Colon cancer

COLON CANCER 

The modification rate from colorectal cancer has decreased over the time two decades in the United States, thanks to the progress made in early identification and in the treatment of this disease. Still, 36% of patients with colorectal cancer will not endure individual than five eld after initial diagnosis. 

Invasive cancers that are confining within the wall of the colon (TNM stages I and II) are curable with surgery. If untreated, they spread to regional lymph nodes (stage III), where up to 73% are curable by surgery and chemotherapy. Cancer that metastasizes to distant sites (stage IV) is usually not curable, although chemotherapy can modify survival, and in rare cases, surgery and chemotherapy unitedly have seen patients through to a cure. Radiation is used with rectal cancer.

Recent  trends in the United States suggest a disproportionally higher frequency and death from colon cancer in African Americans than in whites. American persons hit the minimal frequency and mortality from colorectal cancer.

Colon cancer is not a very ordinary disease in our land and the incidence is such lower than in the Western world. This is primarily due to predominance of vegetarian dietary habits which has a greater material content, less cholesterol, less animal fat as obtains in a predominantly non-vegetarian diet.

Colorectal cancer is a major health burden worldwide. The frequency and mortality from colon cancer has been on a slow decline over the time 20 years in the United States; however, colon cancer remained the third most common drive of cancer-related mortality in 2008. A multitude of risk factors hit been linked to colorectal cancer, including heredity, environmental exposures, and inflammatory syndromes affecting gastrointestinal tract.

CAUSES

Environmental factors also play a alive role in the causation of colon cancer. A classic warning is a change in fare habits when people move to another countries. In Japan, the frequency of colorectal cancer is baritone viz 6 to 8 in 100,000. This frequency increases 2 1/2 times when the Japanese move to  USA with change in their fare habits. Dietary habits hit been blamed for utilization of adenomas of the colorectal region which often acts as a individual to the utilization of a polyp which undergoes hyperplasia and ensuant - carcinoma. The polyp-hyperplasia - cancer chain has been well established in the pathogenesis of 2 purging carcinoma.

There is  the link between type of diet and colon cancer appears strong the data cannot be said to be infallible as inconsistent reports do appear. There is of course, a strong suggestion that increased fruitful intake is contributive to colon cancers.

Cancer of colon is known to hit a significant transmitted background and families with a very high frequency of purging cancers are documented in literature in most parts of the world. The classical hereditary disease in the colon is the well-known FAP - inherited adenomatous poplyposis-syndrome which carries a high risk for developing purging cancer. All patients afflicted with FAP module ultimately develop colon cancer unless surgical intervention acts as a prophylaxis.

There are another syndromes related with purging cancers and the ordinal one in visit of importance is the HNPCC (hereditary non-polyposis colon cancer) which as mentioned above, runs in well documented families, often in siblings.

Progress in genetics module slowly unsnarl the transmitted changes - successive loss of chromosomes - responsible for the utilization of purging cancer. Progress in molecular biology has allowed understanding of the characteristics of transmitted changes responsible for this multi-step process and in the decades ahead purging cancer may become a preventable disease.

Colon cancer treatment and diagnosis

COLON CANCER TREATMENT AND DIAGNOSIS

DIAGNOSTIC INVESTIGATIONS

CT construe (CAT scan): A machine that makes a series of careful pictures of areas exclusive the body, condemned from different angles. The pictures are made by a machine linked to an x-ray machine. A colour haw be injected into a vein or swallowed to help the meat or tissues exhibit up more clearly. This machine is also titled computed tomography, processed tomography, or processed axial tomography.

Lymph convexity biopsy: The removal of all or part of a lymph node. A specialist views the tissue low a microscope to countenance for cancer cells.

Complete blood count (CBC)
MRI (magnetic resonance imaging): A machine that uses a magnet, radio waves, and a machine to attain a series of careful pictures of areas exclusive the colon. A substance titled metal is injected into the patient finished a vein. The metal collects around the cancer cells so they exhibit up brighter in the picture. This machine is also titled thermonuclear attractable resonance imagery (NMRI).

Chest x-ray: An x-ray of the meat and clappers exclusive the chest. An x-ray is a identify of energy shine that can go finished the embody and onto film, making a picture of areas exclusive the body.

Sigmoidoscopy: A lighted probe (sigmoidoscope) is inserted into the rectum and lower colon to analyse for polyps and other abnormalities.

Colonoscopy: A lighted probe titled a colonoscope is inserted into the rectum and the entire colon to countenance for polyps and other abnormalities that haw be caused by cancer. A colonoscopy has the advantage that if polyps are found during the machine they can be immediately removed. Tissue can also be condemned for biopsy.

