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					                                                Cancer
CANCER



What is cancer?
     Cancer is the generic term used to describe a group of disorders caused by an
     uncontrolled multiplication of cells, which usually resulting in the destruction of
neighbouring tissues. Gradually, these tissues and organs stop functioning and death may
occur.

The reasons for cells to start multiplying is unknown in most cases. They may have some inbuilt
abnormality or may be affected by external influences.


What are the common terms associated with cancer?
      Since cancer is a group of disorders, there are some terms commonly used in the description of the
      disease.


    1.   Oncology – „onco‟ meaning „cancer‟, oncology is the study of various types of cancers.
    2.   Tumour – a lump resulting from an uncontrolled growth of cells which may be malignant or
         benign.
    3.   Malignant – a growth of cells that destroys the surrounding tissue and spreads to other parts of
         the body.
    4.   Benign – a growth of cells that is not cancerous.
         Both benign and malignant growths are unwanted multiplications of cells, but whereas a benign
         growth does not generally leave the place of its origin, a malignant growth usually destroys not
         only the tissue of its origin but also the surrounding ones. This is why cancers are caused due to
         malignant growths, which spread to all areas of the body.
    5.   Carcinoma – a term synonymously used with cancer. But carcinomas are specifically malignant
         tumours mostly forming on the outlines (epithelium) of the affected organ. It is the most frequently
         occurring form of cancer.
    6.   Sarcoma – another form of cancer where specifically the connective tissue (that which supports
         the various parts of the body), is affected. It is a malignant form and cancers of the blood,
         lymphatic system, bone and the like, fall under this category.



What are the symptoms?


      Cancers appear in many different ways. Most often they are noticed as a lump or growth in some
part of the body. This is the case with tumours that form on the outlines of organs. When the cancerous
growth is not physically identifiable, there may be other revealing symptoms depending on the form of
cancer and the affected organ.
Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and
memory problems. Tumours of the intestine can present problems in bowel movements and pain in the
stomach. Lung cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are
detected as a painless lump. There may also be some deformity of one or both breasts in some cases.

Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example,
cancer of the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when
the patient passes blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer.
It only occurs in some cases where a nerve is pressed due to rapid enlargement of a tumour.

Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of
weight, general feeling of weakness and fatigue and increased proneness to infections.


How is it diagnosed?


      In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a
biopsy of the affected organ is done. In this procedure, a small part of the tissue is taken for laboratory
testing to detect the presence of cancerous cells.

In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken.
CT scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind
the patient‟s previous medical history.


What is the treatment?


       Treatment is most effective if the cancer is detected early. Chemotherapy is the most common
method of treatment for cancer that has spread to other parts of the body. In this procedure, the malignant
cells are destroyed with the help of powerful chemicals like methotrexate and vincristine which are given
intra-venously i.e. directly injected into the veins. This procedure requires a hospital stay for the duration
of therapy. It is also associated with various side effects like loss of hair, nausea, vomiting, loss of appetite
and weakness for some days.

For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the
cells are destroyed with the help of strong radioactive waves. The exact position of the tumour is marked
and the area is exposed to radiation under strictly controlled conditions. This treatment is given in breaks
and in pre-determined doses.

Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be
treated with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-
hormone drugs are given. This treatment scores over chemotherapy because it usually has less severe
side effects. But the doctor decides the best course of treatment depending on the diagnosis of the form of
cancer.


CANCER PAIN
What is the aim of cancer pain management?
     Two thirds of patients with cancer have pain that is severe enough to prevent them from doing their
     activities of daily living. Poor appreciation of this problem and the inability to assess pain was the
reason why pain was poorly relieved in these patients.

The aim of cancer pain management are to:

 Minimize pain and suffering
 Improve quality of life
 Provide psychological support for patients and their families


What are the common misconceptions about cancer pain?

        Cancer causes intolerable pain that cannot be relieved - in fact some patients with cancer pain
never have pain. For those who do, cancer pain can be relieved.
 Pain means that cancer is getting worse - Pain can be due to cancer or the effects of cancer treatment,
Sometimes the pain is unrelated to cancer.
 “Shots” or injections will be needed to control cancer pain - at least 90% of cancer pain can be
effectively relieved by simple medications that are taken by mouth. “Shots” are almost never necessary.
 Patients who use narcotics will become addicted - patients who take narcotics for pain rarely, if ever,
become addicted.
 If strong narcotics like morphine are used too early in the treatment, they will not work later if the pain
gets worse - strong medications like morphine stay effective as long as they are needed. If pain increases,
the medication dose can be increased.


What causes cancer pain?
     Not all people with cancer have pain, and those who do, do not necessarily have it all the time, nor
     is it always severe. Pain associated with cancer usually comes from one of three sources. The
cancer itself may be the cause of the pain if it pushes against bones, nerves, or organs in the body.
Sometimes, pain can be caused by cancer therapy. In addition, pain may be unrelated to the cancer but is
aggravated by it.


