Uterine cancer

Cancer of the endometrium, or uterine cancer, is the most common gynecologic cancer. It usually affects postmenopausal women between ages 50 and 60; it’s uncommon between ages 30 and 40 and extremely rare before age 30. Most premenopausal women who develop uterine cancer have a history of anovulatory menstrual cycles or another hormonal imbalance.

Incidence
Uterine cancer has an incidence of 1% to 2% in the United States.

Causes
Uterine cancer seems linked to several predisposing factors:

• low fertility index and anovulation
• abnormal uterine bleeding
• obesity, hypertension, or diabetes
• familial tendency
• history of atypical endometrial hyperplasia
• estrogen therapy (still controversial).

Pathology

Generally, uterine cancer is an adenocarcinoma that metastasizes late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and the brain, through the blood or the lymphatic system. Lymph node involvement can also occur. Less common uterine tumors include adenoacanthoma, endometrial stromal sarcoma, lymphosarcoma, mixed mesodermal tumors (including carcinosar- coma), and leiomyosarcoma.

Introduction to Gastric cancer

Introduction

Common throughout the world, gastric cancer affects all races. However, unexplained geographic and cultural differences in incidence occur; for example, mortality is high in Japan, Iceland, Chile, and Austria. In the United States, incidence has decreased 50% during the past 25 years, and the death rate from gastric cancer is one-third that of 30 years ago.
The decrease in gastric cancer incidence in the United States has been attributed, without proof, to the balanced American diet and to refrigeration, which reduces the number of nitrate-producing bacteria in food.
Incidence is highest in men over age 40. The prognosis depends on the stage of the disease at the time of diagnosis; overall, the 5-year survival rate is about 15%.

Etiology
The cause of gastric cancer is unknown. 

This cancer is commonly associated with 

• gastritis, 
• chronic inflammation of the stomach, 
• gastric ulcers, 
• Helicobacter pylori bacteria, and 
• gastric atrophy. 

Predisposing factors include environmental influences, such as smoking and high alcohol intake.

Genetic factors have also been implicated because this disease occurs more frequently among people with type A blood than among those with type O; similarly, it’s more common in people with a family history of such cancer.
Dietary factors include types of food preparation, physical properties of some foods, and certain methods of food preservation (especially smoking, pickling, and salting).

Classification
According to gross appearance, gastric cancer can be classified as 

Chronic Lymphocytic Leukemia

A generalized, progressive disease that’s common in elderly people, chronic lymphocytic leukemia is marked by an uncontrollable spread of abnormal, small lymphocytes in lymphoid tissue, blood, and bone marrow. The prognosis is poor if anemia, thrombocytopenia, neutropenia, bulky lymphadeno-pathy, or severe lymphocytosis is present.
Nearly all patients with chronic lymphocytic leukemia are men older than age 50. According to the American Cancer Society, chronic lymphocytic leukemia accounts for almost one-third of new leukemia cases annually.

Causes
Although the cause of chronic lymphocytic leukemia is unknown, researchers suspect hereditary factors (higher incidence has been recorded within families), still-undefined chromosome abnormalities, and certain immunologic defects (such as ataxia-telangiectasia or acquired agammaglobulinemia). The disease doesn’t seem to be associated with radiation exposure.

Signs and symptoms
Chronic lymphocytic leukemia is the most benign and the most slowly progressive form of leukemia. Signs and symptoms derive from the infiltration of leukemic cells in bone marrow, lymphoid tissue, and organ systems.

Early stages
In early stages, patients usually complain of fatigue, malaise, fever, and nodal enlargement. They’re particularly susceptible to infection, which may be fatal.

Summary of Bladder cancer

Bladder tumors can develop on the surface of the bladder wall (benign or malignant papillomas) or grow within the bladder wall (generally more virulent) and quickly invade underlying muscles. Most bladder tumors (90%) are transitional cell carcinomas, arising from the transitional epithelium of mucous membranes. Less common are adenocarcinomas, epidermoid carcinomas, squamous cell carcinomas, sarcomas, tumors in bladder diverticula, and carcinoma in situ. Bladder tumors are most prevalent in men older than age 50 and are more common in densely populated industrial areas, but women are diagnosed at more advanced stages.