TREATMENT

Surgery is the most common communication for colorectal cancer. During surgery, the tumor, a small edge of the surrounding healthy bowel, and adjacent lymph nodes are removed. The doc then reconnects the healthy sections of the bowel. In patients with rectal cancer, the rectum is permanently removed. The doc then creates an opening (colostomy) on the cavum wall finished which solidified waste in the colon is excreted. Specially trained nurses (enterostomal therapists) can help patients adjust to colostomies, and most patients with colostomies return to a normal lifestyle.
Treatment depends partly on the stage of the cancer. In general, treatments haw include:
Chemotherapy to kill cancer cells
Surgery (most ofttimes a colectomy) to remove cancer cells.
Radiation therapy to destroy cancerous tissue.
Stage 0 colon cancer haw be treated by removing the cancer cells, ofttimes during a colonoscopy. For stages I, II, and threesome cancer, more extensive surgery is needed to remove the part of the colon that is cancerous.
There is whatever debate as to whether patients with stage II colon cancer should obtain chemotherapy after surgery. You should discuss this with your oncologist.
Almost every patients with stage threesome colon cancer should obtain chemotherapy after surgery for roughly 6 - 8 months. The chemotherapy take 5-fluorouracil has been shown to increase the chance of a cure in destined patients.
Chemotherapy is also utilised to treat patients with stage IV colon cancer to meliorate symptoms and preserve survival.
For patients with stage IV disease that has spread to the liver, different treatments directed specifically at the liver can be used.

Although radiation therapy is occasionally utilised in patients with colon cancer, it is commonly utilised in combination with chemotherapy for patients with stage threesome rectal cancer.

Symptoms of colon cancer

Genetically, colorectal cancer represents a complex disease, and genetic alterations are often related with progression from premalignant lesion (adenoma) to intrusive adenocarcinoma. Sequence of molecular and genetic events leading to transformation from adenomatous polyps to naked evilness has been characterized by Vogelstein and Fear on.  The early circumstance is a mutation of  adenomatous polyposis gene, which was first discovered in individuals with familial adenomatous polyposis . The protein encoded by medication is essential in activation of factor c-myc and cyclin D1, which drives the progression to cancerous phenotype. Although FAP is a rare hereditary syndrome accounting for exclusive most 1% of cases of colon cancer, medication mutations are very regular in spasmodic colorectal cancers.

Tumors of the colon arise as intramucosal epithelial lesions, usually in adenomatous polyps or glands. As cancers grow, they invade the muscularis membrane and lymphatic and vascular structures to involve regional lymph nodes, conterminous structures, and distant sites, especially the liver.

SIGN AND SYMPTOMS OF COON CANCER

The clinical features of purging carcinoma depend on the precise site involved. They are prizewinning thoughtful in cost of those features produced by the growth itself, those produced by the presence of topical secondaries, and those produced by another personalty of the tumour.

change in bowel habit - diarrhoea or constipation, or the two alternating with each other. The diarrhoea haw include profuse amounts of mucus. This haw be due to excessive secretion by the tumor. The growth haw be bleed and rectal bleeding or a constructive faecal occult murder test haw result. Rarely melena haw occur.



Intestinal impediment - pain, distension, unconditional degradation - and vomiting. This haw be acute, i.e. sudden and severe, chronic, i.e. insiduous and slowly progressive, or accent on chronic, i.e. habitual that becomes accent as impediment becomes complete.

perforation - into the general peritoneal decay or locally, by a pericolic abscess, or by fistulae into adjacent viscera, e.g. gastro-colic, vesico-colic fistulae.
Jaundice
abdominal enlargement due to ascites
Hepatomegaly
Anemia
Weight loss
Malaise
Anorexia

A tumor that is large sufficiency to fill the entire lumen of the bowel haw drive bowel obstruction. This situation is characterized by constipation, abdominal pain, abdominal enlargement and vomiting. This occasionally leads to the obstructed and distended bowel perforating and feat peritonitis.


Certain topical effects of colorectal cancer occur when the disease has embellish more advanced. A large tumor is more likely to be detected on opinion the abdomen, and it haw be detected by a student on physical examination. The disease haw invade another organs, and haw drive blood or expose in the urine (invasion of the bladder) or vaginal execute (invasion of the female reproductive tract).

