Cancer in pakistan | Cancer Causes, Treatment, Symptoms |cancer.com.pk

1.Breast Cancer

It is one of the most common cancers. If diagnosed early, it is curable in most patients. However, even in advanced stages. It is treatable. Only three to five percent of breast cancers are genetic and inherited from family . The majority of cancers happen randomly.

Diagnosis and screening
Screening means finding cancer before it is found by the women themselves or their doctors by examination of the breast. The best method to find cancer early is a mammogram (x-ray of the breast is called a mammogram).
For early detection of cancer, a mammogram is usually recommended, after age 40, in all women on a yearly or every two-year basis.
The majority of the time In our country women feel the lump themselves and come for further testing.
Diagnosis requires a biopsy which means taking a sample of these tumor cells either by an FNA(fine needle aspiration where a syringe is used to suck few cells out of the cancer in breast or armpit) or a core biopsy (where a large thick needle is used to take a piece out of the cancer mass/lump/tumor).
Then the sample is examined by a pathologist who will determine what kind of cancer it is by various tests including finding out if it is;

– hormone-positive(estrogen and progesterone receptors on cancer cells) or negative,
-her-2-neu positive or negative or
-all negative(triple negative)
Breast cancer treatment depends on the type of breast cancer determined by biopsy and pathology. Every type of cancer has specific treatment protocols that need to be followed for the best outcomes.

Staging
Breast cancer also needs to be staged after diagnosis to make sure you know where the cancer is and whether it has spread to any other place including the armpit or it has spread further to other organs like bones, liver, lung, brain, etc. This will help guide your Oncologist to know how best to treat and what medicines to use first to treat it more effectively.

Treatment of breast cancer involves surgery, chemotherapy, and Radiation.

These treatments could be given before surgery or after surgery.
However, there may be some women who will not need any other treatment except surgery, especially If the tumor is very very small.
Some women will require all the treatments including chemotherapy, surgery and radiation therapy, hormonal therapies.

Surgery .

Type of surgery depends on the size of the tumor and the woman’s wishes. Usually removing only the portion of the breast which has the cancer in it is called lumpectomy. Sometimes the whole breast is removed and is called mastectomy. if only the portion which had the tumor in it is removed ,radiation is needed after the operation. It is also very important that your surgeon removes and checks the lymph nodes in the axilla.
That’s the first place where the tumor spreads if it will spread in the future.
Usually only a few lymph nodes need to be removed to check if there is cancer or not. The procedure is called Sentinel lymph node biopsy where the surgeon injects a dye into the cancer in the breast and that dye travels to the lymph nodes in the axilla .The lymph nodes which take up with the dye , are removed and checked to make sure if there is cancer or not.

Chemotherapy Many young women and older women with aggressive cancers will need chemotherapy .chemotherapy helps to stop the cancer from coming back. There are many kinds of chemotherapy treatments.

Radiation therapy
It’s given after the chemotherapy. It usually lasts for a few days to a few weeks.
Hormonal therapy
The women who have hormone positive cancers, like estrogen positive or progesterone positive cancers will usually require five to ten years of Hormonal therapy.
There are several options. In older women ,for hormonal therapy after the menopause ,drugs like letrozole ,anastrozole ,tamoxifen Etc. are used.
In younger women, tamoxifen is usually used for 5 to 10 years. There are other hormonal therapies, which are also used in some women.
Herceptin is used in women whose cancer is Her-2-Neu positive. In breast cancers about 25 to 30 percent of the women have this type of her-2,nu positive cancer and will benefit from herceptin. This is usually done for six months to a year.
It is an injection form of treatment. It also helps the tumor from coming back.
Treatment of the stage four / metastatic or widespread tumor
It usually involves treatment of the tumor and the tumor related symptoms
If the tumor has spread to the bones, A bone strengthening medicine is also used.
Depending on the type of the breast cancer ,chemotherapy ,hormonal therapy, immunotherapy and biological therapies or other kinds of therapies are utilized to control the cancer from spreading further and helping women to improve their quality of life and live longer.

