Lung Cancer

Q. What is Lung Cancer? A. Lung Cancer is the uncontrolled growth of abnormal cells in one or both of the lungs. While normal lung tissues consist of cells programmed by nature to reproduce and develop into healthy, well formed lungs, these abnormal cells reproduce rapidly and disrupt this natural programming. Tumours are then formed that clog the lung making it difficult for the lung to function properly.

Q. What does Lung Cancer occur? A. Lung Cancer mostly begins in one lung and then spreads to lymph nodes or other tissues of the other lung or part of chest. Lung Cancer can metastasize throughout the body, spreading to bones, brain, lever, or other organs. Cancer that spreads are still considered part of the original cancer.

Q. What is Lung Cancer grown?
A. Since the lungs are large, cancers can grow there for many years before they are detected. Lung Cancer can easily spread outside the lungs without causing any symptoms. Even when a major symptom appears, like persistent cough, it is often mistaken for a common cold, bronchitis or allergy cough.

Q. What are the probable cause of Lung Cancer?
A. Most people who get lung cancer, have been cigarette smokers. However, not all smokers develop lung cancer. In some cases, people who have never smoked, too get lung cancer.

Q. How many types of Lung Cancer are so far known?
A. There are more than a dozen different kinds of Lung Cancer. They differ by type of cells found in the tumour. But the two main kinds of lung cancers are a) small cell and b) non small cell varieties. These two types account for about 90% of all cases of lung cancer. Small Cell Lung Cancers grows rapidly and consist of small round cells often called 'oat cells' because of their shape. Small Cell cancers are about 15% of all lung cancers. This type of cancer grow in the tissues of the lungs. Non small cell cancers are about 75% of all lung cancers. They are of different types and generally grow in the lining of bronchial tubes, muscles glands of the lungs and outer edges of the lungs. Out of remaining 10% of lung cancers, some uncommon ones are like Bronchoalveolar cancer that occur most often in elder populations.

Q. What are symptoms of Lung Cancer?
A.

• Persist at cough
• Coughing up of blood
• Unusual, unexplained fatigue
• Swelling of the neck and face
• Shortness of breath
• Repeated pneumonia or bronchitis
• Loss of appetite and weight
• HoarsenessPersistent chest, shoulder or back pain

Q. How is Lung Cancer diagnosed?
A. Lung Cancer can be diagnosed through different tests like X-rays, Computerized tomography (CT-Scan), Sputum Cytology, Fine needle aspirations cytology, bronchoscopicbiopsy.

Q. What are the different stages of Lung Cancer and how are they treated?
A. There are four stages of Lung Cancer.

• Stage 1 - when cancer is located in the lungs and has not spread to the lymph nodes. Surgical removal is the potential treatment in this stage.
• Stage 2 - cancer has spread to the nearby lymph nodes. Here doctors prescribe for CT scan or mediastinoscopy (testing the lymph node through a small surgery. If the report is positive, surgery followed by radiation/chemotherapy on the nodes are the possible treatments.
• Stage 3 - Cancer is found in the lymph nodes in the middle of the chest away from the lungs. It may be one lymph node or many. Here there are two options - option A for surgery and then treatment with radiation/chemotherapy. Most doctors at this stage do not opt for surgery. Currently combination of chemotherapy and radiotherapy is the most modality.
• Stage 4 - when cancer has spread to a distant part of the body like liver, bones, brain or some other organs. This is the most advanced stage of cancer. Here chemotherapy with different combination of drugs is the only alternative.

Q. Can Lung Cancer be prevented?
A. Lung Cancer can be prevented to a large extent by leading healthy life and practices like not smoking, have regular check up specially at the elderly age, particularly if any of the symptoms shown above, are noticed, at the initial stage.

Q. What is the Breast? A. The breast is a collection of glands and fatty tissue that lies between the skin and the chest wall. The glands inside the breast produce milk after a woman has a baby. Each gland is also called a lobule, and many lobules make up a lobe. There are 15 to 20 lobes in each breast. The milk gets to the nipple from the glands by way of tubes called ducts. The glands and ducts get bigger when a breast is

filled with milk, but the tissue that is most responsible for the size and shape the breast is the fatty tissue. There are also blood vessels and lymph vessels in the breast. Lymph is a clear liquid waste product that gets drained out of the breast into lymph nodes. Lymph nodes are small, pea-sized pieces of tissue that filter and clean the lymph. Most lymph nodes that drain the breast are under the arm in what is called the axilla.

Q. What is Breast Cancer? A. Breast cancer happens when cells in the breast begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of this out of control tissue are called tumors. However, some tumors are not really cancer because they cannot spread or threaten someone's life. These are called benign tumors. The tumors that can spread throughout the body or invade nearby tissues are considered cancer and are called malignant tumors.

