Female Sexual Dysfunction Drug

A new Canadian drug to treat vaginal atrophy and female sexual dysfunction is being developed by a new partnership between Bayer Inc and EndoCeutics Inc, who are based in Quebec. The deal, believed to be worth up to three hundred and thirty million dollars, was revealed on Tuesday and concerns the Phase III development and marketing of the new Canada drug Dehydroepiandrosterone, otherwise known as DHEA.

It could cost up to three hundred and thirty million to finance research costs and pay for clinical trials of the Canadian drug in both Canada and the United States. DHEA is believed to be a major factor in menopausal problems for women, decreased levels of which can cause vaginal atrophy and sexual dysfunction. “Up to seventy five percent of post menopausal women suffer from vaginal atrophy,” claims EndoCeutics CEO Dr. Fernand Labrie. “We believe that Bayer, a world leader in women’s health, is the best partner for this partnership and the commercialization of this product worldwide.

EndoCeutics will carry out the Phase III clinical studies of the Canada drug itself, which Bayer will then pick up from by licensing and commercializing, manufacturing, marketing and distributing any products that emerge from the tests, for which they have been granted an exclusive license all over the world except for Canada itself, which EndoCeutics is reserving the right to commercialize in.

Providing it gets the go ahead by health authorities, the drug is expected to be sold under the name Vaginorm.

What is female sexual dysfunction?

It is estimated that up to 40 per cent of women have suffered from sexual problems in the past year. This might be caused by physical illness, but is often linked to psychological factors.

The female equivalent of impotence is known as female sexual arousal disorder (FSAD).

When men and women become sexually aroused, their genitals become engorged with blood. In women this normally results in:

Enlargement of the clitoris and surrounding tissues (comparable to a male erection)

Secretion of vaginal lubrication

Relaxation and widening of the vaginal opening to permit intercourse

FSAD patients have the desire to have sex but their genital area fails to respond in the normal way, making sex painful or impossible
.

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Causes of female sexual dysfunction

Causes of female sexual dysfunction

FSAD can result from an underlying medical condition, such as high blood pressure or diabetes. It can also be caused by irritations, infections and growths in the vaginal area, or reactions to contraceptive devices. Medications used to treat high blood pressure, peptic ulcers, depression or anxiety and cancer may also cause problems.

Another factor is the physical, hormonal and emotional changes that occur during or after pregnancy, while breastfeeding or, very importantly, during and after the menopause.

FSAD is also often linked to psychological causes. These can include:

Inadequate or ineffective foreplay

Depression

Poor self-esteem

Sexual abuse

Feelings of shame or guilt about sex

Fear of pregnancy

Stress and fatigue

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Symptoms of female sexual dysfunction

Symptoms of female sexual dysfunction

The symptoms of sexual dysfunction can include lack of sexual desire, an inability to enjoy sex, insufficient vaginal lubrication or a failure to achieve an orgasm even if sexually aroused.

Women who suffer from female orgasmic disorder (FOD) are unable to achieve orgasm despite being sufficiently aroused to have sex.

Women differ from men in that orgasm is a learned, not automatic, response. About five to 10 per cent of women never have an orgasm through any type of sexual activity - a condition called anorgasmia. Anorgasmia is most often the result of sexual inexperience, performance anxiety or past experiences, such as sexual trauma or a strict upbringing, that have led to an inhibition of sexual response.

Some women are able to enjoy sexual activity in spite of reaching orgasm only some or even none of the time. FOD is a problem only if it has a negative effect on the satisfaction of a woman or her partner.

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Treatments for female sexual dysfunction

Treatments for female sexual dysfunction

Research has suggested the anti-impotence drug sildenafil citrate (Viagra) may help to treat sexual disorders in women by increasing blood flow to the sexual organs and thereby increasing physical stimulation in the area. However, the scientific community is still waiting for firm evidence to be published to show exactly how effective the drug is for women.

In 2009 a review of trials of Viagra for the treatment of FSAD found that the research showed that drug is moderately effective. It may also be effective in women with FSAD secondary to multiple sclerosis, diabetes or antidepressant use. However, more studies are needed to confirm these findings. A small study published recently found no positive impact on postmenopausal women.

Testosterone has been looked at as a treatment also but again, results have not been as positive as hoped. For the moment, doctors concentrate on eliminating medications that might have a negative effect on sexual performance. They also review contraceptive methods to ascertain whether this is a factor.

Women who suffer from vaginal dryness may also be recommended to use lubricants during intercourse. Some doctors recommend that women use Kegel exercises, which help to develop the muscles around the outer portion of the vagina that are involved in pleasurable sensations.

Psychological counselling can also play an important part in treating women with sexual problems, as can coaching in sexual foreplay and stimulation techniques.

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Top 10 Best Selling Drugs

The following is the result of my research for the data you have

requested on best selling drugs:

A List of the Best-Selling Drugs in the U.S.

(As appeared in the online version of the New York Times 9/30/04)

The top selling drugs in the United States in 2003, their annual

sales, what it treats and its manufacturer. The 2003 data is the most

recent audited figures available.

DRUG ANNUAL SALES TREATS MANUFACTURER

Lipitor $6.8 billion cholesterol Pfizer Inc.

Zocor $4.4 billion cholesterol Merck & Co.

Prevacid $4.0 billion heartburn TAP Pharma

Procrit $3.3 billion anemia Johnson & Johnson

Zyprexa $3.2 billion mental illness Eli Lilly & Co.

Epogen $3.1 billion anemia Amgen

Nexium $3.1 billion heartburn Merck & Co.

Zoloft $2.9 billion depression Pfizer Inc.

Celebrex $2.6 billion arthritis Pfizer Inc.

Neurontin $2.4 billion epilepsy Pfizer Inc.

Advair Diskus $2.3 billion asthma GlaxoSmithKline PLC

Plavix $2.2 billion blood clots Bristol-Myers Squibb

Norvasc $2.2 billion hypertension Pfizer Inc.

Effexor XR $2.1 billion depression Wyeth

Pravachol $2.0 billion cholesterol Bristol-Myers Squibb

Risperdal $2.0 billion mental illness Johnson & Johnson

Oxycontin $1.9 billion pain Perdue Pharma

Fosamax $1.8 billion osteoporosis Merck & Co.

Protonix $1.8 billion gastrointestinal Wyeth

Vioxx $1.8 billion arthritis Merck & Co.

"The information contained in this report was derived using NDCHealth

proprietary methodologies and is based on prescription data and

wholesale acquisition cost (WAC) prices for retail, mail order,

clinics, hospitals, long-term care and home health care organizations

and other non-retail channels."

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WHAT IS CANCER?

WHAT IS CANCER?

