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29 September, 2017
Breast Cancer

What is Breast Cancer?

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. The body is made up of many types of cells, and normally, cells grow and divide to produce more cells only when the body needs them. Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor. There are two types of tumor: benign and malignant.


Benign tumors are not cancer. They can usually be removed, and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body, and are not a threat to life.

Malignant tumors are cancer. Cells in these tumors are abnormal; they divide without control or order, and can invade and damage nearby tissues and organs. Cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system, which is how cancer spreads from the original cancer site to form new tumors in other organs. The spread of cancer is called metastasis.

When cancer arises in breast tissue and spreads outside the breast, cancer cells are often found in the lymph nodes under the arm. If the cancer has reached these nodes, it means that cancer cells may have spread to other parts of the body, including other lymph nodes and other organs, such as the bones, liver, or lungs. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the brain, the cancer cells in the brain are actually breast cancer cells. The disease is called metastatic breast cancer.


What Causes Breast Cancer?

The exact causes of breast cancer are not known. However, studies show that the risk of breast cancer increases with age. The disease is very uncommon in women under the age of 35. Most breast cancers occur in women over the age of 50, and the risk is especially high for women over age 60. Breast cancer occurs more often in white women than African-American or Asian women.

Women with the following conditions have an increased risk for breast cancer:

Personal history of breast cancer - Women who have had breast cancer face an increased risk of getting breast cancer in the other breast.

Family history - Risk for developing breast cancer increases if a close relative (mother, sister, or daughter) has had breast cancer, especially at a young age. In families where many women have had the disease, gene testing can sometimes show the presence of specific genetic changes that increase the risk of breast cancer. Doctors may suggest ways to try to delay or prevent breast cancer, or to improve the detection of this disease in women who have these changes in their genes.

Certain breast changes - Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) may increase the risk of breast cancer.

Other factors associated with an increased risk for breast cancer include:

Estrogen - Evidence suggests that the longer a woman is exposed to estrogen (made by the body, taken as a drug, or delivered by a patch), the higher the risk of developing breast cancer. The risk is somewhat increased among women who began menstruation at an early age (before age 12), experienced late menopause (after age 55), never had children, or took Hormone Replacement Therapy (HRT) for extended periods of time.

Late childbearing - Women who have their first child late (after about age 30) have a greater chance of developing breast cancer than women who have a child at a younger age.

Breast density - Breast cancers nearly always develop in lobular or ductal (dense) tissue rather than in fatty tissue. Breast cancer is more likely to occur in breasts that have a lot of dense tissue. It is also more difficult to see abnormal areas on a mammogram when breasts are dense.

Radiation therapy - Women whose breasts were exposed to radiation during radiation therapy before age 30 are at an increased risk for developing breast cancer. Studies show that the younger a woman was when she received treatment, the higher the risk for developing breast cancer later in life.

Alcohol - Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol.

It is important to know that many of the women who develop breast cancer have none of the risk factors listed above, other than the risk that comes with growing older.


Detecting Breast Cancer

Breast cancer screening has shown to decrease the risk of dying from breast cancer. Women can take an active part in the early detection of breast cancer by having regularly scheduled screening mammograms and clinical breast exams (performed by health professionals). Women should also perform breast self-exams themselves.

A screening mammogram is the best tool available for finding breast cancer early, before symptoms appear. Mammograms can often detect a breast lump before it can be felt. If an area of the breast looks suspicious on the screening mammogram, additional (diagnostic) mammograms may be needed. Depending on the results, the doctor may advise the woman to have a biopsy.


Symptoms of Breast Cancer

Early breast cancer usually does not cause pain, and when breast cancer first develops, there may be no symptoms at all. As the cancer grows, it can cause changes that women should watch for; breast cancer signs or symptoms may include:

A lump or thickening in or near the breast or in the underarm area

A change in the size or shape of the breast

Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast

Ridges or pitting of the breast (the skin looks like the skin of an orange); or

A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly).

Any symptoms such as those listed should be reported to a doctor. Most often, they are not cancer, but it's important to check with the doctor so that any problems can be diagnosed and treated as early as possible.


Diagnosing Breast Cancer

A doctor may perform one or more breast examinations:

Clinical breast exam - involves the doctor carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones. The doctor can examine the size and texture of the lump and determine whether the lump moves easily.

Mammography - X-rays of the breast can give the doctor important information about a breast lump.

Ultrasonography - can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). This exam may be used along with mammography.

Biopsy - involves the removal of fluid or tissue from the breast so the doctor can make a diagnosis.

Fine-needle aspiration - A thin needle is used to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked by a lab.

Needle biopsy - A needle is used to remove tissue from an area that looks suspicious on a mammogram. The tissue is sent to a lab to be checked by a pathologist for cancer cells.

Surgical biopsy - Incisional biopsy involves cutting out a sample of a lump or suspicious area. Excisional biopsy involves removing all of the lump or suspicious area and an area of healthy tissue around the edges. A pathologist then examines the tissue under a microscope to check for cancer cells.


When Cancer Is Found

The most common type of breast cancer is ductal carcinoma, which begins in the lining of the ducts. Lobular carcinoma arises in the lobules. The pathologist is able to tell if the cancer is ductal or lobular, and whether it has invaded nearby tissues in the breast (invasive).

Hormone receptor tests of the tissue looking for estrogen (ER+) and progesterone receptors (PR+) can determine the potential response of the cancer to hormonal therapy. About 2 out of every 3 breast cancers are hormone receptor-positive. HER2 (the human epidermal growth factor receptor-2 or HER-2 gene) is a specialized protein found on breast cancer cells that controls cancer growth. The test for this gene determines the risk of the breast cancer returning and can help to determine the best treatment. Other tests (lab tests and x-rays) are sometimes performed to predict the progression of the cancer. Examinations of the bones, liver or lungs may be performed because the breast cancer may spread to these areas.


Methods of Treatment and Side Effects of Breast Cancer

Breast cancer may be treated with local therapy, systemic therapy, or both.

Local therapies, such as surgery and radiation, are used to remove or destroy breast cancer in a specific area. If the breast cancer has spread to other parts of the body, local therapy may be used to control cancer in those specific areas, such as in the lung or bone.

Systemic therapies, such as chemotherapy, hormonal therapy and biological therapy, are used to destroy or control cancer throughout the body. Sometimes, systemic therapy is used to shrink the tumor before local therapy. Systemic therapy is also used to prevent the cancer from coming back, or to treat cancer that has spread.


Surgery is the most common treatment for breast cancer, and there are several types:

Breast-sparing (or breast-conserving) surgery removes the cancer but not the breast. Examples are lumpectomy and segmental (partial) mastectomy. Radiation therapy is usually given after breast-sparing surgery to destroy remaining cancer cells the area.

Mastectomy is an operation to remove the breast (or as much of the breast as possible). Breast reconstruction is often an option at the same time or after the mastectomy.

In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system. This is called an axillary lymph node dissection.

Surgery causes short-term pain and tenderness in the area of the operation and also carries a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia used during surgery. Removal of a breast can cause a weight imbalance, which can result in discomfort in the neck and back. Skin in the area where the breast was removed may be tight, the muscles of the arm and shoulder may feel stiff, and nerves that may be injured or cut during surgery can cause numbness and tingling in the chest, underarm, shoulder, and upper arm.

These feelings usually go away within a few weeks or months.

Radiation therapy (radiotherapy) is the use of high-energy rays to kill cancer cells. The radiation may be directed at the breast by a machine (external radiation), or may come from radioactive material placed in thin plastic tubes that are placed directly in the breast (implant radiation). Sometimes, both types of radiation therapy are used.

Before surgery, radiation therapy, alone or with chemotherapy or hormonal therapy, is sometimes used to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery.

During radiation therapy, patients may become extremely tired, especially after several treatments. It is also common for the skin in the treated area to become red, dry, tender, and itchy. The breast may feel heavy and hard, but these conditions will clear up with time. Toward the end of treatment, the skin may become moist and weepy but exposing this area to air as much as possible will help the healing process.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs given in a pill or by injection.

The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anti-cancer drugs affect rapidly dividing cells. These include blood cells, which fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, patients are more likely to get infections, may bruise or bleed easily, and may feel unusually weak and very tired. Rapidly dividing cells in hair roots and cells that line the digestive tract may also be affected. As a result, side effects may include loss of hair, poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

Many of these side effects can now be controlled, thanks to new or improved drugs. Side effects generally are short-term and gradually go away. Hair grows back, but it may be different in color and texture.

Hormonal therapy prevents the growth of hormone dependent cancer cells. This treatment may include the use of drugs, or surgery to remove the ovaries, which make female hormones.

The side effects of hormonal therapy depend largely on the specific drug or type of treatment. Tamoxifen is the most common hormonal treatment. Tamoxifen may cause hot flashes, vaginal discharge or irritation, nausea, and irregular periods.

Biological therapy is a treatment designed to enhance the body's natural defenses against cancer. For example, monoclonal antibodies can target breast cancer cells that have too much of a protein known as human epidermal growth factor receptor-2 (HER-2). Blocking HER-2 slows or stops the growth of these cells.

The side effects of biological therapy differ with the types of substances used, and from patient to patient. Rashes or swelling where the biological therapy is injected are common. Flu-like symptoms also may occur.

