Staging bladder cancer using the TNM system

Staging bladder cancer using the TNM system

Staging bladder cancer using the TNM system

Read Bladder Cancer First.

  • T0 ; No tumor in specimen collected
  • Tis ; Carcinoma in situ ( CIS)
  • Ta: Noninvasive papillary carcinoma
  • T1: Tumor invades lamina propria
  • T2: Tumor invades muscle
  1. T2a: Invades superficial muscularis propria
  2. T2b: Invades deep muscularis propria
  • T3: Tumor invades perivesical tissue
  1. T3a: Microscopic perivesical fat invasion
  2. T3b: Macroscopic perivesical fat invasion (extravesical mass)
  • T4
  1. T4a: Invades adjacent organs (uterus, ovaries, prostate stoma)
  2. T4b: Invades pelvic wall, abdominal wall

Invasive of nodal status:

  • N0 No nodal involvement
  • N1-3 Pelvic nodes
  • N4 Nodes above bifurcation
  • Nx Unknown

Invasive of metastatic status:

  • M0 No distant metastases
  • M1 Distant metastases
  • Mx Unknown

Symptoms of bladder cancer

There is painless urination with bleeding( hematuria)

  • Persistent blood in urine
  • Frequency of passing urine
  • Some patients will experience pain on passing urine ( dysuria)
  • Lower abdominal pain
  • Abdominal mass and swelling
  • Lymphedema
  • In severe cases, kidney failure as the cancer spreads to affect the kidneys
  • Nausea and vomiting
  • Metastatic spread to other sites such as the bones will cases pain at the affected regions

Diagnosing bladder cancer

The healthcare provider will perform a thorough medical history and examination in trying to find out how it started. You will be asked about the pain on passing urine, any change in color of urine, any frequency of passing urine and changes to it among others.

The healthcare provider will request for urine tests to rule out any infections such as TB, schistosoma cysts, and blood in urine

The definitive test for diagnosing bladder cancer is the Cystoscopy test. Most urologists will perform these diagnostic cystoscopies in an outpatient setting using a 16F flexible cystoscope and local Intraurethral lidocaine for topical anesthesia.

If a bladder neoplasm is detected, an outpatient transurethral resection (TUR) or biopsy is done with anesthesia.

Radiological tests such as intravenous pyelogram (IVP), retrograde pyelogram, or computed tomography (CT) or magnetic resonance (MR) urogram are used to identify additional tumors and obstruction of the upper urinary tract due to bladder cancer

Other tests done include the complete blood counts, blood indices, Fibrin Degradation Products (FDP) and bladder cancer tumor markers.

Treating Bladder cancer

There are several modes used in treating bladder cancer including, the use of drugs, radiotherapy or both. Most bladder cancers recur in the bladder, but can be managed with a combination of transurethral resection (TUR) and intravesical medications or immunotherapy. Here are some guidelines

  • Bacillus Calmette-Guérin (BCG) vaccine is the most effective agent for treating high-grade superficial lesions. The use of this vaccine leads to reduction in progression rates and increases survival
  • Radical cystectomy (removal of bladder) with diversion of urine bypassing the normal route is the most effective means to eliminate bladder cancer. Types of diversion include; orthotopic diversion with a neobladder.
  • Radiation therapy in combination with TUR and a drug such as cisplatin, has been shown to be effective in preserving the bladder
  • The use of medications using urinary catheters such as methotrexate, vinblastine, doxorubicin, and cisplatin, has shown high levels of toxicity with poor results.
  • New drugs such as paclitaxel and gemcitabine are active, and combinations of these agents with platinum-based compounds have better results with less toxicity.

Why cystectomy (bladder resection) is done

  • When there is a cancer within a bladder diverticulum
  • In cases of primary, and muscle-invasive or high-grade tumors that allow complete excision with adequate surgical margins
  • Patients in whom there is an inability to adequately remove tumor by TUR alone because of size or location
  • When there is a tumor overlying a ureteral opening that may require ureteral reimplantation
  • Patient refuses to have urinary diversion
  • In poor-risk patients where diversion is not possible

Epidemiology of breast cancer

Epidemiology of breast cancer

Epidemiology of breast cancer

Read Breast Cancer first.

