What treatments are available for breast cancer

You need to see a doctor if you notice changes in your breast. Not all breast cancers or breast cancer patients are alike, therefore treatment will vary with the individual.An individual's chance for recovery depends upon a number of factors such as:

• The stage of the cancer (whether it is just in the breast or has spread to other parts of the body)
• The type of breast cancer
• The certain characteristics of the cancer cells
• Your age and weight
• Menopausal status
• Overall state of health

Treatments for early breast cancer can include limpectomy (limited surgery which removes the cancer but not the entire breast) followed by radiation therapy, or breast reconstruction after mastectomy (surgical removal of the breast.) Additional treatment may include chemotherapy or hormone therapy. Biological therapy (using the body's own immune system to fight cancer) and bone marrow transplantation are new methods that are currently being tested in clinical trials. Often, two or more methods are used in combination.An individual with breast cancer should fully review all of the options with a physician before deciding upon the proper treatment program.Once breast cancer has been found, more test are conducted to see if the cancer has spread from the breast to other parts of the body. The spreading of cancer in this manner is called metastasis. Doctors need to know the stage of the disease - how large the tumor is, and if there are cancer cells beyond the breast - to plan the proper treatment.

Listed below are the basic stages of breast cancer:

STAGE I - The cancer is no wider than 2 centimeters (about 1 inch) and has not spread outside the breast.

Stage II - The tumor is more than 2 cm but less than 5 cm in the greatest dimension.

Stage III - Tumor is more than 5 cm in the greatest dimension.

Stage IV- Tumor of any size with growth extending to the chest wall or skin.

Even after an individual has been treated for breast cancer, it is possible for the cancer to come back (recur). However in most cases, the cancer can be treated, but usually cannot be cured, once the breast cancer has spread to other parts of the body.

What causes breast cancer?

Cancers have many different causes and sources. One of these sources is a group of chemicals called carcinogens. These carcinogens have been found in industrial pollutants, pesticides, and food additives. People who are exposed to these carcinogens through their occupation or other activities have been known to be more susceptible to cancer. The development of cancer also has been closely linked to heredity. A genetic mutation (a change in the genetic code) could be passed to a child through the sperm or egg. A family history of cancer could be due to a dominant gene that makes cancer more likely to be passed down from generation to generation.

Some of the following are symptoms that can be associated with cancer. The acronym, C.A.U.T.I.O.N., can remind us of the most common warning signs of cancer.

• C - Change in bowel or bladder habits
• A - A sore that does not heal
• U - Unusual bleeding or discharge
• T - Thickening or lump in the breast or any part of the body
• I - Indigestion or difficulty swallowing
• O - Obvious change in a wart or mole
• N - Nagging cough or hoarseness

(From "Cancer Facts", National Cancer Institute, National Institutes of Health)

What Is Breast Cancer?

Breast cancer is a tumor that has become malignant - it has developed from the breast cells. A 'malignant' tumor can spread to other parts of the body - it may also invade surrounding tissue. When it spreads around the body, we call it 'metastasis'.

A woman's breast consists of lobules. Lobules are milk-producing glands. The breast is also full of ducts - milk passages that connect the lobules to the nipple. There is also fatty and connective tissue surrounding the ducts and lobules - this is called stroma.

The most common breast cancers start in the cells around the ducts. Others can start in the cells that line the lobules. A smaller number of breast cancers can start in other parts of the breast.

The human body has two ways of moving fluid about. One is through the blood stream, which carries plasma, red and white blood cells and platelets. Lymphatic vessels carry tissue fluid, waste products and infection fighting cells (immune system cells). Immune system cells are located in the lymph nodes - the nodes are shaped like a bean.

It is common for cancer cells to grow in the lymph nodes. They get there via the lymphatic vessels.

The lymphatic system of the breasts connect to the lymph nodes in three areas: Under the arm (axillary lymph node), in the chest (internal mammary node) and by the collarbone (supra or infraclavicular node).

Doctors guess that if cancer cells are in the lymphatic system, they are most likely to be in the bloodstream and will spread to other organs in the body. It is very hard to test for breast cancer cells in the bloodstream.

If breast cancer cells have got to the nodes under the arm (axillary), it will most likely swell. Whether or not it has swollen there, will decide what type of treatment a patient should have. If cancer cells are found in more lymph nodes, then the likelihood of it turning up in different parts of the body is greater. However, there is no hard and fast rule here. Women have had swellings in many nodes and did not develop metastases, while some women with no swellings in their nodes did.

What is the treatment for anal cancer?

Treatment for anal cancer will depend on various factors, including how big the tumor is, whether or not it has spread, where it is, and the general health of the patient. If the tumor is small it can be removed surgically, and that's it.

The type of surgery a patient will require depends on the size and position of the tumor.