Cancer is the name given to a large group of diseases, all of which have one thing in common: cells that are growing out of control. Normally, the cells that make up all of the parts of our bodies go through a predictable life cycle -- old cells die, and new cells arise to take their place. Occasionally, this process goes awry, and cells begin to multiply out of control. The end result is a mass of cells, called a tumor. A benign tumor is one that does not spread, or metastasize to other parts of the body. It is considered noncancerous. A malignant tumor, on the other hand, can spread throughout the body and is considered cancerous. When malignant cells break away from the primary tumor and settle into another part of the body, the resulting new tumor is called either a metastasis or a secondary tumor.

There are several major types of cancers: carcinomas form in the cells that cover the skin or line the mouth, throat, lungs and organs; sarcomas are found in the bones, muscles, fibrous tissues and some organs; leukemia are found in the blood, the bone marrow, and the spleen; and lymphomas are found in the lymphatic system.

CAUSES OF CANCER

Cancer often takes many years to develop. The process typically begins with some disruption to the DNA of a cell, the genetic code that directs the life of the cell. There can be many reasons for disruptions, such as diet, tobacco, sun exposure, reproductive history or certain chemicals. Some cells will enter a precancerous phase, known as dysplasia. Some cells will progress further to the state of carcinoma in situ, in which the cancer cells are restricted to a microscopic site, surrounded by a thick covering and do not pose a great threat.

Eventually, unless the body's own immune system takes care of the wayward cells, a cancer will develop. It may take as long as 30 years for a tumor to go through the entire process and become large enough to produce symptoms.

SYMPTOMS OF CANCER

Since cancer can arise from such a wide variety of sites and develop with many differing patterns of spread, there are no clear-cut symptoms . Cancer is unlike many more specific diseases such as heart disease or arthritic disease. The precise nature of symptoms of cancer depends not only on primary site but specifically where the tumor is located in an organ, rate of development and also secondary spread is present or not.

Many primary tumors cause local swelling or lump if they arise at a visible or accessible part of the body, such as a skin, breast, testicle or oral cavity. A typical swelling due to a cancer is initially painless, though ulceration (skin breakdown) can occur, which may then become painful.

TREATMENT OF CANCER

The aim of cancer treatment is to cure the patient and save life. The cases where complete cure is not possible, treatment aims to control the disease and to keep the patient normal and comfortable as long as possible. The treatment of each patient is designed to suit an individual and depends on the age of the patient, stage and type of disease. There may be only one treatment or combination of treatments. There are four main modalities of treatment : Surgery, Radiation therapy, Chemotherapy, hormonetherapy and Immunotherapy. Surgery and radiotherapy aim at eradicating the disease at the primary site (site of origin) of cancer whereas chemotherapy, hormonetherapy and immunotherapy deal with disease which may have spread outside the site of origin of cancer. Surgery is the most important part of the cancer treatment. Surgery attempts to remove cancer cells from the body by cutting away the tumor and any tissues surrounding it which may contain cancer cells. It is a simple, safe and effective method when cancer is small and confined to the site of origin. It is best suited for certain type of cancers such as, breast cancer, head and neck cancers, early cancers of the cervix and lung, many skin cancers, soft tissue cancers and gastrointestinal cancers. Radiotherapy has become the pre-eminent form of cancer treatment since beginning of this century and now it is used for fifty percent of patients. Improvements in radiotherapy equipment, technique and applications, have led to an increasing role both in local treatment and also in its use as a whole-body treatment , as part of bone marrow transplantation techniques for leukaemia and other malignant diseases.

Radiation is a special kind of energy carried by waves or a stream of particles originating from radioactive substances and delivered by special machines. These radioactive x-rays or gamma rays can penetrate the cell wall and damage the nucleus of the cell which prevents growth and division of cells. This also affects the normal cells but these cells recover more fully than cancer cells. Chemotherapy uses drugs which interfere with the growth and division of malignant cells. Once the drugs are administered, they circulate throughout the body. It is advantageous over surgery & radiation for treating cancer that is systemic (spread throughout the body). Chemotherapy is very useful in treating cancers like leukemia, lymphomas, testicular cancer. Chemotherapy can be given as the primary treatment, or following surgery or radiotherapy to prevent reappearance of cancer.

The side-effects of the chemotherapy include nausea, vomiting, hair loss, fever etc. which are temporary and completely reversible. Hormone therapy has limited use in cancer treatment since only a small minority of tumors are hormone sensitive e.g. breast and prostate cancer. This therapy provides systemic means of treatment, i.e. to the whole body, but without the side effects of chemotherapy. In summary, it is misconception that all cancers are incurable. Current methods of treatment are effective for many cancers. A large number of cancer patients are cured and more patients could be cured if their cancers were detected early and treated promptly.

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BLADDER CANCER

BLADDER CANCER

Of the three main types of bladder cancers, the most common is transitional cell carcinoma. Less common bladder cancers include squamous cell carcinomas and adenocarcinomas.

A patient's treatment and survival rate depend on how deeply the cancer has invaded the bladder, and if it has spread to surrounding or distant sites.

SYMPTOMS

The most common symptom of bladder cancer is blood in the urine. This symptom is usually painless, and is not always visible to the naked eye. Often, the diagnosis of bladder cancer is delayed because bleeding is intermittent. Other symptoms include an increased frequency of urination, an increased urgency to urinate, feeling the need to urinate but not being able to, and painful urination.

If you have one or more of these symptoms, it does not mean that you have bladder cancer. However, it is important to see a doctor so that any illness can be diagnosed and treated as early as possible.

DIAGNOSIS

Bladder cancer is most often diagnosed by examining cells in the urine under a microscope and by inspecting the bladder with a cystoscope -- a slender tube fitted with a lens and a light that is inserted into the bladder through the urethra.

If cancer is suspected, a tissue sample is removed during the cystoscopic procedure and examined under a microscope. If cancer is confirmed, computed topography (CT) may also be needed to determine the stage of the cancer -- whether the cancer is confined to the bladder or whether it has spread to other parts of the body, such as the lymph nodes, lungs, bones, or liver. Research is under way at Tata Memorial Centre to determine if magnetic resonance imaging (MRI) and positron emission tomography (PET) can more accurately diagnose and stage bladder cancer.

TREATMENT

Treatment for bladder cancer varies greatly depending on the stage of disease at the time of diagnosis.

Superficial Bladder Cancer

The majority of bladder cancers are transitional cell carcinomas (TCC) that are confined to the lining of the bladder. The standard treatment for superficial bladder cancer is minimally invasive surgery using a cystoscope to remove the tumor.

Invasive Bladder Cancer

Surgery to remove the bladder is the most common treatment for invasive bladder cancer -- cancer that has spread into or beyond the muscle layer of the bladder wall -- and provides the best opportunity for a long-term cure for most patients.