  • It is estimated that, worldwide, more than 1 million new cases of breast cancer are diagnosed yearly.
  • The incidence and death rates for breast cancer differ between races but the rates are more common in the Western nations and lowest among the developing world.
  • About 1% of breast cancers is found in males and 90% are estrogen receptor (ER)-positive
  • The risk of breast cancer increases with age
  • The genetically defined group of women with BRCA-1 or BRCA-2 identified to carry lifetime risk of as high as 80%. Women who carry a germ line mutation in BRCA1 genes have a cumulative lifetime incidence of 50% to 85% of developing breast cancer and 40% to 60% of developing ovarian cancer

Genes and breast cancer

The genetically defined group of women with BRCA-1 or BRCA-2 identified to carry lifetime risk of as high as 80%. These genes function in cells in a variety of ways such as

  1. Repair of damages DNA
  2. Cell-cycle regulation
  3. Transcriptional regulation
  4. Remodeling of chromatin in cells. Chromatin are the gene carrying vehicles in all cells
  5. BRCA-2 is involved primarily in DNA recombination and repair

The reason why these genes predispose primarily to breast cancers remains unknown. BRCA1 and BRCA2 genes can be carried and passed to children by men as well as by women. A drug tamoxifen has been shown to reduce the risk of contralateral breast cancer by about 50% in both BRCA1 and BRCA2 carriers.

The characteristics of BRCA1 and BRCA2 genes

  • BRCA-1 is located in chromosome 17 where as BRCA-2 in chromosome 13
  • The percentage contribution of BRCA-1 genes to hereditary breasts cancer is about 20 to 40% where as the BRCA-2 is 1- to 30%
  • The lifetime risk of developing breast cancer with is 60 to 85% in both genes
  • The lifetime risk of developing secondary breast cancer is about 50% in both
  • The risk of developing male breast cancer is minimal in BRCA-1 and about 4-6% in BRCA-2 genes
  • The risk of developing other types of cancers such as the cancer of the prostate , pancreas , stomach, ovary and melanoma

HER2 genes

Another gene, HER2 presents with its protein over expression in 20% of newly diagnosed breast cancers. HER2 stands for Human Epidermal growth factor Receptor 2.

HER2 gene positive breast cancer is associated with a more aggressive clinical course and decreased survival time compared to tumors with normal levels of HER2. Each normal breast cell contains copies of the HER2 gene found in the DNA of the cell. HER2 contains information that helps to make HER2 proteins.

The HER2 protein is the HER2 receptor found on the surface of some normal cells in the body. The proteins help send growth signals from outside the cell to the inside of the cell and pass the message for cells to grow and divide.

In HER2+ breast cancer, the cancer cells have an abnormally high number of HER2 genes per cell. When this happens, too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein overexpression. This causes the cells to grow and divide more aggressively. This contributes to growth autonomy and genomic instability where the cells growing hev no control at all.
Symptoms of breast cancer

  • Breast cancer is usually first detected as a palpable mass or as a mammographic abnormality. These masses and areas of asymmetrical thickening of breast tissue are the most common manifestations of breast cancer.
  • There is nipple discharge, retraction and flattening of the breast. Spontaneous bloody or watery discharge from the nipple is commonly associated with underlying breast neoplasm. Presence of milky discharge almost always has a noncancerous cause.
  • Changes in the skin over the breast. There is skin swelling, and erythema.
  • Breast pain. the breast pain typically is associated with a palpable lump
  • Paget’s disease of the nipple is a form of adenocarcinoma involving the skin and lactiferous sinuses of the nipple; it usually appears as an eczematous lesion of the skin of the nipple. It’s frequently associated with excoriation of the skin and discharge.
  • Lumps in the armpits and above the clavicles

What are some of the tests done in lung cancer?

What are some of the tests done in lung cancer?

What are some of the tests done in lung cancer?

Read lung cancer and How do those with lung cancer present first.

  • The most important examination at the early stage is plain chest x-ray.
  • Other tests include the endoscopic studies
  • CT scan of the chest
  • MRI of the chest
  • Tissue biopsy ( done during the endoscopy)
  • Flexible fiberoptic bronchoscopy
  • A transbronchial needle aspiration: done via a special needle passed through the bronchoscope. This technique can be used to sample out mediastinal masses or paratracheal lymph nodes
  • Transthoracic fine-needle aspiration biopsy with fluoroscopic or CT scan guidance
  • Mediastinoscopy
  • Pleural biopsy in patients with pleural effusion
  • Thoracentesis of pleural effusion and cytologic evaluation of the obtained fluid

Read moreWhat are some of the tests done in lung cancer?