Resection - this removes a small tumor and some surrounding tissue. This type of surgery can only be carried out if the anal sphincter is not sacrificed. Patients who undergo a resection do not have their ability to pass a bowel movement affected.

Abdominoperineal resection - the anus, rectum and a section of the bowel are surgically removed. The patient will need a colostomy - the end of the bowel is brought out onto the skin on the surface of the abdomen. A bag is placed over the stoma - the opening of the bowel - and collects the stools (feces) outside the patient's body. Although this sounds shocking, people with colostomies can lead normal lives, play sports and have active sex lives.

In most cases, the patient will probably have to undergo chemotherapy and/or radiotherapy.

Chemotherapy and radiotherapy

Radiotherapy combined with chemotherapy treatments (chemoradiation) are commonly used to destroy the anal cancer cells. Treatments are either given simultaneously or consecutively. This combined therapy approach has led to a much higher percentage of patients with an intact anal sphincter - survival and cure rates are good.

Chemotherapy uses cytotoxic drugs (antineoplastics) - cytotoxic drugs prevent the cancer cells from dividing. They are administered either by injection or orally.

Radiotherapy uses high-energy rays that destroy the cancer cells. This can be given by an external beam or internally (brachytherapy).

How is anal cancer diagnosed?

The first person to see will probably be a GP (general practitioner, primary care physician). The GP will ask the patient about his/her symptoms and carry out an examination. The doctor will also need to know about the patient's medical history. Then the patient will be referred to a colorectal surgeon - this is a doctor who specializes in bowel conditions. Colorectal surgeons are sometimes called proctologists. The specialist may carry out the following tests:

• A rectal examination - this may be a bit uncomfortable, but is not painful. A proctoscope or sigmoidoscope may be used - an instrument that allows the doctor to examine the area in more detail. In some countries this device is called an anoscope, and the procedure 'anoscopy'. The examination will determine whether the patient needs a biopsy.


• A biopsy - a small sample of tissue is taken from the anal area and sent to the lab for testing. Tissue will be examined under a microscope.

If cancerous tissue is detected after the biopsy the patient will need further tests to find out how advanced (big) the cancer is and whether or not it has spread. The following tests may be done:

• CT (computerized tomography) scan - X-rays are used to create a 3-dimensional picture of the target area.


• MRI (magnetic resonance imaging) scan - magnets and radio waves produce 2-dimensional and 3-dimensional pictures of the target area.


• Ultrasound scan - sound waves are used to create an image of the target area. This could be done internally with a rectal ultrasound - the instrument is inserted into the anus before the scanning begins.

What are the symptoms of anal cancer?

• Rectal bleeding - the patient may notice blood on feces or toilet paper.
• Pain in the anal area.
• Lumps around the anus. These are frequently mistaken for piles (hemorrhoids).
• Mucus discharge from the anus.
• Jelly-like discharge from the anus.
• Anal itching.
• Change in bowel movements. This may include diarrhea, constipation, or thinning of stools.
• Fecal incontinence (problems controlling bowel movements).
• Bloating.
• Women may experience lower back pain as the tumor exerts pressure on the vagina.

The anus the anal canal and squamous cell carcinomas

The anus, the anal canal and squamous cell carcinomas
The anus is right at the end of the gastrointestinal tract - the area right at the end. While the anal canal is the tube that connects the rectum to the outside of the body. The anal canal is surrounded by the sphincter - a muscle. The sphincter controls bowel movements by contracting and relaxing. In short, the anus is the outside area while the anal canal is the tube.
The point at which the anal canal meets the rectum is called the transitional zone. The transitional zone has squamous cells and glandular cells - these produce mucus which helps the stool (feces) pass through the anus smoothly. Adenocarcinoma (type of cancer) of the anus can develop from these glandular cells. However, squamous cell carcinomas make up the vast majority of anal cancers.

What Is Anal Cancer

Anal cancer occurs in the anus, the end of the gastrointestinal tract. Anal cancer is very different from colorectal cancer, which is much more common. Anal cancer's causes, risk factors, clinical progression, staging and treatment are all very different from colorectal cancer. Anal cancer is a lump which is created by the abnormal and uncontrolled growth of cells in the anus.
Anal cancer is very rare. In the UK approximately 800 patients are diagnosed annually, out of a total population of 61 million (2009). According to the American Cancer Society, approximately 5,070 new cases of anal cancers were diagnosed in the USA in 2008, of which about 60% were women. Most anal cancer patients are diagnosed in their early 60s. Approximately 680 people died from anal cancer in the USA in 2008. The USA has a population of 300 million (2009). Reports indicate that the incidence of this type of cancer is rising. The number of anal cancer cases is increasing in both sexes, particularly among American men, and changing trends in sexual behavior.