Causes
Certain environmental carcinogens—such as 2-naphthylamine, benzidine, tobacco, and nitrates—predispose people to transitional cell tumors. Thus, workers in certain industries (rubber workers, weavers, leather finishers, aniline dye workers, hairdressers, petroleum workers, and spray painters) are at high risk for such tumors. The period between exposure to the carcinogen and development of symptoms is about 18 years.
Squamous cell carcinoma of the bladder is most common in geographic areas where schistosomiasis is endemic. It’s also associated with chronic bladder irritation and infection (for example, from kidney stones, indwelling urinary catheters, and cystitis caused by cyclophosphamide).

Signs and symptoms
In early stages, about 25% of patients with bladder tumors have no symptoms. Commonly, the first sign is gross, painless, intermittent hematuria (often with clots in the urine). Patients with invasive lesions often have suprapubic pain after voiding. Other symptoms include bladder irritability, urinary frequency, nocturia, and dribbling.

Diagnosis
Only cystoscopy and a biopsy can confirm bladder cancer. Cystoscopy should be performed when hematuria first appears. When it’s performed under anesthesia, a bimanual examination is usually done to determine if the bladder is fixed to the pelvic wall. A thorough history and physical examination may help determine whether the tumor has invaded the prostate or the lymph nodes.

Special Considerations in Patients with Laryngeal cancer

Special considerations

• Psychological support and good preoperative and postoperative care can minimize complications and speed recovery.
• Before partial or total laryngectomy:
• Instruct the patient to maintain good oral hygiene. If appropriate, instruct a male patient to shave off his beard.
• Encourage the patient to express his concerns before surgery. Help him choose a temporary nonspeaking method of communication (such as writing).
• If appropriate, arrange for a laryngectomee to visit him. Explain postoperative procedures (suctioning, nasogastric [NG] tube feeding, and care of laryngectomy tube) and their results (the need to breathe through the neck, altered speech). Also, prepare him for other functional losses: He won’t be able to smell, blow his nose, whistle, gargle, sip, or suck on a straw.

After partial laryngectomy:

• Give I.V. fluids and, usually, tube feedings for the first 2 days postoperatively; then give the patient oral fluids. Keep the tracheostomy tube (inserted during surgery) in place until edema subsides.
• Keep the patient from using his voice until he has medical permission (usually 2 to 3 days postoperatively). Then caution him to whisper until healing is complete.

After total laryngectomy:

• As soon as the patient returns to his bed, place him on his side and elevate his head 30 to 45 degrees. When you move him, remember to support his neck.
• The patient will probably have a laryngectomy tube in place until his stoma heals (7 to 10 days). This tube is shorter and thicker than a tracheostomy tube, but requires the same care.
• Watch for crusting and secretions around the stoma, which can cause skin breakdown. To prevent crust formation, provide adequate room humidification. Remove crusting with petroleum jelly, antimicrobial ointment, and moist gauze.
• Teach the patient stoma care.

Testicular cancer

Introduction

Malignant testicular tumors, which rank first in cancer deaths among men ages 20 to 35, primarily affect young to middle-aged men; they are the most common solid tumor in this group. (In children, testicular tumors are rare.) Most testicular tumors originate in gonadal cells. About 40% are seminomas— uniform, undifferentiated cells resembling primitive gonadal cells. The rest are nonseminomas—tumor cells showing various degrees of differentiation.
The prognosis varies with the cell type and disease stage. When treated with surgery and radiation, almost all patients with localized disease survive beyond 5 years.

Causes
The cause of testicular cancer isn’t known, but incidence (which peaks between ages 20 and 40) is higher in men with cryptorchidism (even when surgically corrected) and in men whose mothers used diethylstilbestrol during pregnancy. Exposure to certain chemicals, infection with human immunodeficiency virus, and a family history of testicular cancer increase risk. (Testicular cancer accounts for 1% of all cancers in men.)
Testicular cancer spreads through the lymphatic system to the para-aortic, iliac, and mediastinal lymph nodes and may metastasize to the lungs, liver, viscera, and bone.

Signs and symptoms
The first sign is usually a firm, painless, smooth testicular mass, varying in size and sometimes producing a sense of testicular heaviness. When such a tumor causes chorionic gonadotropin or estrogen production, gynecomastia and nipple tenderness may result.
In advanced stages, signs and symptoms include ureteral obstruction, abdominal mass, cough, hemoptysis, shortness of breath, weight loss, fatigue, pallor, and lethargy.

Thyroid cancer - A Short Discussion

Thyroid cancer occurs in all age groups, especially in persons who have had radiation treatment to the neck area. 

Papillary and follicular carcinomas are most common and are usually associated with prolonged survival.

Papillary carcinoma accounts for half of all thyroid cancers in adults; it’s most common in young adult females and metastasizes slowly. It’s the least virulent form of thyroid cancer. 