Treatment of Cervical cancer

Treatment of Cervical cancer

Treatment of Cervical cancer

Read Cervical Cancer First.

Treatment of cervical cancers depends on the staging and the depth of invasion. For example for invasion of less than 3 mm (stage IA-1) treatment includes a hysterectomy or the option of cervical conization in women who wish to preserve fertility. The staging of cervical cancer involves the following:

The International Federation of Obstetrics and Gynecology (FIGO). It permits assessment through biopsy, physical examination, cystoscopy, proctoscopy, excretory urography (intravenous pyelography or IVP), and plain film x-ray of the chest and skeletal system. The American Joint Cancer Committee staging is also involved.

Staging in cervical cancer

Read moreTreatment of Cervical cancer

How do those with lung cancer present

How do those with lung cancer present

How do those with lung cancer present

Read lung cancer first.

The early symptoms of lung cancer and their prevalence include:

  • Cough or altered cough in 60% of patients.
  • Coughing blood( Haemoptysis) in  27% of cases
  • Chest pain in 34%.
  • Difficulty in breathing (Dyspnea) in 46% of cases.
  • Loss of appetite
  • Weight loss 56%.

On examination of the patients

Read moreHow do those with lung cancer present

How diet helps to prevent or Treat Cervical Cancer

How diet helps to prevent or Treat Cervical Cancer

How diet helps to prevent or Treat Cervical Cancer

Diet has become an important component in fighting different types of cancer. In fact, it is recommended, for example, that you eat at least five servings of fruits and vegetables daily and eat the right amount of food to stay healthy. Here are some of the foods and or ingredients that are important in fighting and helping in treating cervical cancer.

Vegetables

Cruciferous vegetables such as broccoli, cabbage, cauliflowers and kales are known to contain substances such as diindolylmethane (DIM) which has been show to inhibit the development of cervical cancer. The DIM acts by inhibiting the growth of the cancer cells of induce a programmed cell death (apoptosis) of the tumor cells. Other compounds that help in killing the cancer cells include the Indole-3-Carbinol (I3C) which also acts by preventing the papilloma virus-initiated cervical cancer. This is an important factor in managing cervical cancer.

Mushrooms

Karawatake Mushrooms and other compounds that contain PSP have been proven to improve the quality of life in patients suffering from cancers especially cervical cancer.
PSP is a type of Proteoglycan / Peptidomannan found in Japanese medicinal mushrooms.

Fruits

Carotenoids are an important component in inhibiting the development of cervical cancer cells. Fruits that are rich in carotenoids such as carrots, mango, cantaloupe melon, apricot, papaya, banana, apples and straw berry come in handy. Foods rich in beta carotenoids include the above mentioned in addition to water melon, grapes, spinach, Spirulina, garlic and corn.

Selenium

Selenium is an essential micronutrient with extended benefits in improving e immune system, preventing blood clotting, preventing arthrosclerosis and helping to lower blood pressure. Selenium deficiency has been found in patients with cervical cancer. Studies in lab animals have proven the same and an increase in the selenium in water given to the animal reduced the incidence by a significant amount. Foods that are rich in selenium include

  • Cereal Grains such as wheat Germ, whole grain bread, wheat Bran, barley, brown rice, oat Bran, rye, rice bran and white rice
  • Dairy foods such as cow milk and butter
  • Poultry foods  such as  chicken liver, turkey and egg yolk
  • Fungi such as dried shiitake mushrooms
  • Legumes such as kidney Beans
  • Meats including beef, liver, lamb, kidneys rabbit meat and ham
  • Nuts including brazil nuts, peanuts, almond, cashew, walnuts, hazelnuts and macadamia nuts
  • Sea foods like herring, tuna , crab , oysters, lobster, cod and prawns
  • Seeds like sunflower Seeds and mustard Seeds

Vitamins

There is a correlation between vitamin deficiency and development of cervical cancer in some patients. Vitamins such as Folic acid, vitamins B1, 2, 6 and B12, Vitamins C, D and E are important in preventing and treating cancer. Folic acid is important I development of cell DNA and deficiency of folate increases the risk of cancer development. This happens during the weak chromosomal stage when the HPV virus is incorporated into the cells.

