Signs & Symptoms of Cancer: An Introduction

There’s a saying which goes like this – the deadliest disease begins with a simple rash; this holds true for something as deadly as cancer as well. Ominous as it might sound but we would be better off knowing the signs and symptoms which allude to a possibility of cancer occurrence. In the first place, it is important to understand that a symptom is necessarily a signal which is detected and identified by the affected person himself or herself; for instance, sleeplessness, weakness, etc. A sign on the other hand is usually felt or detected by a healthcare professional. Again a solitary sign or symptom is not enough to pin point the disease; it is a combination which leads to proper detection and subsequent diagnosis.
The cancer context
The signs and symptoms for cancer can be multifarious; they are actually dependent on the location of the cancer, the size of the cancerous cells, its spread and the extent to which it has affected particular organs or tissues of the body. Visible signs and symptoms can appear in different parts of the body if the cancer has spread or metastasized.
How signs & symptoms come forth?
Cancer by definition alludes to overgrowth of certain cells. So when a cancer grows, it is likely to push the organs, tissues, nerves and blood vessels near its vicinity. This pressure is one of the causative factors of signs and symptoms. Besides, even the smallest tumor can engender symptoms if the cancer occurs in critical areas like the cerebrum.
Apart from these, there might be instances where the signs and symptoms take a lot of time to appear and by the time they do, the cancer has already grown large. Pancreatic cancer is one such cancer which does not trigger symptoms until it has become large enough to press on the surrounding organs causing back or belly pain. Other cancers can occur near the bile duct and obstruct the flow of bile thus causing the skin and eyes to look yellow – a sign of jaundice.
Other issues
Fatigue, weight loss and fever are some of the other symptoms that may be caused by cancer. The math is simple; food supplies energy to the body and the cancer cells consume a bulk of that energy thus rendering your body weak. Moreover, cancer cells alter the process in which the body garners energy from food and cause the immunity system to give the above mentioned warning signals.
Another notable capability of cancer cells is diversion. At times, symptoms which are not generally associated with cancer are caused when cancer cells expel certain substances into the bloodstream. For instance, some lung cancers produce substances which resemble hormones and raise blood calcium levels thus affecting muscles and nerves and making the person fatigued. Other symptoms may be blood clots in the veins of legs caused by substances released by cancer cells in the pancreas.
Now what?!?
Knowing about certain symptoms that augur cancer, it is important that we understand how these can help in early diagnosis and subsequent treatment. Curing and removing cancer surgically or in some other process can be more than efficacious if it is small, is detected early and is likely to have spread to other parts and organs of the body. Take Melanoma skin cancer for instance; it is easy to remove it if it has not grown deep into the skin and the survival rate for the same is also very high (97%, 5 years after being diagnosed and treated).
Often it has been found that people ignore symptoms by dismissing them as unimportant (assuming that a lump in your breast is probably a cyst which will go away all by itself). Others fear about what dreadful results a checkup might disclose. The usual symptoms mentioned above does not necessarily qualify you as a cancer patient; a momentary tiredness or coughing is most likely to be caused by anything other than cancer. But it is all the more important to have them looked into when symptoms last for longer periods of time or when they get worse for the sake of your own health.
Modern research has made diagnosis of cancer possible even before your body starts to show symptoms. So the bottom-line is a preventive approach wherein you can actually keep the cancer from aggravating if at all you are detected with one.

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Insights on Breast Cancer Treatment III