2.Prostate Cancer

It’s a common cancer in men. In most older men prostate cancer is not very aggressive and sometimes it doesn’t even need any aggressive treatments like operations or radiation therapy, chemotherapy especially if it has spread. If treatment is needed to control the cancer or symptoms related to cancer ,it’s usually hormonal treatment in the form of pills /tablets or hormonal injections on a monthly or three monthly basis.

However, it does need follow-up regularly with the doctor.

Diagnosis of prostate cancer
Requires biopsy and PSA testing and blood tests.
Pathology is very important to determine how aggressive the cancer is .
Surgery removal of the prostate gland by surgery is an option in younger men with Cancers, especially if it has not spread beyond the capsule of the prostate gland.
Radiation therapy Could be effective and safer than surgery for early-stage cancer of the prostate especially in older men.
Hormonal therapy in prostate cancer is very effective and there are several kinds of hormones injections which are given monthly or every three monthly. There are also tablets which help to control the cancer.
Chemotherapy is sometimes used when hormone therapy fails or the cancer progresses or the cancer is very aggressive and spreads rapidly .Chemotherapy does help to slow down the cancer .However, it does not get rid of the cancer. Goal of chemotherapy is to improve symptoms and control the growth of the cancer and improve the life span of the person.

3.Lymphomas

HODGKIN’S LYMPHOMA

Usually patients have swelling in the neck glands or swelling in the axilla/armpit. Sometimes it is found in the chest or abdominal lymph glands or other organs .Usually a biopsy is required for diagnosis.
Most important treatment is chemotherapy. In most patients it is curable, even if the disease has spread all over the body. Sometimes the radiation is also done to get rid of the remaining disease after chemotherapy.

NON-HODGKIN’S LYMPHOMAS

There are several kinds, some could be very aggressive lymphomas and some not as aggressive. This is determined by biopsy and pathology results. Most common types are b-cell lymphomas like follicular lymphoma ,Diffuse large b-cell lymphoma (DLBCL) etc.
There are many effective chemotherapy, immunotherapy and biologic therapy options. Many times Low-grade lymphoma types do not need treatment right away especially if there are no problems or symptoms because of the lymphoma.

3.Multiple Myeloma

Usually it presents with bone pains ,tiredness ,low blood counts ,high calcium in the blood etc.
Diagnosis usually requires a blood test and a bone marrow biopsy and x-rays of all the bones.
There are several effective treatments available and disease can be controlled for longtime with treatments.

4.Ovarian Cancer

Ovarian cancer symptoms are very vague and nonspecific.Usually patients have increasing abdominal size,bloating,pain in abdomen,problems with eating and bowels ,pain in abdomen etc.

Diagnosis is made by taking fluid out of the abdomen and checking it for cancer cells.If there is no fluid,then biopsy of the tumor is needed along with ultrasound,CT scan etc.Also blood tests like ca 125, which is a cancer marker in the blood ,is helpful in many patients ,to make a diagnosis.
Surgery is needed in most patients.However ,many times ,women need chemotherapy to shrink down the tumor and control and dry up the fluid in the abdomen. if the tumor is controlled with chemotherapy , then the surgery is done to get rid of the remaining cancer. At the time of surgery it’s very important to remove the ovaries , uterus and other lining of the abdomen like
omentum and other tumors present in the abdomen.
Sometimes it’s not possible to remove all the cancer with surgery or if the cancer has spread to other organs ,more chemotherapy is used to control the cancer.

5.Lung Cancer

It is one of the common cancers. Usually it happens in smokers, but it occurs in non-smokers as well. Lung cancer is of many kinds including non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancers are subdivided into several types including adenocarcinoma and Squamous cell cancer . If diagnosed early the cancer is usually treated with surgery. If it has spread locally, then it can be treated with a combination of chemotherapy and radiation therapy. However, if it has spread and is stage 4 disease, treatment is chemotherapy immunotherapy or combination of both. The newer drugs like immunotherapy help some patients live longer and better lives .