Quinones

Coenzyme Q10 has a similar molecular structure to the vitamin E and K. It is a fat soluble compound that has been shown to help to prevent cervical cancer. The compound helps to prevent cancer cell growth and leads to rapid death of the cancer cells (apoptosis).

The sources of this compound include:

  • Dietary Oils including rape seed, soybean,  sesame, and cottonseed oil
  • Chicken eggs
  • Grains such as rice bran, wheat germ
  • Legumes including soybeans
  • Meats
  • Nuts such as hazelnuts, walnuts, chestnuts, almonds. Pistachio, and peanuts
  • Vegetables such as cabbage, broccoli, spinach, cauliflower, potato, garlic, onion, eggplant and carrot
  • Commercially available supplements

Cervical cancer is a public health problem. Early diagnosis and treatment is important in reducing the incidences and complications. More over diets management is also important in prevention and treatment. Patients who are over weight are also at a higher risk of developing the cancer. This underscores the importance of having a proper diet in management of cancer among women.
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Treating breast cancer

Treating breast cancer

Treating breast cancer

There are several modes of treatment for breast cancer including:

  • Surgical management of breast cancer
  • Reconstructive surgery
  • Chemotherapy or endocrine therapy
  • Diet management. Dietary phytoestrogens such as those found in soybeans have a chemical structure that is similar to that of 17b-estradiol and can bind to the estrogen receptor to compete with estrogen. Their consumption may have a weak protective effect against breast cancer and are good for preventive treatment.

Treating the invasive breast cancer

Surgery in treatment of breast cancer

  • Treatment with surgery involves removal of the lump in the breast. For patients with tumors smaller than 5 cm are best managed with lump removal (lumpectomy) followed by irradiation treatment to the affected breast.
  • In larger tumors a process called mastectomy (removal of the breasts) is preferred. In this procedure, there an additional use of drugs for treating cancer. In estrogen-receptor positive tumors, endocrine treatment is added to the mastectomy to shrink the tumors before surgery
  • A process of axillary node (lymph nodes in the armpits) evaluation should be performed on most women who are suitable candidates for preventive (adjuvant) treatment. In this process, the sentinel node (the first lymph node where metastatic spread of cancer goes to) is taken for biopsy. Some oncologists will inject a dye, isosulfan blue dye, a radioactive isotope compound around the primary tumor or areolar area of the breasts to help identify the first node (or nodes) draining the primary lesion. Majority of patients have the sentinel node in the same side of the arm pit as the breast. In a study, about 60% of patients with positive tests for the sentinel node, there have been results of only the sentinel node having the tumor.

Breast reconstruction surgery

This type of procedure is performed at the same time with breast mastectomy. With this, women have a chance to overcome the psychological effects of loosing their breasts. A woman will feel complete and better with both breasts intact and the psychological effect of restoring to the original shape the lost breast is paramount.

The choice of breast implants to be used is also important to the patients. Several types are in the market including saline or silicone implants and are less costly and generally easy to implant.

Other types of reconstruction include the use flaps or grafts from other parts of the body. It is recommended to go for the implants in cases of loosing large amounts of tissue during surgery of the breasts.

Psychosocial Support

Loosing a breast to a woman is a tragedy. She will not feel complete and this affects her body image and to some extent her sexual sense too. There is a greater need to have psychological support and counseling before and after the procedure. The good thing is that most implants and types of reconstructive surgeries in the market help in restoring theta lost confidence.

There is need to offer psychosocial support shortly after diagnosis is made, especially to the most vulnerable or the most distressed, to cope better.

Preventive treatment

Preventive (adjuvant) therapy is defined as the use of chemotherapy, hormonal drugs, radiation or a combination of these before, during, or after definitive treatment of the primary breast cancer.

  • The objective of adjuvant therapy is to destroy small, hidden (occult) distant tumor spreads( micrometastases)
  • In addition, adjuvant therapy helps to delay cancer recurrence for a median of 2 to 3 years in the majority of treated women.
  • Those who require this type of treatment are those in menopause, have large tumor size, poor tumor grade, tumor spread to lymph nodes, positive HER2 status and positive estrogen and progesterone status.

