cancer and should be careful, and undergo periodic checkups
The routine checkups advised in our country for common cancers is as follows
Woman • Cancer of Cervix - PAP Smear Test every 2-5 years from the age of 35
• Cancer Breast -Mammography every 5 years from the age of 35 years
• Self Breast Examination every month
• Breast examination by the doctor every 2-5 years
Men • Prostate - PSA (Prostatic Specific Antigen ) every 5 years from the age of 45years
• Colon and Rectum -Stool for occult blood and per rectal examination every 2-5 years from the age of 45 years
Stages of Cancer:-The first question that every patient or the relative ask after diagnosis of cancer is that what is the stage of cancer? Though all cancers have their specific staging systems, there are following four broad stages. Stages 1 and 2 have very good chances of cure, but unluckily more than half of the patients in our country report for treatment in stage three and four due to lack of facilities and ignorance.
Stage 1 The cancer is restricted to the organ or site of origin
Stage 2 The cancer has spread locally outside the organ or site of origin
Stage 3 The Cancer has spread to the nodes
Stage 4 The Cancer has spread to distant organs ( Metastatic Cancer )
Diagnosis of Cancer:-
Proper diagnosis of cancer is essential for starting correct treatment, and diagnosis can be achieved by various methods. The two common methods are Cytology and Histopathology
Cytology:- Here the diagnosis is made by seeing cancer cells in the material sent for testing
Fine Needle Aspiration Cytology or Biopsy (FNA/FNAB):- Here cells are aspirated from the tumor or cancerous lump by a thin (FNAB) needle and seen under a microscope, This is a very simple test, done without anesthesia or hospitalization and has significantly high accuracy. This is generally done for growths which are under the skin, specially cancer of the breast, thyroid, liver etc. FNAC on cancers of deeper or small organs can be done under guidance of ultrasound or CT Scan
Cytology of Fluids:- In certain cases cancer can also be diagnosed on finding cancer cells in fluids collected in the body cavity, like the abdomen or thorax or in urine
Histopathology:- This is the best method of diagnosis. Here a biopsy is taken from the cancerous part for diagnosis. A node, complete growth or a part of it can be removed and biopised
Endoscopic Biopsy:- Biopsy of the foodpipe, stomach and intestines is done by endoscopy and colonoscopy and of the airway by bronchoscopy
Stereostatic Biopsy:- Biopsy of small lesions or lesions in structures like brain are done after being localalised by fine needles under CTSan guidance
Myths and Facts About Cancer
Though cancer has existed since very long, its detailed knowledge is just over a century old in the history of medicine. And in spite of its significant prevalence and adequate efforts to spread cancer awareness amongst the common man, by all concerned, there are still a large number of myths existing, regarding cancer even in the mind of educated people.
· Age:- Cancer is not the disease of old age only, it can occur in any age and at times .Even a baby can be born with cancer.
· Survival and Cure Diagnosis of Cancer does not mean a death warrant. Cancer can be cured if detected early and a large number of patients survive several years and at times even normal life after having cancer
· Spread:- Cancer is not contagious, It does not spread by staying in the same house or by touch .
· Use of Knife:- People feel that use of knife for biopsy or surgery can spread cancer, but it is not so. Biopsy is essential to diagnose most cancers and plan treatment and surgery where ever possible is the most effective method of treatment in majority of cancers. It removes or decreases the diseased part and makes chemotherapy and radiotherapy more effective
·
Early signs of Cancer:-
Early detection of cancer is the most important way of curing it. So we must all be very careful of early signs of Cancer. They can be summarized as follows
C hange in bowel or bladder habits
A sore that does not heal
U nusual bleeding or discharge
T hickening or lump in breast or elsewhere
I ndigestion or difficulty in swallowing
Obvious change in an existing wart or mole
N agging cough or hoarseness of voice
Besides the above Cancer warning signals, one should consult a doctor in the eventuality of unexplained weight loss, continuous prolonged fever, or general weakness. Patients with family history of cancer or those who have had cancer in the past ,or who have had exposure to radiation or are working in an industry where they are in contact with chemicals are at high risk for cancer and should be careful, and undergo periodic checkups
The routine checkups advised in our country for common cancers is as follows
Woman • Cancer of Cervix - PAP Smear Test every 2-5 years from the age of 35
• Cancer Breast -Mammography every 5 years from the age of 35 years
• Self Breast Examination every month
• Breast examination by the doctor every 2-5 years
Men • Prostate - PSA (Prostatic Specific Antigen ) every 5 years from the age of 45years
• Colon and Rectum -Stool for occult blood and per rectal examination every 2-5 years from the age of 45 years
Stages of Cancer:-The first question that every patient or the relative ask after diagnosis of cancer is that what is the stage of cancer? Though all cancers have their specific staging systems, there are following four broad stages. Stages 1 and 2 have very good chances of cure, but unluckily more than half of the patients in our country report for treatment in stage three and four due to lack of facilities and ignorance.
Stage 1 The cancer is restricted to the organ or site of origin
Stage 2 The cancer has spread locally outside the organ or site of origin
Stage 3 The Cancer has spread to the nodes
Stage 4 The Cancer has spread to distant organs ( Metastatic Cancer )
Diagnosis of Cancer:-
Proper diagnosis of cancer is essential for starting correct treatment, and diagnosis can be achieved by various methods. The two common methods are Cytology and Histopathology
Cytology:- Here the diagnosis is made by seeing cancer cells in the material sent for testing
Fine Needle Aspiration Cytology or Biopsy (FNA/FNAB):- Here cells are aspirated from the tumor or cancerous lump by a thin (FNAB) needle and seen under a microscope, This is a very simple test, done without anesthesia or hospitalization and has significantly high accuracy. This is generally done for growths which are under the skin, specially cancer of the breast, thyroid, liver etc. FNAC on cancers of deeper or small organs can be done under guidance of ultrasound or CT Scan
Cytology of Fluids:- In certain cases cancer can also be diagnosed on finding cancer cells in fluids collected in the body cavity, like the abdomen or thorax or in urine
Histopathology:- This is the best method of diagnosis. Here a biopsy is taken from the cancerous part for diagnosis. A node, complete growth or a part of it can be removed and biopised
Endoscopic Biopsy:- Biopsy of the foodpipe, stomach and intestines is done by endoscopy and colonoscopy and of the airway by bronchoscopy
Stereostatic Biopsy:- Biopsy of small lesions or lesions in structures like brain are done after being localalised by fine needles under CTSan guidance
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