It must be understood that no cancer treatment outpaces the effectiveness or utility of another; treatment methods are rather complementary to each other and they offer a better chance of recovery when implemented adjacently. Hormones and genetic changes are responsible for certain physical changes in the human body and more so in case of a patient diagnosed with breast cancer. This is where the pertinence of the systemic therapies of hormones and targeting genetic changes become magnified.
Hormone Therapy
This is mostly used after surgery (adjuvant), but can also be used before (neoadjuvant). If cancer comes back after treatment or has spread, then hormone therapy is a very pragmatic option. Ovaries inside a woman’s womb are the primary source of the hormone estrogen. Estrogen often catalyses the growth of cancer cells; certain cancer cells have receptors for estrogen and/or progesterone and about 66% of breast cancer cases are hormone-receptor-positive. The therapy bars the hormones from acting on the cancer cells or tries to lower the estrogen levels; needless to say that patients whose cancer is hormone-receptor-negative need not undergo such therapy.
Hormone blocking drugs
Fulvestrant is a drug approved by certain drug associations and is generally used to treat advanced cancer. This functions as an anti-estrogen by blocking the estrogen receptors of the cancer cells and also eliminating them subsequently. It is administered through injections which are given two weeks apart in the first month and once a month after that. Tamoxifen & Toremifene are similar drugs which are effective in preventing the hormones from binding with the cancer cells; this actually stops the division and spreading of the same. These drugs are also known as SERM (selective estrogen receptor modulator) since they act like estrogen in some tissues and like an anti-estrogen in some.
Targeted Therapy
To begin with the bright side, this therapy has very less severe side effects. Here, the gene changes due to cancer are emphasized on with the help of targeted drugs. In about 20% of all breast cancer patients, there is a marked increase in a growth promoting protein (HER2). Excessive growth of this protein leads to aggressive spread of the cancer and hence requires special attention. Herceptin or Trastuzumab is a drug which is an immune system protein. This helps in putting a leash on the growth of cancer cells having high HER2 count.
Ado-Trastuzumab emtasine is a drug that is attached to a chemo drug called DM1. It is more like an antibody which acts like a guiding device carrying the chemo drug to the targeted cancer cells. Everolimus is another drug which targets a protein called mTOR which enhances cancer cell growth and division. This is also effective in stopping tumors from generating new blood vessels, thus stunting their growth. Bevacizumab is again an intravenous drug used along with chemo. It targets a growth protein named vascular endothelial growth factor. This is most commonly used in patients with metastatic or advanced breast cancer.
Ayurveda
Finally, amidst the soiree of breast cancer treatments, let us also revert back to our ethnic roots of Ayurveda which has often offered solutions to problems which modern science fails to address. Ayurveda addresses the imbalance of certain hormones which results in the formation of cysts, thus leading to cancer. Panchkarma – the use of massage, steam bath and ayurvedic medicines, Yukti Vyapashraya – the process of removal of dead cells, Rasa Rasayan treatment – the use of medicines like kamadudha-ras, shankh-vati, ashwagandha, shatavari, laghu-sutshekhar-ras for removal of toxic elements and basic elements like mercury, copper, zinc and sulfur to treat deficiencies, are some of the most prominent ayurvedic treatments which have engendered phenomenal results when it comes to curing breast cancer. Ayurveda is also implemented in collaboration with certain chemical drugs for best results.
Numbers don’t lie; if we go by statistics regarding the relative survival rate of breast cancer patients, the numbers are improving gradually, if not by leaps and bounds. Latest reports suggest that stage I cancer patients have a 100% survival rate while around 13% of patients can be rendered disease free with the help of Ayurveda. Stage II breast cancer patients have a survival rate of 93% while around 65% of patients have experienced marked improvements with the help of ayurvedic treatments. At this optimistic pace, we can always look out for that silver lining that outlines the dark cloud of breast cancer.

Insights on Breast Cancer Treatment I

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Let not the huge number of breast cancer cases in India or all over the world, cloud your ray of hope. Proper monitoring, early detection and several other factors influence your chance of getting treated and healed from this much dreaded disease. But again, no treatment is absolute in this context; your doctor might as well prescribe a particular treatment depending upon the stage of breast cancer you are in and the spread of the same. There are certain general treatments which can be classified as follows.

Surgery
A majority of breast cancer patients undergo a surgery of some type whenever the need to remove a tumor becomes dire. Breast conserving surgery, reconstructive surgery, mastectomy and lymph node surgery are some of the most prominent surgery techniques.

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Breast Conserving Surgery (BCS)
Also known as segmental or partial mastectomy, BCS involves partial removal of the breast detected with cancerous tissues. The area to be removed would depend on the size and location of the spread of the tumor. BCS can again be classified into Lumpectomy and Quadrantectomy. Lumpectomy requires removal of an outlining margin of normal tissue in addition to the breast lump whereas the latter technique removes one quarter of the breast. In this regard, radiation therapy is also administered after BCS as and when necessary. Besides, women who are above 70 years of age and have a tumor measuring less than 2 cm can opt out of radiation therapy.