Q. What causes Breast Cancer?
A. The exact cause or causes of breast cancer remain unknown. Yet scientists have identified a number of risk factors that increase a person's chance of getting this disease. Certain risk factors, such as age, are beyond our control; whereas others, like drinking and smoking habits, can be modified.

1. Age - The risk of breast cancer increases with age. For example, annual breast cancer rates are 8-fold higher in women who are 50 years old, in comparison with women who are 30. Most breast cancers (about 80%) develop in women over the age of 50. In one age group (40 to 45 years), breast cancer is ranked first among all causes of death in women. Breast cancer is uncommon in women younger than 35, with the exception of those who have a family history of the disease.
2. Previous Breast Cancer If a woman has already had breast cancer, she has a greater chance of developing a new cancer in the other breast. Such a new, or 'second,' cancer arises from a completely different location and should not be confused with a cancer that has recurred (come back) or metastasized (spread) from another site. The likelihood of a new cancer increases by 0.5% to 0.7% each year after the original diagnosis. After 20 years, a woman has a 10% to 15% chance of developing a new breast cancer.
3. A previous diagnosis of lobular carcinoma in situ (a localized tumor) - is associated with a 10% to 30% greater breast cancer risk, and a previous diagnosis of ductal carcinoma in situ is associated with a 30% to 50% greater risk.
4. Family History of Breast Cancer - Approximately 85% of women with breast cancer do NOT report a history of breast cancer within their families. Of the remaining 15%, about one-third appear to have a genetic abnormality. The risk of breast cancer is about two times higher among women who have a first-degree relative (mother, sister, or daughter) with this disease. The risk is increased 4- to 5-fold if the relative's cancer was found before menopause (the end of menstruation) and involved both breasts. The risk also is increased if breast cancer occurs in several family generations.
5. Inherited disorders - In addition, an increased risk of breast cancer has been found in families with other inherited disorders, such as ataxia Telangiectasia (a progressive disease of the motor system) and Li-Fraumeni syndrome.
6. Genetic Mutations - About 5% to 10% of all breast cancers are hereditary. Scientists have identified certain genetic mutations (permanent changes in genetic material) that place people at increased risk of breast cancer. To date, the genes that have been most studied include BRCA1 and BRCA2.
7. Hormones - Breast cancer risk is increased in women with the longest known exposures to sex hormones, particularly estrogen (female sex hormone). Therefore, breast cancer risk is increased in women who have a history of
   
   

   Early first menstrual period (before age 12)

   Late menopause (end of menstruation)

   No pregnancies

   Late pregnancy (after age 30)

   Birth control pills

   It should be mentioned that the Pill's exact hazards are difficult to assess, since risk apparently disappears in women who have not used oral contraceptives for more than 10 years.

8. Estrogen replacement therapy (ERT) - Known as Hormone Replacement Therapy (HRT), is used by many older women to relieve the symptoms of menopause. Certain studies indicate that ERT may increase the risk of breast cancer after long-term use (10+ years). Yet there is no official consensus on ERT, because scientists also have found that the increase in breast cancer risk is eliminated within 5 years of stopping ERT. In addition, some researchers have reported an increased risk of breast cancer in women taking estrogen or estrogen plus progestin, whereas others have not. Because of these uncertainties - and the fact that ERT has a number of positive benefits (e.g., lowered risks of bone fractures and improved bare health) - a physician should be consulted about risks and benefits before a person uses ERT.

Q. Am I at risk for Breast Cancer?
A. Breast cancer is the most common malignancy affecting women in North America and Europe. Every woman is at risk for breast cancer. Close to 200,000 cases of breast cancer were diagnosed in the United States in 2001. Breast cancer is the second leading cause of cancer death in American women behind lung cancer. The lifetime risk of any particular woman getting breast cancer is about 1 in 8 although the lifetime risk of dying from breast cancer is much lower at 1 in 28.

Risk factors for breast cancer can be divided into those that you cannot change and those that you can change. Some factors that increase your risk of breast cancer that you cannot alter include being a woman, getting older, having a family history (having a mother, sister, or daughter with breast cancer doubles your risk), having a previous history of breast cancer, having had radiation therapy to the chest region, being Caucasian, getting your periods young (before 12 years old), having your menopause late (after 50 years old), never having children or having them when you are older than 30, and having a genetic mutation that increases your risk. Genetic mutations for breast cancer have become a hot topic of research lately. Women can inherit these mutations from their parents and it may be worth testing for either mutation if a woman has a particularly strong family history of breast cancer (meaning multiple relatives affected, especially if they are under 50 years old when they get the disease). If a woman is found to carry either such mutation, she has a 50% chance of getting breast cancer before she is 70.

