It is important to note that some types of cancer do not present any symptoms until they are in advanced stages. This is why cancer screening and risk assessment are vital for cancer prevention and early detection.
Persistent Fatigue: Fatigue is one of the most commonly experienced cancer symptoms. It is usually more common when the cancer is advanced, but still occurs in the early stages of some cancers. Anemia is commonly the culprit -- a condition that is associated with many types of cancer, especially types affecting the bowel. Fatigue is a symptom of both malignant and non-malignant conditions and should be evaluated by a physician.
Pain Typically, pain is not an early symptom of cancer, except in some cancer types like those that spread to the bone. Pain generally occurs when cancer spreads and begins to affect other organs and nerves. Lower pack pain is cancer symptom that is associated with ovarian cancer and colon cancer. Shoulder pain can also be a symptom of lung cancer. Pain in the form of headaches can be associated with brain tumors (malignant and benign). Stomach pains can be related to types of cancer, like stomach cancer, pancreatic cancer, and many others. Stomach pain can be a very vague symptom because so many illnesses can cause stomach pain.
Fever: A fever is a very non-specific symptom of many mild to severe conditions, including cancer. In relation to cancer, a fever that is persistent or one that comes and goes frequently can signal stress on the immune system. Fevers are commonly associated with types of cancer that affects the blood, like leukemia and lymphoma, but are also common in people whose cancer has spread.
Chronic Cough: A persistent, new cough or a cough that won't go away or becomes worse needs to be evaluated by a doctor. Blood and/or mucus may accompany the cough and can be caused many conditions. In relation to cancer, a chronic cough with blood or mucus can be symptom of lung cancer. Keep in mind that these are very general, vague symptoms of cancer. If you have one or two of these symptoms, it is not a red flag for cancer but more an indication to your doctor to run certain medical tests. The symptoms listed above are experienced by most people with cancer at various stages of their disease, but are also linked to many other non-cancerous conditions. For more specific cancer symptoms, see below for symptom information about several types of cancer. You may also get a better understanding ot the strange truths of cancer by going through the details below.
Like other parts of the body, the anus is susceptible to infections and diseases, such as anal cancer.
Symptoms of Anal Cancer : The symptoms of anal cancer are not unique and are also symptoms of other conditions, such as hemorrhoids. Although anal cancer is relatively simple to diagnose, this can cause a delay in diagnosis for those with anal cancer. Symptoms of anal cancer include:
1. lumps or bumps located near the anus
2. anal bleeding or bleeding during bowel movements
3. anal discharge
4. pain in or around the anus
5. itchy sensation around or inside the anus
6. change in bowel habits, such as constipation, diarrhea and the thinning of the stools
What to Do If You Have Anal Cancer Symptoms?
If you are experiencing the symptoms of anal cancer, please see your doctor. It is common for some to delay going to the doctor, because they feel embarrassed by anal symptoms or are fearful of being examined in such a private place. Please don't let these emotions prevent you from being examined by a doctor. Fortunately, anal cancer can be detected early on if the patient seeks medical care at the onset of symptoms..
Bladder cancer:
Bladder cancer is a disease that affects the bladder, the organ responsible for acting as a collection reservoir for urine until it is excreted from the body. Like all other organs in the body, the bladder is vulnerable to disease, such as cancer. There are symptoms of bladder cancer that are common with the disease, but not exclusive to it. Bladder cancer symptoms can also be symptoms of much less serious conditions, so it is important to see your doctor if you experience them.
Bladder Cancer Symptoms: Bladder cancer symptoms are few, yet very noticeable. They can come and go or be persistent. Bladder cancer symptoms include:
1. Blood in the Urine (hematuria): When you can physically see blood in your urine, it is call gross hematuria. Blood can appear in the urine as a pink, brown or red hue. Blood clots can also be present. Many times, blood in the urine is not visible to the naked eye -- a microscopic analysis of the blood can reveal hematuria when it cannot physically be seen.
2. Painful Urination: Pain during urination is called dysuria. Pain can range from mild to severe.
3.Frequent Urination: Having to urinate often and during the night is also a symptom of bladder cancer. People with bladder cancer may also have an intense physical sensation of needing to empty the bladder, despite just having urinating or not expelling urine when trying.
What to Expect When You Go To The Doctor For Bladder Cancer Symptoms ?
If a doctor suspects that something may be wrong with your bladder, one of the first tests done will be a urine culture and urinalysis. Your doctor will want to see if an infection is the underlying cause of symptoms.
A urine culture looks for the presence of bacteria in the urine, while urinalysis checks for the presence of blood. Both a urinalysis and culture require you to provide a sample of urine, either by urinating in a cup or by catheter. Note: If you are being treated for a urinary tract infection or cystitis and are not feeling better after taking all of your medication, it is important that you let your doctor know.