What are the treatment options for oral cancer

Treatment will depend on various factors, such as where the cancer is, its stage, as well as the patient's general health and personal preferences. Some people may have to undergo a combination of treatments

Surgery - this may include:
* Surgical removal of the tumor - the tumor is surgically taken out, as well as a margin of healthy tissue around it. If the tumor is small surgery will be minor. Larger tumors will require more extensive surgery, such as the removal of some of the jawbone or some of the tongue.
* Surgical removal of cancer that spread to the neck - mouth cancer tends to spread to the lymph nodes in the neck. The surgeon may perform a neck dissection - cancerous lymph nodes and related tissue in the neck are surgically removed. A radical neck dissection involves the removal of a tumor from the neck as well as additional normal tissue of at least 2 cm surrounding the tumor, as well as removing the lymph nodes from the neck. In a radical dissection not only is the affected tissue removed, but also nearby tissue that may be affected (but not clearly identified as such).
* Mouth reconstruction - if surgery significantly changed the appearance of the face, or the patient's ability to talk and/or eat, surgeons may transplant grafts of skin, muscle or bone form other parts of the body to reconstruct the face. To help in eating, implants may replace the patient's natural teeth.

Radiotherapy (radiation therapy) - about 40% of all types of cancer patients undergo some kind of radiotherapy. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce. Radiation therapy can be delivered from outside the body (external beam radiation) or from radioactive seeds and wires that are placed near the cancer inside the body (brachytherapy). Oral cancers are especially sensitive to radiotherapy.

Internal radiotherapy (brachytherapy) - often used to treat patients with early stages of cancer of the tongue. Radioactive wires or needles are stuck directly into the tumor while the patient is under a general anesthetic. The wires/needles release a dose of radiation into the tumor. While the patient is receiving internal radiation therapy he/she will stay in a single room at the hospital. Although levels of radiation are generally safe, hospital staff will only be able to spend short periods in the same room during treatment. This is because staff members are dealing with radiation every day of their lives and their exposure, although small each time, can accumulate over the long-term.
Most courses of brachytherapy last from 1 to 8 days.
The patient's mouth will swell and he/she will have some pain five to ten days after the implants are taken out. Within a few weeks the pain will ease and go away. Patients may find that consuming cool, plain, soft foods is easier. Smoking tends to make the pain worse.
Individuals in early-stage mouth cancer may be fortunate enough to have radiation therapy as their only treatment.
Radiation therapy is often used before and after surgery. It is usually given after surgery to help prevent recurrence (cancer coming back). It is sometimes used in combination with chemotherapy.
For those with advanced cancer radiation therapy may help relieve pain.

Chemotherapy - When the cancer is widespread chemotherapy is commonly used with radiotherapy. If there is a significant risk of recurrence (cancer coming back) chemotherapy combined with radiotherapy may be used.
Chemotherapy involves using powerful medicines that kill cancer; they damage the DNA of the cancer cells, undermining their ability to reproduce.
Targeted drug therapy (monoclonal antibodies) - this involves drugs that change aspects of cancer cells that help them grow. Cetuximab (Ebitux) is used for some head and neck cancers - it stops the action of a protein found in many kinds of healthy cells, but is more prevalent in the surface some cancer cells. The protein is called epidermal growth factor receptors (EGFR).
Sometimes targeted drugs are used in combination with radiotherapy or chemotherapy.
Cetuximab is given through a drip into the vein over a period of a few hours during the first administration - subsequent weekly doses take about an hour each.

Stages of cancer of the lip and oral cavity

Stages of mouth cancer and lip cancer are indicated using Roman numerals from I to IV, with I being the smallest and IV the largest or most advanced.

* Stage I - the tumor is under 1 inch in diameter (2 cm) and has not reached nearby lymph nodes.

* Stage II - the tumor is over 1 inch in diameter (2 cm) but less than 2 inches (4 cm) and has not reached nearby lymph nodes.

* Stage III - any of the three possibilities below:
o The tumor is over 2 inches (4 cm) in diameter.
o The tumor has spread to just one nearby lymph node on the same side of the neck as the tumor.
o The cancer in the lymph node is no more than 3cm.

* Stage IV - any of the possibilities below:
o The cancer has reached tissues around the oral cavity and lip. Nearby lymph nodes may or may not contain cancer.
o The cancer has spread to 2 or more lymph nodes on the same side of the neck as the tumor.
o The cancer has spread to lymph nodes on the other side of the neck.
o Lymph nodes on either side have a tumor that measures over 6 cm.
o The cancer has spread further, to other parts of the body.

The TNM staging method

This is another method of staging mouth cancers. T describes the tumor, N describes the lymph node(s), and M describes metastasis (distant spread). X means there is no data to make an assessment.