For patients whose tumors require surgery to remove the entire bladder, it is also necessary to remove the surrounding lymph nodes to help prevent cancer recurrence or metastasis. In women, this procedure also involves the removal of the lower portion of the ureters, the uterus, fallopian tubes, the ovaries, and sometimes part of the vaginal wall and the urethra. In men, the prostate gland, the lower portion of the ureters, and sometimes the urethra are removed. After removing the bladder, surgeons must create a new way for the body to store and eliminate urine. The historical approach, called an ileal conduit, required a patient to wear a bag on the outside of the body to collect urine. During this procedure, a conduit for the urine was created using a segment of the small intestine. It transferred urine directly from the kidneys and ureters, and required a stoma on the skin to funnel the urine into the collection bag.

For people whose urethra has been removed, an internal bladder is created and then attached directly to the abdominal wall. A stoma is attached to the internal bladder, and the patient inserts a catheter into the stoma to eliminate the stored urine. It takes about three to five minutes to empty the bladder this way.

Many patients with muscle-invasive bladder cancer are treated with chemotherapy before or after surgery, using M-VAC or other regimens that have fewer side effects, to help prevent the recurrence of cancer.

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BONE CANCERS

BONE CANCERS

Primary bone cancer -- cancer that actually starts in bone tissue -- is relatively rare. Bone cancer can occur in any of the bones of the body, but it occurs most often in the long bones of the arms and legs.

While it can occur at any age, the most common types occur in children and young adults.

TYPES OF BONE CANCERS

Primary bone cancer, which means cancer that actually starts in bone tissue, is relatively rare. About 2,400 cases are diagnosed every year. Primary bone cancer can occur in any of the 206 bones of the adult human body, but it occurs most often in the long bones of the arms and legs. Although bone cancer can occur at any age, the most common types occur in children and young adults.

Bone cancers form in the cells that make hard bone tissue. Cancers that arise in the cells produced in the bone marrow, such as leukemia, multiple myeloma, and lymphoma, are not considered bone cancers, although they do affect the bone and may require orthopedic management.

Benign (noncancerous) bone tumors are more common than malignant (cancerous) ones. Although benign tumors do not spread, and are rarely life threatening, both types may grow and compress healthy bone tissue and absorb or replace it with abnormal tissue.

Osteosarcoma

Osteosarcoma is the most common type of primary bone cancer, making up 35 percent of bone cancer cases. This cancer affects primarily children and young adults between the ages of 10 and 25. Osteosarcoma often starts in the ends of bones, where new tissue forms as children grow. It arises most often in the knee.

Chondrosarcoma

Chondrosarcomas, one of the most common types of bone cancer in adults over age 50, form in cartilage -- usually around the pelvis, knee, shoulders, or upper part of the thighs. These cancers make up 26 percent of all bone cancer cases.

Ewing's Sarcoma

Ewing's sarcoma occurs most often in the middle part of bones, arising most often in the hip, ribs, upper arm, and thighbones. Like osteosarcoma, this cancer affects primarily children and young adults between the ages of 10 and 25. Ewing's sarcoma is responsible for 16 percent of bone cancer cases.

Rarer Bone Cancers

The following types of bone cancer are rare, and occur primarily in adults:

Fibrosarcomas usually appear in the knee or hip area. They can arise in older patients after radiation therapy for other cancers.

Adamantinomas usually occur in the shinbone.

Chordomas are found most often in the sacrum -- the lower part of the spine, also known as the tailbone.

Metastatic Bone Cancer

Metastatic bone cancer -- cancer that starts somewhere else in the body and then spreads to the bone -- is much more common than primary bone cancer. Although any type of cancer can spread to the bone, the most common types are those of the breast, lung, kidney, thyroid, and prostate. Bone metastases most often arise in the hip, femur (thighbone), shoulder, and spine. Like other types of cancer, those that start in the bone can also spread to other parts of the body. The remainder of this overview focuses on the primary bone cancers osteosarcoma and Ewing's sarcoma.

SYMPTOMS

The most common symptom of bone cancer is pain, which is caused either by the spread of the tumor or by the breaking of bone that is weakened by a tumor. Stiffness or tenderness in the bone may also occur. Sometimes there are other symptoms, such as fatigue, fever, swelling, and stumbling.

But these symptoms can also be caused by other conditions. Only a doctor can tell for sure whether or not a patient has bone cancer.

DIAGNOSIS

As with most illnesses, the first part of the diagnosis of suspected bone cancer is a discussion with the doctor about the patient's personal and family medical history. Then the doctor performs a complete medical examination and conducts various tests.

Laboratory Tests

One key test is an examination of a patient's blood for alkaline phosphatase, an enzyme that can be found at particularly high levels in the blood when bone-forming cells are very active. This kind of high activity occurs normally when a young child's bones are growing, or when a broken bone is mending. Otherwise, it might be an indication that a tumor is creating abnormal bone tissue. Since alkaline phosphatase may rise in response to other causes, high levels don't necessarily indicate whether a patient has bone cancer, but they do signal the need for further evaluation.

Imaging Tests

A physician will usually order imaging tests such as an x-ray, which will allow the doctor to see any unusual bone growths. This may be followed by a bone scan, to see if there are other abnormal areas in the skeleton. Before a bone scan, a small amount of "tracer" material is injected into a vein. After a few hours, this tracer material, which is slightly radioactive, collects in places where there is new bone growth. A CT (computed tomography) or MRI (magnetic resonance imaging) scan is often ordered to show the exact size and shape of the suspected bone tumor, and to determine if it has invaded surrounding tissue or the bone marrow space.

Biopsy

Finally, a biopsy of the suspicious bone tissue is needed to make a definite diagnosis. If the tumor is small enough, the doctor may remove the entire tumor, then analyze samples of it under a microscope to see if it is cancerous. This procedure is called an "excisional biopsy." In other cases, the doctor may make a small opening in the skin and remove just a small part of the tumor for analysis -- an "open biopsy." Or the doctor may do a needle biopsy, in which a sample of the tumor is removed through the skin using a needle. It is important that the biopsy be performed by an experienced and skilled surgeon, because an improperly performed biopsy may limit treatment options later.

A pathologist examines the biopsy samples to determine whether or not the tissue is cancerous, and if it is, to identify the exact type of cancer. Determining the exact type of cancer is critical, because not all types of bone cancer respond to the same types of treatment.

TREATMENT

Though surgical resection remains the mainstay of treatment in musculoskeletal tumors it is uncommon for a patient with a high grade sarcoma to be treated by surgery alone. Adjuvant modalities like chemotherapy and radiotherapy play an essential part in the integrated management of these patients. A majority of bone tumors would receive chemotherapy while some like Ewing's sarcoma would benefit from additional radiotherapy.

