.: Prof. Anup Majumder :.

Prof. Anup Majumder
Registration No: 36240 (WBMC), 1977

	24426555, 22827969, 22827255, 22872321

	9830152485 / 9432423788

	anup.majumdar@gmail.com

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Head & Neck Cancer

The symptoms of mouth, head and neck cancers depend on where the tumour is found. Some common symptoms include:

A sore or ulcer that does not heal
Difficulty or pain on chewing and swallowing
Sore throat, difficulty speaking or a hoarse voice
Changes in your breathing at rest
Unexplained loose tooth
A swelling or lump
Pain in the face or jaw
Earache or ringing in the ear or hearing problems
Numbness
Blocked or bleeding nose
White or red patches in the lining of the mouth or on the tongue that do not go away

For more information, contact the National Cancer Helpline 1800 200 700 to speak to one of our specialist cancer nurses.

Diagnosing

First, visit your family doctor (GP) or dentist if you are worried about any symptoms. They can examine you and do some blood tests. If your GP or dentist is still concerned about you, they can refer you to a hospital for more tests. You may be referred to a specialist doctor, such as a maxillofacial surgeon or an ENT (ear, nose and throat) specialist.

The specialist will discuss your symptoms and examine you again. He or she will inspect your mouth, throat, tongue, nose and neck using a small mirror and/or lights. Your neck, lips, gums and cheeks will also be checked for lumps.

The following tests can diagnose mouth, head and neck cancers.

X-ray
Nasendoscopy
Biopsy
Fine needle aspiration cytology

Lung Cancer

What Is Lung Cancer?

Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs; usually in the cells that line the air passages. The abnormal cells do not develop into healthy lung tissue, they divide rapidly and form tumors. As tumors become larger and more numerous, they undermine the lung’s ability to provide the bloodstream with oxygen. Tumors that remain in one place and do not appear to spread are known as “benign tumors”.

Malignant tumors, the more dangerous ones, spread to other parts of the body either through the bloodstream or the lymphatic system. Metastasis refers to cancer spreading beyond its site of origin to other parts of the body. When cancer spreads it is much harder to treat successfully.

Primary lung cancer originates in the lungs, while secondary lung cancer starts somewhere else in the body, metastasizes, and reaches the lungs. They are considered different types of cancers and are not treated in the same way.

How is lung cancer diagnosed and staged?

Physicians use information revealed by symptoms as well as several other procedures in order to diagnose lung cancer. Common imaging techniques include chest X-rays, bronchoscopy (a thin tube with a camera on one end), CT scans, MRI scans, and PET scans.

Physicians will also conduct a physical examination, a chest examination, and an analysis of blood in the sputum. All of these procedures are designed to detect where the tumor is located and what additional organs may be affected by it.

Although the above diagnostic techniques provided important information, extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose lung cancer. This procedure is called a biopsy. If the biopsy confirms lung cancer, a pathologist will determine whether it is non-small cell lung cancer or small cell lung cancer.

After a diagnosis is made, an oncologist will determine the stage of the cancer by finding out how far the cancer has spread. The stage determines which choices will be available for treatment and informs prognosis. The most common cancer staging method is called the TNM system. T (1-4) indicates the size and direct extent of the primary tumor, N (0-3) indicates the degree to which the cancer has spread to nearby lymph nodes, and M (0-1) indicates whether the cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph nodes or distant organs may be staged as (T1, N0, M0), for example.

For non-small cell lung cancer, TNM descriptions lead to a simpler categorization of stages. These stages are labeled from I to IV, where lower numbers indicate earlier stages where the cancer has spread less. More specifically:

Stage I is when the tumor is found only in one lung and in no lymph nodes.
Stage II is when the cancer has spread to the lymph nodes surrounding the infected lung.
Stage IIIa is when the cancer has spread to lymph nodes around the trachea, chest wall, and diaphragm, on the same side as the infected lung.
Stage IIIb is when the cancer has spread to lymph nodes on the other lung or in the neck.
Stage IV is when the cancer has spread throughout the rest of the body and other parts of the lungs.

Small cell lung cancer has two stages: limited or extensive. In the limited stage, the tumor exists in one lung and in nearby lymph nodes. In the extensive stage, the tumor has infected the other lung as well as other organs in the body.

Breast Cancer

Breast cancer is a kind of cancer that develops from breast cells. Breast cancer usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. A breast cancer that started off in the lobules is known aslobular carcinoma, while one that developed from the ducts is calledductal carcinoma.

The vast majority of breast cancer cases occur in females. This article focuses on breast cancer in women. Click here to read about breast cancer in men (male breast cancer).

Breast cancer is the most common invasive cancer in females worldwide. It accounts for 16% of all female cancers and 22.9% of invasive cancers in women. 18.2% of all cancer deaths worldwide, including both males and females, are from breast cancer.