* TX - not possible to assess primary tumor.
* T0 - there is no evidence of a primary tumor.
* Tis - carcinoma in situ (cancer only in the place where it began; it has not spread).
* T1 - tumor 2 cm maximum measurement in greatest dimension.
* T2 - tumor over 2 cm and 4 cm maximum in greatest dimension.
* T3 - tumor over 4 cm in greatest dimension. In the case of lip cancer, tumor invades adjacent structures, such as cortical bone, deep muscle of tongue, maxillary sinus, and skin.
* T4 - In the cases of oral cavity cancer, tumor invades adjacent structures, such as cortical bone, deep muscle of tongue, maxillary sinus, and skin.

* NX - nearby lymph nodes cannot be assessed.
* N0 - nearby lymph nodes have no cancer.
* N1 - cancer in one nearby lymph node on same side of neck. Maximum 3 cm in greatest dimension.
* N2
o N2a - cancer has spread to one lymph node on same side of neck, no more than 6 cm in greatest dimension.
o N2b - Cancer has spread to 2 or more lymph nodes; none are greater than 6 cm in greatest dimension.
o N2c - Cancer has spread to lymph nodes on either side of the neck, or both sides of the neck, no bigger than 6 cm in greatest dimension.
* N3 - cancer has spread to a lymph node and is over 6 cm in greatest dimension.

* MX - distant metastasis (spread) cannot be assessed.
* M0 - no distant metastasis.
* M1 - distant metastasis.

Therefore if a patient is described as T2N1M0, it means:

There is a primary tumor between 2 cm and 4 cm, it has spread (metastasized) to one single lymph node on one side, that node is less than 3 cm in size, there is no distant metastasis.

How is mouth cancer diagnosed

A GP (general practitioner, primary care physician) will carry out a physical examination and ask the patient questions about his/her symptoms. If oral cancer is suspected the patient will be referred to either an oncologist or an ENT (ear, nose and throat) specialist. An oncologist is a doctor who specializes in diagnosing and treating cancers. ENT specialists are also known as Otolaryngologists.

• Biopsy - the doctor may take a small sample of tissue to see if there are cancerous cells. In most cases the patient will be under general anesthetic. In some instances, just a local anesthetic is used, especially if the biopsy involves taking a sample from the surface of the tissue (fine needle aspiration biopsy).

As soon as mouth cancer is diagnosed the doctor will determine the extent (stage) of the cancer. Tests to help staging may include:

• Endoscopy - the doctor passes a lighted scope down the patient's throat to see whether the cancer has spread beyond the mouth.


• Imaging tests - the following tests may help the doctor determine whether the cancer has spread:
  
  
  • X-rays
  • Computerized tomography (CT) scans
  • Magnetic Resonance Imaging (MRI) scans
  • PET (positron emission tomography) scans

Staging the cancer (identifying its stage) provides a universally understood definition of a particular cancer's progress. It helps in the planning of treatment protocol for that particular cancer, helps in determining prognosis (predicting likely outcomes), and also allows accurate end-results reporting.

What causes oral cancer

Cancer starts when the structure of the DNA (deoxyribonucleic acid) alters - a genetic mutation. DNA provides the cells with a basic set of instructions, much like a computer program for life. The instructions tell cells when to grow, reproduce, and die, among other things. When there is a genetic mutation cells grow in an uncontrollable manner, eventually producing a lump (tumor).

If the cancer is left untreated it grows and eventually spreads to other parts of the body, usually through the lymphatic system - a series of nodes (glands) that exist throughout the body. The lymph glands produce many of the cells of our immune system. As soon as the cancer reaches the lymphatic system it can spread anywhere in the body and invade bones, blood and organs. The cancer cells continue reproducing uncontrollably, gradually occupying more and more space.

Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.

With time, oral cancer may spread firstly to other parts of the mouth, then the head and neck, and eventually to other parts of the body. Mouth cancers typically start in the squamous cells (flat, thin cells) than line the lips and the inside of the mouth - they are referred to as squamous cell carcinomas.

Although we know what the risk factors are, experts are not sure what cause the mutations in squamous cells that eventually lead to mouth cancer.

What are the risk factors for mouth cancer

A risk factor is anything that increases that likelihood of developing a disease or condition. For example, regular smoking increases the risk of developing lung cancer; therefore smoking is a risk factor for lung cancer. The risk factors for mouth cancer include:

• Smoking - studies indicate that a 40-per-day smoker has a risk five times great than a lifetime non-smoker of developing oral cancer.


• Chewing tobacco.


• Taking snuff (snorting tobacco).


• Both heavy and regular alcohol consumption - somebody who consumes an average of 30 pints of beer per week has a risk five times greater than a teetotaler or somebody who drinks moderately.