Learn More: Slideshow: Learn More About Advances in Drug Treatment for Breast Cancer

Avastin (bevacizumab) Indication for Breast Cancer Revoked

In February 2008, FDA approved bevacizumab to be used in combination with the cancer drug paclitaxel for patients with HER2-negative metastatic breast cancer who had not been treated with chemotherapy. However, in November, 2011, the FDA revoked bevacizumab's breast cancer approval because the drug had not been shown to be safe and effective for that use. Prior to the FDA decision, an FDA advisory committee voted unanimously to recall the approval of the drug for breast cancer treatment.

Originally, FDA had approved bevacizumab under an accelerated approval program to allow access to promising drugs for serious or life-threatening conditions while researchers conducted clinical trials to confirm the drug's safety and benefits. However, after reviewing thousands of pages of data and several clinical trials, FDA regulators determined that bevacizumab use in women with metastatic breast cancer could lead to life-threatening side effects without evidence that a delay in tumor growth, survival or enhanced quality of life would occur. Side effects noted by the FDA included: severe high blood pressure; bleeding and hemorrhaging; heart attack and heart failure; and the development of perforations in the nose, stomach, intestines and other parts of the body.


List of Drugs Used in the Treatment of Breast Cancer

Abraxane

ado-trastuzumab emtansine

Adrucil

Afinitor

Adriamycin

aminoglutethimide

anastrozole

Androxy

Arimidex

Aromasin

capecitabine

cyclophosphamide

Cytadren

Cytoxan

docetaxel

Docefrez

doxorubicin

Ellence

epirubicin

eribulin

esterified estrogens

Estratab

everolimus

Evista

exemestane

Fareston

Faslodex

Femara

fluorouracil

fluoxymesterone

fulvestrant

gemcitabine

Gemzar

goserelin

Halaven

Herceptin

Ibrance

ixabepilone

Ixempra

Kadcyla

Kisqali

lapatinib

letrozole

megestrol

methotrexate

Menest

Neosar

Nolvadex

Onxol

paclitaxel

paclitaxel protein-bound

palbociclib

pamidronate 

Perjeta 

pertuzumab

raloxifene

ribociclib

Soltamox

tamoxifen

Taxol

Taxotere

Thioplex

thiotepa

toremifene

trastuzumab

Trexall

Tykerb

Velban

vinblastine

Xeloda

Zoladex


Breast Cancer Prevention in Women at High Risk

Medications like tamoxifen (Nolvadex) and raloxifene (Evista) have been shown to help reduce the risk of breast cancer if a woman has a higher than average risk of getting breast cancer. To determine the risk, a doctor can assess the risk factors for an individual women, such as her family history, age, genetic profile (BRCA mutation), and other risk factors. Clinicians use a tool known as the The Breast Cancer Risk Assessment Tool to estimate the risk of getting breast cancer in the next 5 years or over a lifetime, based on many of these risk factors. It is important to weigh the risk of taking a lifetime of medication versus the predicted risk for getting breast cancer. Most women who have one or more risk factors will never develop breast cancer, and this is important to discuss with a doctor.

Both tamoxifen and raloxifene are selective estrogen receptor modulators (or SERMs), and act to block estrogen, a female hormone, in some tissues. Estrogen can boost breast cancer cell growth, and both tamoxifen and raloxifene block the estrogen hormone in breast cells. To lower the risk of breast cancer, these drugs are taken for 5 years, or possibly longer.

Studies are evaluating an investigational agent known as fenretinide for chemoprevention. Fenretinide is in a class of drugs known as retinoids (drugs related to vitamin A). As reported by the American Cancer Society, this drug reduced breast cancer risk as much as tamoxifen in preliminary research.

Aromatase inhibitors (drugs taken as a pill once daily that lower estrogen levels) are also being studied to reduce the risk of breast cancer. Current studies have shown that taking either exemestane or anastrozole for 3 to 5 years lowered the risk of breast cancer by about half (47%) in post-menopausal, high risk women.

Women with a very high risk of breast cancer, for example with BRCA gene mutations, may decide to have their breasts and/or ovaries surgically removed to help prevent the occurrence of breast cancer and ovarian cancer. This is a drastic decision that should be made in conjunction with a genetic specialist, oncologist and surgeon.

Research in Treatment of Breast Cancer

Many studies of new approaches for patients with breast cancer are under way. Current areas of research and treatment advances include:

Research evaluating best practice with genetic testing and treatments for BRCA1 and BRCA2 mutations

Research looking at environmental causes of breast cancer

Prevention with aromatase inhibitors

Investigation into certain dietary supplements to reduce the risk of breast cancer although published data is scarce.

Further studies evaluating

Immunotherapy and targeted drugs for treatment of breast cancer.

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Blogs

31 August, 2017
Cancer Cure Medicines

What is Cancer?

"Cancer" is the term we give to a large group of diseases that vary in type and location but have one thing in common: abnormal cells growing out of control.

Under normal circumstances, the number and growth of all our cells is a highly controlled mechanism. But when the control signals in one of these cells go wrong, and its life cycle becomes disturbed, it divides and divides. It continues multiplying uncontrollably, and the result of this accumulation of abnormal cells is a mass of cells called a "tumor". A tumor can be either benign or malignant.

Benign tumors are non-cancerous and are rarely life-threatening. They do not spread (metastasize) to other parts of the body. Many breast lumps, for example, are benign tumors.

Malignant tumors are cancerous and can spread to other parts of the body. When a malignant tumor spreads, the malignant cells break off and travel through the blood lymph system to other places in the body to settle and multiply; or metastasize, resulting in a new tumor called a secondary tumor or metastasis. The name was given to cancer, however, is reflective of the origin of cancer, even if it has spread to other areas of the body. For example, if prostate cancer has spread to the liver it is called metastatic prostate cancer.

How does it start?

Cancer starts when one normal cell becomes cancerous. This happens when something disrupts the cell DNA, altering the instructional code that monitors the cell's life cycle. One or more of a variety of risk factors may contribute to the disruption.

The most common cancer risk factors are:

  • Genetic predisposition -- Certain types of cancer, such as colon and breast cancer, often run in families. It is only the predisposition to cancer that is inherited. Other non-genetic (e.g. environmental) factors must be present for cancer to develop. Having a family history of cancer does not necessarily mean you will develop cancer, but does, however, mean that you are at a higher risk. Knowing the risk factors and managing them can help prevent cancer.
  • Estrogen exposure (women) -- A woman is at increased risk for some gynecological cancers (e.g. breast or uterine cancer) if her system is exposed to too much estrogen, as this stimulates cell proliferation in these tissues. Factors that contribute to higher estrogen exposure include early menstruation and late menopause. The risk is reduced in women who have had a baby before the age of 35. Other factors that can reduce the risk include regular exercise and a low-fat diet.
  • Ionizing radiation -- Overexposure to ionizing radiation, such as X rays and nuclear radiation, can cause DNA injury that may lead to cancer.
  • Ultraviolet radiation is the radiation from the sun. Ultraviolet B (UVB) rays damage cell DNA and cause 90 percent of all skin cancers. Prevention involves reducing sun exposure, wearing protective clothing and applying a sunscreen with a high SPF (Sun Protection Factor) number.
  • Carcinogenic chemicals -- Chemical carcinogens such as asbestos, benzene, formaldehyde, and diesel exhaust are dangerous in high concentrations.
  • Tobacco smoke -- Smoking causes 30 percent of all cancer deaths in the United States, making tobacco smoke the single most lethal carcinogen. Smoking can cause cancers in the lungs and other organs. The best way to lower the risk of lung and other cancers is to quit smoking, or never start, and to avoid exposure to secondhand smoke if you are a non-smoker.
  • Alcohol -- People who drink alcohol heavily have a higher risk of mouth, throat, esophagus, stomach, and liver cancer.
  • Carcinogenic foods -- There are certain foods that contain carcinogens. Foods that should be limited include salted, pickled, and smoked foods, such as pickles or smoked fish, and meats treated with nitrites. Foods that should be eliminated from the diet include meats that have been charred over a grill, as the charred area is carcinogenic. Taking Vitamin C, either through the diet or by supplementation, may protect against the cancer-causing effects of carcinogenic foods.
  • Unhealthy diet -- A diet high in saturated fat (especially from red meat) is associated with several different types of cancer, including cancer of the colon, rectum, and prostate gland. Risk can be reduced by reducing dietary fat in the diet, and by eating more soy-based foods, fiber, fruit, and vegetables.
  • Free radicals are dangerous, highly reactive chemical compounds that can damage DNA and lead to cancer. They can be generated in a number of ways, including oxidation of polyunsaturated fats. Antioxidants (such as Vitamin A and C) taken through supplementation, or a diet high in yellow and orange fruits and vegetables, can reduce the risk.

The cause of the uncontrollable multiplication of abnormal cells, as well as how fast it happens, differs from person to person. Many people overcome the disease, and many living with the disease live fulfilled lives for many years. If you or someone close has been diagnosed with cancer, you may be interested to learn more about cancer and/or what treatments to expect.

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Treatment Options

There are a number of treatment options available for cancer. Treatments plans are developed depending on the type of cancer, its location, the extent of the cancer and the stage at which it is diagnosed, and the health and well-being of the patient. Treatment may be one or more of several different therapies.