Surgery

Surgery is used to remove the bone cancer itself. When operating to remove bone tumors, surgeons remove some of the surrounding bone and muscle to be sure that they are removing as much cancerous tissue as possible. If the operation is on an arm or leg, the surgeon will try , as much as possible, to preserve the limb and maintain its fnctionality. Sometimes the bone that is removed will be replaced with bone from another part of the body, bone from the tissue bank or with an artificial replacement.

Radiation Therapy

Radiation therapy is sometimes given together with surgery, to destroy tumors or to reduce the size of the tumor. Radiation therapy may also be used to kill remaining cancer cells after surgery, or treat tumors that cannot be surgically removed -- sometimes in combination with chemotherapy.

Chemotherapy

Chemotherapy is often used to treat primary bone cancers, in conjunction with surgery. Chemotherapy is commonly given before surgery to facilitate surgery and also after surgery to kill any cancer cells that remain in the body after the main tumor is removed surgically.

Osteosarcoma

Once tissue diagnosis is made, chemotherapy is advised. Chemotherapy is given both before and after surgery . Adriamycin, cisplatinum, ifosfamide and etoposide are the effective drugs against osteosarcoma.

Ewing's family of Tumors

Like in osteosarcoma, multiagent chemotherapy improves overall survival. Ifosfamide,etoposide, vincristine, adriamycin, cyclophosphamide and actinomycin-D are the agents used. Radiation had earlier been the preferred method of local control but the role of surgery is now being established. Recent reports indicate that surgery combined with chemotherapy and with or without radiation may have better local control rates than chemotherapy with radiation alone.

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BREAST CANCER

BREAST CANCER

Breast cancer is the most common of all cancers and is the leading cause of cancer deaths in women worldwide, accounting for >1.6% of deaths and case fatality rates are highest in low-resource countries. A recent study of breast cancer risk in India revealed that 1 in 28 women develop breast cancer during her lifetime. This is higher in urban areas being 1 in 22 in a lifetime compared to rural areas where this risk is relatively much lower being 1 in 60 women developing breast cancer in their lifetime. In India the average age of the high risk group in India is 43-46 years unlike in the west where women aged 53-57 years are more prone to breast cancer.

RISK FACTORS

The risk factors influencing breast cancer risk are broadly classified into modifiable and non –modifiable factors. The non modifiable risk factors are age, gender, number of first degree relatives suffering from breast cancer, menstrual history, age at menarche and age at menopause. While the modifiable risk factors are BMI, age at first child birth, number of children, duration of breast feeding, alcohol, diet and number of unsuccessful pregnancies ( abortions).

SCREENING

Women with a higher than average risk of developing breast cancer may be offered screening and genetic testing for the condition. NHS Breast Screening Programme recommends that women between 50-70 years of age of should be screened once every three years. Screening is especially recommended for women with risk factors, a significant one being family history. Having a 1st-degree relative (mother, sister, and daughter) with breast cancer doubles or triples the risk of developing the cancer. About 5% of women with breast cancer carry a mutation in one of the 2 known breast cancer genes, BRCA1 or BRCA2. If relatives of such a woman also carry the gene, they have a 50 to 85% lifetime risk of developing breast cancer. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and an improvement in survival rates. Approximately 20% of the cancers detected in a given year will be missed at the screening, but will become clinically evident in the period before the next screen (interval cancers).

PATHOLOGY

The various abnormalities of the breast include nipple discharge, inflammations, ANDI , benign disorders, phyllodes / sarcomas and carcinoma Most breast cancers are epithelial tumors that develop from cells lining ducts or lobules; less common are nonepithelial cancers of the supporting stroma (eg, angiosarcoma, primary stromal sarcomas, phyllodes tumor). Cancers are divided into carcinoma in situ and invasive cancer. Paget's disease of the nipple is a form of ductal carcinoma in situ that extends into the overlying skin of the nipple and areola, manifesting with an inflammatory skin lesion and may become invasive.

The pathological variations of breast cancer influence the prognosis. In situ cancers (DCIS/LCIS) are slow growing, indolent tumors. Autopsy studies have indicated that the incidence of DCIS in asymptomatic women ranges from .02% to 18.2% indicating that some DCIS do not become evident during a women’s lifetime. Invasive carcinoma is primarily adenocarcinoma. About 80% is the infiltrating ductal type; most of the remainder is infiltrating lobular. The pathological variants with a favorable prognosis are tubular, cribriform, mucinous and adenoid cystic variants, while intermediate prognosis is seen with medullary, secretory and invasive lobular cancers. The most unfavorable pathology is high grade metaplastic, micropalliary, signet ring cell morphology, inflammatory cancer.

PATHOPHSIOLOGY

Breast cancer invades locally and spreads initially through the regional lymph nodes, bloodstream, or both. Metastatic breast cancer may affect almost any organ in the body—most commonly, lungs, liver, bone, brain, and skin.

SYMPTOMS AND SIGNS

Most breast cancers present as

• a lump felt by the patient or during routine physical examination or mammography.

• Less commonly, the presenting symptom is thickening in the breast. Paget's disease of the nipple presents with skin changes, including erythema, crusting, scaling, and discharge.

• A few patients with breast cancer present with signs of metastatic disease (eg, pathologic fracture, pulmonary dysfunction).

During a physical examination a lump is felt distinctly different from the surrounding breast tissue. More advanced breast cancers are characterized by fixation of the lump to the chest wall or to overlying skin, by satellite nodules or ulcers in the skin. Matted or fixed axillary lymph nodes suggest tumor spread. Inflammatory breast cancer is characterized by diffuse inflammation and enlargement of the breast, often without a lump, and has a particularly aggressive course.

DIAGNOSIS

The triple assessment includes: clinical examination, radiological investigation and pathological correlation.

Radiololgy

Mammogram, ultrasound

Diagnostic mammography is a standard procedure done as part of the triple test for diagnosing breast cancer. However the efficacy of diagnostic mammography is anecdotal.

Often, the lump is not even visible on the mammogram or a lump is visible on mammogram but the appearance may be indeterminate. If the lesion is clinically suspicious and is not a cyst by ultrasonography or aspiration, then a biopsy is indicated despite the mammographic results. In this case, the mammogram adds little to the diagnosis. Its main use is for screening the rest of the breast and the contralateral breast for unsuspected cancer.

The lump may have a classic appearance of a benign calcifying fibroadenoma, mixed radiographic density hamartoma, or fat lesion such as fat necrosis or a lipoma. The appearance of these lesions can be used to avoid a biopsy, so that in these cases, the diagnostic mammogram is very helpful.

The lump may have a classic appearance of breast cancer and biopsy is clearly indicated. In this case, the mammographic findings could prevent a delay in diagnosis by making it clear that a biopsy is needed.

Magnetic Resonance Imaging

MRI is useful to locate a suspicious mammographic lesion that cannot be located by CBE or ultrasonography. Especially useful in young women with dense breast, women with implant in situ, previously operated breasts, recurrent lesions, wherein mammography may not be accurate.