It is the cancer which happens in the lining membrane around the lung or rarely in the lining of the abdomen.
Most effective treatment is surgery and is possible if diagnosed early. However, the majority of the time , cancer has already spread at the time of diagnosis .In this situation chemotherapy is the only option and it can work to slow down the cancer.

6.LEUKEMIA

CHRONIC MYELOCYTIC LEUKEMIA (CML)

It is one of the most treatable leukemias with very effective drugs available. People usually have high white blood cell counts and big spleen.Treatment is lifelong.

CHRONIC LYMPHOCYTIC LEUKEMIA

It’s also one of the common leukemias. Many people do not require treatment if they are diagnosed incidentally and have no symptoms.Many treatments are available and effective in controlling the disease.

Acute Leukemia

Acute myeloid leukemia(AML) This is one of the aggressive cancers of the bone marrow.
It usually requires chemotherapy for several months.
About twenty to thirty percent of patients are cured with chemotherapy.
Acute lymphoblastic leukemia(ALL) is also one of the aggressive leukemias.
It responds to the treatment and is cured in thirty to thirty five percent patients .

Hairy Cell Leukemia

It is low-grade leukemia .Patients have large spleen and low blood counts.
Sometimes it requires treatment and treatments are effective in many patients.

7.Cervical Cancer

Patients usually come with abnormal vaginal spotting or bleeding, Pain in the abdomen or back, Weight loss etc.
If it’s diagnosed early ,surgery is done. However, the majority of the time patients need radiation or combination of radiation and chemotherapy after surgery.
If it has spread at the time of diagnosis, chemotherapy is effective to control the disease

8.Uterine Cancer

The symptoms of this cancer ,usually, are abnormal vaginal bleeding and/or abdominal pain. surgery is effective if diagnosed early.
Sometimes radiation is done after surgery . However, if the cancer has spread, chemotherapy works in some women and controls the disease. Sometimes if it’s a hormone positive cancer, hormonal medicines also work .

9.Brain Cancer

There are many types of cancers in the brain .Some are slow growing and only need surgery or radiation after surgery.The most aggressive type is called glioblastoma multiforme (GBM in short). Usually the surgery is done to remove as much tumor as possible without damaging the brain. After the surgery radiation is done along with chemotherapy.
If the cancer comes back or starts to progress again, further chemotherapies are possible to control the disease and keep the quality of life.

10.Bladder cancer

Urinary bladder cancer usually presents with blood in the urine or pain in that area. If diagnosed early, it is treated with surgery. Some people need chemotherapy or radiation therapy before or after surgery.
if cancer can’t be removed with surgery, It is treated with a combination of chemotherapy and radiation therapy.
If it has spread further, it is usually treated with chemotherapy , immunotherapy .These are effective in controlling the disease for some time.

11.Head and neck cancer

There are many kinds of head and neck cancers which can occur in many areas including throat, tongue, cheek etc.
If diagnosed early ,surgery is done .After surgery ,sometimes ,chemotherapy and radiation is needed to prevent the cancer from coming back.
Unfortunately , in many patients, disease is advanced and spread to the neck glands. Then it requires chemotherapy to shrink the tumor and radiation therapy to shrink the tumor further.
Sometimes these treatments are used together at the same time and are called concurrent therapy.
If the tumor has spread beyond the neck ( for example to the lungs or other organs) then it is treated with chemotherapy. Sometimes radiation is used to control the disease and symptoms.
Some people have good responses to treatment and long-term Disease Control is possible.

12.Testicular cancer

This is one of the most curable cancers even if it has spread .
If diagnosed early, surgery is performed first and then chemotherapy is done to stop the cancer from coming back.
However, if the tumor has already spread , the surgery is usually done after treating it with chemotherapy first. The majority of the people get rid of the disease with chemotherapy.
Whatever cancer is left after chemotherapy , is removed with surgery. Rarely radiation is needed.

13.Kidney cancer

Patients with Kidney /renal cell cancer usually have blood in the urine or pain in the back. It can spread to other organs and cause symptoms accordingly.
If diagnosed early before the cancer spreads, the kidney is removed. However, if the tumor has spread, there are many treatment options including immunotherapies .Many patients have good responses to immunotherapy which are given in injection/drip .