Mastectomy
Mastectomy is the complete removal of the entire breast surgically. Simple or total mastectomy is the most commonly used; the entire breast along with the nipple is removed leaving the lymph nodes under the arm and muscle tissues beneath the breast, intact. A double mastectomy which involves removal of both the breasts is more of a preventive surgery for women who are at very high risks of breast cancer. Skin sparing mastectomy is usually advised to patients who have a breast reconstruction plan under strict guidance of a doctor and a plastic surgeon. In this surgical process, barring the nipple and areola, the skin is left intact. But this is possible to administer only when the tumor is a small one or when it is not within the vicinity of the skin surface.
Nipple sparing mastectomy is another variant of the skin sparing technique. This is more applicable to women who are detected with breast cancer at an early stage near the outer part of the breast. Here, the breast tissue is removed keeping the nipple and breast skin intact. If cancer is detected, the nipple has to be removed or else the surgeon can administer a small dose of radiation to the nipple tissue to prevent any recurrence of cancer. Radical Mastectomy used to be a very elaborate and extensive affair and has been replaced by a modified approach to the same. In this case, apart from complete removal of the breast, the auxiliary lymph nodes (situated underarm) are also removed keeping the pectoral or chest wall muscles intact.

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Lymph Node Surgery
There are cases when the spread of the breast cancer reaches the lymph nodes of the underarm. Such a situation calls for lymph node surgery where some nodes are sampled to be studied under the microscope. This actually lays the foundation for staging the cancer spread and determining the treatment accordingly. Auxiliary Lymph Node Dissection or ALND involves removal of around 20 such lymph nodes. It may be done when a preliminary biopsy report shows presence of cancer cells in the nodes. ALND can also be carried along with or after a BCS or mastectomy.
Sentinel Lymph Node Biopsy or SLNB is safe and has relatively much lower rates of side effects; this process determines the presence of cancer cells without removing so many lymph nodes thus preventing the patient from being vulnerable to lymphedema. A radioactive substance or dye is injected into the tumor for identifying lymph nodes which have taken the color of the dye and are likely to contain cancerous cells. These nodes are removed subsequently.
Given, the groundbreaking researches in cancer treatment, which have seen the day’s light in modern times, surgery is just a fractional part of the entire gamut. There still remains a lot to be discussed especially regarding what our ethnic roots of Ayurveda has to offer when it comes to treating breast cancer.

Insights on Breast Cancer Treatment II

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Having discussed about what surgical procedures have to offer in terms of breast cancer treatment, let us look into some other methods as well. Radiation therapy, like surgery also qualifies as a local therapy where specifically the tumor is treated without affecting the rest of the body. Other commonly known therapies like chemotherapy, targeted therapy and hormone therapy come under the purview of systemic therapy. Here, drugs are administered directly into the bloodstream with a view to reach the cancer cells present anywhere in the body.

High energy rays and particles are used to destroy the cancerous cells in this type of treatment. The primary objective of this therapy is to minimize the chance of cancer recurrence even after a patient has undergone BCS or mastectomy especially when the size of the cancerous tumor is more than 5 cm.

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External Beam Radiation

As a very common radiation therapy treatment, this technique is implemented externally on the area affected by cancer. The status of BCS or mastectomy or lymph nodes actually determines the amount of radiation to be given. In case of BCS, usually the entire breast is treated with radiation. Moreover, an extra dosage is given at the place where the cancer was removed or to the entire breast end. On the other hand, in case of mastectomy, radiation is focused on the chest wall and places of drainage on the breast only if lymph nodes are not affected. But it is important that the therapy is given only when the tissues are able to heal after a surgery which might take more than a month.

Brachytherapy

This jargon refers to internal radiation wherein radioactive pellets are placed inside the breast tissue near the cancerous tumor. It is usually given along with external beam radiation to patients who have undergone BCS. Apart from this, brachytherapy can also be implemented in a localized manner where the whole breast is exempted from being exposed to radiation. This therapy is of two types, namely interstitial brachytherapy and intracavitary brachytherapy. The interstitial approach uses small catheters which are inserted into the breast around the affected area. Small radioactive pellets are inserted, kept for short periods and then removed. The most commonly used intracavitary brachytherapy involves putting a device from which accelerated radiation is emanated; it is placed in the remaining area after BCS and is removed only after the treatment is complete.

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Chemotherapy

This systemic treatment deals with administering cancer killing drugs intravenously or orally. The therapy is given for several months in cycles at regular intervals where each cycle is succeeded by a recovery period. Chemotherapy is generally given in the following two cases.