Follicular carcinoma is less common but more likely to recur and metastasize to the regional nodes and through blood vessels into the bones, liver, and lungs.

Medullary carcinoma originates in the parafollicular cells derived from the last branchial pouch and contains amyloid and calcium deposits. It can produce calcitonin, histaminase, corticotropin (producing Cushing’s syndrome), and prostaglandin E2 and F3 (producing diarrhea).
This rare form of thyroid cancer is familial, associated with pheochromocytoma, and completely curable when detected before it causes symptoms. Untreated, it progresses rapidly.
Seldom curable by resection, giant and spindle cell cancer (anaplastic tumor) resists radiation and metastasizes rapidly.

Causes
Predisposing factors include radiation exposure, prolonged thyrotropin stimulation (through radiation or heredity), familial predisposition, or chronic goiter.

Signs and symptoms
The primary signs of thyroid cancer are a painless nodule, a hard nodule in an enlarged thyroid gland, or palpable lymph nodes with thyroid enlargement. Eventually, the pressure of such a nodule or enlargement causes hoarseness, dysphagia, dyspnea, and pain on palpation.
If the tumor is large enough to destroy the gland, hypothyroidism follows, with its typical symptoms of low metabolism (mental apathy and sensitivity to cold). However, if the tumor stimulates excess thyroid hormone production, it induces symptoms of thyrotoxicosis (sensitivity to heat, restlessness, and hyperactivity).
Other clinical features include diarrhea, anorexia, irritability, vocal cord paralysis, and symptoms of distant metastasis.

Introduction to Pituitary Tumors

Constituting 10% of intracranial neoplasms, pituitary tumors typically originate in the anterior pituitary (adenohypophysis). They occur in adults of both sexes, usually during the third and fourth decades of life. The three tissue types of pituitary tumors are chromophobe adenoma (90%), basophil adenoma, and eosinophil adenoma.
The prognosis is fair to good, depending on the extent to which the tumor spreads beyond the sella turcica.

Causes
Although the exact cause is unknown, a predisposition to pituitary tumors may be inherited through an autosomal dominant trait. Some are part of a hereditary disorder called multiple endocrine neoplasia 1. Pituitary tumors aren’t malignant in the strict sense; however, because their growth is invasive, they’re considered a neoplastic disease.
Chromophobe adenoma may be associated with the production of corticotropin, melanocyte-stimulating hormone, growth hormone, and prolactin; basophil adenoma, with evidence of excess corticotropin production and, consequently, with signs of Cushing’s syndrome; and eosinophil adenoma, with excessive growth hormone.

Signs and symptoms
As pituitary adenomas grow, they replace normal glandular tissue and enlarge the sella turcica, which houses the pituitary gland. The resulting pressure on adjacent intracranial structures produces typical clinical features.

Neurologic features

• Frontal headache
• Visual symptoms, beginning with blurring and progressing to field cuts (hemianopias) and then unilateral blindness
• Cranial nerve involvement (III, IV, VI) from lateral extension of the tumor, resulting in strabismus; double vision, with compensating head tilting and dizziness; conjugate deviation of gaze; nystagmus; lid ptosis; and limited eye movements
• Increased intracranial pressure (secondary hydrocephalus)
• Personality changes or dementia, if the tumor breaks through to the frontal lobes
• Seizures
• Rhinorrhea, if the tumor erodes the base of the skull
• Pituitary apoplexy secondary to hemorrhagic infarction of the adenoma. Such hemorrhage may lead to both cardiovascular and adrenocortical collapse.

Introduction to Breast cancer

Breast cancer is the most common cancer affecting women and is the number two killer (after lung cancer) of women ages 35 to 54. It occurs in men, though only rarely. (See Breast cancer in men.) The overall breast cancer death rate for American women has fallen. Lymph node involvement is the most valuable prognostic predictor. With adjuvant therapy, 70% to 75% of women with negative nodes will survive 10 years or more, compared with 20% to 25% of women with positive nodes.
Although breast cancer may develop anytime after puberty, it’s most common after age 50.

Causes
The cause of breast cancer is unknown, but its high incidence in women implicates estrogen. Certain predisposing factors are clear; women at high risk include those who:

• have a family history of breast cancer
• have long menses; began menses early or menopause late
• have never been pregnant
• were first pregnant after age 31
• have had unilateral breast cancer
• have had endometrial or ovarian cancer
• have been exposed to low-level ionizing radiation.