  • Chemotherapy is the use of anti-cancer of drugs. Anti-cancer drugs destroy cancer cells by stopping growth or multiplication at some point in their life cycles. Drugs may be administered intravenously (into a vein), orally (by mouth), by injection into a muscle, topically (applied to the skin) or in other ways, depending on the drug and the type of cancer. Chemotherapy is often given in cycles of alternating treatment and rest periods.
  • Radiation Therapy is the treatment of cancer and other diseases with ionizing radiation. Ionizing radiation destroys cells, or the genetic material of cells, in the area being treated, thereby making it impossible for these cells to continue to grow.
  • Surgery involves removal of the tumor. Sometimes, surrounding tissue and lymph nodes are also removed. Surgery can be performed using conventional instruments or laser.
  • Hormone Therapy is the use of hormones to change the way hormones in the body help cancers to grow.
  • Biological Therapy (Immunotherapy) makes use of the body's immune system, either directly or indirectly, to fight cancer and lessen the side effects that may be caused by some other cancer treatments.
  • Alternative and Complementary Therapy - includes acupuncture and homeopathy.

Drug Treatment of Cancer

Drugs are used not only for treating cancer, but also for relieving symptoms of the cancer (e.g. pain), and side-effects, such as nausea, commonly seen with the various types of treatment.

Anti-Cancer Drugs

Most anti-cancer drugs act by inhibiting DNA synthesis or some other process in the cell growth cycle. Because anti-cancer drugs generally affect rapidly dividing cells, other non-cancerous cells will also be affected. The way in which the other cells are affected determines the side-effects of the individual drugs. Other cells affected include blood cells, which fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, patients are more likely to get infections, may bruise or bleed easily, and may feel unusually weak and very tired. Rapidly dividing cells in hair roots, and cells that line the digestive tract, may also be affected.

As a result, side effects may include loss of hair, poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can now be controlled, thanks to new or improved drugs. Side effects generally are short-term and gradually go away. Hair grows back, but it may be different in color and texture.

Examples of anti-cancer drugs:

Drug Name Trade Name(s)
AltretamineHexalen
AsparaginaseElspar
BleomycinBlenoxane
CapecitabineXeloda
CarboplatinParaplatin
Carmustine, BCNUBiCNU
CladribineLeustatin
CisplatinPlatinol
CyclophosphamideCytoxan, Neosar
CytarabineCytosar-U
DacarbazineDTIC-Dome
Dactinomycin, actinomycin DCosmegen
DocetaxelTaxotere
DoxorubicinAdriamycin, Rubex
ImatinibGleevec
Doxorubicin LiposomalDoxil
Etoposide, VP-16VePesid
FludarabineFludara
Fluorouracil, 5-FUAdrucil
GemcitabineGemzar
HydroxyureaHydrea
IdarubicinIdamycin
IfosfamideIFEX
Irinotecan, CPT-11Camptosar
MethotrexateRheumatrex Dose Pack
MitomycinMutamycin
MitotaneLysodren
MitoxantroneNovantrone
PaclitaxelTaxol
TopotecanHycamtin
VinblastineVelban
VincristineOncovin, Vincasar, Vincrex
VinorelbineNavelbine
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Blogs

31 August, 2017
Cervical Cancer

What Is Cervical Cancer?

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. The body is made up of many types of cells, and normally, cells grow and divide to produce more cells only when the body needs them. Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor. There are two types or tumor, benign and malignant.

Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body and are not a threat to life. Polyps, cysts and genital warts are all types of benign growths of the cervix.

Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor, and can break away from a malignant tumor and enter the lymphatic system or the bloodstream. Cancer of the cervix can spread to other parts of the body, such as nearby lymph nodes, the rectum, the bladder, the bones of the spine, and the lungs. The spread of cancer is called metastasis.

Cancers of the cervix are named for the type of cell in which they begin. Most cervical cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that form the surface of the cervix. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cervical cancer spreads to the bones, the cancer cells in the bones are actually cervical cancer cells. The disease is called metastatic cervical cancer.

Precancerous Conditions

Sometimes cells on the surface of the cervix can appear abnormal but not cancerous, but may however, become cancerous over time. The abnormal cells are known as precancerous lesions or squamous intraepithelial lesions (SIL).

Changes in these cells can be divided into two categories:

  • Low-grade SIL refers to early changes in the size, shape, and number of cells that form the surface of the cervix. Some low-grade lesions may disappear altogether, others can grow larger or become more abnormal, forming a high-grade lesion. Precancerous low-grade lesions may also be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). These early changes in the cervix most often occur in women between the ages of 25 and 35 but can appear in other age groups as well.
  • High-grade SIL means there are a large number of precancerous cells. Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. The cells do not become cancerous and invade deeper layers of the cervix for many months, perhaps years. High-grade lesions may also be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. These changes in the cervix most often occur in women between the ages of 30 and 40 but can occur in other age groups as well.

If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. This occurs most often in women over the age of 40.

Early Detection

The Pap test is a simple, painless test used to detect abnormal cells in and around the cervix. Precancerous conditions can be detected are treated early before cancer develops.

Symptoms

Precancerous changes of the cervix generally do not cause any symptoms and can only be detected by a Pap test. If the cervical cells become cancerous and invade nearby tissue, symptoms will appear, usually in the forms of abnormal vaginal bleeding or increased vaginal discharge.

Bleeding after menopause may also be a symptom of cervical cancer. It is important to see a doctor when suffering from any abnormal vaginal bleeding, so that the cause may be established.

Diagnosis

The following procedures may be used in the diagnosis of cervical cancer:

  • Colposcopy is a widely used method to check the cervix for abnormal areas. A vinegar-like solution is applied to the cervix and viewed with an instrument called a colposcope, which is like a microscope.
  • Schiller test is a procedure where the cervix is coated with an iodine solution, and turns healthy cells brown and abnormal cells white or yellow.
  • Biopsy involves removing a small amount of cervical tissue for examination by a pathologist. A biopsy can be performed using an instrument to pinch off the tissue, or by loop electrosurgical excision procedure (LEEP) where an electric wire loop is used to slice off a thin, round piece of tissue. Both of these biopsies can be performed using a local anesthetic.
  • Endocervical Curettage (ECC) is used to check inside the opening of the cervix, an area that cannot be seen during colposcopy. In this procedure a curette (a small, spoon-shaped instrument) is used to scrape tissue from the cervical opening.
  • Cone Biopsy or Conization involves the removal of a larger, cone-shaped sample of tissue, and is used to determine whether the abnormal cells have invaded the tissue beneath the surface of the cervix. This procedure may also be used as a treatment for a precancerous lesion if the entire abnormal area can be removed.
  • Dilation and Curettage (D and C) is a procedure where the cervical opening is stretched and tissue is scraped from the lining of the uterus as well as from the cervical canal. It is used in situations where it is unclear if the problems are in the cervix or the endometrium (lining of the uterus)

Treating Precancerous Conditions

Treatment of precancerous lesions include Cryosurgery (freezing), cauterization (burning, also called diathermy), and laser surgery, which are all procedures used to remove the abnormal tissue without harming surrounding healthy tissue. Conization and LEEP procedures (used for biopsies) can also be used in the removal of precancerous lesions.

Hysterectomy may be performed if abnormal cells are found inside the opening of the cervix. It is more likely in women who do not intend having children in the future.

Methods of Treatment and Side Effects

Most often, treatment for cervical cancer involves surgery and radiation therapy. Sometimes, chemotherapy or biological therapy is used.

Surgery is local therapy to remove abnormal tissue near the cervix. If the cancer is on the surface of the cervix, the doctor may destroy the cancerous cells in ways similar to the methods used to treat precancerous lesions. Patients may suffer cramping or other pain, bleeding, or a watery discharge after treatment.

If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix, an operation may be performed to remove the tumor but leave the uterus and the ovaries intact. In other cases, a woman may need to, or elect to have a hysterectomy. In this procedure, the entire uterus, including the cervix, and sometimes the ovaries and fallopian tubes, are removed. Lymph nodes near the uterus may also be removed to determine if the cancer has spread. For a few days after a hysterectomy, pain and discomfort will usually need to be controlled with pain relievers and a catheter is inserted into the bladder to drain the urine.

Radiation therapy (radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. Radiation therapy is local therapy and only affects cancer cells in the treated area. The radiation may come from a large machine (external radiation) or from radioactive materials placed directly into the cervix (implant radiation). Some patients receive both types of radiation therapy.

Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. With external radiation, it is common to lose hair in the treated area and for the skin to become red, dry, tender, and itchy. There may be permanent darkening or "bronzing" of the skin in the treated area. This area should be exposed to the air when possible but protected from the sun. Patients who receive external or internal radiation therapy also may have diarrhea and frequent, uncomfortable urination. The doctor can make suggestions or order medicines to control these problems.

Chemotherapy is the use of oral or injected drugs to kill cancer cells. A single drug, or a combination of drugs may be used. It is most often used when cervical cancer has spread to other parts of the body.
Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on.

The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anticancer drugs affect rapidly dividing cells. These include blood cells, which fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, patients are more likely to get infections, may bruise or bleed easily, and may feel unusually weak and very tired. Rapidly dividing cells in hair roots and cells that line the digestive tract may also be affected. As a result, side effects may include loss of hair, poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

Many of these side effects can now be controlled, thanks to new or improved drugs. Side effects generally are short-term and gradually go away. Hair grows back, but it may be different in color and texture.

Biological therapy is a treatment using substances to improve the way the body's immune system fights disease. It may be used to treat cancer that has spread from the cervix to other parts of the body. Interferon is the most common form of biological therapy for this disease; it may be used in combination with chemotherapy.

The side effects caused by biological therapies vary with the type of treatment the patient receives. These treatments may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Sometimes patients get a rash, and they may bleed or bruise easily. These problems can be severe, but they gradually go away after the treatment stops.

Developments in Treatment of Cervical Cancer

At present, early detection and treatment of precancerous tissue remain the most effective ways of preventing cervical cancer.