How is cancer pain relieved?


      Although the doctor will help ease the pain, there are some things the patients can do to make
things a little better. Changing some habits in the lifestyle may help.

Coffee intake must be reduced. Caffeine in coffee increases adrenaline levels that increase the sensitivity
to pain. Similarly, cigarettes also stimulate adrenalin. Toning the body by regular exercises strengthen the
muscles so that the bouts of pain can be better handled. While the exercise may not feel good at first, in
the long run, it helps. A healthy diet, avoiding unhealthy junk foods keeps the body supplied with essential
nutrients. Laughing is good physically; and it helps to increases the amount of oxygen in the blood. It also
helps to relax the muscles. It provides some relief from the stress and anxiety that often accompany
illness.

One of the most important ways doctors work to control pain is to raise the threshold of an individual to
    pain. This is the level at which pain is felt. The idea is to build up a resistance to pain so that one doesn't
    feel it so much when it occurs. Patients may learn methods of resisting pain such as by hypnosis.
    Hypnosis is effective because it trains the mind to attack pain stimuli automatically without having to think
    about it. Hypnosis can be made convenient for most patients under the supervision of a professional and
    by using hypnotic tapes that can be played at home. Although not everyone will respond to hypnosis,
    anyone who has pain can help to control it by reducing stress in his or her life. Stress makes pain hurt
    more, and reducing stress automatically raises the pain threshold. The family can be a strong source of
    support if the patient is experiencing the discomfort associated with cancer.

    The use of analgesics or pain relieving medicines and pain management is not synonymous. Not only is
    pain a complex experience, but also all pain does not respond equally to narcotic analgesic. Use of
    analgesics is regarded as a part of multimodal approach to treatment. They should not be reserved for
    terminal care as they are safe, well tolerated and effective at all stages of the disease.

    In some cases helper drugs may be required. These may include:


            Anti-depressants for neuropathic pain, concurrent depression, and pain related sleep
    disturbances
            Anti-convulsants for neuropathic pain
            Anti-emetics to control morphine related nausea and vomiting
            Anti-anxiety drugs for sleep deprivation
            Local anaesthetic to block the nerves




    CANCER CHEMOTHERAPY


    What is chemotherapy?


          Chemotherapy is the use of medications to treat cancer. It has played a major role in cancer
    treatment for half a century. Years of testing and research have proved chemotherapy to be an effective
    cancer treatment. It may be the only treatment, or it may be used in combination with other treatments,
    such as surgery and radiation therapy.

    Chemotherapy works by killing rapidly dividing cells. These cells include cancer cells, which continuously
    divide to form more cells, and healthy cells that divide quickly, such as those in the bone marrow,
    gastrointestinal tract, reproductive system and hair follicles. Healthy cells usually recover shortly after
    chemotherapy is complete.


    What is chemotherapy used for?
         The main advantages of chemotherapy are that unlike radiation, which treats only the area of the
         body exposed to the radiation, chemotherapy treats the entire body. As a result, any cells that may
    have escaped from the original cancer are treated.
    Depending on what type of cancer a person has, the doctor may use chemotherapy to:
            Eliminate all cancer cells in the body, even when cancer is widespread
            Prolong the life by controlling cancer growth and spread
            Relieve symptoms and enhance the quality of life

    In some cases, chemotherapy may be the only treatment. But more often, it is used in conjunction with
    other treatments, such as surgery, radiation or a bone marrow transplant, to improve results. For example:

    Neoadjuvant therapy: The goal of neoadjuvant therapy is to reduce the size of a tumour before surgery
    or radiation therapy.

    Adjuvant therapy: This is given after surgery or radiation. The goal of adjuvant therapy is to eliminate any
    cancer cells that might linger in the body after earlier treatments.


    What are the types of chemotherapy?
           Chemotherapy may not be limited to a single drug. Most chemotherapy is given as a combination of
           drugs that work together to kill cancer cells. Combining drugs that have different actions at the
    cellular level may help destroy a greater number of cancer cells and might reduce the risk of cancer
    developing resistance to one particular drug. The doctor will recommend drug combinations that have
    been tested in people with similar conditions and have been shown to have some effect against the
    particular type of cancer.

    What chemical the doctor recommends is generally based on the type, stage and grade of the cancer, as
    well as the person's age, general health and willingness to tolerate certain temporary side effects.