Testicular cancer most common in men aged 15-44 years

TESTICULAR  CANCER 

Tumours of the testis are relatively uncommon.accounting for 1-2% of malignant tumours in men ,neverthless they predominantly affect young men .There is a well established link between undescended testis and testicular growth ,and it has been estimated that adults with maldescent of the testis have a 20 to 30 crimp greater incidence of nonindustrial a testicular growth then men with a normally descended testis.Testicular tumours  are of germ celll origin.Germ radiophone tumours include seminoma and terratomas.Non-germ celll tumours include those arising from the Sertoli cells and leydig cells.

Testicular cancer is a 'germ radiophone cancer' as the cells which become cancerous are those participating with making sperm. Around half of all cases become in men under 35 eld but testicular cancer rarely occurs before puberty. It is the most ordinary cancer in men aged 15-44 years. There are about 2000 new cases in the UK each year. Testicular cancers are divided into digit main types (depending on the exact identify of radiophone causing the cancer).

The testicles (also titled testes or gonads) are a unify of phallic sex glands. They produce and store sperm and are the important source of testosterone (male hormones) in men. These hormones control the development of the reproductive organs and other phallic fleshly characteristics. The testicles are located low the penis in a sac-like pouch titled the scrotum.

Testicular cancer accounts for only 1 percent of all cancers in men in the United States. About 8,000 men are diagnosed with testicular cancer, and about 390 men expire of this disease each assemblage .It is most ordinary in albescent men, especially those of Scandinavian descent. The testicular cancer rate has more than multiple among albescent men in the past 40 years, but has only recently begun to increase among black men. The reason for the interracial differences in incidence is not known.

Based on the characteristics of the cells in the tumor, testicular cancers are classified as seminomas or nonseminomas. Other types of cancer that hap in the testicles are rare and are not described here. Seminomas may be digit of three types: classic, choriocarcinoma, brute carcinoma, teratoma, and yolk sac tumors. Testicular tumors may contain both seminoma and nonseminoma cells.

CLASSIFICATIONS

Testicular tumours haw be classified as follows.

Seminoma.

Teratoma.

Combined germ radiophone tumours ( seminoma and teratoma ).

Malignant lymphoma.

Intestinal ( Leydig ) radiophone tumour.

Sertoli radiophone tumour.

The two most ordinary types of growth are seminoma and teraoma.Metastatic tumours are rare and include bowel .bronchus and prostate.

Any patient presenting with a perceptible accumulation in the testis should be thoughtful to have a malignancy of the testis until proved otherwise.

CAUSES

A cancerous tumour starts from digit abnormal cell. The exact reason why a radiophone becomes cancerous is unclear. It is intellection that something damages or alters destined genes in the cell. This makes the radiophone abnormal and multiply 'out of control'. (See separate flap titled 'Cancer - What Causes Cancer' for more detail.)

In whatever cases testicular cancer develops for no apparent reason. However, destined 'risk factors' increase the chance that testicular cancer may develop. These include:

Geography. The highest rate of testicular cancer occurs in white men in northern Europe. So, whatever genetic or environmental bourgeois may be involved.

Family history. Brothers of affected men hit an accumulated risk.

Undescended testes. The testes amend in the abdomen and usually descend into the scrotum before birth. Some babies are born with digit or both testes which hit not come downbound into the scrotum. This can be immobile by a small operation. There is a large accumulated venture in men who hit not had their 'undescended testis' surgically fixed. There is ease whatever accumulated venture in men who had an undescended ball immobile when they were a baby.

Infertility. Infertile men with an abnormal gamete count hit an accumulated risk.

HIV/AIDS. Men who hit HIV or immunodeficiency hit an accumulated risk.

Vasectomy does not increase the venture of testicular cancer. (Several years past there was a 'scare' linking vasectomy with testicular cancer. Studies hit ruled discover this link).

Signs of testicular cancer

Sign and symptoms of testicular cancer

A testicular mass should often be palpated. Because testicular cancer is curable when detected primeval (stage one should have a success evaluate of >98%), experts propose regular monthly testicular self-examination after a blistering shower or bath, when the scrotum is looser. Men should examine apiece testicle, feeling for pea-shaped lumps. The ball should normally see smooth to the touch. Ridges haw be felt because of large blood vessels or tumor growth. Additionally the entire ball haw see hornlike and bumpy to the touch.The U.S. Preventive Services Task Force  recommends against routine screening for testicular cancer in well adolescent and adult.

In most cases, the prototypal symptom noticed is a amass that develops on digit testis. The amass is usually painless. (Note: most swellings and lumps in the scrotum are not cod to cancer. There are various other causes. However, you should always tell a doctor if you discover a symptom or amass in digit of your testes. It needs checking out as soon as possible.)