• Heavy smoking combined with heavy drinking - as tobacco and alcohol have a synergistic effect (their combined effect is greater than each one added together separately), people who drink and also smoke a lot have a significantly higher risk of developing oral cancer compared to others. Somebody who smokes 40 cigarettes per day AND consumes an average of 30 pints of beer a week is 38 times more likely to develop oral cancer compared to other people.


• Too much sun exposure on the lips, as well as sunlamps or sunbeds.


• Diet - people who consume lots of red meat, processed meat and fried foods are more likely to develop oral cancer than others.


• GERD (gastro-esophageal reflux disease) - people with this digestive condition where acid from the stomach leaks back up through the gullet (esophagus) have a higher risk of oral cancer.


• HPV (human papillomavirus) infection.


• Prior radiation treatment (radiotherapy) in the head and/or neck area.


• Regularly chewing betel nuts - these nuts, from the betel palm tree, are popular in some parts of south east Asia. They are slightly addictive and are also carcinogenic.


• Exposure to certain chemicals - especially asbestos, sulphuric acid and formaldehyde.

What are the signs and symptoms of oral cancer?

Most patients have no detectable symptoms during the early stages of oral cancer. Smokers, heavy drinkers should have regular checkups at the dentists' - dentists are often able to identify signs of oral cancer.

When signs and symptoms do appear, the typically include:

• Patches on the lining of the mouth or tongue, usually red or red and white in color.
• Mouth ulcers that do not go away.
• A sore that does not heal.
• A swelling in the mouth that persists for over three weeks.
• A lump or thickening of the skin or lining of the mouth.
• Pain when swallowing.
• Loosening teeth (tooth) for no clear reason.
• Dentures don't fit properly.
• Jaw pain.
• Jaw stiffness.
• Sore Thorat
  
• A sensation that something is stuck in your throat.
• Painful tongue.
• A hoarse voice.
• Pain in the neck that does not go away.

If you have some of these symptoms you should see our doctor. There are many other conditions and diseases with similar symptoms.

What Is Mouth Cancer?

Mouth cancer has the same meaning as oral cancer - it is cancer that occurs in any part of the mouth; on the tongue's surface, in the lips, inside the cheek, in the gums, in the roof and floor of the mouth, in the tonsils, and also the salivary glands.
Mouth cancer is a type of head and neck cancer, and is often treated similarly to other head and neck cancers.
34,000 Americans are diagnosed with oral or pharyngeal cancer each year, and about 8,000 die (annually). In England and Wales about 2,700 cases of oral cancer are diagnosed annually. Oral cancer kills approximately 920 people each year in England and Wales. Most oral cancer cases occur when the patient is at least 40 years old. It affects more men than women.

What is the treatment for malignant melanoma?

Dermatologists say that when melanoma is diagnosed in its earliest, most treatable stages, time is on your side. A study explained why early diagnosis and regular skin exams are vital for beating melanoma.

Compounds that exist in green vegetables, such as broccoli or cabbage could be a powerful drug against melanoma, say researchers from Penn State College of Medicine.

Treatment for malignant melanoma depends on several factors, the patient's..:

• Age
• General health
• Stage of cancer
• Personal preferences

A good doctor should set out to the patient all the different available treatments clearly, including their potential risks and side effects. It is sometimes advisable for the patient to seek out a second opinion if he/she is not sure. Some patients decide not to treat the melanoma, but rather to treat the symptoms the cancer is causing - this is more common among patients who have determined that treatment will not significantly extend their life expectancy.

Treating early-stage melanoma treatment - Stage 1 Melanoma

• Surgical removal
  
  In many cases, all that is needed is the removal of the melanoma (surgical excision), and that's it. If the melanoma is very thin it is most likely that all of it was removed during the biopsy and no further treatment is required. Most surgeons will take out the cancer as well as a small border of normal skin and a layer of tissue below the skin to optimize the chances that all the cancer is eliminated.
  
  Surgeons used to more commonly take out a large border of skin and then the patient would have skin graft. However, it seems that if the surgeon takes out smaller amounts of healthy tissue this is just as effective for many cases of invasive melanomas. The advantage of not taking out too much healthy tissue is that a skin graft is not required.

Stages 2 and 3 melanoma treatments

• Surgical removal and possible removal of nearby lymph nodes
  
  As well as removing any affected area of skin, sometimes the surgeon has to remove a nearby lymph nodes as well in case cancerous cells are present there - this is called a block dissection and the patient is given a general anesthetic. If lymph nodes are removed there is a risk that the patient's lymphatic system will be disrupted and he/she can develop lymphedema. Lymphedema patients experience a build-up of fluids in their limbs.