    Some types of chemotherapy medications commonly used to treat cancer include:


        1.   Alkylating agents: These medications interfere with the growth of cancer cells by blocking the
             replication of DNA. Example: Mechlorethamine
        2.   Antimetabolites: These drugs block the enzymes needed by cancer cells to live and grow.
             Example: Methotrexate.
        3.   Anti-tumour antibiotics: These antibiotics are different from those used to treat bacterial
             infections and interfere with DNA, blocking certain enzymes and cell division and changing cell
             membranes. Example: Doxorubicin
        4.   Mitotic inhibitors: These drugs inhibit cell division or hinder certain enzymes necessary in the
             cell reproduction process. Example: Etoposide and Vinorelbine
        5.   Nitrosoureas: These medications impede enzymes that repair DNA. Example: Cisplatin and
             Cisplatinum.



    How is chemotherapy given?
          One usually receives chemotherapy in cycles, depending on the condition and the type of drugs
          used. Cycles may include taking the drugs daily, weekly or monthly for a few months or several
    months, with a recovery period after each treatment. Recovery period allows the body to rest and produce
    new, healthy cells.
    Chemotherapy drugs can be taken in a number of forms. The treating doctor determines what form(s) to
    use primarily based on what type of cancer a person has and what drug(s) will best treat the cancer.
    Chemotherapy is given through the following methods:


        1.   Intravenous (IV): Chemotherapy is injected into a vein, using a needle inserted through the skin.
             This allows rapid distribution of the chemotherapy throughout the body.
        2.   Oral: The patient swallows this kind of chemotherapy as a pill.
        3.   Topical: This type of drug is applied to the skin to treat localised skin cancers.
        4.   Injection: The doctor injects the drug directly into the muscle using a needle on the skin or into a
             cancerous area on the skin.

    Chemotherapy medications, regardless of how they're given, generally travel in the bloodstream and
    throughout the body. The intravenous route is the most common, allowing chemotherapy drugs to spread
    quickly through the system. In cases where the doctor wants to direct chemotherapy to a more confined
    area, for example, to ensure a tumour is exposed to more of the drug, he may insert a catheter directly
    into that area or into a blood vessel supplying the tumour.


    What are the various side effects of chemotherapy?
          Since chemotherapy drugs can affect healthy cells, one of their disadvantages is that the person
          may experience side effects, some temporary and some long term. Not every drug will cause every
    side effect. The treating doctor can tell what to expect from the drugs.

    Temporary side effects might include:


            Hair loss
            Dry mouth
            Mouth sores (stomatitis)
            Difficult or painful swallowing (oesophagitis)
            Nausea
            Vomiting
            Diarrhoea
            Constipation
            Fatigue
            Bleeding
            Susceptibility to infection
            Infertility
            Loss of appetite
            Changes in the way food tastes
            Cognitive impairment, sometimes referred to as chemo brain
            Liver damage

    How long these temporary side effects last, depends on what drug(s) are being taken and for how long.
    Most side effects subside shortly after the chemotherapy treatment is stopped. Most short-term side
    effects can be minimised with medication. For example, the doctor can give medications to help relieve
    nausea or build up the blood counts. One must always tell the doctor if one is uncomfortable with a side
    effect. If the side effects are more than one is willing to endure, one can change treatments.
    As people with cancer are living longer after treatment, doctors have discovered that some treatments
    cause long-lasting side effects or side effects that become apparent long after treatment ends. These
    long-term side effects are rare. Before one begins treatment, one must discuss with the doctor about the
    long-term effects. Some chemotherapy drugs can cause:


             Organ damage, including problems with heart, lungs and kidneys
             Nerve damage
             Blood in urine (haemorrhagic cystitis)
             Another cancer, including Hodgkin's disease and non-Hodgkin's lymphoma, leukaemia and some
    tumours
             Infertility

    The doctor can explain about the signs and symptoms to watch for after the treatment. Knowing what
    long-term side effects to watch for can help one stay healthy after treatment.

    While beginning chemotherapy can be frightening, one must know that new medications are helping
    reduce unpleasant side effects. But chemotherapy will always cause some significant side effects. One
    must keep in mind that many people with cancer are living longer than ever - thanks partly to
    chemotherapy.




    ACID PHOSPHATASE




    What is acid phosphatase?
    Acid phosphatase is an enzyme present in the cells throughout the body. It is present in
    especially high concentrations in the prostate and semen in men. Prostatic diseases result in its
    release in the blood. A blood test can measure the enzyme acid phosphatase. Drugs and
    substances that can interfere with the test include fluorides, oxalates, clofibrate, and alcohol.


    Why is the test done?
          This test is usually done to check an abnormality of the prostate gland, prostate cancer, or to
          monitor the response of cancer to treatment. This is a good blood test to test for prostate cancer
    (accurate in half to three fourths of cases), but a physical examination is much more reliable.


    How is the test done?
          Blood is drawn from a vein, usually from the inside of the elbow. No special preparation is
          required for the test.