Sign and symptoms of testicular tumours include:

Unilateral painless enlagement of a testis.
Secondary hydrocele.
Retroperitoneal mass.
Lymph node metastases ( occasionally in the cervical nodes ).
Symptoms from other metastases.
Gynaecomastia from hormone secreting interstitial tumours.

DIAGNOSIS

Ultrasound scanning is a non intrusive and very accurate way of defining primary testicular abnormalities.The treatment of choice is radical excision via an inguinal line ,with preclamping of the inguinal cord preceding to excision to preclude manipulation of the testis from disseminating growth cells into the circulation.It is recommended that serological growth markers much as alpha FP and HCG should be estimated preceding to orchidectomy.It is today constituted that carcinoma in situ in the testis predisposes to the ensuant development f a growth and haw occur in a proportion of patients presenting with a primary testicular growth in the contralateral testis .Whilst some workers have recommended biopsy of the contrlateral testis in all patients presenting with a primary testicular neoplasm,the evidence in hold of this is not yet acquirable and this is not recommended in turn practice unless there are other predisposing features much as maldescent of the contralateral testicles ,where the icidence of carcinoma in situ is much higher.

Staging of patients with a primary testicular growth is principallly carried discover on the basis of the serological tests mentioned above and also CT scanning of he cavum and pelvis to countenance for lymph node extension and retroperitoneal growth mass.With a compounding of radiotherapy the aid evaluate for the eld of patients with testicular tumours approaches100%.

The cardinal characteristic finding in the patient with testis cancer is a mass in the center of the testis. Unilateral enlargement of the ball with or without pain in the adolescent or young grown phallic should raise concern for ball cancer.

Treatment for testicular cancer

TREATMENT FOR TESTICULAR CANCER

Surgery is performed by urologists; irradiation therapy is administered by irradiation oncologists; and chemotherapy is the impact of scrutiny oncologists. In most patients with testicular cancer, the disease is well readily with minimal long-term morbidity.

SURGERY
ORCHIDECTOMY
While it may be possible, in some cases, to remove testicular cancer tumors from a ball patch leaving the ball functional, this is nearly never done, as the strained ball usually contains pre-cancerous cells spread throughout the whole testicle. Thus removing the growth lonely without added communication greatly increases the risk that added cancer will form in that ball . Since only one ball is typically required to maintain fertility, hormone production, and added phallic functions, the sick ball is nearly always distant completely in a procedure called inguinal orchiectomy. (The ball is nearly never distant through the scrotum; an cutting is prefabricated beneath the belt line in the inguinal area.) Most notably, since removing the growth lonely does not eliminate the precancerous cells that exist in the testis, it is usually better in the long run to remove the whole ball to prevent added tumor. A plausible omission could be in the case of the second ball later developing cancer as well. In the UK, the procedure is famous as a Radical Orchidectomy.

Surveillance: This is sometimes called "watchful waiting" or "observation." What it means is that you obtain no further communication after excision but must adhere to a very demanding schedule of regular follow-up visits with your urologist. The idea is to grownup the earliest hint of residual cancer and then proceed with communication at that point.

Surveillance is a gamble. You are betting that you have no residual disease but that, if you do, it will be found early. On the other hand, you are avoiding the potentially severe lateral personalty of and lengthy recovery from chemotherapy or irradiation therapy.
RETROPERITONEAL LYMPH NODES DISSECTION

In the case of nonseminomas that materialize to be stage I, surgery may be done on the retroperitoneal/Paraaortic lymph nodes (in a separate operation) to accurately determine whether the cancer is in stage I or stage II and to reduce the venture that cancerous testicular cancer cells that may hit metastasized to lymph nodes in the modify abdomen. This surgery is called Retroperitoneal Lymph Node Dissection . However, this approach, while accepted in some places, especially the United States, is out of souvenir due to costs and the high take of expertise required to perform the surgery. The urologist may take extra care in the case of males who hit not fathered children, to preserves the nerves involved in ejaculation.

CHEMOTHERAPY

Chemotherapy uses medicines to destroy cancer cells. If there are lots of cancer cells in the lymph nodes in your abdomen, or if the cancer has spread beyond these, you will have chemotherapy. Chemotherapy haw also be presented after surgery to turn the chance of the cancer backward in the future. This is famous as adjuvant chemotherapy.

Sometimes chemotherapy is utilised to shrink a super growth before surgery, making it easier to remove. This is neo-adjuvant chemotherapy.

RADIOTHERAPY
Radiotherapy uses radiation to blackball cancer cells. You haw have radiotherapy after surgery to prevent the cancer coming backwards or to impact some cancer cells that have spread to the lymph nodes at the backwards of the abdomen.