What is bone cancer?
Normal bone tissue
Bone is the framework supporting your body. Most bones are hollow. The outer part of the bone is a network of fibrous tissue called matrix upon which calcium salts are established.
The hard outer bone layer is made of compact bone (cortical) covering the spongy (trabecular) bone lighter within. Outside the bone is covered with a layer of fibrous tissue called periosteum. Some bones are hollow and have a space called the medullary cavity containing the soft tissue called bone marrow (discussed below). The tissue lining the marrow cavity is called endosteum. At each end of the bone is an area of a milder form of bone-like tissue called cartilage.
Cartilage is softer than bone, but firmer than most tissues. It is made of a matrix mixed with a fibrous tissue similar to a gel that does not contain a lot of calcium substance.
Most of the bones start out as cartilage. The body then put down on calcium cartilage to form bone. After bone forms, some cartilage may remain in the ends to act as a buffer between the bones. This cartilage, along with ligaments and other tissues connect bone to form a joint. In adults, the cartilage is mainly at the end of some bones, as part of a joint. It also looks at the place in the chest where the ribs meet the sternum (breastbone) and parts of the face. The trachea (windpipe), larynx (voice box), and the outer ear are other structures that contain cartilage.
Own bone is very hard and strong. Some bone is capable of supporting up to 12,000 pounds per square inch. It takes as much as 1,200 to 1,800 pounds of pressure to break the femur (thigh bone). Bone itself contains two types of cells. The osteoblast cell is established new bone, and osteoclasts dissolves cell is the old bone. Bone often seems as if it does not change much, but the truth is that is very active. Throughout our bodies, new bone is always forming while old bone is dissolving.
In some bone marrow is only fatty tissue. In other bone marrow is a mixture of fat cells and blood-forming cells. Forming cells produce red blood cells, white cells and platelets in the blood. Other cells include bone marrow plasma cells, fibroblasts and reticuloendothelial cells.
The cells of any of these tissues can become a cancer.
Types of bone tumors
Most of the time when people with cancer are told they have cancer in your bones, the doctor is talking about a cancer that has spread to the bone from elsewhere. This is known as metastatic cancer. It can be seen in many different advanced cancers, such as breast cancer, prostate cancer, and lung cancer. When these types of cancer in the bone are viewed under a microscope, they look like they came tissue. For example, if someone has lung cancer that has spread to bone cancer, cancer cells in the bone still look and act like cell lung cancer. They do not look or act like cells of bone cancer, although they are in the bones. Because these cancer cells still act as cell lung cancer, which still need to be treated with drugs used for lung cancer.
Other cancers that are sometimes called "bone cancers" start in the cells that form bone marrow blood - not in the bone itself. The most common cancer that originates from the bone marrow, causing bone tumors is called multiple myeloma. Another cancer that starts in the bone marrow is leukemia, but is generally considered a cancer of the blood instead of bone cancer. Sometimes lymphomas, most often originate in lymph nodes, they can begin in the bone marrow. Multiple myeloma, lymphoma, and leukemia are not discussed in this document. For more information on these cancers, refer to each individual document.
A primary bone tumor begins in the bone itself. True (or primary) bone cancers are called sarcomas. Sarcomas are cancers that start in the bones, muscles, fibrous tissue, blood vessels, fatty tissue and some other tissues. They can develop anywhere in the body.
There are several different types of bone tumors. Their names are based on the area of bone or surrounding tissue that is affected and the type of cells that form the tumor. Some primary bone tumors are benign (noncancerous), and others are malignant (cancerous). Most bone cancers are sarcomas.
Benign bone tumors
Benign tumors do not spread to other tissues and organs, and usually are not life threatening. They are generally cured by surgery. Types of benign bone tumors include:
Osteoid osteoma (OS-tee-Oya OS-tee-oh-ma)
Osteoblastoma (OS-tee-oh-blas-TOE-muh)
Osteochondroma (OS-tee-oh-kon-droh-muh)
Enchondroma (en-kon-droh-muh)
Chondromyxoid (kon-dro-MIX-Oya) fibroma.
These benign tumors are discussed later in this document, which is limited to bone cancers.
Malignant bone tumors
Osteosarcoma: Osteosarcoma (also called osteogenic sarcoma) is the most common primary bone cancer. This type of cancer starts in bone cells. It most often occurs in young people between the ages of 10 and 30, but about 10% of osteosarcoma cases develop in people aged 60 to 70 years. It is uncommon in middle age and is more common in men than in women. These tumors develop most often in the bones of the arms, legs or pelvis. This type of cancer is not discussed in detail here, but is covered in our osteosarcoma document.