    What are the normal values?
           Normal values range from 0 to 0.8 U/L (units per litre)



    What do the abnormal results (high levels) lead to?

             Prostatitis (swelling or infection in the prostate)
       Prostate cancer with spread to bones
       Paget's disease of bones (thicker and softer bones)
       Hyperparathyroidism
       Stimulation of the prostate during colonoscopy, enemas or prostate examination
       Multiple myeloma


    ANTIOXIDANTS

    What are antioxidants?
         Antioxidants are substances that may protect cells from the damage caused by unstable
         molecules known as free radicals. Damage due to free radicals damage may lead to
    cancer. Antioxidants interact with and stabilise free radicals and may prevent some of the
    damage free radicals otherwise might cause. Examples of antioxidants include beta-carotene,
    lycopene, vitamins C, E, and A, and other substances.


    Which foods are rich in antioxidants?
          Fruits and vegetables provide a range of antioxidants, vitamins A, C and E, carotenoids and
          flavonoids. Fruits and vegetables that have comparatively high levels of antioxidants include apples,
    grapefruit, green grapes, oranges, peach, red plums, strawberries, beetroot, sprouts cauliflower, green
    cabbage, lettuce, onion, spinach and tomatoes. Antioxidants are abundant in other foods including nuts,
    grains and some meats, poultry and fish.


             Beta-carotene is found in many foods that are orange in colour, including sweet potatoes,
    carrots, apricots, pumpkin, and mangoes. Some green leafy vegetables including spinach, are also rich in
    beta-carotene
             Lutein, best known for its association with healthy eyes, is abundant in green, leafy vegetable,
    spinach etc.
             Lycopene is a potent antioxidant found in tomatoes, watermelon, guava, papaya, apricots, pink
    grapefruit, oranges, and other foods
             Selenium is a mineral, not an antioxidant nutrient. However, it is a component of antioxidant
    enzymes. The amount of selenium in soil, which varies by region, determines the amount of selenium in
    the foods grown in that soil. Animals that eat grains or plants grown in selenium-rich soil have higher
    levels of selenium in their muscle
             Vitamin A is found in three main forms: retinol (Vitamin A1), 3,4-didehydroretinol (Vitamin A2),
    and 3-hydroxy-retinol (Vitamin A3). Foods rich in vitamin A include liver, sweet potatoes, carrots, milk, egg
    yolks and mozzarella cheese
             Vitamin C is also called ascorbic acid, and can be found in high abundance in many fruits and
    vegetables and is also found in cereals, beef, poultry and fish
              Vitamin E, also known as alpha-tocopherol, is found in almonds, in many oils including wheat
    germ, safflower, corn and soybean oils, and also found in mangoes, nuts, broccoli and other foods



    What are the uses?
          Antioxidants help to reduce the risk of cancer, heart attack and stroke.

    Protection against heart disease:

    Deficiencies in Vitamins A, C, E and beta carotene have been linked to heart disease. All of these
    nutrients have antioxidant effects and other properties that may benefit the heart.


              Vitamin E: eating foods rich in natural vitamin E may be protective. Vitamin E may prevent blood
    clots and the formation of fatty plaques and cell proliferation on the walls of the arteries
              Vitamin C: Vitamin C appears to maintain blood vessel flexibility and to improve circulation in the
    arteries
              Folate, Vitamin B6, and Vitamin B12. Several important studies have demonstrated a link
    between deficiencies in the B vitamins folate, B6, and B12 and elevated blood levels of homocysteine, an
    amino acid believed to be a risk factor for atherosclerosis. Both B12 and folate reduce homocysteine
    levels, and evidence is increasing that this effect may protect the heart.
              Vitamin B3. Niacin (vitamin B3) is used for lowering unhealthy cholesterol levels
              Carotenoids and heart protection: a high intake of fruits and vegetables containing beta carotene,
    lycopene, and other carotenoids may reduce the risk of heart attack
              Phytochemicals and heart protection: Flavonoids, particularly those found in both black and
    green tea, onions, red wine or red grape juice, and apples, may protect against damage done by
    cholesterol and help prevent blood clots



    Protection against stroke:

           Vitamin C. There is a lower risk for stroke in subjects with the highest blood levels of vitamin C.
    Studies have found protection in foods rich in vitamin C, although supplements do not appear to offer any
    advantage.
     B Vitamins: Vitamins B6, B12, and folate are important for the production of neurotransmitters, the
    chemical messengers in the brain that regulate mood and concentration. Deficiencies in these vitamins
    have been observed in people with depression and dementia. People who have higher blood levels of folic
    acid have a lower than average risk for stroke
     Carotenoids and stroke protection: Studies have reported a lower risk of stroke from carotenoids,
    including beta carotene and lycopene.