The outlook for women with precancerous changes of the cervix or very early cancer of the cervix is excellent, and nearly all patients with these conditions can be cured. Researchers still continue to look for new and better ways to treat invasive cervical cancer.

Drugs used in the Treatment of Cervical Cancer

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31 August, 2017
Lung Cancer

Lung Cancer

Lung cancer is the second most common cancer among both men and women and is the leading cause of cancer death in both sexes. Cigarette smoking causes almost 90% of lung cancers, and passive smoking contributes to the development of lung cancer among nonsmokers.

What is Lung Cancer?

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life.  The body is made up of many types of cells, and normally, cells grow and divide to produce more cells only when the body needs them.  Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor.  There are two types or tumor, benign and malignant.

Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body and are not a threat to life.

Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor, and can break away from a malignant tumor and enter the lymphatic system or the bloodstream. The spread of cancer is called metastasis.

Cancers that begin in the lungs are divided into two major types, called non-small cell lung cancer and small cell lung cancer, depending on how the cells look under a microscope. Each type of lung cancer grows and spreads in different ways and is treated differently.

Non-small cell lung cancer is the most common type, and it generally grows and spreads more slowly than small cell lung cancer. There are three main types of non-small cell lung cancer named for the type of cells in which the cancer develops: squamous cell carcinoma (also called epidermoid carcinoma), adenocarcinoma and large cell carcinoma.

Small cell lung cancer, sometimes called oat cell cancer, is less common than non-small cell lung cancer. This type of lung cancer grows more quickly and is more likely to spread to other organs in the body.

What causes Lung Cancer?

Several causes of lung cancer have been discovered, most of which are related to the use of tobacco. The following list identifies the risk factors for lung cancer:

Cigarettes -- Smoking cigarettes causes lung cancer. Carcinogens in the tobacco damage the cells in the lungs, and over time, the damaged cells may become cancerous. The risk of a cigarette smoker developing lung cancer is dependent on the number of cigarettes smoked each day, the age at which smoking began and how long the person has smoked. Stopping smoking greatly reduces the risk of developing lung cancer.

Cigars and Pipes -- Cigar and pipe smokers also have a higher risk of lung cancer than nonsmokers. The risk of developing lung cancer is dependent on the number of pipes or cigars smoked each day and the number of years a person has smoked

Environmental Tobacco Smoke -- The chance of developing lung cancer is increased by exposure to environmental tobacco smoke (ETS), which is the smoke in the air when someone else smokes. Exposure to ETS, or secondhand smoke, is called involuntary or passive smoking.

Radon is an invisible, odorless, and tasteless radioactive gas that occurs naturally in soil and rocks. Exposure to radon (in mines or even houses) can cause damage to the lungs that may lead to lung cancer.

Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air and stick to clothes. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk for lung cancer.

Pollution -- There is a link between lung cancer and exposure to certain air pollutants, such as by-products of the combustion of diesel and other fossil fuels. This relationship has not been clearly defined, however and more research is being done.

Lung Diseases -- Certain lung diseases, such as tuberculosis (TB), increase the risk of developing lung cancer. Lung cancer tends to develop in areas of the lung that are scarred from TB.

Personal History -- A person who has had lung cancer once is more likely to develop a second lung cancer compared with a person who has never had lung cancer. Quitting smoking after lung cancer is diagnosed may prevent the development of a second lung cancer.

The best way to prevent lung cancer is to quit, or never start, smoking.

Symptoms of Lung Cancer

Common signs and symptoms of lung cancer include:

  • A cough that doesn't go away and gets worse over time
  • Constant chest pain
  • Coughing up blood
  • Shortness of breath, wheezing, or hoarseness
  • Repeated problems with pneumonia or bronchitis
  • Swelling of the neck and face
  • Loss of appetite or weight loss
  • Fatigue.

These symptoms may be caused by lung cancer or by other conditions. It is important to check with a doctor.

Diagnosing Lung Cancer

To help find the cause of symptoms, the doctor assesses the medical history, including smoking history and family history of cancer. The doctor also performs a physical exam and may order a chest x-ray and other tests. Sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer. To confirm the presence of lung cancer, the doctor must examine tissue from the lung.

A biopsy (the removal of a small sample of tissue for examination under a microscope by a pathologist) can show whether a person has cancer. A number of procedures may be used to obtain this tissue:

Bronchoscopy is where a bronchoscope (a thin, lighted tube) is put into the mouth or nose and down through the windpipe to look into the breathing passages. Cells or small samples of tissue can be taken through this tube.

Needle aspiration involves inserting a needle through the chest into the tumor to remove a sample of tissue.

Thoracentesis is a procedure where a needle is used to take a sample of the fluid that surrounds the lungs to check for cancer cells.

Thoracotomy is a major operation where the chest is opened.

Staging the Disease

If the diagnosis is cancer, staging is done to determine the stage (or extent) of the disease, to find out whether the cancer has spread, and if so, to which parts of the body. Lung cancer can often spread to the brain or bones. Some tests used to determine whether the cancer has spread include:

  • CAT (or CT) Scan (computed tomography). A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.
  • MRI (Magnetic Resonance Imaging) A powerful magnet linked to a computer makes detailed pictures of areas inside the body.
  • Radionuclide Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.
  • Bone Scan is a type of radionuclide scanning, and can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein. It travels through the bloodstream and collects in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas and records them on x-ray film.
  • Mediastinoscopy can help show whether the cancer has spread to the lymph nodes in the chest. Using a lighted viewing instrument, called a scope, the center of the chest is examined and nearby lymph nodes. In mediastinoscopy, the scope is inserted through a small incision in the neck; in mediastinotomy, the incision is made in the chest. In either procedure, the scope is used to remove a tissue sample under general anesthetic.

Methods of Treatment and Side Effects

Treatment depends on a number of factors, including the type of lung cancer, the size, location, and extent of the tumor, and the general health of the patient. Many different treatments and combinations of treatments may be used to control lung cancer, and/or to improve quality of life by reducing symptoms.

Surgery is an operation to remove the cancer. The type of surgery performed depends on the location of the tumor. An operation to remove only a small part of the lung is called a segmental or wedge resection.
When the entire lobe of the lung is removed, the procedure is called a lobectomy. The removal of an entire lung is called pneumonectomyis.

Lung cancer surgery is major surgery. After an operation, air and fluid tend to collect in the chest. Patients often need help turning over, coughing, and breathing deeply. Pain or weakness in the chest and the arm and shortness of breath are common side effects of lung cancer surgery. Patients may need several weeks or months to regain their energy and strength.

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Even after cancer has been removed from the lung, cancer cells may still be present in nearby tissue or elsewhere in the body. Chemotherapy may be used to control cancer growth or to relieve symptoms.

Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, and fatigue.

Radiation therapy (radiotherapy) involves the use of high-energy rays to kill cancer cells. Radiation therapy is directed to a limited area and affects the cancer cells only in that area. Radiation therapy may be used before surgery to shrink a tumor, or after surgery to destroy any cancer cells that remain in the treated area. Radiation therapy, often combined with chemotherapy, is often used as primary treatment instead of surgery. Radiation therapy may also be used to relieve symptoms such as shortness of breath. Radiation for the treatment of lung cancer most often comes from a machine (external radiation). The radiation can also come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation).

Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of radiation therapy are a dry, sore throat; difficulty swallowing; fatigue; skin changes at the site of treatment; and loss of appetite.

Photodynamic therapy (PDT), a type of laser therapy, involves the use of a special chemical that is injected into the bloodstream and absorbed by cells all over the body. The chemical rapidly leaves normal cells but remains in cancer cells for a longer time. A laser light aimed at the cancer activates the chemical, which then kills the cancer cells that have absorbed it. Photodynamic therapy may be used to reduce symptoms of lung cancer (to control bleeding or to relieve breathing problems due to blocked airways) when the cancer cannot be removed through surgery. Photodynamic therapy may also be used to treat very small tumors in patients for whom the usual treatments for lung cancer are not appropriate.

PDT makes the skin and eyes sensitive to light for 6 weeks or more after treatment. Patients are advised to avoid direct sunlight and bright indoor light for at least 6 weeks. If patients must go outdoors, they need to wear protective clothing, including sunglasses. Other temporary side effects of PDT may include coughing, trouble swallowing, and painful breathing or shortness of breath. Patients should talk with their doctor about what to do if the skin becomes blistered, red, or swollen.

Treating Non-small Cell Lung Cancer

Surgery is the most common way to treat non-small lung cancer. Radiation therapy and chemotherapy may also be used to slow the progress of the disease and to manage symptoms.

Drugs used in the Treatment of Non-Small Cell Lung Cancer

Treating Small Cell Lung Cancer

Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.

Drugs used in the Treatment of Small Cell Lung Cancer

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31 August, 2017
Skin Cancer

Skin cancer is the most common type of cancer in the United States.

According to current estimates, 40 to 50 percent of Americans who live to age 65 will have skin cancer at least once. Melanoma is the most serious of the skin cancers, and the number of people who develop melanoma is increasing at a faster rate than that of any other cancer.

The skin is the body's outer covering which protects us from heat, light, injury and infection. It regulates body temperature, and stores water, fat and vitamin D. It is the body's largest organ. It is made up of two layers called the epidermis and the dermis. The epidermis is the outer layer of the skin and it is mostly of flat, scale-like cells called squamous cells. Under the squamous cells are round cells called basal cells The deepest part of the epidermis contains melanocytes which are cells that produce a pigment called melanin which gives the skin its color.

When skin is exposed to the sun, the melanocytes produce more pigment causing the skin to tan or darken. Clusters of melanocytes and surrounding tissue form common noncancerous growths called moles.

