Dr. Arun Kumar Goel

Cancer refers to the uncontrolled growth of abnormal cells anywhere in a body. Anything that may cause a normal body cell to develop abnormally potentially can cause cancer. Although there are many tests to screen and presumptively diagnose cancer, the definite diagnosis is made by examination of a biopsy sample of suspected cancer tissue.

Ovaries are small structures present in the lower part of abdomen adjacent to the uterus. Cancers arising from ovaries can be of different types: 

Germ cell type (these cancers arise from cells that produce ova or cells that grow into the new born upon fertilization), epithelial (these arise from the outer lining of the ovaries) and others (multiple types from remaining tissue in ovaries).

Epithelial ovarian cancer is the commonest type of ovarian cancers and is also the one associated with high fatality. High fatality is related to the aggressive behaviour of cancer but is also due to the fact that majority of epithelial ovarian cancers are diagnosed late.

In the early stages of ovarian cancer, very few symptoms may be present. Many women do not experience any symptoms at all. The symptoms that may be experienced can be associated with other conditions and hence often go unrecognized. However, in the case of ovarian cancer, these symptoms will gradually increase and worsen with time. Some of the symptoms of ovarian cancer are: 

1. Pain in the lower abdomen or pelvic area 
2. Back ache 
3. Frequent urge to urinate 
4. Painful intercourse 
5. Change in bowel habits (constipation usually) 
6. Indigestion 
7. Nausea 
8. Loss of appetite or feeling full without eating too much 
9. Fullness or distension of the abdomen

Ovarian cancer usually affects women over the age of 50 but can occur in younger women also. Women with a family history of breast cancer or ovarian cancer have a higher risk of developing these tumours. Endometriosis and hormone replacement therapy could also increase one’s risk of ovarian cancer. 

As with other types of cancer, treatment for ovarian cancer depends largely on how far it has advanced. The main forms of treatment include surgery and chemotherapy. Surgery is usually the first step of treating ovarian cancer. Surgery for early ovarian cancer is called “staging laparotomy” while surgery for advanced ovarian cancer is called “cytoreductive surgery”. Surgery involves complete hysterectomy with removal of both tubes and ovaries. In addition, lymph nodes in the pelvis and retroperitoneum are removed. Removal of omentum (a fatty layer of tissue attached to stomach and large intestine) is also done.

In addition, biopsy samples are collected from the peritoneal lining of the abdomen. If there are other sites of disease, they are also removed surgically. In very advanced cases, parts of intestine (large intestine, small intestine), spleen, liver etc. may also be removed. In some early stage ovarian cancer that are not very aggressive, uterus and one side fallopian tube and ovarian can be saved. This can permit child bearing and is called fertility sparing surgery. 

Surgery is usually followed by chemotherapy. Usually six cycles of chemotherapy are used. For early stage ovarian cancer that is low grade, chemotherapy may not be required. Ovarian cancer can come back and all patients need regular follow up after surgery and/or chemotherapy. Physical examination, blood tests, ultrasound and/or CT scan of abdomen are used for follow up. If the disease comes back, chemotherapy may be repeated and sometimes additional surgery can be carried out. In case you have a concern or query you can always consult an expert & get answers to your questions!

Cancer that starts in the testicles is called testicular cancer. Testicular cancer is more commonly seen in men who are from 25 to 40 years of age. It is generally of two major types. 

1. Seminomatous: These are less aggressive and respond very well to chemotherapy and radiation therapy 
2. Non-seminomatous: These grow and spread rapidly, and often require surgery and chemotherapy

While the exact causes for testicular cancer are not clear, the following are considered to be the possible risk factors: 

1. Family history 
2. Undescended testicles 
3. Prior history of testicular cancer 
4. Genetic abnormalities of some types 

Symptoms:

While testicular cancer is often diagnosed late, the patient can have early symptoms, which are often ignored. 