    Protection against cancer:
          Many fresh fruits and vegetables contain chemicals that may fight many cancers, including lung,
          breast, colon, and prostate cancers. Examples of important cancer-fighting foods include the
    following:


            Cruciferous vegetables (e.g., cabbage, sprouts, broccoli)
            Tomatoes (which contain lycopene)
            Carrots (which contain alpha and beta carotene)

    There is some evidence that antioxidants may enhance the anticancer effects of chemotherapy.
    Antioxidant nutrients that may have properties that may help reduce the side effects of chemotherapy
    include vitamins E and C, beta carotene, isoflavones found in soy, and quercetin (found in red wine and
    purple grape juice).


    Vitamins and cancer protection.
          Although supplements of vitamins A, C, and E appear to have no advantages, studies have reported
          an association between low blood levels of these antioxidant vitamins and a higher risk for cancer.


            Vitamin D. Some studies have suggested that certain vitamin D compounds may inhibit certain
    cancer cells, specifically prostate cancer, from proliferating.
            Folate and B12. These B vitamins helps prevent cells from becoming malignant. Folic acid
    supplements may provide some protection against cervical and colon cancer and may reduce the risk for
    breast cancer among women who regularly drink alcohol
            Carotenoids and cancer protection. A number of studies have reported that fruits and vegetables
    rich in carotenoids are associated with protection against many cancers. Lycopene, found in tomatoes,
    may have particular value in protection against prostate, colon, lung, and bladder cancer.

    Protection against other diseases include: Alzheimer's Disease, asthma, eye disorders, skin disorders,
    wrinkles, osteoporosis, gall stones and menstrual disorders


    AIDS-ASSOCIATED TUMOURS
    What are AIDS-associated tumours?
            AIDS (acquired immunodeficiency syndrome) caused by HIV (Human immunodeficiency virus)
            attacks the body's immune system. In AIDS, the body can no longer fight off disease successfully.
    As a result, certain cancers, infections, diseases of the nervous system and muscles occur more easily in
    individuals infected with HIV compared to healthy people. Cancers seen more frequently in AIDS include
    Kaposi's sarcoma, lymphomas, cancers of the cervix and the anus. Kapsoi's sarcoma often manifests
    itself as raised purplish-red bumps on the skin. These bumps can vary greatly in size. Lymph nodes, the
    intestines and the lungs can also be affected. In fact, any part of the body can be affected by this tumour.
    Several kinds of lymphomas can occur including those which involve the brain exclusively.


    What are the symptoms?
          The symptoms of AIDS-associated cancers relate to the affected organs like the skin,
          internal organs of the body, or the lymphatic system.


    How are they diagnosed?
          The diagnosis of a cancer can be suspected on the symptoms and the results of the
          physical examination. Kaposi's sarcoma is diagnosed by a biopsy of any purple patch or
    sore on the skin or mucous membrane. Lymphoma and the other cancers require a biopsy of
    the affected lymph nodes.


    What is the treatment?
          Treatment for AIDS-associated cancers include:

                   Chemotherapy: This uses drugs that kill the tumour cells.
            Radiotherapy: is also used to destroy cancerous growths and slow
    their spread.
            Combination therapy: Treatment includes a combination of surgery,
    chemotherapy and radiotherapy.



    How can AIDS be prevented?

            Avoid sexual contact with HIV infected individuals or use a condom during sex.
     Ensure the barber doesn't reuse blades.
     Intravenous drug users shouldn't share needles.
     HIV infected individuals should not donate blood, semen, or body
    parts.
     Breast feeding should be avoided because the virus can be
    transmitted to the infant.



    BREAST CANCER
    What is breast cancer?


           Breast cancer is the uncontrolled malignant growth of cells in the breast tissue. There are many
    types of breast cancers, those that form in the milk glands, in the ducts that carry milk, in the fatty area or
    in the connective tissue of the breast.

    Cancer of the milk ducts is the most commonly occurring form of breast cancer. Usually only one breast is
    affected. There is a rare type of breast cancer in which the breast becomes red and swollen and
    resembles infection of the breast.


    How is it caused?
         The exact reason for the cancerous growth of cells is not known. There are certain factors that do
         not cause cancers by themselves, but make a person more at risk for the development of cancer.
    These risk factors may be genetic or environmental in nature:


            Cancer tends to run in families. The risk for cancer increases for a person if one or more of his
    family members suffer from the disease.
            Genetic predisposition that is, a person may carry genes that make certain normal cells
    cancerous.
            Women who begin menstruating before the age of 12 years or stop after 55 years are more at
    risk for developing breast cancer.
            Women who have not borne children or have had children late in their life (usually after the age
    of 30) are also more at risk.
            Obesity or overweight is a condition that is associated with an increased risk of breast cancer.
            Other factors like excessive drinking of alcohol and lack of exercise are also risk factors for
    breast cancer.
            Environmental factors like exposure to harmful radiation, cigarette smoke over a long period of
    time and pesticides also increases the risk.
            In some cases, women who undergo hormone replacement therapy have an increased risk of
    cancer of the breast.