Breast cancer:
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It is estimated 1 in every 7 American women will develop breast cancer in their lifetime. Two hundred and twenty thousand American women will develop breast cancer this year. Reported breast cancer symptoms include:
1. Discharge from the nipple(clear or bloody)
2. Persistent tenderness of the breast
3. Pain in the nipple
4. Swelling or mass in the armpit (lymph nodes)
5. inverted or scaly nipples
6. A lump that can be felt, no matter how small
7. Swelling of the breast
Sometimes there are no symptoms of breast cancer when it is in the early stages. If you notice a lump, or are experiencing anything unusual, you must report the symptoms to your doctor as soon as possible. Performing a monthly self breast exam is the one of the best ways to notice any changes in your breasts.
Cervical cancer :
Cervical cancer symptoms often go unnoticed because they mimic so many other ailments. Many women pass these symptoms off as PMS or ovulation pains. Many times, however, cervical cancer has no symptoms. When symptoms are present, they usually do not appear until the cancer is more advanced. This does vary from woman to woman.
Cervical Cancer Symptoms
1. Abnormal bleeding. Women with cervical cancer may experience abnormal vaginal bleeding. This can be heavy or light bleeding during the month.
2. Unusual heavy discharge. An increased vaginal discharge is also a symptom of cervical cancer. It may be foul smelling, watery, thick, or contain mucus. It varies from woman to woman. It is important to report any unusual vaginal discharge to your doctor.
3. Pelvic pain. Pelvic pain that is not related to the normal menstrual cycle can be a cervical cancer symptom. Many women describe them ranging from a dull ache to sharp pains that can last hours. It can be mild or severe.
4. Pain during urination. Bladder pain or pain during urination can be a symptom of advanced cervical cancer. This cervical cancer symptom usually occurs when cancer has spread to the bladder.
5. Bleeding between regular menstrual periods, after sexual intercourse, douching, or pelvic exam. Bleeding after sexual intercourse, douching, or pelvic exam can be cervical cancer symptoms. This is due to the irritation of the cervix during these activities. While a healthy cervix may have a very small amount of bleeding, many conditions may cause bleeding after activities like sex.
What to Do If You Have Cervical Cancer Symptoms
keep in mind that these cervical cancer symptoms are also symptoms of many other illnesses. If you are experiencing these cervical cancer symptoms, please see a doctor. He or she will most likely do a pelvic exam and may order further tests..
Colon cancer :
Colon cancer does not always present symptoms in the early stages. Colon cancer symptoms usually do not appear until the disease has progressed into an advanced stage. This makes colon cancer screening highly valuable -- it can detect colon cancer in the early stages, before symptoms begin to appear.
1. Blood in Stool:
Blood in the stool is a common symptom of colon cancer, but you can't always actually see blood that may be in the stool. Tests like the fecal occult blood test (FOBT) detect blood in the stool that may be unseen to the naked eye. It is also associated with less severe health problems, such as hemorrhoids and anal fissures.Remember that some foods, like beets, watermelon, and red licorice can make the stools turn red. To be on the safe side, always report suspicious stool activity to your doctor.
When Should You Worry About the Color of Your Stool?
Causes of Red Stools
2. Thin Stools:
The size of our stool gives us good insight to what may be going on in our bowel. Thin or ribbon-like stools can indicate that there may be an obstruction -- something is blocking the passage of stool, like a tumor. Other conditions may also cause thin stools, like a large benign polyp or hemorrhoids. How thin is too thin? A thin stool is considered to be as thin as a pencil. If consistently notice thinner stools, even if they aren't as thin as a pencil, let your doctor know.
What is a Normal Bowel Movement?
Causes of Bowel Obstructions
3. Constipation:
Constipation is a non-specific symptom of colon cancer. Frequent constipation can be the symptom of many things, more than likely a condition much less serious than colon cancer. However, chronic constipation can be serious, so it is important to let your doctor know. In reference to colon cancer, constipation occurs when a tumor is obstructing the colon.
How to Eat When You Have Constipation
What is the Treatment for Chronic Constipation?
Prevent Constipation Before It Becomes a Problem
Feeling Like You Have to Empty Your Bowel, Even When You Don't:
If you feel like you have to empty your bowel, even after just doing so or simply feel like there is something in your bowel, talk to your doctor. This colon cancer symptom can indicate the presence of a tumor, which causes the bowel to feel full, even when it is not.
Bowel Incontinence Basics
Exercises to Retrain the Bowel
4. Abdominal Pain:
Abdominal pain is also vague symptom of colon cancer. This usually occurs when the colon is blocked by a tumor. Gas pains are also common because tumor obstruction doesn't allow the gas to travel properly down the colon to exit the body.
What Could Your Abdominal Pain Be?
5. Fatigue:
Fatigue that last more than a few days can indicate a medical problem. In relation to colon cancer, fatigue is often related to anemia, because of blood loss in the stool. Like other symptoms of colon cancer, fatigue is a vague symptom and can be related to many other less serious conditions.