• Interferon
  
  After surgery the patient may be given interferon. Interferon can reduce the chances of melanoma recurrence. Interferon encourages the body's immune system to fight off any remaining cancer cells. Most patients are given three interferon injections each week. Many patients can learn how to inject themselves - meaning they do not have to leave home for treatment. How long this treatment lasts depends on several factors, including how advanced the melanoma is.
  
  Interferon treatment may have the following side effects, which can be quite bad at first:
  
  
  • Chills
  • Fever
  • Joint pain
  • Tiredness (fatigue)
  The following side effects are also possible, but less common:
  • Vomiting
  • Nausea
  • Irritation at injection site
  • Hair loss
  • Pins and needles in the hands and toes
  • Depression
  • Mood changes
  • Infertility
  • Higher susceptibility to infection
  • Alterations in heart rhythm
  • Alterations in blood pressure
  
  After the second and third doses the side effects start to subside. Patients should report any less common side-effects to their doctor, who may consider offering another treatment. Most patients are monitored closely while on interferon treatment, this may include regular blood tests, urine tests, and blood pressure checks.

Stage 4 melanoma treatment

At this point the chances of a cure are improbable. However, it is possible to slow down progression of the cancer and help the patient to live longer. The following treatments are available:

• Interferon treatment (details above in Stage 2 and 3 treatments).


• Chemotherapy - cells are destroyed with the aid of drugs. Doctors will usually administer at least two drugs simultaneously, either intravenously, orally or both. Chemotherapy, which is often resistant to melanoma, is sometimes used to relieve the symptoms of patients with advanced metastatic melanoma.
  
  Side effects may include:
  
  
  • Nausea
  • Vomiting
  • Hair loss
  • Tiredness (fatigue)
  • Weakened immune system
  
  In the vast majority of cases symptoms will subside as soon as treatment has finished.


• Radiation therapy (radiotherapy) - High energy X-rays are targeted at the cancer cells and destroy them. Radiotherapy is also used to relieve symptoms of patients with advanced metastatic melanoma.
  
  Side effects may include:
  
  
  • Tiredness (fatigue)
  • Loss of appetite
  • Hair loss
  • Sore skin
  • Lower libido (lack of interest in sex)
  • Nausea
  
  Side effects may persist for several weeks, or even months after treatment has stopped.


• Clinical trials - some doctors may suggest participating in a clinical trial. A clinical trial is a study of a drug that has not yet been approved by the regulatory authorities. It usually involves a certain number of participants who either take the trial drug, an existing drug, or a placebo. Anyone who enrolls in a clinical trial has the opportunity to try out evolving therapies. The downside is that the outcome is unclear, as well as the side effects. Currently (June 2009) the following therapies are in clinical trials for malignant melanoma: chemoimmunotherapy, gene therapy, targeted therapy, and vaccine treatment.

What are the stages of malignant melanoma?

• Stage 1 - The melanoma is just on the surface of the skin. It is less than 2mm thick (less than 1/10th of an inch).


• Stage 2 - The melanoma is still just on the surface of the skin. However, it is over 2mm thick. There may be other small pockets of cancerous cells near the main melanoma.


• Stage 3 - The melanoma has reached nearby lymph nodes. Cancerous cells are present which are further away than 5cm (2 inches) from the main melanoma.


• Stage 4 - Melanoma cells have spread elsewhere in the body, such as the brain or the lungs.

How is malignant melanoma diagnosed?

Anybody who detects a mole that looks different from before should see their GP (general practitioner, primary care physician) immediately. The doctor will look at the patient's skin and determine whether further assessment is required. In the UK it is common for a GP to take a digital photograph of an unusual-looking mole and to email it to a skin specialist (dermatologist).

If the doctor suspects there may be something unusual he will usually refer the patient to a dermatologist. The dermatologist will most likely perform a biopsy - the mole is removed and examined under a microscope to find out whether it has cancerous cells in it.

If the biopsy indicates there are cancerous cells, the doctor may carry out further biopsies on the lymph nodes nearest to where the mole was.

If the doctor wants to find out whether the cancer might have spread into other parts of the body, he/she may carry out:

• Blood tests
• A chest X-ray
• An MRI (magnetic resonance imaging) scan
• A CT (computerized tomography) scan

A team of researchers from the University of California, San Francisco, has developed a technique to distinguish benign moles from malignant melanomas by measuring differences in levels of genetic markers.

Who is at high risk of developing malignant melanoma?

The following people have a higher risk of developing malignant melanoma:

• Those with a history of blistering sunburns as a teenager.
• People with pale skin, especially skin that does not tan easily (goes red instead).
• People with red hair.
• People with blond hair.
• People with light eyes (blue).
• People with many moles.
• People with HIV or any condition that lowers their immune system.
• People taking immunosuppressants (medicines to lower your immune system).
• People who have a family history of melanoma.

What are the symptoms of melanoma?