Adjuvant Endocrine Treatment

  1. Tamoxifen is used to treat patients who are in postmenopausal stage and are estrogen or progesterone receptor positive. Its estrogen-agonist effects on bone and liver help to maintain bone density and to lower cholesterol levels in postmenopausal women. The risk is that it may cause bone loss in premenopausal women, risk of endometrial cancer, increase the risk in developing deep venous thrombosis and exacerbate hot flashes in 10 to 30% of postmenopausal women.
  2. The use of aromatase inhibitors such as anastrozole, exemestane and letrozole are used in endocrine management of breast cancer too. Unlike tamoxifen, aromatase inhibitors are not associated with an increased risk of vein thrombosis or endometrial cancer. There common risks are joint pins, muscle aches and bone loss with fractures.

Chemotherapy

  • There are various drugs in the market for treating breast cancer. Most treatments involve the use of combination therapy to achieve the best results. These are also superior in the management of breast cancer
  • The commonest drugs used in management include: Anthracyclines such as epirubicin or doxorubicin, taxanes, humanized monoclonal antibodies such as trastuzumab against a protein encoded by the HER-2 gene.

Radiation treatment of breast cancer

  • Studies have proven that breast irradiation following removal of the affected breast lumps ( lumpectomy)reduces the risk of breast tumor recurrence
  • This kind of treatment involves the streaming of radiation beams to the chest wall following mastectomy. There is a significant decrease I rates of recurrence besides killing of the tumor in early stage cancer
  • The treatment is offered to women who have lumps ranging is sizes of > 5cm in diameter and those with extensive lymph node involvement.
  • There is a risk of developing Lymphedema in the upper limbs and on the side of the mastectomy in radiation treated patients.

Cervical cancer

Cervical cancer

Cervical cancer

Introduction

Cervical cancer is uncontrolled growth of abnormal cells and tissue within the cervix (the neck of the uterus). The uterus is the womb where babies are grown. There is then an abnormal growth of cells presenting with hypertrophy (increase of cell size), hyperplasia (the increase of the numbers of cervical cells), anaplasia (formation of atypical shapes of cervical cell shape), and poor cervical cell function.The increasing cell size and numbers lead to an increase in the size of the surrounding tissues with the invasion of more abnormal cells from the cervix.

The cells are so aggressive and invade the surrounding tissues by competing for blood supply to the tissues. These cells are easily detected by a Pap smear test as they are shed from the.

Cervical cancer causes

There are several know causes of cervical cancer. The main cause of cervical cancer is an infection with Human papilloma virus (HPV) serotypes 16, 18, 31, 33, 45, and 56 which account for more than 80% of all invasive cervical cancers.

However most of the causes are associated with specific risk factors that women face. A regular Pap smear tests is important as a screening tool and a preventive measure for cervical cancer among women.

What are the risk factors for cervical cancer?

  • Associated risk factors include
  • Having multiple sexual partners
  • Women living in lower socioeconomic status
  • Cigarette smoking
  • A history of sexually transmitted diseases such as chlamydia, HPV infection
  • Immunosuppression
  • Oral contraceptive use.
  • Certain types of sexual behavior such as
    1. Women who have sex at an early age
    2. Women who have multiple sexual partners
    3. Women who have partners who have many other sex partners
    4. Women who have sex with uncircumcised men
  • Smoking or nicotine
  • Infections with Human immunodeficiency virus (HIV)
  • Diet with increased levels of homocysteine has been associated with increased risk of having cervical cancer. Vitamin deficiency has also been implicated in development of cervical cancer. Lack of
  • Prolonged use of oral contraceptives (birth control pills)
  • Women who have multiple pregnancies
  • Women living in low socioeconomic status
  • Injection with diethylstilbestrol (DES) drugs
  • Women who have relatives who had cervical cancer
  • Exposure to radiation of any type especially these on treatment for other cancers
  • Exposure to compounds that may affect nuclear genetic material such as benzene
  • Prolonged stressful conditions

Screening for cervical cancer

From the evidence obtained from large control studies, it is recommended that:

Screening for cervical cancer with a Pap smear test can achieve an 80% reduction in death rates from the cancer in the target population of women aged between 25 to 60 years.

It is also recommended that women have a screening interval of one year with conventional Pap smear tests or every 2 years using liquid-based cytology.

After the age of 30, women who have had three consecutive, technically satisfactory screening results may be screened every 2-3 years.