Could Your Fatigue Be a Symptom of Chronic Fatigue Syndrome?
What to Do for Energy When You Are Tired
How to Combat Fatigue Caused by Cancer
Talking to Your Doctor:
Many people feel shy to talk about bowel habits with their doctor. This can easily lead to a avoidable delay in diagnosing colon cancer. Remember, the earlier colon cancer is diagnosed, the easier it can be treated with a better prognosis.
Endometrial cancer :
Endometrial cancer symptoms are often what prompt women to seek medical attention. Most of the time, the disease remains silent until it has spread to nearby tissues and organs.
Common Endometrial Cancer Symptoms :
1. Abnormal bleeding- heavy bleeding between periods, or heavy bleeding during irregular periods
2. Pain during sexual intercourse
3. Pelvic pain or pain in the legs or back
4. Difficulty urinating or pain during urination
5. Enlarged uterus found upon medical exam
6. Vaginal discharge that can be thick or watery; pink or brown; and foul smelling
7. Unexpected weight loss
Keep in mind that these symptoms of endometrial cancer are also symptoms for many other illnesses. Please see your doctor if you are experiencing symptoms for a definitive diagnosis.
Esophageal cancer :
There are many signs and symptoms of esophageal cancer. If you experience any of the symptoms of esophageal cancer, consult your doctor. Unfortunately, the disease is often diagnosed when the disease has advanced, limiting treatment options.
1. Unintentional Weight Loss :If you aren't trying to lose weight and have noticed you have been or are losing weight, you should consult your doctor. Unintentional weightloss can mean many things, but it is better to have it checked out.
2. Pain and/or Difficulty Swallowing :Pain or difficulty in swallowing is one of the most common symptoms of esophageal cancer. The throat feels irritated or with pressure. This symptom is not associated with flu or flu related illnesses. The pain or difficulty swallowing related with esophageal cancer does not go away.
3. Hoarseness :If your voice is hoarse, or you feel like you have to often clear your throat, you should get checked out by a doctor. This symptom of esophageal cancer is also that of many other illnesses, so a consult is necessary.
4. Persistant Cough :Having a cough that does not go away is a symptom of esophageal cancer.
5. Heartburn :Having heartburn often is also a symptom of esophageal cancer. Heartburn is defined as pain or burning sensation behind the breast bone. Heart burn that occurs often or increasingly warrants a consult to the doctor.
6. Feeling Like Food is Stuck in Throat or Chest :In certain cases of esophageal cancer, the esophagus narrows, thus reducing the amount of space foods have to travel down to the stomach. The sensation of food being stuck in the throat or chest is that of esophageal cancer.
7. Hiccups with Pain or Difficulty Swallowing :If you often have the hiccups and also have pain or difficulty swallowing, you need to see a doctor. These two condition when experienced together are a symptom of esophageal cancer.
Kidney cancer :
Kidney Cancer Symptoms: There are many variations of kidney cancer. The most commonly diagnosed type of kidney cancer is renal cell carcinoma. It accounts for more than 85% of kidney cancer diagnosis'.The most commonly experienced kidney cancer symptoms (renal cell carcinoma) are:
1. Chronic fatigue
2. Unexplained, rapid weightloss
3. Leg and ankle swelling
4. Hypertension (high blood pressure)
5. Fever
6. Presence of blood in urine (seen either by the eye, or microscopically)
7. Pain in side or lower back
8. Mass or lump in the abdomen
Keep in mind that these symptoms are also the signs for many other illnesses. Please see a health care professional if you are experiencing anything abnormal for further diagnosis.
Leukemia :
Leukemia is a disease that affects both children and adults. It begins in the bone marrow and spreads to other parts of the body. Leukemia symptoms can occur all of a sudden or gradually progress.The symptoms of leukemia are broad, but there are specific symptoms of leukemia to keep an eye out for:
1. Fever
2. Infection
3.Excessive bruising
4. Fatigue
5. Physical exercise intolerance
6. Abdominal pain, or generally feeling fullness
7. Weight loss
8. Abnormal bleeding
9. Enlargement of the lymph nodes, spleen, and/or liver
10. Weakness
Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of white blood cells. Leukemia is a broad term covering a spectrum of diseases. In turn, it is part of the even broader group of diseases called hematological neoplasms.
In 2000, approximately 256,000 children and adults around the world developed some form of leukemia, and 209,000 died from it.
Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its acute and chronic forms:
Acute leukemia is characterized by a rapid increase in the numbers of immature blood cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children.
Chronic leukemia is characterized by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal cells, resulting in many abnormal white blood cells in the blood. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.
Additionally, the diseases are subdivided according to which kind of blood cell is affected. This split divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias:
In lymphoblastic or lymphocytic leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes, which are infection-fighting immune system cells. Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B cell.