1. Painful swelling in one (or both) testicle(s) 
2. Pain in the lower abdomen and groin area

Often, this type of cancer originates in the testicles and spreads to the lymph nodes inside the abdomen. It can also reach distant organs like lungs, liver, and lymph nodes in chest, neck. If attention to paid to early symptoms such as testicular swelling with or without pain, testicular cancer can be diagnosed early. However, even if diagnosed in the late stages, treatment is quite effective and outcome is good.

Tumor Markers in Testicular Cancers

Tumor markers are very important for diagnosis of testicular cancers. Alpha feto protein (AFP) and human chorionic gonadotrophin (hCG) and lactate dehydrogenase (LDH) are very important markers that are testing in blood. They are very useful in diagnosis, staging and follow up of testicular cancer. 

Stages of Testicular Cancer


There are three stages of testicular cancer – I to III, and treatment and prognosis would depend on the stage at which it is diagnosed. 

Treatment:

Various modalities are used depending on the stage and extent of spread. 

1. Surgery: Removal of the testicle is usually the first step in testicular cancer treatment. Removal of testicle for cancer is done by a procedure called “high orchidectomy” or radical orchidectomy and not through the scrotum. This may need to be followed up by chemotherapy or radiation in most cases. 
2. Chemotherapy: Chemotherapy drugs are used to kill the existing cancer cells and arrest the further growth of testicular cancer. Chemotherapy can be given in early cancers to prevent recurrence of cancer and for advanced cancer to cure the advanced cancer. Chemotherapy is very effective in testicular cancer and cures majority of cases in advanced stages too. 
3. Radiation: External radiation can be used to target nodes in the abdomen. Radiation is very effective in seminomatous cancers. As is true of all cancers, surveillance and follow-up is very essential. History, examination and testing (blood tests for tumor markers) and scanning (CT scan of abdomen, thorax) are used for follow up.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Breast cancer is the most common cancer in females, affecting one in every eight women in the US. Knowing the symptoms can help in early diagnosis and thereby early treatment and better outcome.  

How and why of breast cancer?


Breasts have milk producing glands as well as connective tissue including fat, fibrous tissue, nerves, blood vessels, etc. Milk produced in the glands reaches the exterior through a network of ducts. Most cancers develop in milk producing glands and ducts and later continue to grow and spread to lymph nodes in armpit as well as distant organs.  

Warning signs and symptoms: 


Given the high incidence of breast cancer, knowing the symptoms helps in early identification. Read on to know more. Pay extra attention if there is a family history. 

1. Appearance of a lump in the breasts or the armpits 
2. Any change in the size, shape, or contour of the breasts  
3. Presence of a watery or bloody discharge from the nipple  
4. The breast or the nipple turning red
5. Sudden thickening of breast tissue or skin that continues for a while 
6. Change in the feel or look of the skin (dimpling, puckering, scaliness, reddishness, warmth, etc.)
7. Hardening of the tissue under the breast skin 
8. Difference in appearance or feel of one area in comparison with other areas 

The presence of any of these or a combination of these symptoms should be an indication for a detailed check-up. As mentioned, early diagnosis helps in improving outcome. Treatment is also easier with early stage of disease. It is also good to know risk factors, which also indicate if you need to watch for symptoms. 

1. Family history: Breast cancer can run in families, and if you have close relative(s) with breast cancer, watch out for symptoms.  Family member or self have a positive test for BRCA1 and BRCA2 Family history of other cancers Age Women over the age of 40 years are at an increased risk of developing breast cancer. 
2. Hormones: Increased use of estrogen increases the chances of developing breast cancer. Therefore, women who have used birth control pills for long time or are on hormone replacement therapy are at greater risk.  
3. Abnormal gynaecologic milestones: Women who have abnormal menstrual milestones are more predisposed to developing breast cancer. For instance, girls who have start of menstrual cycles before age of 12, get pregnant after 30, and reach menopause after 55. Women with menstrual irregularities including cycles earlier than 26 days and later than 29 days are also likely to have hormonal issues and are, therefore, at higher risk of breast cancer.  
4. Other factors: Smoking, alcohol consumption, and obesity also increase the chances of a woman developing breast cancer."