Many other predisposing factors have been investigated, including estrogen therapy, antihypertensives, high-fat diet, obesity, and fibrocystic disease of the breasts.

Women at lower risk include those who:

• were pregnant before age 20
• have had multiple pregnancies
• are Indian or Asian.

Pathophysiology
Breast cancer is more common in the left breast than in the right and more common in the upper outer quadrant. Growth rates vary. Theoretically, slow-growing breast cancer may take up to 8 years to become palpable at 1 cm in size. It spreads by way of the lymphatic system and the bloodstream, through the right side of the heart to the lungs and, eventually, to the other breast, the chest wall, liver, bone, and brain.
Many refer to the estimated growth rate of breast cancer as doubling time, or the time it takes the malignant cells to double in number. Survival time for breast cancer is based on tumor size and spread; the number of involved nodes is the single most important factor in predicting survival time.

Classified by histologic appearance and location of the lesion, breast cancer may be:
adenocarcinoma—arising from the epithelium
intraductal—developing within the ducts (includes Paget’s disease)
infiltrating—occurring in parenchymatous tissue of the breast
inflammatory (rare)—reflecting rapid tumor growth, in which the overlying skin becomes edematous, inflamed, and indurated
lobular carcinoma in situ—reflecting tumor growth involving lobes of glandular tissue
medullary or circumscribed—a large tumor with a rapid growth rate.

Introduction to Lymphomas

Also known as non-Hodgkin’s lymphomas and lymphosarcomas, malignant lymphomas are a heterogeneous group of malignant diseases originating in lymph glands and other lymphoid tissue. Nodular lymphomas have a better prognosis than the diffuse form of the disease, but in both, the prognosis is worse than in Hodgkin’s disease.

Causes
The cause of malignant lymphomas is unknown, although some theories suggest a viral source. 

Incidence

Up to 35,000 new cases appear annually in the United States. Malignant lymphomas are two to three times more common in males than in females and occur in all age-groups.
Although rare in children, these lymphomas occur one to three times more often and cause twice as many deaths as Hodgkin’s disease in children under age 15. Incidence rises with age (median age is 50). Malignant lymphomas seem linked to certain races and ethnic groups, with increased incidence in whites and people of Jewish ancestry.

Signs and symptoms
Usually, the first indication of malignant lymphoma is swelling of the lymph glands, enlarged tonsils and adenoids, and painless, rubbery nodes in the cervical or supraclavicular areas. In children, these nodes are usually in the cervical region, and the disease causes dyspnea and coughing.
As the lymphoma progresses, the patient develops symptoms specific to the area involved and systemic signs and symptoms, such as fatigue, malaise, weight loss, fever, and night sweats.

Brief Summary of Multiple myeloma

Multiple myeloma is also known as malignant plasmacytoma, plasma cell myeloma, and myelomatosis. It’s a disseminated neoplasm of marrow plasma cells that infiltrates bone to produce osteolytic lesions throughout the skeleton (flat bones, vertebrae, skull, pelvis, ribs); in late stages, it infiltrates the body organs (liver, spleen, lymph nodes, lungs, adrenal glands, kidneys, skin, GI tract). Multiple myeloma strikes mostly men older than age 40.
The prognosis is usually poor because the disease is commonly diagnosed after it has already infiltrated the vertebrae, pelvis, skull, ribs, clavicles, and sternum. By then, skeletal destruction is widespread and, without treatment, leads to vertebral collapse. Early diagnosis and treatment prolong the lives of many patients by 3 to 5 years. Death usually follows complications, such as infection, renal failure, hematologic disorders, fractures, hypercalcemia, hyperuricemia, or dehydration.

Pathophysiology
Multiple myeloma is characterized by excessive growth and malformation of plasma cells in bone marrow. The growth of these extra cells interferes with the production of red blood cells, white blood cells, and platelets, resulting in anemia, susceptibility to infection, and increased tendency toward bleeding. As the cancer cells grow and expand, pain and destruction of bone occurs.

Signs and symptoms
The earliest symptom of multiple myeloma is usually back pain. This disease should be considered in diagnosis or treatment of elderly patients with new onset of lower back pain. Arthritic symptoms may also occur: achiness, joint swelling, and tenderness, possibly from vertebral compression. Other effects include fever, malaise, slight evidence of peripheral neuropathy (such as peripheral paresthesia), pathologic fractures, and easy bruising.

As multiple myeloma progresses, symptoms of vertebral compression may become acute, accompanied by anemia, weight loss, thoracic deformities (ballooning), and loss of body height due to vertebral collapse.