The American Cancer society recommend that cervical cancer screening should begin 3 years after the onset of vaginal intercourse and no later than age 21 years of age

Women who are age 70 years or older with an intact cervix and who have had 3 or more documented satisfactory cervical screening test results within the 10-yr period before age 70 may cease to have the routine cervical cancer screening tests

Those who have had uterus removal (with removal of the cervix need not undergo screening tests.

Cervical cancer epidemiology

Although cervical cancer is the third most common gynecologic cancer in the United States, it is the most common malignancy worldwide.

Cervical cancer is the second most common cancer in women in the world, with an estimated 500,000 cases in 2003.

Screening for cervical cancer with follow up and treatment has helped reduce the incidences of cancer. How ever this may not be true in some countries or regions such as the Latin America, the Caribbean, and Africa, where cervical cancer is the most common cause of cancer-related death in women

The incidences are high among the whites in the United States with an estimated 8.1 new cases per 100,000 each year as compared with 11 per 100,000 in African-American women and 14.4 per 100,000 in Hispanic populations.
Symptoms of cervical cancer

  • There are no symptoms in those in precancerous stage
  • There is an unusual vaginal bleeding, particularly after sex
  • A vaginal discharge with odor
  • Early invasive cancers may also present with no symptoms although some women will notice postcoital (after sex), between menses, or postmenopausal spotting.
  • Some women will present with malodorous vaginal discharge
  • Painful coitus (dyspareunia)
  • Cramping pelvic pain from uterine contractions
  • Chronic blood loss may result in symptoms of anemia in some patients
  • There may be pelvic pain
  • In advanced stages, there may b lower limb swelling (from occlusion of pelvic lymph vessels or thrombosis of the external iliac vein)
  • Advanced stages of disease may lead to anorexia, dysgeusia and unintentional weight loss

Diagnosing cervical cancer

  • The following tests may be performed to help in diagnosis of cervical cancer.
  • The healthcare provider will perform a detailed history and physical examination
  • Pelvic examination which includes examination of the vagina, cervical and related organs
  • Pap smear test.
  • Test for human papilloma virus (HPV) DNA. There is a high sensitivity for the detection of cervical intraepithelial neoplasia with these tests. This test helps to reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia (CIN) or cancer detected by subsequent screening examinations.
  • Colposcopy The method of examining the vagina and by means of a binocular instrument known as the colposcope, to screen for cancer of the cervix. The clinician may also use this test to do biopsy and endocervical curettage.
  • Complete blood count
  • A squamous cell carcinoma (SCC) antigen test
  • Carcinoembryonic antigen (CEA)
  • Chest x-ray examination

Continue reading about Treatment of Cervical cancer.

Bladder Cancer

Bladder Cancer

Bladder Cancer

Definition

Bladder cancer involves a group of cancers that range from non–life-threatening, low-grade, superficial papillary lesions to high-grade invasive tumors. There are various types of bladder cancer defined.

What are the types of bladder cancer?

The international Society of Urological Pathology Consensus had defined a mode of classification of bladder cancer as follows:

Normal

There is a normal bladder lining (urothelium) on physical and microscopic examination. Some cases of mild dysplasia may be classified here.

Hyperplasia

There is a flat bladder lining increased growth (urothelial hyperplasia) and papillary urothelial hyperplasia

Flat urothelial Lesions with atypia

  • Histological examination reveals a reactive (inflammatory) cell abnormality (atypia)
  • Histology may reveal cell abnormality (atypia) of unknown clinical significance
  • Microscopic cell examination shows low-grade bladder lining type of cancer or dysplasia (intraurothelial neoplasia)
  • There is a carcinoma in situ presenting with a high-grade intraurothelial neoplasia.

Papillary urothelial cancers

  • Urothelial papilloma
  • Inverted urothelial papilloma
  • Papillary urothelial neoplasm of low malignant potential
  • High grade papillary urothelial neoplasm
  • Low grade papillary urothelial neoplasm

Invasive urothelial neoplasm

  • Urothelial carcinoma with lamina propria invasion
  • Urothelial carcinoma with muscularis propria (affecting the detrusor muscle) invasion

What cause bladder cancer?

