By Dr Anirban Banerjee, MS, MRCS (Consultant Surgeon)
In continuation of our discussion on cancer, this week we will look at the diagnosis and treatment of cancer.
How is cancer diagnosed?
Cancer can be suspected from your symptoms.
Local symptoms: unusual lumps or swelling, bleeding, pain and/or ulceration. Compression of surrounding tissues may cause symptoms such as jaundice (yellowing the eyes and skin).
Symptoms of metastasis (spreading): enlarged lymph nodes, cough, enlarged liver, bone pain, fracture of affected bones. Although advanced cancer may cause pain, it is often not the first symptom.
Systemic symptoms: weight loss, poor appetite, fatigue, excessive sweating (night sweats), anaemia.
Biopsy
A biopsy is a procedure when a small piece of tissue is removed from a part of the body. The sample is then examined under the microscope or tested in other ways to detect abnormal cells. Sometimes it is easy to obtain a biopsy, for example, from a lump on the skin which may be a skin cancer. However, it can be difficult to obtain a biopsy from deeper tissues and that may require specialized procedures.
Cancer screening
Cancer screening is done for many types of cancer, including breast, prostate, colon, lung, etc. It is tests to detect unsuspected cancers in an asymptomatic population. Screening tests must be suitable for large numbers of healthy people and they must be affordable, safe and non-invasive. If signs of cancer are detected, more definitive and invasive follow-up tests are performed to confirm the diagnosis. Screening for cancer can lead to earlier diagnosis in specific cases. Early diagnosis may lead to early treatment with extended life.
Cancer stages
The stage of a cancer describes how much the cancer has spread. The stage often takes into account the size of a tumour, how deeply it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasized to (if any), and whether it has spread to distant organs.
The staging of cancer is important because the stage at diagnosis is the most powerful predictor of survival, and treatments are often changed based on staging. The TNM Classification of Malignant Tumours (TNM) is a system that is followed worldwide as the standardized method of cancer staging that describes the extent of cancer in a patient’s body. T describes the size of the tumour and whether it has invaded nearby tissue, N describes the regional lymph nodes that are involved, and M describes distant metastasis (spread of cancer from one body part to another).
The overall staging system uses numerals I, II, III, and IV (plus the 0) to describe the progression of cancer.
Stage 0 – Carcinoma in situ.
Stage I – Cancers are localized to one part of the body.
Stage II – Cancers are locally advanced.
Stage III – Cancers are also locally advanced.
Stage IV – Cancers have often metastasized, or spread to other organs or throughout the body.
What are the treatment options for cancer?
Treatment options vary, depending on the type of cancer and how far it has grown and spread.
Surgery: It may be possible to cut out a malignant tumour.
Chemotherapy: This is a treatment that uses anti-cancer drugs to kill cancer cells, or to stop them from multiplying. There are various types of drugs used for chemotherapy. The drug or combination of drugs selected depends on the type of cancer being treated.
Radiotherapy: This is a treatment that uses high energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.
Other treatments have been introduced which include:
Bone marrow transplant
Hormone therapy: This is where drugs are used to block the effects of hormones. This treatment may be used for cancers that are ‘hormone sensitive’ such as some cancers of the breast, prostate and uterus (womb).
Immunotherapy: Some treatments can boost the immune system to help to fight cancer.
Gene therapy: A new area of possible treatments. Research is underway to find ways of blocking, repairing or replacing abnormal genes in cancer cells.
Special techniques: Can sometimes be used to cut off the blood supply to tumours. The tumour then dies.
For some cancers, a combination of two or more treatments may be used. A range of other treatments may also be used to ease cancer related symptoms such as pain.
The aims of treatment
The aims of treatment can vary, depending on the cancer type, size, spread, etc. For example:
– Treatment aims to cure the cancer in many cases. With modern drugs and therapies, many cancers can be cured, particularly if they are treated in the early stages of the disease.
– Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
– Treatment may aim to ease symptoms in some cases. Even if a cure is not possible, a course of radiotherapy, an operation, or other techniques may be used to reduce the size of a cancer which may ease symptoms such as pain.
If a cancer is advanced then you may require treatments such as nutritional supplements, painkillers, or other techniques to help keep you free of pain or other symptoms.
What is the outlook for people with cancer?
Cancer has a reputation for being a deadly disease. While this certainly applies to certain types, cancer is increasingly being overturned by advances in medical care. Some types of cancer have a prognosis that is substantially better than non-malignant diseases such as heart failure and stroke.
Progressive and disseminated malignant disease has a substantial impact on the quality of life, and many cancer treatments may have severe side effects. In the advanced stages of cancer, many patients need extensive care, affecting family members and friends.
Palliative care may include permanent care in a hospital.
Therefore, it is not possible give an overall outlook. The outlook is usually better the earlier the cancer is detected and treatment has started.