The dermis is the inner layer of the skin, which contains blood and lymph vessels, hair follicles and glands that produce sweat (to regulate body temperature), and sebum (an oily substance that helps keep the skin from drying out). Sweat and sebum reach the skin's surface through tiny openings called pores.

What is Skin Cancer?

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life.  The body is made up of many types of cells, and normally, cells grow and divide to produce more cells only when the body needs them.  Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor.  There are two types, benign and malignant.

Benign tumors are not cancer. They can usually be removed by surgery, and in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body and are not a threat to life.

Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancer cells also can spread, or metastasize, to other parts of the body and form new tumors.

Two common kinds of skin cancer are basal cell carcinoma and squamous cell carcinoma (also called nonmelanoma skin cancer). Carcinoma is cancer that begins in the cells that cover or line an organ. Melanoma is a malignancy of the melanocytes and is the most serious form of skin cancer.

Basal cell carcinoma is a slow-growing cancer that seldom spreads to other parts of the body.

Squamous cell carcinoma also rarely spreads, but it does so more often than basal cell carcinoma. It is important that skin cancers be found and treated early because they can invade and destroy nearby tissue.

Melanoma occurs when melanocytes become malignant. When melanoma starts in the skin (it may also start in other parts of the body such as the eye) the disease is called cutaneous melanoma. When melanoma spreads (metastasizes), cancer cells are also found in the lymph nodes, and it may mean that the cancer has also spread to other parts of the body such as the liver, lungs or brain. The cancer cells of the new tumor are still melanoma cells, and the disease is called metastatic melanoma rather than liver, lung or brain cancer.

What causes Skin Cancer?

Although anyone can get skin cancer, the risk is greatest for people who have fair skin that freckles easily, and often those with red or blond hair and blue or light-colored eyes.

Ultraviolet (UV) Radiation from the sun is the main cause of skin cancer. Artificial sources of UV radiation, such as sunlamps and tanning booths, can also cause skin cancer. The risk of developing skin cancer is affected by where a person lives.

People who live in areas that get high levels of UV radiation from the sun are more likely to get skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong.

Worldwide, the highest rates of skin cancer are found in areas that receive high amounts of UV radiation such as South Africa, Australia and New Zealand.

The risk of developing skin cancer is related to lifetime exposure to UV radiation. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood to prevent skin cancer later in life.

Whenever possible, people should avoid exposure to the midday sun (from 10 a.m. to 2 p.m. standard time, or from 11 a.m. to 3 p.m. daylight saving time). Protective clothing, such as sun hats and long sleeves, can block out the sun's harmful rays. Sunscreens with a sun protection factor (SPF) of 15 to 30 or higher block most of the sun's harmful rays.

What are the risk factors for Melanoma?

Family history of melanoma -- Having two or more close relatives who have had this disease is a risk factor because melanoma sometimes runs in families

Dysplastic nevi -- Dysplastic nevi are a certain type of mole, more likely than ordinary moles to become cancerous. The risk of melanoma is greater for people with a large number of dysplastic nevi.

History of melanoma -- People who have been treated for melanoma are at a high risk for developing a second melanoma.

Weakened immune system -- People whose immune system is weakened by certain cancers, by drugs given following organ transplants, or by AIDS are at increased risk of developing melanoma.

Large numbers of ordinary moles (more than 50) -- Because melanoma usually begins in the melanocytes of an existing mole, having many moles increases the risk of developing this disease.

Exposure to Ultraviolet (UV) radiation -- UV radiation from the sun causes premature aging of the skin and skin damage that can lead to melanoma. Artificial sources of UV radiation, such as sunlamps and tanning booths, also can cause skin damage and probably an increased risk of melanoma.

Severe, blistering sunburns -- People who have had one or more severe, blistering sunburns as a child or teenager are at increased risk for melanoma. Sunburns in adulthood are also a risk factor for melanoma.

Fair skin -- Melanoma occurs more frequently in people who have fair skin that burns or freckles easily (these people also usually have red or blond hair and blue eyes).

People who are concerned about melanoma should talk with their doctors about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the person's personal and family history, medical history, and the other risk factors described above.

Symptoms of Skin Cancer

Basal and Squamous cell cancers are found mainly on areas of the skin that are exposed to the sun such as the head, face, neck, hands, and arms however, skin cancer can occur anywhere. The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore that doesn't heal. Skin cancers don't all look the same. For example, the cancer may start as a small, smooth, shiny, pale, or waxy lump. Or it can appear as a firm red lump. Sometimes, the lump bleeds or develops a crust. Skin cancer can also start as a flat, red spot that is rough, dry, or scaly.

Symptoms of Melanoma

Melanomas are usually first noticed because of a change in the size, shape, color or feel of an existing mole. Other frequent findings are newly formed fine scales or itching in a mole. Thinking of "ABCD" can help you remember what to watch for:

  • Asymmetry -- the shape of one half does not match the other.
  • Border -- The edges are often ragged, notched, blurred, or irregular in outline; the pigment may spread into the surrounding skin.
  • Color - -The color is uneven. Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue also may be seen.
  • Diameter -- There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (5 mm or 1/4 inch).

Melanomas can vary greatly in the ways they look. Many show all of the ABCD features but some may show changes or abnormalities in only one or two of the ABCD features.

Melanoma can be cured if it is diagnosed and treated when the tumor is thin and has not deeply invaded the skin. However, if a melanoma is not removed at its early stages, cancer cells may grow downward from the skin surface, invading healthy tissue. When a melanoma becomes thick and deep, the disease often spreads to other parts of the body and is difficult to control.

Changes in the skin are not sure signs of cancer; however, it is important to see a doctor if any symptom lasts longer than 2 weeks. Don't wait for the area to hurt -- skin cancers seldom cause pain.

Detection of Skin Cancer

The cure rate for skin cancer is very high if detected early. It is important to examine the skin regularly to check for new growths or other changes in the skin. Any new, colored growths or any changes in growths that are already present should be reported to a doctor without delay

Doctors should also check the skin during routine physical exams. People who have already had skin cancer should be sure to have regular exams so that the doctor can check the treated are of skin and other areas cancer may develop.

How To Do a Skin Self-Exam

The best time to do a skin self-exam is after a shower or bath. The skin should be checked in a well-lit room using a full-length mirror and a hand-held mirror. It's best to begin by learning where birthmarks, moles, and blemishes are and what they usually look and feel like. Check for anything new, especially a change in the size, shape, texture, or color of a mole or a sore that does not heal.

Check yourself from head to toe. Don't forget to check all areas of the skin, including the back, the scalp, between the buttocks, and the genital area:

  1. Look at the front and back of your body in the mirror, then raise your arms and look at your left and right sides.
  2. Bend your elbows and look carefully at your fingernails, palms, forearms (including the undersides), and upper arms.
  3. Examine the back, front, and sides of your legs. Also look between the buttocks and around the genital area.
  4. Sit and closely examine your feet, including the toenails, the soles, and the spaces between the toes.
  5. Look at your face, neck, ears, and scalp. You may want to use a comb or a blow dryer to move hair so that you can see better. You also may want to have a relative or friend check through your hair because this is difficult to do yourself.

By checking your skin regularly, you will become familiar with what is normal for you. It may be helpful to record the dates of your skin exams and to write notes about the way your skin looks. If you find anything unusual, see your doctor right away.

Diagnosis of Skin Cancer

Basal cell carcinoma and squamous cell carcinoma are generally diagnosed and treated in the same way. When an area of skin does not look normal, the doctor may remove all or part of the growth. This is procedure is called a biopsy. The tissue is examined to check for cancer cells

Doctors generally divide skin cancer into two stages: local (affecting only the skin) or metastatic (spreading beyond the skin). Because basal cell carcinomas and squamous cell carcinomas rarely spread beyond the skin, a biopsy often is the only test needed to determine the stage.

In cases where the growth is very large or has been present for a long time, the doctor will carefully check the lymph nodes in the area, and additional tests, such as special x-rays, will be used to find out whether the cancer has spread to other parts of the body. Knowing the stage of a skin cancer helps determine the treatment plan.

Diagnosis of Melanoma

A biopsy is also the only way to make a definite diagnosis of melanoma. Usually, attempts are made to remove the entire growth. If the growth is too large to be removed entirely, a sample of tissue will be taken.

If melanoma is found, various tests and procedures will be conducted to determine the extent or stage of the disease. Removal of nearby lymph nodes is sometimes necessary. The treatment plan is dependent of the location and thickness of the tumor, how deep and whether it has metastasized.

Treatment of Skin Cancer

The main objective of treating skin cancer is to remove or destroy the cancer completely with as small a scar as possible.

Treatment of skin cancer usually involves some type of surgery. In some cases, treatment will involve radiation therapy, chemotherapy or a combination of both.

Surgery -- Many skin cancers can be cut from the skin quickly and easily. In fact, the cancer is sometimes completely removed at the time of the biopsy, and no further treatment is needed.

Curettage and Electrodesiccation involves numbing the area with a local anesthetic and scooping the skin cancer out with a sharp spoon shaped instrument called a curette. The area is then treated with an electric current from a special machine (a procedure called electrodesiccation) to control bleeding and kill any cancer cells remaining around the edge of the wound. Most patients develop a flat white scar.

Moh's Surgery is a special type of surgery performed by specialists. The aim is to remove all of the cancerous tissue and as little of the healthy tissue as possible, and is particularly useful when the shape and depth of the tumor is unknown. This method is also used to remove large tumors, those in hard-to-treat places, and cancers that have recurred. The procedure is performed under local anesthetic, and the cancer is shaved off one thin layer at a time. Each layer is checked under a microscope until the entire tumor is removed. The degree of scarring depends on the location and size of the treated area.