Certain factors which increase a woman's risk of breast cancer can be altered including taking hormone replacement therapy (long term use of estrogens with progesterone for menopause symptoms slightly increases your risk), taking birth control pills (a very slight increased risk that disappears in women who have stopped them for over 10 years), not breastfeeding, drinking 2 to 5 alcoholic drinks a day, being overweight (especially after menopause), and not exercising. All of these modifiable risk factors are not nearly as important as gender, age, and family history, but they are things that a woman can control that may reduce her chances of developing a breast malignancy. Remember that all risk factors are based on probabilities, and even someone without any such risk factors can still get breast cancer. Proper screening and early detection are our best weapons in reducing the mortality associated with this disease.

Q. What are the signs of breast cancer?
A. Unfortunately, the early stages of breast cancer may not have any symptoms. This is why it is important to follow screening recommendations. As a tumor grows in size, it can produce a variety of symptoms including:

• Lump or thickening in the breast or underarm
• Change in size or shape of the breast
• Nipple discharge or nipple turning inward (retracted)
• Redness or scaling of the skin or nipple
• Ridges or pitting of the breast skin

If you experience these symptoms, it doesn't necessarily mean you have breast cancer, but you need to be examined by a doctor.

Q. What are the examinations available for Breast Cancer?
A. The earlier that a breast cancer is found, the more likely it is that treatment can be curable. For this reason, we screen for breast cancer using mammograms, clinical breast exams, and breast self-exams. Screening mammograms are simply x-rays of each breast. The breast is placed between two plates for a few seconds while the x-rays are taken. If something appears abnormal, or better views are needed, magnified views or specially angled films are taken during the mammogram. Mammograms often detect tumors before they can be felt and they can also identify tiny specks of calcium that could be an early sign of cancer. Regular screening mammograms can decrease the mortality of breast cancer by 30%. The majority of breast cancers are associated with abnormal mammographic findings. Woman should get a yearly mammogram starting at age 50 (although some groups recommend starting at 40), and women with a genetic mutation that increases their risk or a strong family history may want to begin even earlier.

Between the ages of 20 and 39, every woman should have a clinical breast exam every 3 years; and after age 40 every woman should have a clinical breast exam done each year. A clinical breast exam is an exam done by a health professional to feel for lumps and look for changes in the size or shape of your breasts. During the clinical breast exam, you can learn how to do a breast self-exam. Every woman should do a self breast exam once a month, about a week after her period ends. If you find any changes in your breasts, you need to contact your doctor.

In india also breast cancer incidence is showing rising trend in all the tumor registries from major metropolitan cities.

Q. How is breast cancer diagnosed?
A. Once a patient has symptoms suggestive of a breast cancer or an abnormal screening mammogram, they will usually be referred for a diagnostic mammogram. A diagnostic mammogram is another set of x-rays; however, it is more complete with close ups on the suspicious areas. Sometimes, particularly if your doctors think that you may have a cyst or you are young and have dense breasts, you may be referred for an ultrasound. An ultrasound uses high-frequency sound waves to outline the suspicious areas of the breast.

Depending on the results of the mammograms and/or ultrasounds, your doctors may recommend that you get a biopsy. A biopsy is the only way to know for sure if you have cancer, because it allows your doctors to get cells that can be examined under a microscope. There are different types of biopsies; they differ on how much tissue is removed. Some biopsies use a very fine needle, while others use thicker needles or even require a small surgical procedure to remove more tissue. Your team of doctors will decide which type of biopsy you need depending on your particular breast mass.

Once the tissue is removed, a doctor known as a pathologist will review the specimen. The pathologist can tell if it is cancer or not; and if it is cancerous, then the pathologist will characterize it by what type of tissue it arose from, how abnormal it looks (known as the grade), whether or not it is invading surrounding tissues, and if the entire lump was excised, the pathologist can tell if there are any cancer cells left at the borders.

Q. What are the different stages of Breast Cancer?
A.

• Stage 0 - (called carcinoma in situ) Lobular carcinoma in situ (LCIS) refers to abnormal cells lining a gland in the breast. This is a risk factor for the future development of cancer, but this is not felt to represent a cancer itself. Ductal carcinoma in situ (DCIS) refers to abnormal cells lining a duct. Women with DCIS have an increased risk of getting invasive breast cancer in that breast. Treatment options are similar to patients with Stage I breast cancers.
• Stage I - early stage breast cancer where the tumor is less that 2 cm across and hasn't spread beyond the breast
• Stage II - early stage breast cancer where the tumor is either less than 2 cm across and has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm (with or without spread to the lymph nodes under the arm); or the tumor is greater than 5 cm and hasn't spread outside the breast
• Stage III - locally advanced breast cancer where the tumor is greater than 5 cm across and has spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast
• Stage IV - metastatic breast cancer where the cancer has spread outside the breast to other organs in the body

Depending on the stage of your cancer, your doctor may want additional tests to see if you have metastatic disease. If you have a stage III cancer, you will probably get a chest x-ray, CT scan and bone scan to look for metastases. Each patient is an individual and your doctors will decide what is necessary to adequately stage your cancer.