Melanoma exists in a deeper layer of skin compared to other skins cancers. Experts say this is one of the reasons it is the most serious type of skin cancer. The deeper it starts from, the higher are the chances of it spreading.

Patients mainly have melanomas on the back of the legs, arms and face. However, it can affect other locations too.

The first signs of a melanoma could be:

• A new mole appears.


• An existing mole changes in appearance from its usual single color and round/oval shape, not larger than ¼ of an inch (6mm) in diameter.


• Melanomas look like moles with an irregular shape. They tend to have more than just one color. They are generally larger than ¼ of an inch (6mm) in diameter.


• With some patients the melanoma may itch, and even bleed.

There is an ABCDE checklist for finding out whether a mole is more likely to be normal or a melanoma:

• Asymmetrical - the mole is not symmetrical, one half is different in shape from the other.


• Border - the border is ragged or notched. Most normal moles have regular borders.


• Colors - while most normal moles have just one color, melanomas often have two or more.


• Diameter - the diameter of a melanoma is greater than most moles (1/4 inch or 6mm)


• Elevation - when touched the melanoma will feel slightly raised above the skin

Some people refer to Enlarging when talking about the last letter E.

What Is Melanoma?

Melanoma is a malignant tumor of melanocytes. The tumors are generally found in the skin, but may also appear in the bowel and the eye (uveal melanoma). Melanoma is a type of skin cancer - one of the rarer types - but the cause of most skin cancer related deaths. Malignant melanoma is caused by an uncontrolled growth of skin pigment cells (melancytes). The word "melanoma" comes from the Ancient Greek melas
meaning "black", and the Ancient Greek oma meaning "disease, morbidity".

What is the treatment for ovarian cancer?

Treatment for ovarian cancer consists of surgery, chemotherapy, a combination of surgery with chemotherapy, and sometimes radiotherapy. The kind of treatment depends on many factors, including the type of ovarian cancer, its stage and grade, as well as the general health of the patient.
Some studies have indicated that specialized hospitals tend to have better survival rates for ovarian cancer patients, compared to general hospitals

Surgery

The surgical removal of the cancer is performed in the vast majority of ovarian cancer cases, and is often the first treatment the patient will undergo.

Unless the ovarian cancer is very low grade, the patient will require an extensive operation that includes the removal of both ovaries, the fallopian tubes, the uterus, nearby lymph nodes, and the omentum (a fold of fatty abdominal tissue). Cancer often spreads into the omentum. In most cases the operation will be carried out by a gynecologic oncologist surgeon - a specialist in surgery for women with cancer of the reproductive organs. This operation, sometimes referred to as a total hysterectomy, will mean that the woman will begin her menopause immediately. Recent research by Canadian scientists found that premature removal of the ovaries increases the risk of lung cancer.

If the cancer is confined to just one of the ovaries the surgeon may just remove the affected ovary and the adjoining fallopian tube. The woman will have a chance of being able to conceive. If both ovaries are removed it will not be possible to conceive.

Surgery for ovarian cancer will require a hospital stay of up to two weeks, plus a recovery period of at least six weeks when the patient gets back home.

Chemotherapy

Chemotherapy is the use of chemicals (medication) to treat any disease - more specifically in this text, it refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others. Chemotherapy for ovarian cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove.

Patients will typically receive a combination of carboplatin (Paraplatin) and paclitaxel (Taxol) intravenously (injected into the bloodstream). As it is injected into the bloodstream it can target cancer cells in the reproductive system, as well as any cancer cells that may have reached elsewhere in the body.

Treatment usually involves 6 to 12 chemotherapy sessions which will be given three to four weeks apart so that the body has time to recover. One session usually consists of a 3-hour gradual injection of the medicine into the body; sometimes it may be extended to 24 hours. Extended injections require an overnight stay in hospital.

Radiotherapy

Radiation is not the mainstay of ovarian cancer treatment - it is not generally considered effective for ovarian cancer. It may be used if there are small traces of cancer in the reproductive system, or to treat the symptoms of advanced cancer. External radiotherapy may be used to clear traces of cancer left after chemotherapy, while internal radiotherapy may be used for advanced cancer. Radiotherapy may cause the following symptoms; some symptoms may not appear until a long time after treatment is over:

The 4 stages of ovarian cancer

Ovarian cancer is classified into four stages, with stage 4 being the most advanced.

• Stage 1 - the cancer is confined to one or both ovaries. This is subdivided into three groups:
  
  
  • Stage 1a - the cancer is confined to just one ovary (contained inside it).
  • Stage 1b - the cancer is confined to both ovaries (contained inside them).
  • Stage 1c - either 1a or 1b, but there is come cancer on the surface of one or both ovaries, cancer cells are found in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.