Pathology

Needle Biopsy / FNAC

Confirmation of malignancy with cytology or histology is the minimum requirement for “indeterminate” or “high-risk” solid lesions.

Fine-needle aspiration / Tru cut / core biopsy / surgical excision/ Incision biopsy / percutaneous breast biopsy for non-palpable disease are the various methods used to obtain tissue for pathological confirmation.

If a woman is being treated with neoadjuvant therapy it is essential to perform a biopsy to obtain the ER/PR status of the tissue.

STAGING

The TNM staging is traditionally used to stage breast cancer (link) Patients are clinically grouped into one of the following categories

• Operable Breast Cancer

• Large Operable Breast Cancer

• Locally Advanced Breast Cancer

• Metastatic Breast Cancer

TREATMENT

Evidence Based Guidlines

Breast cancer can be treated using a multimodality approach of surgery, chemotherapy, radiotherapy and targeted therapy. The treatment options vary as per the stage of the tumor. There are multiple ongoing clinical trials in breast cancer; TMH is involved in many of the same.

INFORMATION FOR PATIENTS

Breast cancer is one of the commonest cancers in women in India. It is also one of the curable cancers if detected early. Any woman would dread getting cancer of the breast. Cancer subjects the family to unimaginable emotional stress. If you or someone you know has been diagnosed to have breast cancer it is important that you understand the disease, since ignorance breeds myths. We then have to fight not just the 'CANCER' but also the 'MYTHS'.

• Breast Cancer Awareness

• What After Diagnosis

• Treatment plan

• Post op instructions

• Adjuvant therapy

• Follow up

• Coping with cancer

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CERVICAL CANCER

CERVICAL CANCER

Cervical cancer is cancer of the cervix -- the opening of the uterus, extending into the upper end of the vagina. Some 12,000 American women will be diagnosed with cervical cancer this year. Thanks to effective screening, which can detect cervical precancers and cancers early, most of them can be cured.

With the advent of widespread screening by a vaginal smear test developed by George Papanicolaou in the 1950s (commonly known as the "Pap smear"), the number of deaths from cervical cancer has fallen dramatically -- from more than 35,000 per year to about 4,000 per year today.

A Slow-Growing, Treatable Cancer

Cervical cancer usually grows slowly over many years. Before true cancer cells develop, the tissues of the cervix undergo changes -- called dysplasia, or precancers -- that a pathologist can detect in a Pap smear. These changes range from mild dysplasia or cervical intraepithelial neoplasia (CIN1) to moderate (CIN2) to high-grade lesions (CIN3). They can also resemble cancer cells without invasion, also known as carcinoma in situ.

If left untreated, these precancers have the propensity to invade and become cancerous. Once they spread beyond the borders of the cervix, they can invade tissues more deeply, into either the vagina or the uterus, and ultimately metastasize to other parts of the body.

OVERVIEW

There are two main types of cervical cancer:

Squamous Cell Carcinoma

The majority of cervical cancers -- 85 to 90 percent -- are squamous cell carcinomas.

Adenocarcinoma

The remaining 10 to 15 percent of cervical cancers are adenocarcinomas.

Cancers that have features of both cell types are known as mixed, or adenosquamous, carcinomas.

RISK FACTORS

The most significant risk factor for cervical cancer is infection with the human papillomavirus (HPV), which can be transmitted during sex.

Papillomaviruses have been known to cause cervical dysplasia, or precancers, for more than two decades. More recently, DNA from these viruses has been found to exist in virtually all cervical squamous cell carcinomas (the most common type of cervical cancer).

By avoiding the following known risk factors for HPV infection, women can reduce their likelihood of developing cervical cancer:

early age at first sexual intercourse (15 years or younger)

having a history of many sexual partners (more than seven)

smoking (which produces chemicals that can damage cervical cells, making them more vulnerable to infection and cancer)

infection with HIV (which reduces the body's ability to fight off HPV infection and early cancers)

Women without these risk factors rarely develop cervical cancer. Although all women can help protect themselves from disease by having their sexual partners use condoms, condoms do not provide complete protection from HPV infection because this virus (unlike HIV) can be spread by contact with any infected area of the body.

SYMPOMS

Cervical cancer, especially in its earliest stages, often causes no symptoms. That's why it's so important to see your doctor for regular screening with a Pap test.

When symptoms do occur, they may include the following:

pain or bleeding during or after intercourse

unusual discharge from the vagina

blood spots or light bleeding other than a normal period

These symptoms can be caused by cervical cancer or by a number of serious conditions, and should be evaluated promptly by a medical professional.

DIAGNOSIS

A Pap test is used to detect the possibility of a cervical cancer or dysplasia (precancer).

Biopsy

If a Pap test shows an abnormality, your doctor will perform a biopsy (by removing a sample of cervical tissue for microscopic examination). A gynecologist will often use a colposcope (a viewing tube attached to magnifying binoculars) to find the abnormal area and remove a tiny section of the surface of the cervix, which a pathologist will examine to see if it contains precancer or cancer cells. He or she may also perform a Schiller test, in which the cervix is coated with an iodine solution. Iodine causes the healthy cells to turn brown, while abnormal cells appear white or yellow.

Cone Biopsy

If the diagnosis isn't clear, a surgeon may remove a slightly larger, cone-shaped piece of tissue (called a cone biopsy). At Tata Memorial Centre, cone biopsies are often performed by loop excision, in which an electrical current is passed through a thin wire loop to remove the sample tissue. Loop excision takes only about 10 minutes under local anesthetic. The cone biopsy is also a treatment, and can completely remove many precancers and early cancers. More than 90 percent of cervical cancers can be halted with this technique without further treatment.

Cytoscopy & Other Imaging Tests

If your doctor suspects that the cancer may have spread beyond the cervix, you may have cytoscopy (examination of the bladder using a lighted tube), proctoscopy (examination of the rectum), a chest x-ray, or other imaging tests -- such as a computerized tomography scan (CT scan) of the abdomen and pelvis to check for metastatic disease, or magnetic resonance imaging scan (MRI scan) of the pelvis to check the extent of local disease.

TREATMENT

Options for treating cervical cancer depend chiefly on the stage of disease -- the size of the cancer, the depth of invasion, and whether the cancer has spread to other parts of the body. The primary forms of treatment are surgery and combined radiation therapy and chemotherapy.

Carcinoma In Situ

These cancers are preinvasive and can be treated conservatively, sparing the uterus. Options for treatment include

laser surgery (in which a narrow beam of intense light is used to kill the cancerous cells)

loop excision (in which an electrical current is passed through a thin wire loop to remove the cells)

cone biopsy (to surgically remove a cone-shaped piece of tissue containing the cancer)

These treatments are almost always effective in removing precancers and stopping them from developing into true cancers.