Q. What are the treatments for breast cancer?
A.
1. Surgery
Almost all women with breast cancer will have some type of surgery in the course of their treatment. The purpose of surgery is to remove as much of the cancer as possible, and there are many different ways that the surgery can be carried out. More advanced breast cancers are usually treated with a modified radical mastectomy. Modified radical mastectomy means removing the entire breast and dissecting the lymph nodes under the arm.

2. Chemotherapy
Despite the fact that the tumors are removed by surgery, there is always a risk of recurrence because there may be microscopic cancer cells that have already spread to distant sites depending on their age, stage of disease and tumor type in the body. In order to decrease a patient's risk of recurrence, breast cancer patients are offered chemotherapy. Chemotherapy is the use of anti-cancer drugs that spread throughout the entire body. The higher the stage of cancer you have, the more important it is that you receive chemotherapy; however, even stage I patients may benefit from chemotherapy in certain specific cases.

There are many different chemotherapy drugs, and they are usually given in combinations for 3 to 6 months after you receive your surgery. Depending on the type of chemotherapy regimen you receive, you may get medication every 3 or 4 weeks; and you may have to go to a clinic to get the chemotherapy because many of the drugs have to be given through a vein.

Sometimes patients have a recurrence of their cancer, or present in stage IV with disease outside of their breast. These patients will all need chemotherapy, and a variety of different agents may be tried until a response is achieved. Sometimes chemotherapy is administered before surgery to make the tumor smaller and better for operation and to take care of any suspected spread.

3. Radiotherapy
Breast cancer patients commonly receives radiation therapy. Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. It comes from an external source, and it requires patients to come in 5 days a week for up to 6 weeks to a radiation therapy treatment center. The treatment takes just a few minutes, and it is painless.

4. Hormonal Therapy
When the pathologist examines your tumor specimen, he or she finds out if the tumor is expressing estrogen and progesterone receptors. Patients whose tumors express estrogen receptors are candidates for therapy with an estrogen blocking drug called Tamoxifen. Tamoxifen is taken by pill form for 5 years after your surgery. Presently many more drugs known as aromatase inhibitors have became popular i.e. hormone receptor positive breast cancer patients.

5. Biologic Therapy
The pathologist also examines your tumor for the presence of HER-2/neu overexpression. HER-2/neu is a receptor that some breast cancers express. If your cancer expresses it, you usually have a higher chance of having your tumor recur after surgery and your disease tends to fare more than if your tumor HER-2/neu negative.

Q. Do I need to do anything after treatment?
A. Follow-up testing
Once a patient has been treated for breast cancer, they need to be closely followed up for detection of any recurrence. At first, you will have follow-up visits every 3-4 months. The longer you are free of disease, the less often you will have to go for checkups. After 5 years, you could see your doctor once a year. You should have a mammogram of the treated and untreated breasts every year. Because having had breast cancer is a risk factor for getting it again, having your mammograms done every year is extremely important.

Q. How can I prevent breast cancer?
A. The most important risk factors for the development of breast cancer cannot be controlled by the individual. There are some risk factors that are associated with an increased risk, but there is not a clear cause and effect relationship. In no way can strong recommendations be made like the cause and effect relationship seen with tobacco and lung cancer. There are a few risk factors that may be modified by a woman that potentially could influence the development of breast cancer. If possible, a woman should avoid long-term hormone replacement therapy, have children before age 30, breastfeed, avoid weight gain through exercise and proper diet, and avoid alcohol and cigarette consumption. These are commonly recommended breast healthy measures. For women already at a high risk, their risk of developing breast cancer can be reduced by about 50% by taking a drug called Tamoxifen for five years. Tamoxifen has some common side effects (like hot flashes and vaginal discharge), which are not serious and some uncommon side effects (like blood clots, pulmonary embolus, stroke, and uterine cancer) which are life threatening. Tamoxifen isn't widely used for prevention, but may be useful in some cases. There are limited data suggesting that vitamin A may protect against breast cancer but further research is needed before it can be recommended for prevention. Other things being investigated include phytoestrogens (naturally occurring estrogens that are in high numbers in soy), vitamin E, vitamin C, and other drugs. Further testing of these substances is also needed before they can be recommended for breast cancer prevention. Right now, the most important thing any woman can do to decrease her risk of dying from breast cancer is to have regular mammogram screening, learn how to perform breast self exams, and have a regular physical examination by their physician.

