A Family Doctor's Tale - CANCER SCREENING 2

DOC DO I NEED TO GO FOR CANCER SCREENING 2

Cancer Screening tests:

A.Colorectal cancer

Colorectal cancer is the most common cancer in Singapore and can begin as behign growths (polyps)in the colon.

Early detection of these polyps means they can be removed to prevent colorectal cancer.

People who are at high risk are:

1. all men and women above the age of 50 years

2. those with a family history of colorectal cancer


Cancer screening procedures includes:

1.Faecal Occult Blood Test(FOBT)

This test detects tiny amounts of blood in the stools from bleeding in the colon and rectum.

Those who has a positive test should go for colonoscopy to exclude cancer.

This test should be done yearly.

2.Colonoscopy

A colonoscope has a light, camera and surgical instruments which can be used to examine the entire large intestine and removes polyps found during the procedure.

This test should done at 5 years interval especially for people above the age of 50 with a history of positive blood in the stools and a family history of colorectal cancer.

3.CT Colonography Special X ray equipment is used to create detailed images of the inside of the colon and rectum using computer tomograpghy. It can detect early polyps or cancer in the colon.

4.Blood test-tumor markers such as CEA may be raised in colorectal cancer but are not significant in making a diagnosis as they may be raised in other cancers as well.

CA 19.9 may also be raised in 64% of colorectal cancer.

B.Lung cancer

Lung cancer is the second most common cancer after colorectal cancer.

It is usually associated with smoking, air pollution, chemicals such as asbesto, gasoline.

People who are at high risk are:

1.People with a family history of lung cancer

2.smoking

3.exposure to inhalation of chemicals such as asbesto, gasolines,

They should be screened even at a early age of 25 years and above.

Cancer screening procedures includes:

1.CT scan of the lungs is the best way of determining the presence of cancer of the lungs.

2.Blood test -tumor marker such as CEA(carcinoembryonic antigen) is usually raised but can also be high in other cancers such as lung, stomach, breast, ovary abd cervix and also benign diseases such as inflammations of bowel, lung, pancreas and liver cirrhosis.

A Simple Guide to Lung Cancer

A Simple Guide to Lung Cancer
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What is Lung Cancer?
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Lung Cancer is the uncontrolled growth of abnormal cells in one or both lungs.
The cells lining air passages grow and divide until an abnormal mass or tumour is formed. The cells then grow and spread to the rest of the body.

What are the types of Lung Cancer?
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There are 2 main types of Lung Cancer:
1. small cell lung cancer (SCLC) has the most aggressive clinical course of any type of pulmonary tumor, with poor survival rate from diagnosis of only 2 to 4 months.

2. non-small cell lung cancer:
a.Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales.
b.Large cell carcinoma: Cancer that may begin in several types of large cells.
c.Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
d.Other less common types of non-small cell lung cancer are: pleomorphic, carcinoid tumor, salivary gland carcinoma, and unclassified carcinoma.

These types are diagnosed based on how the cells look under a microscope.

The Non-small cell Lung cancer may take up to 10-30 years to develop. Thus it is often seen in middle aged and elderly persons.
Once developed Lung cancers tend to spread quickly because the lungs are richly supplied by blood and lymph vessels.
In the travel through the lymph vessels, it can cause enlarged lymph nodes.
If it enter the blood , the cancer cells can spread to the liver, bone, brain or other parts of the body.

What are the causes of Lung Cancer?
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1.Cigarette smoking is the main cause of lung cancer.

2. Cigar and pipe smoking is also a source of lung cancer though less than those who smoke cigarettes.

3. Passive smoking in a family where one member smokes has been to increase the risk of lung cancer by 35%

4. Industrial hazards such as chemicals and smoke emitted at work[place also increase the risk of lung cancer. Examples are asbestos, coal gas,chromates,uranium.

5.Being treated with radiation therapy to the breast or chest.

What are the symptoms of Lung Cancer?
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1.Persistent cough which does not improve
2. shortness of breath and wheezing dut to the pressure of the tumour on the airway
3.Production of blood stained sputum
4. chest pain especially together with a chronic cough
5.Sudden unexplained loss of weight
6. Loss of appetite
7. General weakness and tiredness
8.Recurrent chest infections and fever
9. hoarseness of voice

How do you diagnose Lung Cancer?
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1. History & Medical examination especially history of smoking and exposure to chemicals
2. Chest X-ray to check for lung shadows
3. Sputum cytology- sometimes the cancer cells may be detected in the sputum
4. Bronchoscopy- a bronchoscope is passed into bronchi to study the airway while the patient is under general anesthesia.
Suspicious growth can be taken for biopsy(examination under microscope for cancer cells)
5.CT Scan & MRI produce 3D mages of the lung
6.Ultrasound or another imaging procedure is used to locate the abnormal tissue or fluid in the lung.
7.Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision is made between two ribs, and a thoracoscope is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. This procedure may be used to remove parts of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.

What is the Treatment of Lung Cancer?
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As usual the treatment consists of Surgery, Radiotherapy and chemotherapy.The choice of treatment depends on the size, extent of cancer , the type of lung cancer and the general health of the patient.

Surgery:
Part or whole of the lung can be removed in the treatment of lung cancer.
After surgery the patient may required assisted ventilation for a short period.
Physical activity may be limited for a while.
If the remaining lung is in good condition, the patient may be able to live a normal life.

Chemotherapy:
Certain type of lung cancer( small cell) are sensitive to chemotherapy. It is used in combination with surgery and radiotherapy.

Radiotherapy:
Radiation may be used in conjunction with surgery or to relieve pressure symptoms or pain caused by the lung cancer.

What is the prognosis of Lung Cancer?
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The prognosis (chance of recovery) depend on the following:

The stage of the cancer (the size of the tumor and whether it is in the lung only or has spread to other places in the body).
The type of lung cancer.
Whether there are symptoms such as coughing or trouble breathing.
The patient’s general health.

For most patients with non-small cell lung cancer, current treatments do not cure the cancer.

Small cell lung cancer has a greater tendency to be widely disseminated by the time of diagnosis but is much more responsive to chemotherapy and radiation therapy.
Because patients with small cell lung cancer tend to develop distant metastases, localized forms of treatment, such as surgical resection or radiation therapy, rarely produce long-term survival. With use ofchemotherapy regimens in the treatment program, however, survival is much prolonged.


Added 4th October 2008
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Lung Cancer
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1. Lung cancer is still the biggest cancer killer in the world.

2. Every 30 seconds someone dies of lung cancer

3. About 40% of smokers who continues smoking from their early teens risk early death from lung cancer

4. 1 in 10 people with lung cancer lives for more than 5 years after diagnosis

5. Women smokers are twice as likely to get lung cancer than male smokers.