Chondrosarcoma: Chondrosarcoma (KON-droh-sar-KOH-muh) is a cancer of the cartilage cells. It is the second most common primary bone cancer. This cancer is rare in people under age 20. After age 20, the risk of getting a chondrosarcoma goes up until about 75 years women receive this type of cancer as often as men.
Chondrosarcomas can develop anywhere there cartilage. Most develop in bones such as the pelvis, leg bone or arm bone. Occasionally, chondrosarcoma will develop in the trachea, larynx and chest wall. Other sites are the scapula (shoulder blade), ribs or skull.
(Not cancerous), benign tumors of cartilage are more common than malignant. These are called enchondromas. Another type of benign tumor that has cartilage is a bony projection covered by cartilage called an osteochondroma. These benign tumors rarely develop into cancer. There is a slightly greater chance of developing cancer in people who have many of these tumors, but this is not yet common.
Chondrosarcomas are classified by grade, which measures how quickly they grow. The rating for the pathologist (a specially trained to examine and diagnose tissue samples under a microscope doctor) is assigned. The lower the level, the slower the cancer grows. When a cancer is slow growing, the possibility of spreading is minor and so the prognosis is better. Most chondrosarcomas are either low grade (grade I) or intermediate grade (grade II). High grade (grade III) chondrosarcomas, which are most likely to spread, are less common.
Some chondrosarcomas have distinctive features under a microscope. These variants of chondrosarcoma may have a different prognosis (outlook) than usual chondrosarcomas.
(Dee dih-feh-REN-shee-AY-ted) you dedifferentiated chondrosarcoma chondrosarcoma typical start but then some parts of the change in tumor cells as a high-grade sarcoma (eg high-grade forms fibrous histiocytoma malignant [SU-tee-oh-sy-TOH-muh], osteosarcoma, or fibrosarcoma). This variant of chondrosarcoma tends to occur in older patients and is more aggressive than usual chondrosarcomas.
Clear cell chondrosarcoma are rare and grow slowly. Rarely spread to other parts of the body unless they have already returned several times in the original location.
Mesenchymal chondrosarcoma (meh-ZEN-kih-mul) can grow rapidly, but like Ewing tumor, are sensitive to treatment with radiation and chemotherapy.
Ewing tumor: Ewing tumor is the third most common primary bone cancer and the second most common in children, adolescents and young adults. This cancer (also called Ewing's sarcoma) is named after the doctor who first described it in 1921, Dr. James Ewing. Most Ewing tumors develop into bone, but may begin at other tissues and organs. The most common sites for this cancer are the pelvis, chest wall (such as ribs or shoulder blades), and long bones of the legs or arms. This cancer is more common in children and adolescents is rare in adults over 30. Ewing tumors occur most often in white people and are very rare among African Americans and Asian Americans. More detailed information on this type of cancer can be found in our document Ewing family of tumors.
Malignant fibrous histiocytoma: Malignant fibrous histiocytoma (MFH) more often begins in soft tissue (connective tissue such as ligaments, tendons, fat and muscle) than in bone. This type of cancer is also called undifferentiated pleomorphic sarcoma, especially when starting on soft tissues. When MFH occurs in bones, usually affecting the legs (often around the knees) or arms. This cancer occurs most often in older and middle-aged adults and is rare in children. MFH mostly tends to grow locally, but may spread to distant sites such as the lungs.
Fibrosarcoma: This is another type of cancer that develops most often in soft tissue that makes the bones. Fibrosarcoma usually occurs in the elderly and middle-aged adults. The bones of the legs, arms and jaw are the most affected.
Giant cell tumor of bone: This type of primary bone tumor has benign and malignant forms. The (non-cancerous) benign form is the most common. Giant cell bone tumors typically affect the leg (usually near the knees) or arm bones of young adults and middle-aged. They often do not spread to distant sites, but they tend to go back where they started after surgery (this is called local recurrence). This can happen several times. With each repetition, it becomes more likely to spread to other parts of the body as the tumor. Rarely, a malignant bone giant cell tumor spreads to other parts of the body without recourse first locally.