Before Surgery
Also known as neoadjuvant chemotherapy, this treatment has the ability to shrink larger cancers. This actually helps patients in having their cancer removed without undergoing any extensive surgery. Besides, this also helps doctors to identify the right set of chemo drugs that need to be given to the patient in case certain drugs fail to shrink the cancer. If the breast cancer is diagnosed as too large or locally advanced, then chemo is the only way in which the cancer can be shrunk.

After Surgery
Chemo given after surgery is called adjuvant chemotherapy. The treatment is given when no cancer cells are found after surgery. It is more like a double check or precautionary treatment to ensure that cancer cells that can’t be seen are not left behind. This is very crucial in early stages as well since cancer cells can break away from the tumor and spread through the bloodstream. Simply put, adjuvant chemo is instrumental in eliminating undetected cancer cells. In majority of cases a combination of chemo drugs is used for best results. Dense dose chemotherapy is another avenue where the cycles are given close to one another to improve the chances of preventing cancer recurrence.
The efficaciousness of a particular chemo drug or a particular radiation therapy would again depend upon the compatibility of the treatment with the patient or in other words the patient’s ability to respond to the same. In time, certain systemic treatment procedures have come forth and that too with far reaching effects. They not only engender positive results but also have very rare side effects.

The Life We Chose!!!

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How many of us have complains with our lives? How many of us want something more in life? How many of us crave for a better life? We are sure almost all of us do that. And that’s quite normal, isn’t that? We are not happy with certain things in life, the way our life is running, are worried about our problems etc.

But have we ever paused and thought about Cancer Warriors? Yes, we call them Cancer warriors because they are combating the dreadful disease. They are struggling with the onslaughts of this disease every day without complaining.

We take this forum to talk about these Warriors who have fought the Cancer battle without any grief, complain or regret and are happy with their lives. Fighting the cancer battle needs conviction, trust, firm determination and fortitude. These Warriors have depicted all of these and have set examples for millions. These are celebrities and common people like us who have shown courage and perseverance and have given a different meaning to their lives.

Robin Roberts: Robin Roberts is a renowned American television broadcaster. She is the anchor of ABC’s morning show Good Morning America. She was diagnosed with Breast Cancer in 2008 and underwent surgery. She was leading a cancer free life when in 2012 she was diagnosed with MDS Myelodysplastic Syndromes. She got a Bone Marrow Transplant in Aug 2012 and joined back Good Morning America in Early 2013. She is an epitome of a true fighter. Cancer never let her spirits go fed away. With support from her friends, fans and viewers she could win the Cancer battle. In her 5 years of Cancer combat, she never had a sign of worry on her face. Neither did she let the disease win over her. Such magnanimous is her will power.

Lisa Ray: Lisa Ray is a famous Bollywood actress who was diagnosed with multiple myeloma a relatively rare and incurable cancer of the white blood cells in the year 2009. She underwent a stem cell transplant and conquered Cancer. She believes her victory over cancer is all about healing her mind. She accepts the fact that she too just like any other cancer patient felt isolated, scared and dejected; nevertheless, her positive attitude and zeal let her win over the disease. She has realized the worth of life after bearing the onslaughts of the disease and devotes her time for cancer causes and family.

Dr. Mary Francis: Dr. Mary who owns a clinical research company, is a born fighter. She never let her zest and zeal fade away and faced Cancer valiantly and with confidence. While she was undergoing the painful surgery and chemotherapy, she continued doing her everyday activities both at work and at home. She considers life after cancer a new beginning and spends her quality time in spreading cancer awareness.

Anurag Basu: The famous Barfi Director Anurag Basu was diagnosed with acute promyelocytic leukemia (a condition that is usually found only in kids) in 2004. Apparently he was told he only had 50% chances of survival. It is incredible that he directed part of his movie sitting at the hospital while his treatment was on. He diverted his mind from cancer by keeping himself busy and undertaking projects. He has a beautiful quote for cancer survival, “Cancer had to fight me, I didn’t have to fight it.”

Russ Carlson: Russ is an ordinary person like you and me. He was diagnosed with pancreatic cancer in 2000 and had a thin chance of survival. After 13 years of victory over the disease, Carlson feels he has found a new life and purpose for existence. Carlson devotes his time helping cancer patients and spreading cancer awareness.