    What are the symptoms?


          The most common symptom of cancer of the breast is the presence of a lump in the breast. The
    patient herself often detects the lump either accidentally or during a routine self-examination. The lump is
    usually painless and hard. Sometimes, there may be changes in the shape and size of the breast and the
    nipple.

    A dimple in the skin overlying the breast accompanied with dryness and scaling should be a cause for
    concern. There may be discharge of blood stained fluid from the nipple along with dryness and cracking of
    the skin of the nipple.


    How is it diagnosed?
          A breast lump is usually first detected by a woman on self examination. This procedure
          should be regularly done by all women over the age of 40 years. In this procedure, the
    woman lies down, raises the arm on the side of the breast and feels the breast with the other
    hand. Any difference from in the normal feel of the breast is noted. The woman may then look
    at herself in the mirror and note any changes in the shape and size of her breasts. Any change
    should be brought to the doctor‟s notice.

    The doctor may palpate or feel the breast for any unusual lumps or any other signs. In case a
    lump is detected by the doctor, mammography may be done. This is a special X-ray of the
    breast. It can detect early breast cancers and gives a fairly accurate picture of any changes in
    the breast. Any spots that show up in the mammogram are then further analysed by a biopsy.
    In this procedure, a small part of the lump tissue is taken for laboratory testing. The biopsy can
    also be done in many ways. In some cases, a small needle may be inserted into the lump and a
    small portion of the fluid may be taken.

    In another form of biopsy, a small cut may be made on the breast to get to the lump, a piece of
    which is then taken for testing. In some cases, the entire lump may be removed. The procedure
followed is decided by the doctor keeping in mind the patient‟s history.

In case cancer of the breast is confirmed, other tests may be done to look for spread of the
disease. These include blood tests, X-rays and ultrasound scan of the abdomen. In some cases
a bone scan may be done.


What is the treatment of breast cancer?
     Since the breast is not an organ that is necessary for survival, it is generally removed by a
     surgical procedure called mastectomy. In some cases only the lump is removed, in others
the whole breast is removed.

Later, the patient may be given radiotherapy. This procedure helps to destroy the cancerous
cells without harming the neighbouring tissue. If the cancer has spread to other parts of the
body as well, chemotherapy using drugs like vincritine, adriamycin and cyclophosphamide is
done. In some cases, hormonal treatment using tamoxifen is advised. Usually a combination of
all of these procedures is followed for complete treatment. In most cases, if the cancer is
detected early and treated appropriately, breast cancer patients can usually lead a cancer free
life.

-----------------------------
BRAIN TUMOUR



What is brain tumour?
       A brain tumour, like a tumour anywhere else in the body, is a result of an abnormal
       proliferation of cells in the brain. A primary brain tumour is one where the tumour
originates from the brain cells. Secondary brain tumours are cancers originating elsewhere in
the body and spreading to the brain through the blood stream. It may be mentioned that some
chronic infections like tuberculosis and fungal infections often produce a tumour like moss in
the brain which may mimic a cancerous lesion. A brain tumour may directly destroy brain cells
or it may cause brain dysfunction by various other means.

The skull is a hard bony structure and thus provides only limited space to the structures within.
Since the brain does not have any space to expand, a space-occupying tumour may be
especially dangerous. Brain tumours can cause indirect damage by compressing brain tissue,
inflammation of the brain (cerebral oedema) and increasing the pressure within the brain
(intracranial pressure) by interfering with the circulation of brain fluid (cerebrospinal fluid or
CSF).

Though most tumours are classified as 'malignant' or 'benign', brain tumours are usually
classified as "high grade" or rapidly growing and "low grade" or slow growing. This is because
even non-cancerous brain tumours may be life threatening since they do not have space to
grow and thus endanger other parts of the brain.


What are the various kinds of tumours?
    Brain tumours are basically of two kinds – those that originate from the layers covering the brain
    (meninges) and those that originate from the brain cells. The former are called meningiomas. They are
    almost always non-cancerous and are easy to remove surgically. The tumours arising from the supportive
    tissues of the brain are called gliomas. They are more common in adults and are more dangerous, since
    they are usually malignant and can often not be completely removed.

    The most commonly occurring tumours in adults are gliomas, while in children, tumours usually arise near
    the brain stem (medulloblastoma).