Cryosurgery is the use of extreme cold to freeze and kill the abnormal cells. Liquid nitrogen is used to treat precancerous skin conditions such as actinic keratosis, and certain small skin cancers. After the area is thawed, the dead tissue falls off. More than one treatment may be necessary to remove the growth completely. Pain and swelling may be present after the area thaws, and a white scar may form in the treated area.

Laser Therapy uses a narrow beam of light to remove or destroy cancer cells. This procedure is sometimes used for cancers that only involve the outer layer of skin.

Skin Grafts are often needed to close the wound and reduce the amount of scarring, especially if a large cancer is removed. The procedure involves taking a piece of healthy skin from another part of the body to replace the skin that was removed.

Radiation Therapy (radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. This treatment is often used for cancers in areas that are difficult to treat with surgery (example eyelid, the tip of the nose, or the ear). Several treatments may be necessary. Radiation therapy may cause a rash or make the skin in the area dry or red. Changes in skin color or texture may develop after the treatment, and may become more noticeable many years later.

Topical Chemotherapy is the use of anticancer drug in a cream or lotion applied to the skin. Fluorouracil (also called 5-FU) is used to treat precancerous conditions such as actinic keratosis and cancers limited to the top layer of skin. Intense inflammation is common during treatment, but scars usually do not occur.

Treatment of Melanoma and Side Effects

Surgery -- The standard treatment for melanoma is removal (excision). It is necessary to remove not only the tumor but also some normal tissue around it in order to minimize the chance that any cancer will be left in the area. The amount of healthy tissue removed depends on the thickness of the melanoma and how deeply it has invaded the skin. In cases where the melanoma is very thin, enough tissue is often removed during the biopsy, and no further surgery is necessary.

If the melanoma was not completely removed during the biopsy, the remaining tumor is removed. In most cases, additional surgery is performed to remove normal-looking tissue around the tumor (called the margin) to make sure all melanoma cells are removed. This is necessary, even for thin melanomas. For thick melanomas, it may be necessary to do a wider excision to take out a larger margin of tissue. Where large areas of tissue are removed, a skin graft may be performed.

Lymph nodes near the tumor may be also removed during surgery. If cancer cells are found in the lymph nodes, it may mean that the disease has spread to other parts of the body.

Surgery is generally not effective in controlling melanoma that is known to have spread to other parts of the body. In such cases, doctors may use other methods of treatment, such as chemotherapy, biological therapy, radiation therapy, or a combination of these methods. When therapy is given after surgery (primary therapy) to remove all cancerous tissue, the treatment is called adjuvant therapy. The goal of adjuvant therapy is to kill any undetected cancer cells that may remain in the body.

The side effects of surgery depend mainly on the size and location of the tumor and the extent of the operation. Pain and discomfort after surgery can be controlled with pain relieving medicine. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient. Scarring may also be a concern for some patients.

Chemotherapy is the use of one or more drugs to kill cancer cells. It is generally a systemic therapy, meaning that it can affect cancer cells throughout the body. Anticancer drugs are given by mouth or by injection into a blood vessel. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on.

Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, hair loss, mouth sores, and fatigue.

Biological therapy (immunotherapy) is a form of treatment that uses the body's immune system, either directly or indirectly, to fight cancer or to lessen side effects caused by some cancer treatments. Biological therapy is also a systemic therapy and involves the use of substances called biological response modifiers (BRMs). The body normally produces these substances in small amounts in response to infection and disease.

Using modern laboratory techniques, scientists can produce BRMs in large amounts for use in cancer treatment. In some cases, biological therapy given after surgery can help prevent melanoma from recurring.

For patients with metastatic melanoma or a high risk of recurrence, interferon-alfa and interleukin-2 (also called aldesleukin) may be recommended after surgery.

The side effects caused by biological therapy vary with the type of treatment. These treatments may cause flu-like symptoms, such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients may also bleed or bruise easily, get a skin rash, or have swelling. These problems can be severe, but they go away after treatment stops.

Radiation therapy (radiotherapy) is the use of high-energy rays to kill cancer cells. In some cases, radiation therapy is used to relieve some of the symptoms caused by melanoma. Radiation therapy is a local therapy, as it affects cells only in the treated area. Radiation therapy is most commonly used to help control melanoma that has spread to the brain, bones, and other parts of the body.

Side effects of radiation therapy depend mainly on the part of the body that is treated and the treatment dose. Common side effects of radiation therapy include fatigue and hair loss in the treated area.

Developments in Treatment of Skin Cancer

There are a number of new treatments in development for the treatment of skin cancer. Photodynamic therapy is a treatment that destroys cancer cells with a combination of laser light and drugs that make the cells sensitive to light.

Biological therapy (also called immunotherapy) is a form of treatment to improve the body's natural ability to fight cancer. Interferon and tumor necrosis factor are types of biological therapy under study for skin cancer.

Drugs used in the Treatment of Skin Cancer

Developments in Treatment of Melanoma

One method of giving chemotherapy drugs currently under investigation is called limb perfusion. It is being tested for use when melanoma occurs only on an arm or leg.

In limb perfusion the flow of blood to and from the limb is stopped for a while with a tourniquet. Anticancer drugs are then put into the blood of the limb. The patient receives high doses of drugs directly into the area where the melanoma occurred. Since most of the anticancer drugs remain in one limb, limb perfusion is not truly systemic therapy.

A new procedure for the treatment of melanoma is sentinel lymph node biopsy, which may eventually reduce the number of lymph nodes that need to be removed for biopsy. The procedure involves injecting a blue dye or a small amount of radioactive material near the area where the tumor was. This material flows into the sentinel lymph node(s) (the first lymph node(s) that the cancer is likely to spread to from the primary tumor).

A surgeon then looks for the dye or uses a scanner to find the sentinel lymph node(s) and then removes it for examination by a pathologist. If the sentinel lymph node(s) is positive for cancer cells, then the rest of the surrounding lymph nodes are usually removed; if it is negative, the remaining lymph nodes may not need to be removed.

Drugs used in the Treatment of Malignant Melanoma

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31 August, 2017
imatinib

Generic Name: imatinib (im MA ta nib)
Brand Name: Gleevec

What is imatinib?

Imatinib interferes with the growth of some cancer cells.

Imatinib is used to treat certain types of leukemia (blood cancer), bone marrow disorders, and skin cancer, or certain tumors of the stomach and digestive system.

Imatinib may also be used for purposes not listed in this medication guide.

What is the most important information I should know about imatinib?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.


What should I discuss with my healthcare provider before taking imatinib?

You should not use imatinib if you are allergic to it.

To make sure imatinib is safe for you, tell your doctor if you have:

  • liver disease;

  • kidney disease;

  • underactive thyroid, recent or upcoming thyroid surgery;

  • heart disease, congestive heart failure;

  • history of stomach ulcer or bleeding; or

  • if you are receiving chemotherapy.

Do not use imatinib if you are pregnant. It could harm the unborn baby. Use effective birth control to prevent pregnancy, and tell your doctor if you become pregnant during treatment.

It is not known whether imatinib passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Imatinib can affect growth in children. Talk with your doctor if you think your child is not growing at a normal rate while using this medicine.

How should I take imatinib?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Imatinib should be taken with a meal. Do not take imatinib on an empty stomach.

Take imatinib with a full glass of water.

You may dissolve the imatinib tablet in water or apple juice to make swallowing easier.

Do not crush, chew, or break an imatinib tablet. The medicine from a crushed or broken pill can be dangerous if it gets in your eyes, mouth, or nose, or on your skin. If this occurs, wash your skin with soap and water or rinse your eyes with water. Ask your doctor or pharmacist how to safely handle and dispose of a crushed or broken tablet.

Imatinib can lower blood cells that help your body fight infections and help your blood to clot. Your blood will need to be tested often. Your cancer treatments may be delayed based on the results of these tests.

You will also need frequent tests to check your liver function.

Do not stop using imatinib without your doctor's advice.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember, making sure you also eat a meal and drink a large glass of water. Skip the missed dose if it is almost time for your next dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking imatinib?

This medicine may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Dizziness or severe drowsiness can cause falls, accidents, or severe injuries.

Grapefruit and grapefruit juice may interact with imatinib and lead to potentially dangerous effects. Avoid the use of grapefruit products while taking imatinib.

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

This medicine can pass into body fluids (urine, feces, vomit). Caregivers should wear rubber gloves while cleaning up a patient's body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Imatinib side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • fluid retention--shortness of breath (even while lying down), swelling, rapid weight gain (especially in your face and midsection);

  • fluid build-up in the lungs--pain when you breathe, wheezing, gasping for breath, cough with foamy mucus;

  • liver problems--upper stomach pain, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • low blood cell counts--fever, chills, flu-like symptoms, swollen gums, mouth sores, skin sores, rapid heart rate, pale skin, easy bruising, unusual bleeding, feeling light-headed;

  • signs of stomach bleeding--bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;

  • signs of tumor cell breakdown--lower back pain, blood in your urine, little or no urinating; numbness or tingly feeling around your mouth; muscle weakness or tightness; fast or slow heart rate, weak pulse; confusion, fainting;

  • thyroid symptoms--extreme tired feeling, dry skin, joint pain or stiffness, muscle pain or weakness, hoarse voice, feeling more sensitive to cold temperatures; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • nausea, vomiting, stomach pain, diarrhea;

  • joint or muscle pain;

  • skin rash; or

  • feeling tired.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Imatinib dosing information

Usual Adult Dose for Chronic Myelogenous Leukemia:

Chronic phase: 400 mg orally once a day
Accelerated phase or blast crisis: 600 mg orally once a day

A dose increase may be considered in the absence of a severe adverse drug reaction and severe non-leukemia related neutropenia or thrombocytopenia in the following circumstances: disease progression (at any time), failure to achieve a satisfactory hematologic response after at least 3 months of treatment, failure to achieve a cytogenetic response after 6 to 12 months of treatment, or loss of a previously achieved hematologic or cytogenetic response:
Disease progression chronic phase: 600 mg orally once a day
Disease progression accelerated phase or blast crisis: 400 mg orally 2 times a day

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-This drug should be taken with a meal and a large glass of water.