• Stage 2 - the cancer has spread to the uterus, fallopian tubes or some other areas in the pelvis (tummy area). This is subdivided into 3 groups:
  
  
  • 2a - the cancer has spread into the uterus (womb) or the fallopian tubes.
  • 2b - the cancer has spread into other tissues in the pelvis, such as the rectum or bladder.
  • 2c - 2a and 2b, and there is cancer on the surface of one or both ovaries, or cancer cells are identified in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.


• Stage 3 - the cancer has spread into the peritoneum (the lining of the abdomen), or to the lymph nodes in the upper abdomen, groin or behind the uterus. Most ovarian cancers are diagnosed at this stage. This stage is divided into three subgroups:
  
  
  • 3a - an examination with a microscope of tissue taken from the peritoneum (lining of the abdomen) or the omentum (fatty layer over the top of the intestines) detects cancer cells.
  • 3b - tumor growths are identified in the peritoneum 2cm or smaller.
  • 3c - tumor growths larger than 2cm are identified in the peritoneum. Cancer is found in the lymph nodes in the groin, behind the womb or the upper abdomen.


• Stage 4 - the cancer has spread beyond the abdomen to other parts of the body, including such organs as the lungs or the liver. If cancer is just found on the surface of the liver, but not inside it, it is still stage 3.

Diagnosis of ovarian cancer

There is a tragic myth among many health care professionals and patients in too many countries about early stage ovarian cancer having no symptoms. A UK study, called The Target Ovarian Cancer Pathfinder study which surveyed 400 UK general practitioners and over 1,000 women, including 132 with ovarian cancer, found that 80% of GPs in the UK were wrongly of the view that women have no symptoms in the early stages of ovarian cancer. Studies in countries with top healthcare services have come up with similar findings.

The GP (general practitioner) will carry out a vaginal examination and check for any visible abnormalities in the uterus or ovaries. The doctor will also check the patient's medical history and family history. Further tests will be ordered - these are usually done by a gynecologist - a doctor who specializes in treating diseases of the female reproductive organs.

If the woman is diagnosed with ovarian cancer the doctor will want to identify its stage and grade. The stage of a cancer refers to the cancer's spread while the grade refers to how aggressively it is spreading. By identifying the stage and grade of the cancer the doctor will be able to decide on the best treatment. The stage and grade of ovarian cancer alone cannot predict how it is going to develop.

The following tests are used to diagnose ovarian cancer:

• Blood test
  There is a cancer marker called CA 125 (cancer antigen 125) which is made by certain cells in the body. A high blood level of CA 125 may indicate the presence of cancer, but could also be due to something else, such as infections of the lining of the abdomen and chest, menstruation, pregnancy, endometriosis, or liver disease. This blood test is just one test among others, designed to help the doctor make a diagnosis. Normal blood levels of CA125 alone do not definitely mean there is no cancer either. They are just indications.


• Ultrasound
  This is a device that uses high frequency sound waves which create an image on a monitor of the ovaries and their surroundings. A transvaginal ultrasound device may be inserted into the vagina, while an external device may be placed next to the stomach. Ultrasound scans help doctors see the size and texture of the ovaries, as well as any cysts.


• Laparoscopy and possibly Endoscopy
  A laparoscope - a thin viewing tube with a camera at the end - is inserted into the patient through a small incision in the lower abdomen. The doctor can examine the ovaries in detail, and can also take a biopsy (extract a small sample of tissue for examination). The patient will undergo a general anesthetic for this procedure. The doctor may carry out an endoscopy to determine whether the cancer has spread to the digestive system.


• Colonoscopy
  If the patient has had bleeding from the rectum, or constipation the doctor may order a colonoscopy to examine the large intestine (colon). The colonoscope - a thin tube with a camera at the end - will be inserted into the rectum.


• Laparoscopy and possibly Endoscopy
  If the patient's abdomen is swollen the doctor may decide to carry out this test. A build up of fluid in the abdomen might indicate that the ovarian cancer has spread. A thin needle goes through the skin into the abdomen and a sample of the liquid is extracted. Some of the liquid may be drained into a bag if there is a lot of it (abdominal tap). The fluid is checked in the laboratory for cancer cells.


• Chest X-ray
• This test will help the doctor see if the cancer has spread to the lungs, or to the pleural space surrounding the lungs.


• CT (computerized tomography) scan
  X-rays are used to create a 3-dimensional picture of the target area.


• MRI (magnetic resonance imaging) scan
  Magnets and radio waves produce 2-dimensional and 3-dimensional pictures of the target area.
  Combined positron emission tomography (PET) and computed tomography (CT) scanning of patients in the early stages of ovarian cancer can enable physicians to determine whether the cancer has spread to nearby lymph nodes without having to perform surgery, reported scientists at San Gerardo Hospital, Monza, Italy.