In myeloid or myelogenous leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets.
Combining these two classifications provides a total of four main categories. Within these main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme.
Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in young children. This disease also affects adults, especially those age 65 and older. Standard treatments involve chemotherapy and radiation. The survival rates vary by age: 85% in children and 50% in adults.Subtypes include precursor B acute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia.
Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%. It is incurable, but there are many effective treatments. One subtype is B-cell prolymphocytic leukemia, a more aggressive disease.
Acute myelogenous leukemia (AML) occurs more commonly in adults than in children, and more commonly in men than women. AML is treated with chemotherapy. The five-year survival rate is 40%.Subtypes of AML include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.
Chronic myelogenous leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease. Treatment is with imatinib (Gleevec in US, Glivec in Europe) or other drugs. The five-year survival rate is 90%.One subtype is chronic monocytic leukemia.
Hairy cell leukemia (HCL) is sometimes considered a subset of CLL, but does not fit neatly into this pattern. About 80% of affected people are adult men. There are no reported cases in young children. HCL is incurable, but easily treatable. Survival is 96% to 100% at ten years.[10]
T-cell prolymphocytic leukemia (T-PLL) is a very rare and aggressive leukemia affecting adults; somewhat more men than women are diagnosed with this disease.[11] Despite its overall rarity, it is also the most common type of mature T cell leukemia;[12] nearly all other leukemias involve B cells. It is difficult to treat, and the median survival is measured in months.
Large granular lymphocytic leukemia may involve either T-cells or NK cells; like hairy cell leukemia, which involves solely B cells, it is a rare and indolent (not aggressive) leukemia.[13]
Adult T-cell leukemia is caused by human T-lymphotropic virus (HTLV), a virus similar to HIV. Like HIV, HTLV infects CD4+ T-cells and replicates within them; however, unlike HIV, it does not destroy them. Instead, HTLV "immortalizes" the infected T-cells, giving them the ability to proliferate abnormally.
[edit] Signs and symptoms
Common symptoms of chronic or acute leukemia:
Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process. This means people with leukemia may easily become bruised, bleed excessively, or develop pinprick bleeds (petechiae).
White blood cells, which are involved in fighting pathogens, may be suppressed or dysfunctional. This could cause the patient's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some patients experience frequent infection, ranging from infected tonsils, sores in the mouth, or diarrhea to life-threatening pneumonia or opportunistic infections.
Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor.
Some patients experience other symptoms, such as feeling sick, having fevers, chills, night sweats and other flu-like symptoms, or feeling fatigued. Some patients experience nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in unintentional weight loss. If the leukemic cells invade the central nervous system, then neurological symptoms (notably headaches) can occur. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.
The word leukemia, which means 'white blood', is derived from the disease's namesake high white blood cell counts that most leukemia patients have before treatment. The high number of white blood cells are apparent when a blood sample is viewed under a microscope. Frequently, these extra white blood cells are immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing a harmful imbalance in the blood count.
Some leukemia patients do not have high white blood cell counts visible during a regular blood count. This less-common condition is called aleukemia. The bone marrow still contains cancerous white blood cells which disrupt the normal production of blood cells, but they remain in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia.
Causes :
No single known cause for all of the different types of leukemia exists. The known causes, which are not generally factors within the control of the average person, account for relatively few cases.The different leukemias likely have different causes.
Leukemia, like other cancers, results from somatic mutations in the DNA. Certain mutations produce leukemia by activating oncogenes or deactivating tumor suppressor genes, and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as a result of exposure to radiation or carcinogenic substances, and are likely to be influenced by genetic factors.
Among adults, the known causes are natural and artificial ionizing radiation, a few viruses such as Human T-lymphotropic virus, and some chemicals, notably benzene and alkylating chemotherapy agents for previous malignancies. Use of tobacco is associated with a small increase in the risk of developing acute myeloid leukemia in adults.Cohort and case-control studies have linked exposure to some petrochemicals and hair dyes to the development of some forms of leukemia. A few cases of maternal-fetal transmission have been reported.Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit.
Viruses have also been linked to some forms of leukemia. Experiments on mice and other mammals have demonstrated the relevance of retroviruses in leukemia, and human retroviruses have also been identified. The first human retrovirus identified was Human T-lymphotropic virus, or HTLV-1, is known to cause adult T-cell leukemia.
Some people have a genetic predisposition towards developing leukemia. This predisposition is demonstrated by family histories and twin studies.The affected people may have a single gene or multiple genes in common. In some cases, families tend to develop the same kind of leukemia as other members; in other families, affected people may develop different forms of leukemia or related blood cancers.
In addition to these genetic issues, people with chromosomal abnormalities or certain other genetic conditions have a greater risk of leukemia.For example, people with Down syndrome have a significantly increased risk of developing forms of acute leukemia, and Fanconi anemia is a risk factor for developing acute myeloid leukemia.