    What are the causes?
           The exact cause of tumours is not known. However, there is a higher risk of tumours in:


                    Children and elderly
             People with certain rare congenital abnormalities like Li-Fraumeni syndrome, tuberous sclerosis
    etc.
             People with disorders of the immune system or auto-immune disorders like AIDS
             People who are exposed to X-rays of the head
             People who work in certain industries like oil refining, drug and rubber manufacturing.



    What are the symptoms of tumours?
          Symptoms of brain tumours are usually non-specific in the beginning. They also depend on the size
          and location of the tumour in the brain. The symptoms of a brain tumour may be varied since they
    may affect different functioning capacities of the brain. For example, a tumour that causes swelling of the
    brain may exhibit different symptoms than that which compresses the tissues of the brain.

    Some of the common symptoms indicating a tumour in the brain are:


             Frequent headaches that vary in intensity and time of the day. These headaches are usually
    intense in the mornings and ease out during the day.
             Nausea or vomiting
             Epileptic seizures or convulsions
             Visual disturbances due to compression of the optic nerve or oedema of the optic disc
    (papilloedema)
             Changes in memory functions
             Changes in speech
             Drowsiness and bouts of incoherence
             Partial or local paralysis. Neurological deficits like weakness or paralysis of some parts of the
    body, loss of sensation, unsteadiness of gait (ataxia), etc.



    How is it diagnosed?
      The doctor first conducts a thorough physical examination of the patient and takes his
      medical and family history. The physical examination includes a detailed neurological
examination. The latter consists of examinations for alertness, muscle strength, coordination,
reflexes and response to pain. Any swelling of the eyes and visual disturbances is also
ascertained.

The doctor may ask for tests like CT or MRI scan to study the tissues of the brain. These
procedures help to identify any changes in the brain tissues, and outline any abnormal growth.
Other tests that may be requested by the doctor are EEG, angiogram and a skull X-ray.


When should the doctor be consulted urgently?
    Persistent or increasing frequency of headache specially if it is associated with vomiting,
    blurring or double vision, weakness of any part of the body, epileptic fits, difficulty in
speaking, instability of gait. Change of behaviour, memory impairment with or without the above
symptoms should also prompt expert consultation.


What is the treatment?
      Depending on the type of tumour, its location, and the extent of its spread, the treatment may be
      surgery, chemotherapy and/or radiation therapy. These procedures may be used exclusively or in
combination. Before treatment begins, patients are usually given steroid treatment to reduce brain
swelling. They may also be given medication to keep the seizures (epileptic fits) under control.


    1.   Surgery - The most common form of treatment of brain tumours is removal of the cancerous
         mass. The neurosurgeon makes a hole in the skull and reaches the site of the tumour through
         that. The procedure is called craniotomy. As far as possible, the entire tumour is removed. This is
         usually possible to achieve in case of benign tumours like meningiomas, neuro fibromas, etc.
         Gliomas on the other hand, cannot be excised completely as they do not have clearly defined
         limits. However, the doctor is careful not to damage any vital tissues of the brain, and thus in
         cases where the whole tumour cannot be removed, partial removal is done. This helps to relieve
         the pressure within the skull and leaves a smaller portion of the tumour to be treated through
         radiation and/or chemotherapy.
    2.   Chemotherapy – it is the destruction of cancerous cells with the help of powerful drugs. Drugs
         are usually given orally or as injections into the vein.
    3.   Radiation therapy – in this high power rays are used to kill cancerous cells and prevent them
         from proliferating. Radiotherapy is given for a short period of time followed by a break. The period
         of therapy depends on the age of the patient, the site of the tumour and its size. The radiation is
         given with pin point accuracy, so that the surrounding healthy brain tissue is protected.



What are the side effects of treatment?
       Brain tumour treatment may leave many side effects which may become less with time.
       Since craniotomy is a major procedure, there may be side effects like coordination
difficulties, problems in comprehension and memory and personality changes. This is caused
due to some damage to normal tissues surrounding the tumour.
Post surgery complications include cerebral oedema and seizures. Other side effects depend
upon the location and extent of the tumour. In case there is no neurological deficit before
operation, post-operatively also there should be no defect. In a large majority of cases even
pre-operative deficit improves. However if tumour removed is delayed or the deficit is already
severe this may not recover fully.

Side effects of radiation and chemotherapy include nausea, vomiting, weight loss, loss of hair
and allergic reactions of the skin. Children who have had radiation therapy for brain tumours
may have learning difficulties and visual problems. There may also be growth deficiencies in
some children due to hormonal imbalance.

Some anticancer drugs may cause infertility. Women on anticancer drugs may experience
menopausal symptoms like hot flashes and vaginal dryness. Some drugs may also cause
kidney damage. A common condition is the formation of blood clots, usually in the leg, after the
drug treatment.