Early Cervical Cancer (Stages I-IIA)

For early cervical cancers that are confined to the cervix, surgical options may include hysterectomy (removal of the uterus), sometimes along with the tissue next to the uterus. Lymph nodes from the pelvis are also removed and examined for cancer cells. If the cancer is associated with "high-risk" features -- such as involvement of the pelvic lymph nodes, invasion of the lymph channels or blood vessels of the cervix, or involvement of the tissue along the uterus -- doctors recommend chemotherapy combined with radiation therapy.

Advanced Cervical Cancer (Stages IIB-IVA)

If cervical cancer has spread beyond the cervix and into the surrounding pelvic tissues, surgery alone is usually not an effective cure. Patients with this degree of invasive cancer have traditionally also been treated with radiation therapy (the use of x-rays or other high-energy waves to kill cancer cells and shrink tumors), either alone or in addition to surgery.

In recent years, however, there has been a major shift in the treatment of advanced cervical cancer. Based on the results of large clinical trials, the standard of care for regionally advanced cervical cancer is now chemotherapy combined with radiation therapy. The radiation therapy may be delivered externally and/or internally (by placing an implant to deliver radioactive material immediately around the cervix).

Stage IVB & Recurrent Cervical Cancer

For women whose cancer spreads beyond the pelvis (into the lungs or liver, for example) or who have recurrent disease, treatment is aimed at reducing cancer-related symptoms in order to improve a patient's quality of life, and hopefully to prolong her survival. Chemotherapy is the primary modality of treatment for these patients, and several drugs are available for treating these women.

For women whose disease recurs in the pelvis, extensive surgery may be the only curative option and requires a highly experienced multidisciplinary team.

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COLORECTAL CANCER

COLORECTAL CANCER

Prevention and early detection are key factors in controlling and curing colorectal cancer. Indeed, colorectal cancer is the second most preventable cancer, after lung cancer. When the cancer is found early, initial treatment can often lead to an excellent outcome. Colorectal cancer is cancer that occurs in the large intestine and rectum. The colon is a muscular tube that is about five feet long. It absorbs water and nutrients from food. The rectum, the lower six inches of the digestive tract, serves as a holding place for stool, which then passes out of the body through the anus. This year, about 148,000 people in the United States will be diagnosed with colorectal cancer. Although many people think of colorectal cancer as a disease that primarily affects men, it is slightly more common in women. Today, the average person has about a 1 in 20 chance of developing colorectal cancer during his or her life.

How Colorectal Cancer Develops?

The colon is divided into four sections: the ascending colon, transverse colon, descending colon, and sigmoid colon. Most colorectal cancers arise in the sigmoid colon -- the portion just above the rectum. They usually start in the innermost layer and can grow through some or all of the several tissue layers that make up the colon and rectum. The extent to which a cancer penetrates the various tissue layers determines the stage of the disease. Most colorectal cancers grow slowly over a period of several years, often beginning as small benign growths called polyps. Removing these polyps early, before they become malignant, is an effective means of preventing colorectal cancer.

SYMPTOMS

Colorectal cancer sometimes arises without any symptoms. For this reason, screening tests (such as colonoscopy and a test for blood in the stool) are recommended to detect the cancer early, when it is more curable.

When symptoms do occur, however, they may include the following:

• rectal bleeding or blood in the stool

• a change in bowel habits (such as diarrhea, constipation, and narrowing of the stool) that lasts for more than a few days

• abdominal pain

a continuous feeling that you need to have a bowel movement, which does not resolve after passing stool

• weakness

Some of these symptoms may be caused by other conditions. But you should see your doctor if they persist. Any incidence of rectal bleeding or blood in the stool should be brought to your doctor's attention.

SCREENING AND DIAGNOSIS

The best way to cure colorectal cancer is to prevent it from occurring in the first place. A regular program of screening examinations is the best way to ensure an early diagnosis, and an early diagnosis offers the best chance for a cure.

Screening & Diagnostic Tests

Colorectal cancer screening and diagnosis may involve one or more of a number of procedures:

• Colonoscopy

This examination allows the doctor to inspect the rectum and colon, using a thin tube that has a light on the end. It is inserted into the rectum while the patient lies on his or her side. Patients often receive a mild sedative during this procedure to ensure their comfort. Any polyps or other growths that are found during these examinations are usually removed at the time and sent to a laboratory for examination.

A ten-year study by Tata Memorial Centre investigators showed that colonoscopy was more effective than another screening technique called double-contrast barium enema for detecting precancerous colon polyps. The findings of this study were the first to show that the various surveillance tools used to follow patients who have had colon polyps removed are not equally reliable. Moreover, unlike barium enema, colonoscopy allows the doctor to remove any polyps at the time of the examination.

• Fecal Occult Blood Test

Also known as a stool blood test, this laboratory test looks for blood in the stool. The patient is asked to follow a special diet and then bring in stool specimens (usually applied to small, folded cards) from three successive days.

• Flexible Sigmoidoscopy

This examination is similar to the colonoscopy exam, but it uses a shorter tube to inspect the lower colon.

Virtual Colonoscopy

Virtual colonoscopy is a new technique that uses CT scans to create a 3-D image that can be used to evaluate the bowel. At this time, it is still a research tool and is not generally available. It is also important to note that, while this is a promising technique, it does not allow for a biopsy or polyp removal at the same time an abnormality is found.

For more information about diagnostic tests, see Staging.

Screening Guidelines

If you do not have an increased risk of colorectal cancer because of your personal or family medical history, we recommend the following screening tests, beginning at age 50:

• colonoscopy every 10 years

• a yearly test for blood in the stool, preferably combined with flexible sigmoidoscopy every five years

If you have an increased risk of colorectal cancer because of your personal or family medical history, you should have a colonoscopy every 5 years beginning at age 40, or younger if hereditary non-polyposis colorectal cancer (HNPCC) is suspected. For first-degree, direct relatives of patients with colorectal cancer that has presented before age 50, screening should begin 10 to 20 years before the age of the diagnosed patient. For example, if your father is diagnosed with colorectal cancer at age 48, then you should begin your own colorectal cancer screening between ages 28 and 38.

STAGING

If tests show that you have colorectal cancer, additional examinations may be performed to determine its extent -- a process called staging. Knowing how far your cancer has progressed is important when deciding what regimen of treatment might be most appropriate for you. The following tests are routinely used to stage colorectal cancer:

• computed tomography (CT) and magnetic resonance imaging (MRI) scans, which may be used to see if the cancer has spread to other organs, such as the liver and lungs

• chest x-ray, which may be performed to see if the cancer has spread to the lungs

• blood tests for CEA, a protein that acts as a marker for colorectal cancer

Depending on your specific clinical situation, these additional tests may be ordered:

• positron-emission tomography (PET) scanning, which may be conducted to find other places where cancer may be lurking

• angiography, which may be done to find blood vessels next to cancer that has spread to the liver, allowing doctors to plan surgery to minimize blood loss

• endorectal ultrasound probe, which uses sound waves to produce an image of the tumor; it may be placed in the rectum to see how far a cancer has invaded the rectal wall. This procedure is used for staging rectal cancer only.