Minakshi Chaudhry: Minakshi Chowdhury, a breast cancer survivor feels that worst is over and there’s no point in worrying about uncertainties. She admits the fact that the process of treatment was an ordeal for her. Nevertheless, like any other winner, she takes pride in saying that she fought the battle with utmost bravery. She has penned down her struggle and success in a book, Sunshine: My Encounter with Cancer. The book has been an inspiration for many who are combating the Cancer battle.

There are many such instances and examples of people who have shown their valor and never let their spirits die away. Positive attitude coupled with fervor and zest can make life simpler and our struggles more enjoyable. These people are happy and proud to say that this is the life they have chosen!

We are starting with our Cancer Topic Blogs. We would take up various topics on cancer and discuss on those.

The various diagnoses for Breast Cancer

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Bangalore, the IT haven of India has unfortunately qualified as a leading city with 36.6 cases of breast cancer per lakh of population; such was the poignant revelation of the report released by Population Based Cancer Registry. Other cities need not be relieved as data released by WHO state that around 7 lakh Indians died from cancer in 2012, of which 3.26 lakh were women predominantly afflicted with breast cancer. But, this malady can be nipped in the bud with proper diagnosis at the very outset. Apart from self examination, there are several other diagnostic techniques implemented by oncologists to detect and subsequently prescribe the necessary treatments.

Imaging Tests 

Imaging tests are by far the most preliminary techniques to diagnose for breast cancer. Diagnostic mammograms, breast ultrasound, MRI and ductogram are some of the most prevalent imaging tests.

Diagnostic Mammogram & Breast Ultrasound

A diagnostic mammogram is simply an x-ray used to detect breast disease in case there are no visible signs or symptoms. A mammogram aids in detecting abnormalities such as areas of abnormal tissue growth, lump formation, etc. It actually forms the platform on which other tests like biopsy or ultrasound can be carried out. In this regard, it must be noted that breast ultrasound qualifies as a diagnostic process complementary to diagnostic mammography. Breast ultrasound uses sound waves with the help of transducers to outline specific parts of the breast; this helps in telling a normal fluid filled cyst from a solid lump or tumor which might be cancerous in nature.

Breast MRI & Ductogram

The MRI or Magnetic Resonance Imaging of the breast is again used along with a diagnostic mammogram. It has far reaching results when it comes to detecting suspicious areas found in an initial mammogram. On an advanced level, when a woman is detected with breast cancer, MRI helps in determining the actual size of the cancerous tissues, which in turn helps in biopsy. The ductogram on the other hand is efficacious in isolating the cause of nipple discharge. Here, a very thin tube is placed at the affected duct opening and a contrast medium is injected in small quantity. This helps in determining the shape of the duct and presence of any cancerous lump inside.

Biopsy

Biopsy is another diagnostic technique used to detect breast cancer; fine-needle, core needle, lymph node, vacuum assisted and surgical being some of the prominent types. It is the only way to confirm the presence of cancer having found a breast abnormality in a diagnostic mammogram initially.

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Fine Needle & Core Needle Biopsy

In case of fine needle, a minimal amount of tissue is withdrawn through a thin and hollow needle. If the tissue or fluid withdrawn is clear or bloody then lumps are probably benign, but if solid tissue fragments are drawn out then they need to be studied under a microscope to examine whether they are cancerous or not. A core needle biopsy aims at collecting larger samples of the abnormal changes in one’s breast. Relatively larger cylindrical portions of the tissues (known as core tissues) are removed thus offering greater clarity in the diagnostic process.

Lymph Node, Vacuum Assisted & Surgical Biopsy

Lymph Node Biopsy, also known as Sentinel Node Biopsy involves use of the needle to check for cancer spread to the lymph nodes under the arm especially after the affected part of the breast is removed during surgery. Vacuum assisted biopsy again involves suction of affected tissues through a miniscule incision using the Automated Tissue Excision and Collection or ATEC system. The bright side is that several tissue samples can be collected from the same area of incision without much scarring. Surgical biopsy is implemented rarely in case the area afflicted with abnormalities is too large to be removed by incision. This is done only when fine needle or core needle biopsies fail to engender concrete results.

The purview of breast cancer diagnosis is not exhaustive since newer and modified techniques are being brought into effect time and again. Tests of cell proliferation, gene patterns and more advanced imaging tests are also being carried out to diagnose breast cancer even better and even more effectively. There may not be a definite solution to this disease as of now, but the evolution of modern diagnostic methods are definitely a step forward towards discovering that desired panacea beyond any doubt.