What are the long term effects?
      Early treatment of the tumour is necessary for better chances of recovery. The prognosis is grim for
      patients in whom the tumour is not completely removed. Although the inevitable is delayed with
medication, survival chances are very low. The average life expectancy is about 6 months in case of a
malignant tumour. In cases of benign tumours, and those which are completely removed, the prognosis is
good and the patient can gain full recovery. The side effects of treatment lessen with time and the patient
can resume his normal routine. Physiotherapy and rehabilitative therapy may be given to minimise the
residual effects. There are various support groups that are working in the area of rehabilitation of cancer
patients and they may provide the much needed support.




BONE MARROW TRANSPLANT



What is bone marrow transplant?
      Bone marrow transplant is a procedure in which healthy bone marrow is transplanted into
      a patient whose bone marrow is not functioning properly. Problems in bone marrow are
often caused by chemotherapy or radiation treatment for cancer. This procedure can also be
done to correct hereditary blood diseases. The healthy bone marrow may be taken from the
patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor
(allograft).


What is bone marrow?
      Bone marrow is the soft, sponge-like material found inside bones. It contains immature
      cells called stem cells that produce blood cells. There are three types of blood cells: white
blood cells, which fight infection; red blood cells, which carry oxygen to and from organs and
tissues; and platelets, which enable the blood to clot.
    Why is it done?
         If a patient develops a disease of the blood cells, especially cancers such as leukaemia,
         he may require high doses of chemotherapy to destroy the cancer. However, this also
    destroys normal blood cells.

    Alternatively, hereditary or acquired disorders may cause abnormal blood cell production. In
    these cases, transplantation of healthy bone marrow may save a patient's life. Transplanted
    bone marrow will restore production of white blood cells, red blood cells, and platelets.


    What is the procedure?
          Bone marrow transplant patients are usually treated in specialised centres and the patient
          stays in a special nursing unit (a bone marrow transplant unit) to limit exposure to
    infections. The hospitalisation period is from 4 to 6 weeks, during which time the patient is
    isolated and under strict monitoring because of the increased risk of infection and/or bleeding.

    Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a
    living relative (usually a brother or a sister), or from an unrelated donor. Donors are matched
    through special blood tests called HLA tissue typing.

    Bone marrow is taken from the donor in the operating room while one is unconscious and pain-
    free (under general anaesthesia). Some of the donor's bone marrow is removed from the top of
    the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and
    stored for later use. Then, transplant material is transfused into the patient through a vein and is
    naturally transported back into the bone cavities where it grows to replace the old bone marrow.

    Alternatively, blood cell precursors, called stem cells, can be induced to move from the bone
    marrow to the blood stream using special medications. These stem cells can then be taken
    from the bloodstream through a procedure called leukapheresis.

    The patient is prepared for transplantation by administering high doses of chemotherapy or
    radiation (conditioning). This serves two purposes. First, it destroys the patient's abnormal
    blood cells or cancer. Second, it inhibits the patient's immune response against the donor bone
    marrow (graft rejection).

    Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10
    to 20 days for the bone marrow to establish itself. During this time, the patient requires support
    with blood cell transfusions.


    What are the indications?
         Bone marrow transplant may be recommended for:
         Bone marrow deficiency disease caused by:


           abnormal red blood cell production, such as thalassaemia or sickle cell disease
           aggressive cancer treatments (chemotherapy, radiation therapy), especially for leukaemia or
    lymphoma
           lack of normal blood cell production (aplastic anaemia)
    Immune system disorders (immunodeficiency) such as:
            congenital neutropenia
            severe combined immunodeficiency syndrome

    Bone marrow transplant is not recommended for:


            patients with heart, kidney, lungs, or liver disorders
            patients with other diseases that may limit survival



    What are the risks?
          The risks for any anaesthesia are:


                  reactions to medications
            problems breathing

    Chemotherapy given prior to bone marrow transplant (conditioning) can cause significant toxicity, such as
    mouth sores, diarrhoea, liver damage, or lung damage. While waiting for bone marrow to grow, the patient
    is at high risk for infection as also bleeding.

    The major problem with bone marrow transplants (when the marrow comes from a donor, not the patient)
    is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as
    though they were foreign organisms. In this case, drugs to suppress the immune system must be taken,
    but this also decreases the body's ability to fight infections.

    Other significant problems with a bone marrow transplant are those of all major organ transplants - finding
    a donor and the cost. The donor is usually a sibling with compatible tissue. The more siblings the patient
    has, the more chances there are of finding a compatible donor.


    What is the prognosis?
         Bone marrow transplant prolongs the life of a patient who would otherwise die. Relatively
         normal activities can be resumed as soon as the patient feels well enough and after
    consulting with the doctor.

    The patient will require attentive follow-up care for 2 to 3 months after discharge from the
    hospital. It may take 6 months to a year for the immune system to fully recover from this
    procedure

				
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