Whether non-ionizing radiation causes leukemia has been studied for several decades. The International Agency for Research on Cancer expert working group undertook a detailed review of all data on static and extremely low frequency electromagnetic energy, which occurs naturally and in association with the generation, transmission, and use of electrical power.They concluded that there is limited evidence that high levels of ELF magnetic (but not electric) fields might cause childhood leukemia. Exposure to significant ELF magnetic fields might result in twofold excess risk for leukemia for children exposed to these high levels of magnetic fields.However, the report also says that methodological weaknesses and biases in these studies have likely caused the risk to be overstated. No evidence for a relationship to leukemia or another form of malignancy in adults has been demonstrated.Since exposure to such levels of ELFs is relatively uncommon, the World Health Organization concludes that ELF exposure, if later proven to be causative, would account for just 100 to 2400 cases worldwide each year, representing 0.2 to 4.9% of the total incidence of childhood leukemia for that year (about 0.03 to 0.9% of all leukemias).
Diagnosis
Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the symptoms, however, in rare cases blood tests may not show if a patient has leukemia, usually this is because the leukemia is in the early stages or has entered remission. A lymph node biopsy can be performed as well in order to diagnose certain types of leukemia in certain situations.
Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the patient. When concerns arise about visible damage due to leukemia, doctors may use an X-ray, MRI, or ultrasound. These can potentially view leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound). Finally, CT scans are rarely used to check lymph nodes in the chest.
Despite the use of these methods to diagnose whether or not a patient has leukemia, many people have not been diagnosed because many of the symptoms are vague, unspecific, and can refer to other diseases. For this reason, the American Cancer Society predicts that at least one-fifth of the people with leukemia have not yet been diagnosed.
Treatment :
Most forms of leukemia are treated with pharmaceutical medications, typically combined into a multi-drug chemotherapy regimen. Some are also treated with radiation therapy. In some cases, a bone marrow transplant is useful.
Liver cancer :
Like many types of cancers, liver cancer does not usually cause any symptoms in the early stages. As the disease progresses, liver cancer symptoms begin to appear, prompting one to seek medical attention. Due to the delayed onset of symptoms, liver cancer is often diagnosed in an advanced stage.
Symptoms of Liver Cancer :
1. Jaundice:(condition that causes the yellowing of the skin and eyes)
2. Unintentional weight loss
3. Loss of appetite
4. Pain and/or discomfort on the right side of the abdomen
5. Pain or discomfort that occurs in the right shoulder blade area
Other liver cancer symptoms that may be experienced are fever, general fatigue that is not relieved with rest, and nausea and/or vomiting. Symptoms can appear separately or together. These liver cancer symptoms can be nonspecific --if you have them, they do not exactly pinpoint liver cancer. However, they do alert your doctor that your liver and how it is functioning may need to be evaluated.
What Drinkers Need to Know About Alcohol Induced Liver DiseaseThere are no current recommended screening test for those at an average risk of liver cancer. Though this may aid in early detection, it is not very cost effective for the general population. People suffering from hepatitis or cirrhosis are most at risk of developing liver cancer and are monitored closely for physical signs and symptoms of the disease.
Lung cancer :
Lung cancer symptoms are commonly not experienced until the disease had advanced, sometimes delaying diagnosis. The symptoms of lung cancer also mimic the symptoms of other benign illnesses.The most common lung cancer symptoms experienced are :
1. Onset of wheezing
2. Recurrent pneumonia or bronchitis
3. Shortness of breath
4. A persistent cough that does not go away
5. Coughing up blood
6. Hoarseness
7. Weight loss or loss of appetite
If you are experiencing any of the above lung cancer symptoms, please see your doctor. The symptoms described are also symptoms for many other illnesses. Consult your physician for a definitive diagnosis
Ovarian cancer :
Ovarian cancer is a type of cancer that affects the ovaries in women. It is often referred as the "silent killer" because ovarian cancer symptoms do not often appear until it is too late for effective treatment. Experts recommend that women who experience these ovarian cancer symptoms daily for three weeks or longer should see their doctor. Keep in mind that these symptoms are also signs of other, less serious conditions
Despite being touted as a silent killer, experts have identified three symptoms of ovarian cancer that may aid in early detection. Ovarian cancer symptoms that women should watch out for include:
1. Feeling full quickly after eating or difficulty eating
2. abdominal bloating and/or pelvic pain
3. Frequent urge to urinate
Symptoms of Advanced Ovarian CancerAs ovarian cancer progresses, women may experience these symptoms:
1. Changes in bowel movements (frequency and consistency)
2. Pain during sexual intercourse
3. Persistent fatigue
4. Abdominal weight gain
5. Sudden weight gain or weight loss
Pancreatic cancer :
Pancreatic cancer symptoms often do not appear until the disease is in an advanced stage, thus making early detection difficult. When pancreatic cancer symptoms do appear, they can be vague and non-specific, such as stomach pain and weight loss
Pancreatic Cancer Symptoms:
Below you will find some of the most common pancreatic cancer symptoms:
1. Yellowing of the Skin and Eyes. Jaundice, a condition marked by the yellowing of the skin and eyes commonly occurs in people pancreatic cancer. It occurs when an increased level of bilirubin is in the blood. This can occur when a tumor completely or partially blocks bile ducts, slowing the flow of bile.