Q. What is Colorectal Cancer ? A. Colorectal cancer circumferences the Colon and Rectum. The colon and rectum are parts of the digestive system. They form a long, muscular tube called the large intestine (also called the large bowel). The colon is the first 4 to 5 feet of the large intestine, and the rectum is the last 4 to 5 inches. The part of the colon that joins to the rectum is the sigmoid colon. The part that joins to the small

intestine is the cecum. Partly digested food enters the colon from the small intestine. The colon removes water and nutrients from the food and stores the rest as waste. The waste passes from the colon into the rectum and then out of the body through the anus. Cancer that begins in the colon is called colon cancer, and cancer that begins in the rectum is called rectal cancer. Cancers affecting either of these organs may also be called colorectal cancer. When colorectal cancer spreads outside the colon or rectum, cancer cells are often found in nearby lymph nodes. If cancer cells have reached these nodes, they may also have spread to other lymph nodes, the liver, or other organs. When cancer spreads (metastasizes) from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if colorectal cancer spreads to the liver, the cancer cells in the liver are actually colorectal cancer cells. The disease is metastatic colorectal cancer, not liver cancer. It is treated as colorectal cancer, not liver cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

Q. Who are at risk of Colorectal Cancer?
A. No one knows the exact causes of colorectal cancer. Doctors can seldom explain why one person develops the disease and another does not. Research has shown that people with certain risk factors are more likely than others to develop colorectal cancer. A risk factor is anything that is linked to an increased chance of developing a disease.

Studies have found the following risk factors for colorectal cancer:

• Age: Colorectal cancer is more likely to occur as people get older. More than 90 percent of people with this disease are diagnosed after age 50. The average age at diagnosis is in the mid-60s.
• Colorectal polyps: Polyps are growths on the inner wall of the colon or rectum. They are common in people over age 50. Most polyps are benign (noncancerous), but some polyps (adenomas) can become cancer.
  Removing polyps may reduce the risk of colorectal cancer.
• Family history of colorectal cancer: Close relatives (parents, brothers, sisters, or children) of a person with history of colorectal cancer are somewhat more likely to develop this disease themselves, especially if the relative had the cancer at a young age. If many close relatives have a history of colorectal cancer, the risk is even greater.
• Genetic alterations: Changes in certain genes increase the risk of colorectal cancer.
• Personal history of colorectal cancer: A person who has already had colorectal cancer may develop colorectal cancer a second time. Also, women with a history of cancer of the ovary, uterus (endometrium), or breast are at a somewhat higher risk of developing colorectal cancer.
• Ulcerative colitis or Crohn's disease: A person who has had a condition that causes inflammation of the colon (such as ulcerative colitis or Crohn's disease) for many years is at increased risk of developing colorectal cancer.
• Diet: Studies suggest that diets high in fat (especially animal fat) and low in calcium, folate, and fiber may increase the risk of colorectal cancer. Also, some studies suggest that people who eat a diet very low in fruits and vegetables may have a higher risk of colorectal cancer. More research is needed to better understand how diet affects the risk of colorectal cancer.
• Cigarette smoking: A person who smokes cigarettes may be at increased risk of developing polyps and colorectal cancer. People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Q. What are the symptoms of Colorectal Cancers?
A. Common symptoms of colorectal cancer include:

• A change in bowel habits
• Diarrhea, constipation, or feeling that the bowel does not empty completely
• Blood (either bright red or very dark) in the stool
• Stools that are narrower than usual
• General abdominal discomfort (frequent gas pains, bloating, fullness, and/or cramps)
• Weight loss with no known reason
• Constant tiredness
• Nausea and vomiting

Q. How is Colorectal Cancer diagnosed?
A. The disease is diagnosed through series of investigations like :

• Fecal occult blood test (FOBT) - Sometimes cancers or polyps bleed, and the FOBT can detect tiny amounts of blood in the stool. If this test detects blood, other tests are needed to find the source of the blood. Benign conditions (such as hemorrhoids) also can cause blood in the stool.
• Sigmoidoscopy - The doctor checks inside the rectum and lower (sigmoid) colon with a lighted tube called a sigmoidoscope. If polyps are found, the doctor removes them. The procedure to remove polyps is called a polypectomy.
• Colonoscopy - The doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscope. The doctor removes polyps that may be found.
• Double-contrast barium enema (DCBE) - A DCBE is a series of x-rays of the colon and rectum. The patient is given an enema with a barium solution, and air is pumped into the rectum. The barium and air outline the colon and rectum on the x-rays. Polyps may show up on the x-ray.
• Digital rectal exam (DRE) - A rectal exam is often part of a routine physical examination. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for abnormal areas in the lower part of the rectum.

Q. How is the diagnosis done for Colorectal Cancer?
A. If a person has any signs or symptoms of colorectal cancer, it must first be determined whether the complaint is due to cancer or some other cause. The doctor asks about personal and family medical history and may do a physical exam. The person may have one or more of the tests. If the physical exam and test results do not suggest cancer, the doctor may decide that no further tests are needed and no treatment is necessary. However, the doctor may recommend a schedule for checkups. If tests show an abnormal area (such as a polyp), a biopsy to check for cancer cells may be necessary. Often, the abnormal tissue can be removed during colonoscopy or sigmoidoscopy. A pathologist checks the tissue for cancer cells using a microscope.