TREATMENT

The choice of treatment for colorectal cancer depends on the stage of the disease -- that is, how large the tumor has grown, how deeply it has invaded the layers of the colon or rectum, and whether it has spread to other organs (most commonly the liver), lymph nodes, or other parts of the body.

Treatment options include surgery, radiation therapy, chemotherapy, and combinations of these approaches.

Read more »

GASTRIC CANCER

GASTRIC CANCER

Your stomach is a J-shaped organ in the upper abdomen where digestion begins before food is passed to your intestines. Cancer can arise in any part of the stomach, and is believed to develop slowly over many years.

Stomach cancer -- also referred to as gastric cancer -- is usually preceded by precancerous changes in the stomach lining, although these changes rarely produce symptoms. Because stomach cancer often does not cause symptoms until it is quite advanced, it is not often detected in its earliest stages.

Most stomach cancers (90 to 95 percent) are classified as adenocarcinomas. Other types of stomach cancer include squamous cell carcinoma, lymphoma, stromal tumors (cancer of the muscle or connective tissue of the stomach wall), and carcinoid tumors (cancer of the hormone-producing cells of the stomach).

RISK FACTORS

The following factors increase the risk of stomach cancer:

• infection with the Helicobacter pylori bacterium, which may lead to chronic inflammation of the inner layer of the stomach and possibly precancerous changes; recent research has shown that antibiotic treatment may reduce the risk of stomach cancer -- particularly stomach lymphoma -- in people infected with this bacterium

• a diet high in consumption of smoked and salted foods, such as smoked fish and meat and pickled vegetables; conversely, eating a diet high in fruits and vegetables (particularly those high in beta-carotene and vitamin C can decrease stomach-cancer risk

• high consumption of red meat; studies show that eating red meat more than 13 times per week can double the risk of stomach cancer

• smoking

• alcohol abuse

• previous stomach surgery, such as removal of stomach tissue in patients with ulcers

• pernicious anemia, a severe inability to produce red blood cells, due to a deficiency of vitamin B12

• Menetrier's disease, a very rare condition associated with large folds in the stomach and low production of stomach acids

• blood type A (for unknown reasons)

• family cancer syndromes, such as Lynch syndrome and familial adenomatous polyposis, which increase colorectal-cancer risk and slightly increase stomach-cancer risk

• family history of stomach cancer

• stomach polyps (small benign growths that sometimes develop into stomach cancers).

SYMPTOMS

When symptoms of stomach cancer arise, they may include:

• indigestion and stomach discomfort

• a bloated feeling after eating

• mild nausea

• loss of appetite

• heartburn

In the more advanced stages of stomach cancer, a patient may experience the following symptoms:

• blood in the stool

• vomiting

• unexplained weight loss

• stomach pain

These symptoms may also result from more benign illnesses, such as simple indigestion or a stomach virus. However, if you have these symptoms over a long period of time, you should see your doctor.

DIAGNOSIS

If your doctor suspects that you may have stomach cancer, you may have a barium x-ray of your upper gastrointestinal system. For this test, you will be asked to drink a liquid containing barium, which makes your stomach easier to see on an x-ray. This test can be performed in a doctor's office or a hospital's radiology department.

The doctor may also look inside your stomach using a gastroscope, a thin, lighted tube that is inserted into your mouth and guided into your stomach (also called upper endoscopy). A camera at the end of the tube enables your doctor to see inside your stomach. Your doctor may take small samples of tissue to examine for cancer cells. (You will receive a spray of anesthetic into your throat or other medication to ensure that you are comfortable during this examination.)

A third, newer technique to diagnose stomach cancer is called endoscopic ultrasound. Similar to gastroscopy, endoscopic ultrasound relies on a thin tube inserted into the mouth and down into the stomach. At the tip of the tube is a small ultrasound probe that bounces sound waves off the stomach walls. This test is useful for estimating how far cancer has spread into the wall of the stomach, to nearby organs, and to nearby lymph nodes -- a process called staging.

Another staging technique is called laparoscopy. This procedure involves minor surgery using a small tube with a camera at the end to look inside your abdomen. Doctors can look at the outside wall of your stomach, examine the lymph nodes, and evaluate the surfaces of other abdominal organs to determine if the cancer has spread to those areas.

In addition to these diagnostic tests, your doctor will take your medical history into account, perform a physical examination, and order laboratory studies such as blood tests.

TREATMENT

The choice of treatment for stomach cancer depends on the stage of the disease -- that is, how large the tumor has grown, how deeply it has invaded the layers of the stomach, and whether it has spread to nearby organs, lymph nodes, or other parts of the body.

Recent investigations suggest that a three-pronged attack on stomach cancer -- utilizing surgery to remove most of the tumor and chemotherapy and radiation therapy to control cancer spread -- may improve the survival of patients with stomach cancer. This combination approach is expected to become the standard of care for patients with this disease.

Surgery

Surgery is the most common form of treatment for stomach cancer. If the results of staging indicate that surgery is likely to help you, your doctor may perform one of these operations to remove the cancer:

• subtotal gastrectomy : removal of the part of the stomach that contains the cancer and parts of other tissues or organs near the tumor (such as the small intestine or esophagus, depending on the location of the tumor)

• total gastrectomy : removal of the entire stomach and parts of the esophagus, small intestine, and other tissue near the tumor; in this case the esophagus may be connected to the small intestine so that you can continue to eat and swallow.

During the surgery, the surgeon will also remove nearby lymph nodes to examine them for cancer cells. Sometimes the spleen (an organ in the upper abdomen that filters blood and removes old blood cells) and part of the pancreas are also removed.

Chemotherapy

Chemotherapy -- treatment with cancer-killing drugs -- is another option for treating stomach cancer. It can be given to patients whose cancers have invaded the layers of the stomach wall, nearby lymph nodes, and nearby organs. Chemotherapy may be given before surgery (so-called neoadjuvant therapy) -- to shrink the tumor first -- or after surgery (adjuvant therapy), to kill any remaining cancer cells. These approaches are being evaluated in clinical trials.

When given alone or with radiation therapy, chemotherapy is also useful in some patients to relieve stomach-cancer symptoms or to delay cancer recurrence and extend a patient's life, especially in patients whose cancers cannot be completely removed through surgery. 5-fluorouracil and cisplatin are the drugs most commonly used to treat stomach cancer; other drugs (including paclitaxel, docetaxel, and irinotecan) and new combinations of conventional drugs are currently under investigation. Some are given intravenously (through a vein), while others are given intraperitoneally (delivered directly into the abdominal cavity).