Cancer is a disease characterized by abnormal multiplication of cells in a particular part of the body. After starting in one body part, cancer cells spread to other body parts and lead to the formation of tumours (metastases) in other parts of the body. Throat cancer refers to the development of tumours in the different parts of the throat. Various parts of the throat include oropharynx (tonsil, soft palate, base of tongue), nasopharynx (part behind the nose), hypopharynx and larynx (voice box). Throat cancers are a common type of cancer in India. The most common causes of throat cancer are - 

1. Tobacco is the most important cause of throat cancer. Smoking in any form increases the risk of pharyngeal and laryngeal cancer greatly. Chewing tobacco can also increase the risk of pharyngeal cancers. No amount of tobacco exposure is safe. 
2. Alcohol: Alcohol is an important contributor to risk of pharyngeal cancer. Alcohol intake multiplies the risk of cancer that is due to tobacco exposure. 
3. Human Papilloma Virus: Human papilloma virus or HPV is famous as the cause of cancer of uterine cervix. However, in recent years it has been found to be an important cause of throat cancer. HPV infection is transmitted through sexual contact. 
4. Epstein Barr Virus (EBV) infection: EBV infection is responsible cancer of the nasopharynx or part of pharynx behind the nasal cavity. 

The risk of throat cancer can be reduced by avoided tobacco and alcohol. HPV infection can be avoided through safe sexual practices. These practices can prevent large majority of throat cancers. Other that prevention, timely testing for early diagnosis and immediate treatment when cancer is diagnosed will lead to successful outcomes.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Gastric cancer is more commonly known as stomach cancer. It is usually diagnosed in later stages as symptoms are few in early disease and are often neglected by people. Feeling of fullness in upper abdomen, decrease in hunger, weight loss, weakness, vomiting, are some of the common symptoms. Like all cancers, stomach cancer is shrouded in a culture of myths and baseless facts. Here are some of these myths and actual facts to dispel any doubts: 

1. It’s not cancer if there is no pain: In the early stages of stomach cancer, symptoms are either absent or very mild so that they are usually neglected. This leads to delay in diagnosis. It needs to be stressed again that absence of pain does not mean that cancer can not be there. Slight fullness in the upper abdomen, decrease in appetite, etc. can be signs of stomach cancer.
2. Sustained indigestion equals stomach cancer: While it is true that one of the symptoms of stomach cancer is indigestion, burping and/or acidity. But, indigestion doesn't always mean that it is stomach cancer. Most of the times, indigestion is not due to cancer. However, if there is recent onset of indigestion (from 2 weeks to a few months) with loss of appetite, weight loss and vomiting, possibility of cancer should be thought of and testing carried out. 
3. Stomach cancer is rare: Stomach cancer occurrence varies and it is more common in some areas and much less common in other areas. However, in totality, it is one of the very common cancer types. In India, stomach cancer is more common in southern and north-eastern parts of the country but it can occur in persons in any part of the country. 
4. Stomach cancer is not genetic: Even though it is not commonly seen as a hereditary disease, stomach cancer can be passed down through the genes, thereby increasing the chances of stomach cancer in people who possess it by 70 to 80 percent. Mutation in the CDH1 gene is usually the reason behind this. Sometimes also known to contribute to breast cancer in women. 
5. Stomach cancer has no cure: This is a misconception. Except for most advancer stage of cancer (stage IV), stomach cancer can be cured by proper treatment. Surgery is the mainstay of curative treatment for stomach cancer. Chemotherapy and radiation therapy are also required in addition to surgery in many cases." In case you have a concern or query you can always consult an expert & get answers to your questions!