Q. What are the stages of Colorectal Cancer?
A. If the biopsy shows that cancer is present, the doctor needs to know the stage of the disease to plan the best treatment. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Staging may involve some of the following tests and procedures:

• Blood tests - The doctor checks for carcinoembryonic antigen (CEA) and other substances in the blood. Some people who have colorectal cancer or other conditions have a high CEA level.
• Colonoscopy - If colonoscopy was not performed for diagnosis, the doctor examines the entire length of the colon and rectum with a colonoscope to check for other abnormal areas.
• Endorectal Ultrasound - An ultrasound probe is inserted into the rectum. The probe sends out sound waves that people cannot hear. The waves bounce off the rectum and nearby tissues, and a computer uses the echoes to create a picture. The picture shows how deep a rectal tumor has grown or whether the cancer has spread to lymph nodes or other nearby tissues.
• Chest X-ray - X-rays of the chest can show whether cancer has spread to the lungs.
• CT scan - An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body. The patient may receive an injection of dye. Tumors in the liver, lungs, or elsewhere in the body show up on the CT scan.
• MRI - to see whether the cancer has spread. Sometimes staging is not complete until the patient has surgery to remove the tumor. (Surgery for colorectal cancer is described in the "Treatment" section.)

Q. What are the different stages of Colorectal Cancer?
A. Different Stages of Colorectal Cancers are :

• Stage 0 - At this stage, cancer is found only in the innermost lining of the colon or rectum. Carcinoma in situ is another name for Stage 0 colorectal cancer.
• Stage I - The cancer has grown into the inner wall of the colon or rectum. The tumor has not reached the outer wall of the colon or extended outside the colon.
• Stage II - The tumor extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes.
• Stage III - The cancer has spread to nearby lymph nodes, but not to other parts of the body.
• Stage IV - The cancer has spread to other parts of the body, such as the liver or lungs.

Q. What are the possible treatment for Colorectal Cancers?
A. Treatment for colorectal cancer may involve surgery, radiation therapy, or chemotherapy. Some people have a combination of treatments. Colon cancer sometimes is treated differently from rectal cancer. Treatments for colon and rectal cancer are described separately. At any stage of colorectal cancer, treatments are available to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care.

Surgery
Surgery is the most common treatment for colorectal cancer. It is a type of local therapy. It treats the cancer in the colon or rectum and the area close to the tumor. A small malignant polyp may be removed from the colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through the anus without a colonoscope.

For a larger cancer, the surgeon makes an incision into the abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes also may be removed. The surgeon checks the rest of the intestine and the liver to see if the cancer has spread.

When a section of the colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, the surgeon creates a new path for waste to leave the body. The surgeon makes an opening (a stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place.

For most people who have a colostomy, it is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent colostomy.

Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body. Anticancer drugs are usually given through a vein, but some also may be given by mouth. The patient may be treated in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed. The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Chemotherapy given before surgery is called neoadjuvant therapy. Chemotherapy before surgery may shrink a large tumor.

Chemotherapy after surgery is called adjuvant therapy. Adjuvant therapy is used to destroy any remaining cancer cells and prevent the cancer from coming back in the colon or rectum, or elsewhere. Chemotherapy is also used to treat people with advanced disease.

Radiation Therapy
Radiation therapy (also called radiotherapy) is a local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. Doctors use two types of radiation therapy to treat cancer. Sometimes people receive both types:

• External radiation: The radiation comes from a machine in a hospital or clinic for treatment, generally 5 days a week for several weeks. In some cases, external radiation is given during surgery.
• Internal radiation (Implant Radiation): The radiation comes from radioactive material placed in thin tubes put directly into or near the tumor. The patient stays in the hospital or clinic, and the implants generally remain in place for several days. Usually they are removed before the patient goes home.

Treatment for Colon Cancer
Most patients with colon cancer are treated with surgery. Some have both surgery and chemotherapy. A colostomy is seldom needed for people with colon cancer. Although radiation therapy is not commonly used to treat colon cancer, sometimes it is used to relieve pain and other symptoms.

Treatment for Rectal Cancer
For all stages of rectal cancer, surgery is the most common treatment. Some patients receive surgery, radiation therapy, and chemotherapy. About 1 out of 8 people with rectal cancer needs a permanent colostomy. Radiation therapy may be used before and after surgery. Some people have radiation therapy before surgery to shrink the tumor, and some have it after surgery to kill cancer cells that may remain in the area. At some hospitals, patients may have radiation therapy during surgery. This is called IORT. People also may have radiation therapy to relieve pain and other problems caused by the cancer.