2. Abdominal Pain. Abdominal pain is common symptom of pancreatic cancer. It usually occurs on the upper abdomen and may even radiate to the back. Abdominal pain may worsen when lying down or 3 to 4 hours after eating.
3. Unintended Weight Loss. While losing weight without trying may welcomed by many, but it can indicate something is wrong. Again, unintended weight loss is a common symptom of pancreatic cancer and one that is usually one of the first symptom experienced along with abdominal pain. Weight loss is common in many types of cancer and other benign conditions.
4. Nausea/Vomiting. Again, another vague symptom of pancreatic cancer that is common among many other conditions. Non-specific symptoms, like nausea, often result in a delay in a pancreatic cancer diagnosis.
5. Loss of Appetite. Appetite loss is a symptom of hundreds of diseases and conditions, including pancreatic cancer. It can signal something severe or even be related to something as small as a stomach virus. When symptoms are vague like this, medical tests are necessary to make an accurate diagnosis.
6. Itchy Skin. Itchy skin is a less common symptom of pancreatic cancer. Again, a vague symptom, but when coupled with another symptom like abdominal pain or jaundice, it can be significant in making a more accurate, timely diagnosis. Unfortunately, when someone with undiagnosed pancreatic cancer is experiencing itchy skin, it is often misdiagnosed as a dermatological condition.Unexpected Onset of Diabetes. In some cases, pancreatic cancer may impede the pancreas' ability to produce insulin, resulting in diabetes. It is important note that most people develop diabetes because of reasons unrelated to pancreatic cancer. Changes in Stool and Urine Color. Urine may become much darker, while stools loser their brown color, becoming a pale, clay color. This is often due to the bile duct being blocked. Stools can also have a odd, strong smell. Unsure of what your symptoms may be?
Prostate cancer :
Prostate cancer symptoms do not usually appear until the disease has advanced, and many times has already been diagnosed. However, there are symptoms of prostate cancer you should watch aware of, especially signs and symptoms related to urination.
Urinary difficulties can be common prostate cancer symptoms, but can also indicate other non-malignant prostate problems, like BPH. Prostate cancer symptoms related to urination include:
1. Burning or pain during urination
2. Inability to urinate
3. Frequent nocturnal urination
4. Weak urine stream
5. Blood in urine (either seen by the eye or microscopically, although less common)
Other Symptoms of Prostate CancerUrinary difficulties in men over 40 usually raises red flags for doctors to check the prostate gland for abnormalities. However, prostate cancer can cause some other vague symptoms. Non-specific symptoms that may accompany urinary symptoms include:
1. Pelvic pain
2. Back or hip pain
3. Weight loss
What to Do If You Have the Symptoms of Prostate Cancer ?
You should see your doctor at the onset of any symptoms you may be experiencing. The delay in waiting for symptoms to "go away" could affect your treatment options and prognosis. Again, other conditions and diseases cause symptoms similar to that of prostate cancer, especially an enlarged prostate. It is essential to see your doctor when you begin experiencing symptoms. That way you can detect any benign or malignant conditions early before treatment options may become more aggressive and limited.
Skin cancer :
Skin cancer is one of the most preventable types of cancer. Excessive exposure to the sun's UV rays are the most common cause of the disease. In fact over 1,000,000 people are affected each year.Skin cancer can be dvided into three different types of cancer.
1. Squamous Cell Carcinoma : These carcinomas are found usually in places on the body that have been exposed to the sun, like ears, the face and the mouth.Symptoms include a bump that turns in to an open sore (ulceration, reddish, flat spot that is sometimes crusty, a bump that gets larger and a sore that won't heal.Left untreated, it can spread quickly to other parts of the body, like the lymphatic system, bloodstream, and nerve routes.
2. Basal Cell Carcinoma : Accounting for more than 75% of skin cancers diagnosed, basal cell carcinoma is the most commonly developed skin cancer.These carcinomas are most commonly found on the face, neck, and hands. It is considered highly treatable and rarely spreads to other parts of the body. Symptoms include a sore that oozes or bleeds, a redness area that is irritated, a yellow or white area that resembles a scar, and a pink pearly bump.