Bladder cancer is a potentially preventable disease associated with specific causative factors. Most of the causative factors also cat as risk factors . Continuous exposure to these leads to bladder cancer. Here are some of the causes:
  • Cigarette smoking
  • Occupational exposures to chemicals
  • Exposure to human papilloma virus type 16
  • Infections such as schistosomiasis, tuberculosis
  • Urinary calculi
  • Prolonged use of urinary indwelling catheters
  • Diverticula
  • Drugs such as cyclophosphamide
  • Radiation to pelvic structures
  • Exstrophy of bladder a congenital condition of being born with the abdominal wall open with the bladder muscle open
  • Females with endometriosis
  • Other congenital bladder abnormalities
  • Metastatic spread from other sites such as the colon and ovary

What are the risks of having bladder cancer?

Several factors play a role in having bladder cancer such as:
  • Extremes of age. There is an increased risk of bladder cancer especially among the aged population of over 65years. Close to 70% of these cancers are common among males of this age group and 75% among the females.
  • Cigarette smoking has been show to increase the risks of having bladder cancer among both sexes. Smokers have twice the risk of bladder cancer as nonsmokers. There is a twofold to threefold increase in risk of bladder cancer in subjects who smoke at least 10 cigarettes per day. Close to 50% of males who have bladder cancer are smokers while 30% of females are smokers.
  • Exposure to certain chemicals poses a risk to many. Occupational chemical exposure to substances such as arylamines and its derivatives which may also be found in cigarette smoke, O-toluidine, and benzidine-based dyes leads to cancer of the bladder. Other occupational risks include exposure to dyes, rubber, leather products, paint products, and drill press operators.
  • Drugs such as cyclophosphamide can cause bladder cancer if used on a long term basis.
  • Diet that are rich in beef, pork, and animal fat consumption increase risk of bladder cancer among both sexes.
  • Evidence suggests that consumption of non-beer alcoholic drinks can cause bladder cancer. The high levels of nitrosamines in beer has been implicated in causing bladder cancer
  • In populations living in swampy or stagnant waters and lakes, there are cases of infections with bilharzias (schistosomiasis) that can lead to bladder cancer.
  • Spinal cord injury is associated with increased risk for squamous cell carcinoma of the bladder.

How smoke increases the risk of bladder cancer

  • Tobacco Smoke Contains these Substances ;
  1. Aldehydes such as acetaldehyde, and acrolein
  2. Alkaloids such as nicotine
  3. Minerals & Elements such as aluminum; arsenic; cadmium ;Carbon Monoxide; Hydrocarbons; lead ; mercury; nitrogen oxides ; ozone; polynuclear aromatic hydrocarbons; radioactive polonium; lithium. Each cigarette contains 2 micrograms of Cadmium and more than 50% of this is absorbed through the Lungs.
  4. Tobacco smoke is the most significant source of environmental exposure to Cadmium.
  • Studies have shown that there is a twofold increased risk of bladder cancer in people smoking at least 10 cigarettes per day
  • Smokers who consume low-tar and nicotine cigarettes have a lower risk of developing bladder cancer when compared with those who consume higher tar and nicotine cigarettes.
  • Those who consume high numbers of unfiltered cigarettes and to some extent the passive smokers have a 50% increased risk of bladder cancer compared with those who smoke filtered cigarettes.
  • Those who smoke pipe have a lower risk of bladder cancer compared with cigarette smokers.

Substances that may increase the toxic effects of tobacco

  • Consumption of high levels of beta-Carotene supplements in concurrent with the use of tobacco has been shown to increase the risks of blade and other types of cancer. The intake of the beta carotenes in the presence of tobacco smoke in the lungs leads to oxidation of epoxides that can increase the binding of polynuclear aromatic hydrocarbon diolepoxides to the deoxyribonucleic acid (DNA) of the Lungs. This can cause mutations that lead to Cancer.
  • High consumption of caffeine among smokers leads to the craving for tobacco. The alkaloids found in the tobacco are responsible.
Continue reading Staging bladder cancer using the TNM system.

Diagnosing and screening breast cancer

Diagnosing and screening breast cancer

Diagnosing and screening breast cancer

What breast cancer may resemble

These non cancerous conditions may resemble breast cancer because of the presentation and on mammography examination

  1. Fibrocystic changes of the breasts
  2. Fibroadenoma
  3. Hamartoma

What test are done to diagnose breast cancer

The healthcare provider will perform a series of tests including taking a detailed history and physical examination from the patient. Among the test done include:

Read moreDiagnosing and screening breast cancer

Breast Cancer

Breast Cancer

Breast Cancer

Definition

Breast cancer is an invasive cancer of the breast affecting both men and women. The local cells of the breast grow abnormally and uncontrollable increase in size and spread to other area s of the body.