Q. What is the role of Follow up treatment?
A. Follow-up Care
Follow-up care after treatment for colorectal cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. The doctor monitors the person's recovery and checks for recurrence of the cancer. Checkups help ensure that any changes in health are noted. Checkups may include a physical exam , lab tests (including fecal occult blood test and CEA test), colonoscopy, X-rays, CT scans, or other tests. Between scheduled visits with the doctor, patients should contact the doctor as soon as any health problems appear.

The mouth is an amazing machine for speech and eating, it actually starts the process of digestion. Normally good mouth hygiene ensures healthy teeth, and a lifetime of trouble free chewing (the muscles of the jaw are the strongest of the body). Occasionally people develop a cancer in the mouth.

From doctor the perspective of a doctor who deals with cancers (oncologist), the mouth is anything forward of the last molar, up to the lips. This includes the part of the tongue we see in the mirror, the hard palate, and the inside of the cheeks. Anything behind the last molar is called "oropharynx" and is a different area which includes the tonsils and base of tongue.

Cancer of the mouth, or "oral cavity", includes that extending back as far as behind the last molar ("wisdom tooth"). This would include the area behind the lips, gums, inside of the cheeks, palate, and front 2/3 of the tongue. The tonsils and back of the tongue are further back, and are located in the "oropharynx". Thus, cancers of areas behind the last molar are not considered "mouth cancer". Also, cancers of our 3 major salivary glands (parotid, submaxillary, sublingual) are considered separately, as well as those of the jaw bones and muscles. Therefore, it is important to identify the area the cancer arose from, even if it subsequently spread to other areas. It is this area it originally arose from which determines what type of cancer it is.

Cells in the mouth are subjected to lots of injury from heat and abrasion, and thus must divide frequently to replace those lost due to injury and old age. Normally, cells divide quickly as we develop in the womb and through infancy, and then the rate slows down considerably, just to replace cells that die. The division of cells in the mouth and elsewhere is under very tight control, regulated by the genes within the cells. When this control is lost, the cells may start to divide in a haphazard, uncontrolled manner, and grow to form a swelling of abnormal cells, called a "tumor". A "benign" tumor only grows within it's local area.

Q. What is Oral cancer?
A. Most people have heard of cancer affecting parts of the body such as the lungs or breasts. However, cancer can occur in the mouth, where the disease can affect the lips, tongue, cheeks and throat.

Q. Who can be affected by oral cancer?
A. Anyone can be affected by mouth cancer, whether they have their own teeth or not. Mouth cancers are more common in people over 40, particularly men. However, research has shown that mouth cancer is becoming more common in younger patients and in women. There are, on average, over 4,300 new cases of mouth cancer diagnosed in the UK each year. The number of new cases of mouth cancer is on the increase.

Q. Do people die from oral cancer?
A. Yes. Thousands of people die from mouth cancer every year. Many of these deaths could be prevented if the cancer was caught early enough. As it is, people with mouth cancer are more likely to die than those having cervical cancer or melanoma skin cancer.

Q. What can cause oral cancer?
A. Most cases of mouth cancer are linked to tobacco and alcohol. Cigarette, cigar and pipe smoking are the main forms of tobacco use in the UK. However, the traditional ethnic habits of chewing tobacco, betel quid, gutkha and paan are particularly dangerous. Alcohol increases the risk of mouth cancer, and if tobacco and alcohol are consumed together the risk is even greater. Over-exposure to sunlight can also increase the risk of cancer of the lips.

Q. What are the signs of oral cancer?
A. Mouth cancer can appear in different forms and can affect all parts of the mouth, tongue and lips. Mouth cancer can appear as a painless mouth ulcer that does not heal normally. A white or red patch in the mouth can also develop into a cancer. It is important to visit your dentist if these areas do not heal within two weeks.

Q. How can oral cancer be detected early?
A. Mouth cancer can often be spotted in its early stages by your dentist during a thorough mouth examination. If mouth cancer is recognised early, then the chances of a cure are good. Many people with mouth cancer go to their dentist or doctor too late.

Q. What is involved in a full check-up of the mouth?
A. The dentist examines the inside of your mouth and your tongue with the help of a small mirror. Remember, your dentist is able to see parts of your mouth that you cannot see easily yourself.

Q. What happens if my dentist finds a problem?
A. If your dentist finds something unusual or abnormal they will refer you to a consultant at the local hospital, who will carry out a thorough examination of your mouth and throat. A small sample of the cells may be gathered from the area (a biopsy), and these cells will be examined under the microscope to see what is wrong.

Q. What happens next?
A. If the cells are cancerous, more tests will be carried out. These may include overall health checks, blood tests, x-rays or scans. These tests will decide what course of treatment is needed.

Q. Can mouth cancer be treated?
A. If mouth cancer is spotted early, the chances of a complete cure are good, and the smaller the area or ulcer the better the chance of a cure. However, too many people come forward too late, because they do not visit their dentist for regular examinations.