Other options in tablet forms are also useful and work to control the disease ,improve symptoms and prolong life in many patients.

14.Thyroid cancer

The thyroid cancers are of many types and are treated with surgery if diagnosed early. Sometimes patients need Radioactive iodine therapy after surgery .If cancer has spread or comes back after surgery and iodine therapy ,chemotherapy is used .

15.Sarcomas

Sarcomas are cancers of muscles ,bones ,joints ,fat and other soft tissues in the body.Best option is surgery If the tumor can be removed. However, if the tumor cannot be removed, then chemotherapy and radiation therapy is used to control the cancer. Some sarcomas respond well to the treatment like Ewing sarcoma or osteosarcoma of the bone or GIST.

16.Rectal Cancer

The patients have bleeding in stool ,pain or lump in the rectal area .Its diagnosed with biopsy.
It’s usually treated with a combination of chemotherapy and radiation therapy first to control and shrink the tumor in the rectum.Then surgery is performed. Some patients need more chemotherapy after surgery.

17.Liver Cancer

Liver cancer is very common in Pakistan because of hepatitis.
Usually if diagnosed early it can be cured with surgery or transplant. However, the majority of the time cancer is diagnosed late and can not be cured with treatments. If the cancer has not spread beyond the liver and it is smaller in size , it can be treated with treatments which include radiation to the tumor , or TACE (trans-arterial chemo embolization)in which medicines/chemotherapy is injected into the liver directly going through the vein from the Inguinal area into the liver and injecting medicine to stop the cancer and choking the cancer.
Treatment with medicines and chemotherapy is sometimes effective. There are several medicines which are approved for liver cancer including sorafenib, chemotherapy and nowadays immunotherapy is also Being used and does help some patients.

18.Gallbladder Cancer

It is usually diagnosed when patients present with pain in the abdomen or jaundice?
If it’s diagnosed early, it can be treated with surgery. However, if it has spread into the liver or beyond ,it is treated with chemotherapy which helps some patients to control the disease.

19.Pancreatic Cancer

It is one of the most common and difficult to treat cancer. Surgery is done if it’s diagnosed early .After operation ,chemotherapy or radiation or both are done to prevent the cancer from coming back.However, many times disease is advanced and the surgery is not possible. If the cancer has already spread at the time of diagnosis ,only chemotherapy is an option and helps some patients .

20.Esophageal Cancer

Patients usually have problem eating or swallowing the food either solid or liqid ,loose weight ,pain in chest ,bleeding ,black stools etc.If it is diagnosed early, It is treated with surgery.
However, if the tumor is spread locally, it is treated with a combination of chemotherapy and radiation therapy, which sometimes is effective . If it has spread the treatment is possible with chemotherapy,immunotherapy and works in some people to control the symptoms and the cancer .

21.Oral Cancer

Mouth cancer has the same significance as oral diseases – it is cancer that happens in any piece of the mouth; on the tongue’s surface, in the lips, inside the cheek, in the gums, in the top and floor of the mouth, in the tonsils, further more the salivary glands.

22.Colon Cancer

This is one of the common cancers. Usually people have constipation ,blood in the stool, abdominal pain etc as symptoms.
The diagnosis requires colonoscopy/endoscopy for the biopsy. If the cancer is diagnosed when it is still localized in the colon ,People can have surgery and get rid of the cancer.
If the cancer spreads to the local lymph nodes/ glands around the colon area, then people do require chemotherapy after the surgery which helps prevent the cancer from coming back.
Majority of the time, unfortunately in Pakistan , colon cancer is diagnosed in late stages when it has already spread. Treatments do help to control the disease, but do not get rid of the disease.
There are many chemotherapies , biological and immunotherapies which are effective in this situation .
If people, especially in the younger age have had colon cancer, they should have their close blood relatives tested for colon cancer as some of these cancers could be inherited.

Cancer Types