Other names

Carcinoma of the breast

What causes breast cancer?

Various causes of breast cancer have been explained, but the exact cause is still unknown. There are numerous risk factors that increasingly relate to the development of breast cancer such as:

  • The increase in age of a person. It is estimated that close to 50% of women with breast cancer in the western world are more that 60years of age
  • The earlier a girl gets in to menarche especially at <12 year, the higher the risk of developing breast cancer.
  • When approaching menopause late especially at over 55 years, one has an increased risk of developing breast cancer. This is an indirect cause.
  • The increasing the number of menstrual cycles could predispose women to greater DNA damage in the proliferating breast ductal tissue and thus could increase the risk of mutations that directly lead to breast cancer.
  • Child bearing at a later age is a predisposing factor to breast cancer in women.
  • Any form of benign breast tissue disease may increase the risk of cancer
  • Women who live sedentary lifestyles and do not exercise often are at an increased risk of developing breast cancer
  • Breast cancer has been associated with women who live in upper socioeconomic classes. This may also be associated with more sedentary lifestyles
  • Personal history of breast cancer (in situ or invasive)
  • Postmenopausal hormone replacement treatments with estrogen hormones (with or without progestin) have been shown to increase the risk of getting breast cancer. The risk is increased by about 1.5times
  • Developing obesity after menopause increases the risks of breast cancer in women
  • The use of oral contraceptives increases breast cancer risk minimally if at all. It is t known whether estrogen replacement alone increases risk. However there is a much more increased risk in using these hormones in leaner postmenopausal women. The exact mechanism of cancer formation is unknown but there is a possibly of interaction of ovarian estrogen and other types of estrogens of external origin with breast tissue that leads to susceptibility to develop cancer of the breast
  • Alcohol is also associated with increased risks of developing breast cancer. Surveys show that moderate alcohol intake (two to three drinks/day) has a 1 to 1.8 times the risk of developing cancer.
  • Diet effects. Increased estrogen levels have been found in women with a higher BMI. These pose as an increased risk of developing breast cancer.
  • Family history of breast cancer is a risk factor in women. The risk in first degree relatives is 2 to 4 times more. Having relatives of known high risk factors also play a role. Having two first degree relatives with breast cancer increases the risk by 5 times.
  • Women with an increased bone density have been shown to have a risk of developing cancer.
  • Having children at a later age of more than 30 years poses as a risk to women to develop breast cancer. There is even an increased risk in non-child bearing women ( nulliparous)
  • Women with a personal history of endometrial cancer do have a risk of developing breast cancer.
  • Women with larger breast masses have a more breast density that increases the breast cancer risk. The density can be shown through mammography
  • Exposure to radiation to the chest poses as a risk of developing breast cancer in women.
  • Women with an established breast cancer gene BRCA-1 and BRCA-2 are associated with high risk of developing the cancer

Continue reading Epidemiology of breast cancer.

Lung cancer

Lung cancer

Lung cancer

Definition

This is primary lung malignancy that arises from the lung tissue. There are several types of primary cancer of the lung including squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and large cell carcinoma. Here are some of the listed types

Adenocarcinomas: These types of cancers are common in North America and Japan. They tend to occur among smokers, although nonsmokers are more likely to develop adenocarcinoma than other lung cancer types. On radiological examination, they are found more peripherally, but can occur almost anywhere, and can be multifocal. They have been known to fill the entire lobe of the lung tissue. Other x-ray findings show that they are associated with solid opacities, ground-glass opacities, or mixed patterns. Epidemiologically, Adenocarcinomas represent 35%-40% of lung carcinomas. The variants of adenocarcinomas include types such as signet ring, clear cell, mucinous, and fetal adenocarcinomas

Squamous cell (Epidermoid): This type of cancer tends to occur centrally and is highly associated a history of smoking. It’s a malignancy that shows squamous differentiation 20% to 30% of lung cancers. It spreads by locally invading the surrounding tissues and forms cavities in the lungs. The differential diagnosis includes reactive processes that may result in squamous metaplasia with reactive atypia as seen during infections or radiation-induced injury

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