Breast cancer rates are much higher in developed nations compared to developing ones. There are several reasons for this, with possibly life-expectancy being one of the key factors - breast cancer is more common in elderly women; women in the richest countries live much longer than those in the poorest nations. The different lifestyles and eating habits of females in rich and poor countries are also contributory factors, experts believe.

According to the National Cancer Institute, 232,340 female breast cancers and 2,240 male breast cancers are reported in the USA each year, as well as about 39,620 deaths caused by the disease.

Diagnosing breast cancer

Women are usually diagnosed with breast cancer after a routine breast cancer screening, or after detecting certain signs and symptoms and seeing their doctor about them.

If a woman detects any of the breast cancer signs and symptoms described above, she should speak to her doctor immediately. The doctor, often a primary care physician (general practitioner, GP) initially, will carry out a physical exam, and then refer the patient to a specialist if he/she thinks further assessment is needed.

Below are examples of diagnostic tests and procedures for breast cancer:

Breast exam - the physician will check both the patient's breasts, looking out for lumps and other possible abnormalities, such as inverted nipples, nipple discharge, or change in breast shape. The patient will be asked to sit/stand with her arms in different positions, such as above her head and by her sides.
X-ray (mammogram) - commonly used for breast cancer screening. If anything unusual is found, the doctor may order a diagnostic mammogram.

Breast cancer screening has become a controversial subject over the last few years. Experts, professional bodies, and patient groups cannot currently agree on when mammography screening should start and how often it should occur. Some say routine screening should start when the woman is 40 years old, others insist on 50 as the best age, and a few believe that only high-risk groups should have routine screening.

In July, 2012, The American Medical Association said that women should be eligible for screening mammography from the age of 40, and it should be covered by insurance.

In a Special Report in The Lancet (October 30th, 2012 issue), a panel of experts explained that breast cancer screening does reduce the risk of death from the disease. However, they added that it also creates more cases of false-positive results, where women end up having unnecessary biopsies and harmless tumors are surgically removed.

Another study, carried out by scientists at the The Dartmouth Institute for Healthy Policy & Clinical Practice in Lebanon, N.H., and reported in the New England Journal of Medicine (November 2012 issue), found thatmammograms do not reduce breast cancer death rates.

A team from the University of Copenhagen reported that women who have false-positive mammogram outcomes may suffer long-lasting stress and anxiety, in some cases this can last up to three years. They published their findings in Annals of Family Medicine (March 2013 issue).

Researchers from the Barbara Ann Karmanos Cancer Institute in Detroit, Michigan, found that breast cancer mortality was higher among older women whose time-lapses between their last mammogram and their breast cancer diagnosis were longer. They presented their findings at the American Association for Cancer Research (AACR) Annual Meeting 2013.

Team leader, Michael S. Simon, M.D., M.P.H., said "We found that for women age 75 and older, a longer time interval between the last mammogram and the date of breast cancer diagnosis was associated with a greater chance for dying from breast cancer."

Liver Cancer

Liver cancer is a condition that happens when normal cells in the liver become abnormal and grow out of control into cancer.

Malignant or cancerous cells that arise out of liver cells are called hepatocellular carcinoma, and cancer that arises in the ducts of the liver is called cholangiocarcinoma.

How is liver cancer diagnosed?

The best way to detect liver cancer is through surveillance ultrasound of the liver done every six months in a patient with a diagnosis of cirrhosis and to treat the liver cancer as soon as it is detected.
Once a suspicion of liver cancer arises, a physician will order one the following:

Blood tests: alfa-fetoprotein (AFP), which may be elevated in 70% of patients with liver cancer. AFP levels could be normal in liver cancer. A rising level of AFP is suspicious for liver cancer. Other labs tests include des-gamma-carboxy prothrombin, which can be elevated in most patients with liver cancer.
Imaging studies: Multiphasic helical CT scan and MRI with contrast of the liver are the preferred imaging for detecting the location and extent of blood supply to the cancer. If any imaging study is inconclusive, then an alternative imaging study or follow-up imaging study should be performed to help clarify the diagnosis. Lesions smaller than 1 cm are usually difficult to characterize.
Liver biopsy is performed to sample tissue from the lesion in the liver, which is analyzed by a pathologist to confirm the suspected diagnosis of liver cancer. Liver biopsy is not needed in every case, especially if the imaging study and lab markers are characteristic for liver cancer. Risks of liver biopsy are infection, bleeding, or seeding of the needle track with cancer. Seeding is when cancer cells get on the needle used for a biopsy and spread to other areas touched by the needle. Liver biopsy of suspected liver cancer carries the added risk of seeding the liver biopsy needle track in 1%-3% of cases. If a liver biopsy is inconclusive, then a repeat imaging study is recommended at three- to six-month intervals.

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