Saturday, December 5, 2015

Clinical Diagnosis of Cancer or Cancers

figure 1: Commonly diagnosed cancers. It shows estimated cases and
deaths due to these cancers
There is a major problem on internet discussion forums on the understanding of cancer. Some people say cancer as a general term but it is not a single disease we are dealing with. So let me clarify the meaning of cancer..

Cancer came from word "carcinoma". Cancer is not a single disease it is a generalised/ generic term used for multiple disease types. To simplify.. each organ in human body is made of a group cells with unique morphology and functional characteristics. As per nature each cell has definite life span. They are supposed to die after sometime. However, some of these group of cells has tendency to break the law of nature, go rogue and continue to multiply uncontrollably. This leads to formation of tumor like structures protruding out from the organs which we call cancer for e.g. Brain tumor, pancreatic tumor, breast tumor/ cancer, head and neck tumors and others.

Please note that all cancers can be tumours but vice versa is not true.

There are certain type of cancers where we don't see tumor formation for example Leukemia (blood cancer), stomach ulcers, skin cancer and others. It is important to note that each cancer type has its unique symptoms. Most common types of cancer, incidence rate and their death toll in America are discussed in detail by National Cancer Institute (NCI).

Most commonly seen basic symptoms that can be linked to cancer a
  1. Unexplained weight loss of 10 pounds or more
  2. Fever due to unknown reason. 
  3. Fatigue
  4. Severe chronic episodes of pain that does not go away.         
                                                                                                                    Details are available here.

We do not have single cure for cancer. But we do have relatively good therapies for it, which may or may not give favourable treatment. There are obvious reports which says that the same cancer from two different patients may behave differently to the same therapeutic regime. This mainly happens due to complex evolutionary advantage to cancer cells.

Commonly used diagnostic methods prescribed by American cancer society is given below. You can get more details on each tests by clicking on each cancer type.

Cancer TypeTissue BiopsyBlood TestsBiomarker and Gene mutation TestsUrine TestImaging TestsOther Tests
Bladder CancerYesYesNMP22 and BTA testUrine cytologyIntraveous Pyelogram
Immunocyt testUrine cultureRetrograde Pyelogram
UroVysion testUrine marker testsComputed Tomography (CT) Scan
Magnetic Resonance Imaging (MRI) Scan
Breast CancerCore needle biopsyNANANAMammogramsNipple discharge examination
Fine needle aspiration (FNA)UltrasoundDuctal lavage and nipple aspiration
Surgical biopsyMRILymph node biopsy
Lymph node biopsy
Colon and Rectal CancerYesYesKRAS gene*NAColonoscopyLiver enzyme tests**
BRAF gene*MRImicrosatellite instability (MSI) testing
blood markers carcinoembryonic antigen (CEA) and CA 19-9CT Scan
Positron Emission Ttomography (PET) Scan**
Chest X-ray**
Endometrial CancerYesYesCA 125 levels in bloodNAPelvic and transvaginal ultrasound (TVUS)Dilation and curettage (D&C)
CT Scan
Cytoscopy and proctoscopy
Kidney CancerFine Needle Aspiration and Core Needle BiopsyYes (check for polycythemia)NACyto analysis of urine sampleCT ScanBiochemical tests
Fuhrman gradeMRI
PET Scan
Intravenous Pyelogram
Chest X-ray**
Bone Scan**
LeukemiaBone marrow aspiration and biopsyYes NANAmicroscopic examinationinationBiochemistry and coagulation tests
Lymph node biopsyX-raycytochemistry
Lumber puncture (spinal tap)CT Scanflow cytometry and immunohistochemistry
Gallium Scan and bone Scan**
Lung CancerNeedle biopsyYesEGFR testNAX-raySputum cytology
KRAS gene*CT ScanThoracentesis
ALK gene*MRIImmuno histochemistry (IHC)
ROS1 gene*Ultrasoundpulmonary function test
RET gene*PET Scan
Bone Scan**
MelanomaSkinYesBRAF gene*NAX-rayIHC
ShaveCT Scanfluoroscence insitu hybridization (FISH)
PunchMRIcomparative genomic hybridization (CGH)
Incisional and excisional biopsyPET Scan
Final needle aspiration (FNA)
Surgical lymph node
Sentinel lymph node
Non-Hodgkin LymphomaIncisional and excisional biopsyYesNANAX-rayflow cytometry
FNACT Scancytogenetics
Bone marrow aspirationMRIFISH
Lumber punctureUltrasoundPCR
Pleural or peritoneal fluid PET Scan
Gallium Scan
Bone Scan
Pancreatic CancerPercutaneous biopsyYesCA 19-9NACT ScanLiver function test
surgical biopsygastrin measurementsabdominal ultrasound
glucagon measurementsendoscopic ultrasound
somatostatin measurementsEndoscopic retrograde cholangiopancreatography
pancreatic polypeptideMagnetic resonance cholangiopancreatography
vasoactive intestinal peptidePercutaneous transhepatic cholangiography
PET Scan
Prostate CancerProstate BiopsyProstate Specific Antigen (PSA)NANATransrectal ultrasound
Grading prostate Prostatic intraepithelial neoplasiaBone Scan
Lymph Node BiopsyAtypical small acinar proliferationCT Scan
Laparoscopic biopsyProliferative inflammatory atrophyMRI
FNAProstaScintTM Scan
Thyroid CancerThyroid gland biopsyYesThyroid function testNAUltrasoundVocal chord examinationination
T3 and T4 hormone levelRadioiodine Scan
Carcinoembryonic antigenPET Scan

We have discussed more information on how ageing and its correlation with cancer. We are constantly working towards finding new ways of fighting these cancer types. Newest way is by personalised medicine. Pathway pharmaceuticals provides newer ways of diagnosis of cancer conditions please check here.

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