Radiation Therapy

Radiation therapy is most commonly used in combination with chemotherapy for the treatment of gastric cancer. New studies reveal that for many patients with gastric cancer, the addition of radiation therapy plus chemotherapy after surgery improves survival compared to surgery alone.

Read more »

GASTRIC CANCER

GASTRIC CANCER

Your stomach is a J-shaped organ in the upper abdomen where digestion begins before food is passed to your intestines. Cancer can arise in any part of the stomach, and is believed to develop slowly over many years.

Stomach cancer -- also referred to as gastric cancer -- is usually preceded by precancerous changes in the stomach lining, although these changes rarely produce symptoms. Because stomach cancer often does not cause symptoms until it is quite advanced, it is not often detected in its earliest stages.

Most stomach cancers (90 to 95 percent) are classified as adenocarcinomas. Other types of stomach cancer include squamous cell carcinoma, lymphoma, stromal tumors (cancer of the muscle or connective tissue of the stomach wall), and carcinoid tumors (cancer of the hormone-producing cells of the stomach).

RISK FACTORS

The following factors increase the risk of stomach cancer:

• infection with the Helicobacter pylori bacterium, which may lead to chronic inflammation of the inner layer of the stomach and possibly precancerous changes; recent research has shown that antibiotic treatment may reduce the risk of stomach cancer -- particularly stomach lymphoma -- in people infected with this bacterium

• a diet high in consumption of smoked and salted foods, such as smoked fish and meat and pickled vegetables; conversely, eating a diet high in fruits and vegetables (particularly those high in beta-carotene and vitamin C can decrease stomach-cancer risk

• high consumption of red meat; studies show that eating red meat more than 13 times per week can double the risk of stomach cancer

• smoking

• alcohol abuse

• previous stomach surgery, such as removal of stomach tissue in patients with ulcers

• pernicious anemia, a severe inability to produce red blood cells, due to a deficiency of vitamin B12

• Menetrier's disease, a very rare condition associated with large folds in the stomach and low production of stomach acids

• blood type A (for unknown reasons)

• family cancer syndromes, such as Lynch syndrome and familial adenomatous polyposis, which increase colorectal-cancer risk and slightly increase stomach-cancer risk

• family history of stomach cancer

• stomach polyps (small benign growths that sometimes develop into stomach cancers).

SYMPTOMS

When symptoms of stomach cancer arise, they may include:

• indigestion and stomach discomfort

• a bloated feeling after eating

• mild nausea

• loss of appetite

• heartburn

In the more advanced stages of stomach cancer, a patient may experience the following symptoms:

• blood in the stool

• vomiting

• unexplained weight loss

• stomach pain

These symptoms may also result from more benign illnesses, such as simple indigestion or a stomach virus. However, if you have these symptoms over a long period of time, you should see your doctor.

DIAGNOSIS

If your doctor suspects that you may have stomach cancer, you may have a barium x-ray of your upper gastrointestinal system. For this test, you will be asked to drink a liquid containing barium, which makes your stomach easier to see on an x-ray. This test can be performed in a doctor's office or a hospital's radiology department.

The doctor may also look inside your stomach using a gastroscope, a thin, lighted tube that is inserted into your mouth and guided into your stomach (also called upper endoscopy). A camera at the end of the tube enables your doctor to see inside your stomach. Your doctor may take small samples of tissue to examine for cancer cells. (You will receive a spray of anesthetic into your throat or other medication to ensure that you are comfortable during this examination.)

A third, newer technique to diagnose stomach cancer is called endoscopic ultrasound. Similar to gastroscopy, endoscopic ultrasound relies on a thin tube inserted into the mouth and down into the stomach. At the tip of the tube is a small ultrasound probe that bounces sound waves off the stomach walls. This test is useful for estimating how far cancer has spread into the wall of the stomach, to nearby organs, and to nearby lymph nodes -- a process called staging.

Another staging technique is called laparoscopy. This procedure involves minor surgery using a small tube with a camera at the end to look inside your abdomen. Doctors can look at the outside wall of your stomach, examine the lymph nodes, and evaluate the surfaces of other abdominal organs to determine if the cancer has spread to those areas.

In addition to these diagnostic tests, your doctor will take your medical history into account, perform a physical examination, and order laboratory studies such as blood tests.

TREATMENT

The choice of treatment for stomach cancer depends on the stage of the disease -- that is, how large the tumor has grown, how deeply it has invaded the layers of the stomach, and whether it has spread to nearby organs, lymph nodes, or other parts of the body.

Recent investigations suggest that a three-pronged attack on stomach cancer -- utilizing surgery to remove most of the tumor and chemotherapy and radiation therapy to control cancer spread -- may improve the survival of patients with stomach cancer. This combination approach is expected to become the standard of care for patients with this disease.

Surgery

Surgery is the most common form of treatment for stomach cancer. If the results of staging indicate that surgery is likely to help you, your doctor may perform one of these operations to remove the cancer:

• subtotal gastrectomy : removal of the part of the stomach that contains the cancer and parts of other tissues or organs near the tumor (such as the small intestine or esophagus, depending on the location of the tumor)

• total gastrectomy : removal of the entire stomach and parts of the esophagus, small intestine, and other tissue near the tumor; in this case the esophagus may be connected to the small intestine so that you can continue to eat and swallow.

During the surgery, the surgeon will also remove nearby lymph nodes to examine them for cancer cells. Sometimes the spleen (an organ in the upper abdomen that filters blood and removes old blood cells) and part of the pancreas are also removed.

Chemotherapy

Chemotherapy -- treatment with cancer-killing drugs -- is another option for treating stomach cancer. It can be given to patients whose cancers have invaded the layers of the stomach wall, nearby lymph nodes, and nearby organs. Chemotherapy may be given before surgery (so-called neoadjuvant therapy) -- to shrink the tumor first -- or after surgery (adjuvant therapy), to kill any remaining cancer cells. These approaches are being evaluated in clinical trials.

When given alone or with radiation therapy, chemotherapy is also useful in some patients to relieve stomach-cancer symptoms or to delay cancer recurrence and extend a patient's life, especially in patients whose cancers cannot be completely removed through surgery. 5-fluorouracil and cisplatin are the drugs most commonly used to treat stomach cancer; other drugs (including paclitaxel, docetaxel, and irinotecan) and new combinations of conventional drugs are currently under investigation. Some are given intravenously (through a vein), while others are given intraperitoneally (delivered directly into the abdominal cavity).

Radiation Therapy

Radiation therapy is most commonly used in combination with chemotherapy for the treatment of gastric cancer. New studies reveal that for many patients with gastric cancer, the addition of radiation therapy plus chemotherapy after surgery improves survival compared to surgery alone.

Read more »