3. Melanoma : Melanoma is the most dangerous and deadly type of skin cancer.It can develop on any part of the body, however the arms, legs and trunk are the most common area of the body. When detected early, it is considered highly treatable.Symptoms include a mole, freckle, or new/existing spot that changes color in size, shape, and color. It may have an irregular outline and possible be more than one color.Your best defense in preventing skin cancer is to avoid excessive exposure to the sun. When you are outdoors, be sure to always wear a sunscreen, and stay in a shady area if possible!
Stomach cancer :
Stomach cancer often does not have symptoms in the early stages, or they can be vague and non-specific -- such as nausea or weight loss. Also, there is no single symptom that exactly pinpoints stomach cancer; therefore, further evaluation and testing is required for a diagnosis.
1. Blood in the Stool:
Blood in the stool is a symptom of stomach cancer; however, you can't always actually see blood that may be in the stool. Tests like the fecal occult blood test (FOBT) detect blood in the stool.
This symptom can also be related to other types of cancer, such as colon cancer. It is also associated with less severe health problems, such as hemorrhoids and anal fissures.
2. Abdominal Pain and Discomfort:
Abdominal pain is one of the most common stomach cancer symptoms and is usually what prompts people to seek medical attention. Abdominal pain can range from persistent mild discomfort to severe pain. Pain and discomfort generally occurs in the upper abdomen area. Persistent abdominal pain, regardless of where it occurs, needs to be evaluated by your doctor.
3. Peristent Nausea and/or Vomiting:
Nausea and vomiting are very non-specific symptoms that can be common among people with stomach cancer. Persistent nausea and/or vomiting needs to be checked by your doctor. It can indicate a serious health problem, and can cause damage to the lining of your esophagus. If you are vomiting blood, it is important to see your doctor right away.
4. Loss of Appetite:
Not feeling like eating for a day or two can be normal, but anything longer should really be reported to your doctor. Again, loss of appetite is a very vague symptom and is related to many health conditions, not just stomach cancer.
5. Abdominal Bloating:
Abdominal bloating is also a common symptom of stomach cancer, especially after meals. Indigestion and heartburn are also symptoms related to stomach cancer.
6. Changes in Bowel Habits:
Changes in bowel habits related to stomach cancer include constipation and/or diarrhea.
7. Feeling Excessively Tired:
Fatigue that lasts more than a few days can indicate a medical problem. In stomach cancer, fatigue is often related to anemia due to blood loss in the stool or from vomiting.
8. Losing Weight Without Trying:
Most of us would welcome weight loss without dieting, but it really is a health concern that needs to be brought to your doctor's attention. If you have lost about 5 percent of your normal body weight in the course of six months or less, and haven't been dieting or exercising, call your doctor. Unintentional weight loss can be the result of many conditions, including cancer.
Mesothelioma :
Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, the mesothelium. It is usually caused by exposure to asbestos.
Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the pericardium (a sac that surrounds the heart),or the tunica vaginalis (a sac that surrounds the testis).
Most people who develop mesothelioma have worked on jobs where they inhaled asbestos and glass particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos or glass can put a person at risk for developing mesothelioma.Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers. Those who have been exposed to asbestos often utilize attorneys to collect damages for asbestos-related disease, including mesothelioma. Compensation via asbestos funds or lawsuits is an important issue in mesothelioma.
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Signs and symptoms :
Symptoms or signs of mesothelioma may not appear until 20 to 50 years (or more) after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space (pleural effusion) are often symptoms of pleural mesothelioma.
Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of Peritoneal Mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
1. Chest wall pain
2. Pleural effusion, or fluid surrounding the lung
3. Shortness of breath
4. Fatigue or anemia
5. Wheezing, hoarseness, or cough
6. Blood in the sputum (fluid) coughed up (hemoptysis)
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage.
Symptoms include:
1. Abdominal pain
2. Ascites, or an abnormal buildup of fluid in the abdomen
3. A mass in the abdomen
4. Problems with bowel function
5. Weight loss
6. In severe cases of the disease, the following signs and symptoms may be present:
Blood clots in the veins, which may cause thrombophlebitis
7. Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
8. Jaundice, or yellowing of the eyes and skin
9. Low blood sugar level
10. Pleural effusion
11. Pulmonary emboli, or blood clots in the arteries of the lungs
12. Severe ascites
A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs.
Cause :
Working with asbestos is the major risk factor for mesothelioma. In the United States, asbestos is the major cause of malignant mesothelioma and has been considered "indisputably" associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor.A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite. Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the official position of the U.S. Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and "permissible exposure limits" required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, they are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma. Likewise, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE assumes that no such "safe" threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease. Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer. Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.
The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 1–3 months of exposure. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 30–40 years. In a review of occupationally related mesothelioma cases, the median latency was 32 years.Based upon the data from Peto et al, the risk of mesothelioma appears to increase to the third or fourth power from first exposure.