Uses:
-Newly diagnosed patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+CML) in chronic phase
-Patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+CML) in blast crisis (BC), accelerated phase (AP), or in chronic phase (CP) after failure of interferon-alpha therapy

Usual Adult Dose for Acute Lymphoblastic Leukemia:

600 mg orally daily

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-This drug should be taken with a meal and a large glass of water.

Use: For relapsed or refractory Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL)

Usual Adult Dose for Myeloproliferative Disorder:

400 mg orally once a day

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-Determine PDGFRb gene rearrangements status prior to initiating treatment. Information on FDA-approved tests for the detection of PDGFRb rearrangements is available at http://www.fda.gov/companiondiagnostics.
-This drug should be taken with a meal and a large glass of water.

Use: For patients with myelodysplastic/myeloproliferative (MDS/MPD) diseases associated with PDGFR (platelet-derived growth factor receptor) gene rearrangements as determined with an FDA-approved test

Usual Adult Dose for Myelodysplastic Disease:

400 mg orally once a day

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-Determine PDGFRb gene rearrangements status prior to initiating treatment. Information on FDA-approved tests for the detection of PDGFRb rearrangements is available at http://www.fda.gov/companiondiagnostics.
-This drug should be taken with a meal and a large glass of water.

Use: For patients with myelodysplastic/myeloproliferative (MDS/MPD) diseases associated with PDGFR (platelet-derived growth factor receptor) gene rearrangements as determined with an FDA-approved test

Usual Adult Dose for Systemic Mastocytosis:

-For patients with ASM without the D816V c-Kit mutation: 400 mg orally daily
-If c-Kit mutational status is not known or unavailable: 400 mg orally daily may be considered for patients with ASM not responding satisfactorily to other therapies
-For patients with ASM associated with eosinophilia, a clonal hematological disease related to the fusion kinase FIP1L1-PDGFR alpha, a starting dose of 100 mg/day is recommended. Dose increase from 100 mg to 400 mg for these patients may be considered in the absence of adverse drug reactions if assessments demonstrate an insufficient response to therapy.
-For patients with ASM associated with eosinophilia (a clonal hematological disease related to the fusion kinase FIP1L1-PDGFR alpha: 100 mg orally daily; a dose increase from 100 mg to 400 mg for these patients may be considered in the absence of adverse drug reactions if assessments demonstrate an insufficient response to therapy

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-Determine D816V c-Kit mutation status prior to initiating treatment.
-This drug should be taken with a meal and a large glass of water.

Use: For patients with aggressive systemic mastocytosis without the D816V c-Kit mutation as determined with an FDA-approved test

Usual Adult Dose for Hypereosinophilic Syndrome:

-For patients with HES/CEL: 400 mg orally daily
-For patients with HES/CEL with demonstrated FIP1L1-PDGFR alpha fusion kinase: 100 mg orally daily; dose increase from 100 mg to 400 mg for these patients may be considered in the absence of adverse drug reactions if assessments demonstrate an insufficient response to therapy

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-This drug should be taken with a meal and a large glass of water.

Use: For patients with hypereosinophilic syndrome and/or chronic eosinophilic leukemia who have the FIP1L1-PDGFR alpha fusion kinase (mutational analysis or FISH demonstration of CHIC2 allele deletion) and for patients with HES and/or CEL who are FIP1L1-PDGFR alpha fusion kinase negative or unknown

Usual Adult Dose for Chronic Eosinophilic Leukemia:

-For patients with HES/CEL: 400 mg orally daily
-For patients with HES/CEL with demonstrated FIP1L1-PDGFR alpha fusion kinase: 100 mg orally daily; dose increase from 100 mg to 400 mg for these patients may be considered in the absence of adverse drug reactions if assessments demonstrate an insufficient response to therapy

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-This drug should be taken with a meal and a large glass of water.

Use: For patients with hypereosinophilic syndrome and/or chronic eosinophilic leukemia who have the FIP1L1-PDGFR alpha fusion kinase (mutational analysis or FISH demonstration of CHIC2 allele deletion) and for patients with HES and/or CEL who are FIP1L1-PDGFR alpha fusion kinase negative or unknown

Usual Adult Dose for Dermatofibrosarcoma Protuberans:

100 mg orally daily

Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-This drug should be taken with a meal and a large glass of water.

Use: For patients with unresectable, recurrent and/or metastatic dermatofibrosarcoma protuberans (DFSP)

Usual Adult Dose for Gastrointestinal Stromal Tumor:

-For patients with unresectable and/or metastatic, malignant GIST: 400 mg orally daily; the dose may be increased up to 800 mg daily (given as 400 mg 2 times a day) may be considered, as clinically indicated, in patients showing clear signs or symptoms of disease progression at a lower dose and in the absence of severe adverse drug reactions; therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.
-For the adjuvant treatment of adult patients following complete gross resection of GIST: 400 mg orally daily; in clinical trials, therapy was administered for one year; the optimal treatment duration is not known

Comments:
-This drug should be taken with a meal and a large glass of water.

Uses:
-Kit+ Gastrointestinal Stromal Tumors (GIST): Patients with Kit (CD117) positive unresectable and/or metastatic malignant gastrointestinal stromal tumors
-Adjuvant Treatment of GIST: Adjuvant treatment of adult patients following complete gross resection of Kit (CD117) positive GIST

Usual Pediatric Dose for Chronic Myelogenous Leukemia:

1 year and older:
340 mg/m2 orally once a day or 170 mg/m2 orally 2 times a day
Maximum Dose: 600 mg daily
Duration of therapy: Therapy may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-Therapy can be given as a once daily dose or the daily dose may be split into 2 doses, with one portion dosed in the morning and one portion in the evening.
-This drug should be taken with a meal and a glass of water.
-There is no experience with this drug in children under 1 year of age.

Use:
-Newly diagnosed patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+CML) in chronic phase

Usual Pediatric Dose for Acute Lymphoblastic Leukemia:

1 year and older:
340 mg/m2 orally once a day
Maximum Dose: 600 mg once a day
Duration of therapy: Treatment may be continued as long as there is no evidence of progressive disease or unacceptable toxicity.

Comments:
-This drug should be taken with a meal and a glass of water.
-There is no experience with this drug in children under 1 year of age.

Use: For pediatric patients with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) in combination with chemotherapy

What other drugs will affect imatinib?

Many drugs can interact with imatinib. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with imatinib, especially:

  • bosentan;

  • dihydroergotamine or ergotamine;

  • fentanyl (Abstral, Actiq, Fentora, Duragesic, Lazanda, Onsolis);

  • nefazodone;

  • pimozide;

  • St. John's wort;

  • an antibiotic--clarithromycin, erythromycin, telithromycin;

  • antifungal medicine--itraconazole, ketoconazole, posaconazole, voriconazole;

  • antiviral medicine to treat hepatitis C or HIV/AIDS--atazanavir, boceprevir, cobicistat (Stribild, Tybost), delavirdine, efavirenz, fosamprenavir, indinavir, nelfinavir, nevirapine, ritonavir, saquinavir, telaprevir;

  • a blood thinner--warfarin, Coumadin, Jantoven;

  • heart medicine--nicardipine, quinidine;

  • medicine to prevent organ transplant rejection--cyclosporine, sirolimus, tacrolimus;

  • seizure medication--carbamazepine, fosphenytoin, oxcarbazepine, phenobarbital, phenytoin, primidone; or

  • tuberculosis medication--isoniazid, rifabutin, rifampin, rifapentine.

This list is not complete and many other drugs can interact with imatinib. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.


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Prostate Cancer

Prostate Cancer

Prostate cancer is the most common type of cancer in men in the United States (other than skin cancer), and accounts for more than one-quarter of all men diagnosed with cancer each year.

The prostate is a gland in the male reproductive system, which makes and stores seminal fluid, a milky fluid that nourishes sperm and is released to from part of semen.
The prostate gland is about the size of a walnut, and surrounds the upper part of the urethra, the tube that empties urine from the bladder. If the prostate gland grows too large, the flow of urine can be slowed or stopped.

What is Prostate Cancer?

Cancer is a group of many related diseases that begin in cells, the body's basic unit of life.  The body is made up of many types of cells, and normally, cells grow and divide to produce more cells only when the body needs them.  Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor.  There are two types of tumor, benign and malignant.

Benign tumors are not cancer. They can usually be removed, and in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body and are not a threat to life. Benign prostatic hyperplasia (BPH) is the abnormal growth of benign prostate cells. In BPH, the prostate grows larger and presses against the urethra and bladder, interfering with the normal flow of urine. More than half of the men in the United States between the ages of 60 and 70 have symptoms of BPH. For some men, the symptoms may be severe enough to require treatment.