Chordoma: This primary tumor of bone usually occurs at the base of the skull and bones of the spine. It develops most often in adults over 30 years and is twice as common in men as in women. Chordomas tend to grow slowly and often do not spread to other parts of the body, but they often come back in the same area if not eliminated altogether. Lymph nodes, lungs and liver are the most common areas of secondary spread of tumor.
Other cancers that develop in the bones
Non-Hodgkin lymphomas
Non-Hodgkin lymphoma usually develops in the lymph nodes, but sometimes starts in the bone. Primary non-Hodgkin lymphoma of bone is often a widespread disease due to multiple sites in the body are often involved. The picture is similar to other non-Hodgkin lymphomas of the same subtype and stage. It is not treated as a primary bone sarcoma - primary lymphoma of bone in the same way that lymphomas that originate in the lymph nodes occurs.
Multiple myelomas
Multiple myeloma usually develops in the bone, but doctors do not consider it a primary bone cancer, as it develops from the plasma cells in the bone marrow (the soft inner part of some bones). Although cause bone destruction, is no longer a bone cancer it is leukemia. It is a widespread disease. Sometimes, myeloma can be found first as a single tumor (called a plasmacytoma) in a bone, but most of the time it will spread to the marrow of other bones.
Wednesday, 20 May 2015
Bladder Cancer
What is bladder cancer?
To understand bladder cancer, it helps to know about the normal structure and function of the bladder.
The bladder is a hollow organ in the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. The average adult bladder holds about 2 cups of urine. Urine is made by the kidneys and is then carried to the bladder through tubes called ureters.
When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra. In women, the urethra is very short and opens just in front of the vagina. In men, the urethra is longer. It passes through the prostate gland and the penis, and opens at the tip of the penis.
The wall of the bladder has 4 main layers.
The innermost lining is made up of cells called urothelial or transitional cells, so this layer is called the urothelium or transitional epithelium.
Beneath the urothelium is a thin layer of connective tissue, blood vessels, and nerves, which is called the lamina propria.
Next is a thick layer of muscle called the muscularis propria.
Outside of this muscle, a layer of fatty connective tissue separates the bladder from other nearby organs.
Knowing about these layers is important in understanding how bladder cancer grows. Most bladder cancers start in the urothelium. As the cancer grows into or through the other layers in the bladder, it becomes more advanced and harder to treat.
To understand bladder cancer, it helps to know about the normal structure and function of the bladder.
The bladder is a hollow organ in the pelvis with flexible, muscular walls. Its main function is to store urine before it leaves the body. The average adult bladder holds about 2 cups of urine. Urine is made by the kidneys and is then carried to the bladder through tubes called ureters.
When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra. In women, the urethra is very short and opens just in front of the vagina. In men, the urethra is longer. It passes through the prostate gland and the penis, and opens at the tip of the penis.
The wall of the bladder has 4 main layers.
The innermost lining is made up of cells called urothelial or transitional cells, so this layer is called the urothelium or transitional epithelium.
Beneath the urothelium is a thin layer of connective tissue, blood vessels, and nerves, which is called the lamina propria.
Next is a thick layer of muscle called the muscularis propria.
Outside of this muscle, a layer of fatty connective tissue separates the bladder from other nearby organs.
Knowing about these layers is important in understanding how bladder cancer grows. Most bladder cancers start in the urothelium. As the cancer grows into or through the other layers in the bladder, it becomes more advanced and harder to treat.
Types of bladder cancer
Bladder cancers are divided into several types based how their cells look under a microscope. Different types can respond differently to treatments.
Transitional cell (urothelial) carcinoma
This is by far the most common type of bladder cancer. More than 9 out of 10 bladder cancers are this type. The cells from transitional cell carcinomas (TCCs) look like the urothelial cells that line the inside of the bladder.
Urothelial cells also line other parts of the urinary tract, such as the lining of the kidneys (called the renal pelvis), the ureters, and the urethra, so TCCs can also occur in these places. In fact, patients with bladder cancer sometimes have other tumors in the lining of the kidneys, ureters, or urethra. If someone has a cancer in one part of their urinary system, the entire urinary tract needs to be checked for tumors.
Bladder cancers are often described based on how far they have invaded into the wall of the bladder:
Non-invasive bladder cancers are still in the inner layer of cells (the transitional epithelium) but have not grown into the deeper layers.
Invasive cancers grow into the lamina propria or even deeper into the muscle layer. Invasive cancers are more likely to spread and are harder to treat.