Environmental exposures :
Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villages — Tuzköy, Karain and Sarıhıdır. Initially, this was attributed to erionite, a zeolite mineral with similar properties to asbestos, however, recently, detailed epidemiological investigation showed that erionite causes mesothelioma mostly in families with a genetic predisposition.The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.
Occupational :
Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.
Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Paraoccupational secondary exposure :
Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos related diseases.This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibres, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
Asbestos in buildings :
Many building materials used in both public and domestic premises prior to the banning of asbestos may contain asbestos. Those performing renovation works or DIY activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
Diagnosis :
CXR demonstrating a mesothelioma
CT scan of a patient with mesothelioma, coronal section (the section follows the plane that divides the body in a front and a back half). The mesothelioma is indicated by yellow arrows, the central pleural effusion (fluid collection) is marked with a yellow star. Red numbers: (1) right lung, (2) spine, (3) left lung, (4) ribs, (5) descending part of the aorta, (6) spleen, (7) left kidney, (8) right kidney, (9) liver.
Micrograph of a pleural fluid cytopathology specimen showing mesothelioma.
Micrographs showing mesothelioma in a core biopsy.
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial[disambiguation needed] effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Unfortunately, the diagnosis of malignant mesothelioma by cytology alone is difficult, even with expert pathologists.
Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics. There are numerous tests and panels available. No single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant.
Typical immunohistochemistry results
Positive
Negative
EMA (epithelial membrane antigen) in a membranous distribution
CEA (carcinoembryonic antigen)
WT1 (Wilms' tumour 1)
B72.3
Calretinin
MOC-3 1
Mesothelin-1
CD15
Cytokeratin 5/6
Ber-EP4
HBME-1 (human mesothelial cell 1)
TTF-1 (thyroid transcription factor-1)
There are three histological types of malignant mesothelioma: (1) Epithelioid; (2) Sarcomatoid; and (3) Biphasic (Mixed). Epithelioid comprises about 50-60% of malignant mesothelioma cases and generally holds a better prognosis than the Sarcomatoid or Biphasic subtypes.
Staging :
Staging of mesothelioma is based on the recommendation by the International Mesothelioma Interest Group.[23] TNM classification of the primary tumor, lymph node involvement, and distant metastasis is performed. Mesothelioma is staged Ia–IV (one-A to four) based on the TNM status.
Screening :
There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Pathophysiology :
Diffuse pleural mesothelioma with extensive involvement of the pericardium.
The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.
Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).[6] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.
Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.
Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph). However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.
Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.
Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:
Neurofibromatosis type 2 at 22q12
P16INK4A
P14ARF
Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:
Inactivation of tumor suppressor genes
Activation of oncogenes
Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
Activation of DNA repair enzymes, which may be prone to error
Activation of telomerase
Prevention of apoptosis
Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.
Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.
[edit] Treatment
The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments.[28] Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis.
Surgery :
Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months.[28] However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.
Radiation :
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[29] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy :
Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.[30] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the group of patients treated with cisplatin in the combination with pemetrexed and who also received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.[31]
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Immunotherapy :
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
Heated Intraoperative Intraperitoneal Chemotherapy :
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.
This technique is also used in patients with malignant pleural mesothelioma.[33]
Multimodality Therapy :
All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors.[29] However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years).[28] Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation depends on the size of the patient's tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma.[34] Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation.[35] Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy.[36]
Epidemiology :
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate varies from one country to another, from a low rate of less than 1 per 1,000,000 in Tunisia and Morocco, to the highest rate in Britain, Australia and Belgium: 30 per 1,000,000 per year.[37] For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades.[38] It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[39] Between 1973 and 1984, the incidence of pleural mesothelioma among Caucasian males increased 300%. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma
Notable people who have lived for some time with mesothelioma
Although life expectancy with this disease is typically limited, there are notable survivors. In July 1982, Stephen Jay Gould was diagnosed with peritoneal mesothelioma. After his diagnosis, Gould wrote "The Median Isn't the Message"[45] for Discover magazine, in which he argued that statistics such as median survival are just useful abstractions, not destiny. Gould lived for another 20 years, eventually succumbing to metastatic adenocarcinoma of the lung, not mesothelioma. Author Paul Kraus was diagnosed with peritoneal mesothelioma in July 1997. He was given a prognosis of less than a year to live and used a variety of complementary modalities. He continues to outlive his prognosis and wrote a book about his experience "Surviving Mesothelioma and Other Cancers: A Patient's Guide"in which he presented his philosophy about healing and the decision making that led him to use integrative medicine
Mesothelioma: Questions and Answers
Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.
What is the mesothelium?The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma
Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.
How is mesothelioma diagnosed?Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is mesothelioma treated?Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.
Are new treatments for mesothelioma being studied?Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI's cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI's Cancer.gov Web site, located at http://www.cancer.gov/clinicaltrials on the Internet, provides general information about clinical trials and links to PDQ..
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