Malignant tumors are cancer. Cells in these tumors are abnormal, they divide without control or order, and can invade and damage nearby tissues and organs. Cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system, which is how cancer spreads from the original cancer site to form new tumors in other organs. The spread of cancer is called metastasis.

When prostate cancer spreads (metastasizes) outside the prostate, cancer cells are often found in nearby lymph nodes and possibly other parts of the body (other lymph nodes and other organs, such as the bones, bladder, or rectum). When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the new tumor are prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.

What causes Prostate Cancer?

The causes of prostate cancer are not well understood. There are a number of risk factors associated with prostate cancer:

  • Age -- In the United States, prostate cancer is found mainly in men over age 55. The average age of patients at the time of diagnosis is 70.
  • Family history of prostate cancer -- The risk for developing prostate cancer is higher if a close relative (father or brother) has had the disease.
  • Race -- Prostate cancer is much more common in African American men than in white men. It is less common in Asian and Native American men.
  • Diet and dietary factors -- A diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk. Studies are in progress to learn whether men can reduce their risk of prostate cancer by taking certain dietary supplements.

There is very little evidence that a vasectomy, BPH, obesity, lack of exercise, smoking, radiation exposure, or a sexually transmitted virus might increase the risk for prostate cancer.

Detecting Prostate Abnormalities

The following tests are used to detect prostate abnormalities, but they cannot show whether abnormalities are cancer or another, less serious condition. The doctor will take the results into account in deciding whether to check the patient further for signs of cancer.

Digital rectal exam involves the doctor inserting a lubricated, gloved finger into the rectum to feel the prostate through the rectal wall and to check for hard or lumpy areas.

Blood test for Prostate-Specific Antigen (PSA) -- The level of PSA may rise in men who have prostate cancer, BPH, or infection in the prostate.

Symptoms of Prostate Cancer

Early prostate cancer often does not cause symptoms. But prostate cancer can cause any of these problems:

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Inability to urinate
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen; or
  • Frequent pain or stiffness in the lower back, hips, or upper thighs.

Any of these symptoms may be caused by cancer or by other, less serious health problems, such as BPH or an infection. A man who has symptoms like these should see his doctor or urologist.

Diagnosing Prostate Cancer

If symptoms or test results suggest prostate cancer, the doctor checks personal and family medical histories, will perform a physical exam, and may order laboratory tests. The exams and tests may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA. In some cases, the level of prostatic acid phosphatase (PAP) in the blood will be checked, especially if the results of the PSA indicate there might be a problem.

Other exams the doctor may order include:

  • Transrectal Ultrasonograpy -- Ultrasound waves are sent out by a probe inserted into the rectum, the waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.
  • Intravenous pyelogram is a series of x-rays of the organs of the urinary tract.
  • Cystoscopy is a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube.
  • Biopsy is ordered if test results suggest that cancer is present. During a biopsy, the doctor removes tissue samples from the prostate, usually with a needle. A pathologist looks at the tissue under a microscope to check for cancer cells. If cancer is present, the tumor will be graded. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow.

If the test results do not suggest cancer, the doctor may recommend medicine to reduce the symptoms caused by an enlarged prostate, or surgery. The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine.

Stages of Prostate Cancer

If cancer is found in the prostate, the doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The doctor may use various blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these results.

Prostate cancer staging is a complex process. The doctor may describe the stage using a Roman number (I-IV) or a capital letter (A-D). These are the main features of each stage:

  • Stage I / Stage A -- The tumor cannot be felt during a rectal exam. There is no evidence that the cancer has spread outside the prostate.
  • Stage II / Stage B -- The tumor can be felt during a rectal exam, or is found with a biopsy that was performed because of a high PSA level. There is no evidence that the cancer has spread outside the prostate.
  • Stage III / Stage C -- The cancer has spread outside the prostate to nearby tissues.
  • Stage IV / Stage D -- The cancer has spread to lymph nodes or to other parts of the body.

Methods of Treatment and Side Effects

Treatment for prostate cancer depends on the stage of the disease and the grade of the tumor. Other important factors are the man's age, general health and his feelings about the treatments and possible side effects. Prostate cancer can be managed in a number of ways:

Watchful Waiting may be suggested for some men who have prostate cancer that is found at an early stage and appears to be slow growing, and for older men or men with other serious medical problems where the risks and possible side effects of surgery, radiation therapy, or hormonal therapy may outweigh the possible benefits.

Although men who choose watchful waiting avoid the side effects of surgery and radiation, there can be some negative aspects to this choice. Watchful waiting may reduce the chance of controlling the disease before it spreads, and older men should keep in mind that it may be harder to manage surgery and radiation therapy as they age.

Surgery is a common treatment for early stage prostate cancer. The doctor may remove all of the prostate (radical prostatectomy) or only part of it:

  • In radical retropubic prostatectomy, the doctor removes the entire prostate and nearby lymph nodes through an incision in the abdomen.
  • In radical perineal prostatectomy, the doctor removes the entire prostate through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.
  • In transurethral resection of the prostate (TURP), the doctor removes part of the prostate with an instrument that is inserted through the urethra. The cancer is cut from the prostate by electricity passing through a small wire loop on the end of the instrument. This method is used mainly to remove tissue that blocks urine flow.

If cancer cells are found in the lymph nodes, it is likely that the disease has spread to other parts of the body. Sometimes, the lymph nodes are removed before doing a prostatectomy. If the prostate cancer has not spread to the lymph nodes, the prostate is removed, but if cancer has spread to the nodes, usually the prostate is not removed and other treatment will be suggested.

For the first few days after surgery, pain will usually need to be controlled with pain relief. A catheter will be inserted into the urethra to drain urine. It is also common to experience tiredness and weakness. Surgery to remove the prostate may cause long-term problems, including rectal injury, urinary incontinence and impotence.

Radiation therapy (called radiotherapy) uses high-energy x-rays to kill cancer cells. Like surgery, radiation therapy is local therapy and it can affect cancer cells only in the treated area. In early stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages, it may be given to relieve pain or treat other problems.

Radiation may be directed at the body by a machine (external radiation), or it may come from tiny radioactive seeds placed inside or near the tumor (internal or implant radiation, or brachytherapy). Men who receive radioactive seeds alone usually have small tumors. Some men with prostate cancer receive both kinds of radiation therapy.

Radiation therapy may cause patients to become extremely tired, especially in the later weeks of treatment. Some men may also experience diarrhea or frequent and uncomfortable urination. External radiation therapy may cause the treated area of skin to become red, dry and tender and can also cause hair loss. Both types of radiation therapy can cause impotence, but internal radiation therapy is not as likely to cause nerve damage. Internal radiation therapy may cause temporary incontinence.

Hormonal therapy deprives cancer cells from getting the male hormones they need to grow. It is called systemic therapy because it can affect cancer cells throughout the body. Systemic therapy is used to treat cancer that has spread and is sometimes used to prevent the cancer from coming back after surgery or radiation treatment.

There are several forms of hormonal therapy:

  • Orchiectomy is surgery to remove the testicles, which are the main source of male hormones.
  • Drugs known as luteinizing hormone-releasing hormone (LH-RH) agonists can prevent the testicles from producing testosterone. Examples are leuprolide, goserelin, and buserelin.
  • Drugs known as antiandrogens can block the action of androgens. Examples are flutamide and bicalutamide.
  • Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.

After orchiectomy or treatment with an LH-RH agonist, the body no longer gets testosterone from the testicles. However, the adrenal glands still produce small amounts of male hormones. Sometimes, the patient is also given an antiandrogen, which blocks the effect of any remaining male hormones. This combination of treatments is known as total androgen blockade.

Prostate cancer that has spread to other parts of the body usually can be controlled with hormonal therapy for a period of time, often several years. Eventually, however, most prostate cancers are able to grow with very little or no male hormones. When this happens, hormonal therapy is no longer effective, and other forms of treatment may be suggested.

The side effects of hormonal therapy depend largely on the type of treatment. Orchiectomy and LH-RH agonists often cause side effects such as impotence, hot flashes, and loss of sexual desire. Antiandrogens can cause nausea, vomiting, diarrhea, or breast growth or tenderness. If used for a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes. Men who receive total androgen blockade may experience more side effects than men who receive a single method of hormonal therapy. Any method of hormonal therapy that lowers androgen levels can contribute to weakening of the bones in older men.

Drugs used in the Treatment of Prostate Cancer

Developments in Prevention of Prostate Cancer

Several studies are under way to explore how prostate cancer might be prevented. These include the use of dietary supplements, such as vitamin E and selenium. Recent studies suggest that a diet that regularly includes tomato-based foods may help protect men from prostate cancer.

Researchers also are investigating whether diets that are low in fat and high in soy, fruits, vegetables, and other food products might prevent the recurrence of prostate cancer.

The drug finasteride is being studied in the Prostate Cancer Prevention Trial, which involves thousands of men across the country participating for 7 years, until 2004.

Developments in Treatment of Prostate Cancer

Cryosurgery is under study as an alternative to surgery and radiation therapy. This involves placing an instrument known as a cryoprobe in direct contact with the tumor to freeze it and destroy cancer cells, while avoiding healthy tissue.

There are also studies of new treatment schedules such as the usefulness of hormonal therapy before primary therapy (surgery or radiation) to shrink the tumor.

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Blogs

31 August, 2017
Verzenio Approval History

Verzenio (abemaciclib) is a selective ATP-competitive inhibitor of cyclin dependent kinases (CDK) 4 and 6 for the treatment of metastatic breast cancer. 

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