Q. How can I make sure that my mouth stays healthy?
A. It is important to visit your dentist at least once a year, even if you wear dentures. This is especially important if you smoke and drink alcohol. When brushing your teeth, look out for any changes in your mouth, and report any red or white patches, or ulcers, that have not cleared up within two weeks. When exposed to the sun, be sure to use a good protective sun cream, and put the correct type of barrier cream on your lips. A good diet, rich in vitamins A, C and E, provides protection against the development of mouth cancer. Plenty of fruit and vegetables help the body to protect itself, in general, from most cancers. Cut down on your smoking and drinking.

Q. What are the different types of Brain Tumors? A. There are many different kinds of brain tumors. The first way to divide brain tumors is based on whether they are primary or secondary. Primary tumors are tumors that begin in the brain. Secondary tumors are tumors that started our elsewhere in the body and spread, or metastasized, to the brain. For example, secondary brain tumors could have begun as breast cancer or lung cancer. Primary brain tumors can be further divided based on what type of

cell the tumor began as. Some types of primary brain tumors are astrocytomas, oligodendrogliomas, meningiomas, medulloblastomas, neuronomas, ependymomas, craniopharingiomas, pineal tumors, germ cell tumors, and schwannomas. The name of a tumor depends on what kind of cell it comes from. Astrocytomas come from astrocytes, oligodendrogliomas from oligodendrocytes, meningiomas from meningeal cells, medulloblastomas from medulloblasts, etc.

Q. What is a Glioma? A. A Glioma is a tumor of the glial cells. Glial cells are the supportive cells of the central nervous system; they help neurons(nerve cells), do their jobs. Glial cells include astrocytes, oligodendrocyts, and ependymal cells, so gliomas can be astrocytomas, oligodendrogliomas, or ependymomas. Gliomas are the most common type of primary brain tumor, but not every brain tumor is a glioma. Because there are different types of

gloimas and because factors such as patient's age or tumor location can affect tumor behavior, two people with gliomas may have very different experiences.

Q. What does grade mean in case of Brain Tunour?
A. Grading is a way of telling how bad a tumor is. The grade of a tumor depends on how the cells look to a pathologist using a microscope. Generally, higher grade tumors look less like the specialized cells they came from and more like unspecialized cells that can divide indefinitely. Such cells are described as anaplastic, so tumors that are described as anaplastic are often higher grade than those that are not.

Many patients have the grade of their tumor change during the course of the disease. This change can happen for two reasons. First, tumors can become more aggressive, making them a higher grade than they were initially. Second, the grade is based entirely on the piece of a tumor removed for a biopsy. Tumors are often heterogeneous, so one part of a tumor may be one grade and another part of a tumor another grade. The pathologist will usually assign to a tumor the highest grade he or she sees, but there may be higher grade cells lurking elsewhere, especially if the biopsy sample is small. Although there are rules for determining tumor type and grade, it is as much an art as a science. Therefore, it is important to have your biopsy samples looked at by a neuropathologist who sees a large number of brain tumors.

The most common system for grading gliomas is called the WHO system because it is approved by the World Health Organization. In the WHO system, there are four grades of astrocytomas. Grade I are the slowest growing, least aggressive tumors and grade IV are the fastest growing, most aggressive tumors. In the WHO system, grade III is synonymous with anaplastic astrocytomas and grade IV is synonymous with glioblastoma multiforme. There are also other systems used at individual institutions, so it is worth asking a doctor to explain what system he or she is using.

Q. My doctor says a brain tumor is not cancer. Is that true?
A. Technically, yes. A tumor is cancerous if it will spread, or metastasize, beyond it's original site to other parts of the body. Primary brain tumors rarely, if ever, spread outside the brain, so they are not technically cancer. However, psychologically and practically, brain tumors are a lot like cancerous tumors. The treatments are often the same, and resources that are helpful to cancer patients, such as cancer support groups, the American Cancer Society, and the National Cancer Institute, are helpful to patients with brain tumors.

Q. Is a benign brain tumor safe?
A. There are two meanings of the word benign in reference to brain tumors. Just as brain tumors are not cancerous, brain tumors are benign because they do not spread outside the brain. However, growths in the brain are dangerous because of the importance of the brain and the limited amount of space inside the skull. Therefore, this meaning of the word benign is meaningless and misleading when applied to brain tumors.

Brain tumors are often divided between benign and malignant tumors based on grade. Low grade tumors are considered benign, while high grade tumors are considered malignant. Generally, the term malignant includes grade III and IV astrocytomas, including glioblastoma multiforme, and grade III oligodendroglioma. In this division, benign tumors are slower growing and less intertwined with normal brain tissue than malignant tumors. Benign tumors often can be removed more completely and respond better to treatment than malignant tumors.

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