A bladder cancer can also be described as superficial or non-muscle invasive. These terms include both non-invasive tumors as well as any invasive tumors that have not grown into the main muscle layer of the bladder.
Transitional cell carcinomas are also divided into 2 subtypes, papillary and flat, based on how they grow
Papillary carcinomas grow in slender, finger-like projections from the inner surface of the bladder toward the hollow center. Papillary tumors often grow toward the center of the bladder without growing into the deeper bladder layers. These tumors are called non-invasive papillary cancers. Very low-grade, non-invasive papillary cancer is sometimes called papillary neoplasm of low-malignant potential and tends to have a very good outcome.
Flat carcinomas do not grow toward the hollow part of the bladder at all. If a flat tumor is only in the inner layer of bladder cells, it is known as a non-invasive flat carcinoma or a flat carcinoma in situ (CIS).
If either a papillary or flat tumor grows into deeper layers of the bladder, it is called an invasive transitional cell (or urothelial) carcinoma.
Other cancers that start in the bladder
Several other types of cancer can start in the bladder, but these are all much less common than transitional cell (urothelial) cancer.
Squamous cell carcinoma: In the United States, only about 1% to 2% of bladder cancers are squamous cell carcinomas. Under a microscope, the cells look much like the flat cells that are found on the surface of the skin. Nearly all squamous cell carcinomas are invasive.
Adenocarcinoma: Only about 1% of bladder cancers are adenocarcinomas. The cancer cells have a lot in common with gland-forming cells of colon cancers. Nearly all adenocarcinomas of the bladder are invasive.
Small cell carcinoma: Less than 1% of bladder cancers are small-cell carcinomas, which start in nerve-like cells called neuroendocrine cells. These cancers often grow quickly and typically need to be treated with chemotherapy like that used for small cell carcinoma of the lung.
Sarcoma: Sarcomas start in the muscle cells of the bladder, but they are rare. More information about sarcomas can be found in our documents Sarcoma - Adult Soft Tissue Cancer and Rhabdomyosarcoma.
These less common types of bladder cancer (other than sarcoma) are treated similar to transitional cell cancers, especially for early stage tumors, but different drugs may be needed if chemotherapy is required.
Bladder cancers are divided into several types based how their cells look under a microscope. Different types can respond differently to treatments.
Transitional cell (urothelial) carcinoma
This is by far the most common type of bladder cancer. More than 9 out of 10 bladder cancers are this type. The cells from transitional cell carcinomas (TCCs) look like the urothelial cells that line the inside of the bladder.
Urothelial cells also line other parts of the urinary tract, such as the lining of the kidneys (called the renal pelvis), the ureters, and the urethra, so TCCs can also occur in these places. In fact, patients with bladder cancer sometimes have other tumors in the lining of the kidneys, ureters, or urethra. If someone has a cancer in one part of their urinary system, the entire urinary tract needs to be checked for tumors.
Bladder cancers are often described based on how far they have invaded into the wall of the bladder:
Non-invasive bladder cancers are still in the inner layer of cells (the transitional epithelium) but have not grown into the deeper layers.
Invasive cancers grow into the lamina propria or even deeper into the muscle layer. Invasive cancers are more likely to spread and are harder to treat.
A bladder cancer can also be described as superficial or non-muscle invasive. These terms include both non-invasive tumors as well as any invasive tumors that have not grown into the main muscle layer of the bladder.
Transitional cell carcinomas are also divided into 2 subtypes, papillary and flat, based on how they grow
Papillary carcinomas grow in slender, finger-like projections from the inner surface of the bladder toward the hollow center. Papillary tumors often grow toward the center of the bladder without growing into the deeper bladder layers. These tumors are called non-invasive papillary cancers. Very low-grade, non-invasive papillary cancer is sometimes called papillary neoplasm of low-malignant potential and tends to have a very good outcome.
Flat carcinomas do not grow toward the hollow part of the bladder at all. If a flat tumor is only in the inner layer of bladder cells, it is known as a non-invasive flat carcinoma or a flat carcinoma in situ (CIS).
If either a papillary or flat tumor grows into deeper layers of the bladder, it is called an invasive transitional cell (or urothelial) carcinoma.
Other cancers that start in the bladder
Several other types of cancer can start in the bladder, but these are all much less common than transitional cell (urothelial) cancer.
Squamous cell carcinoma: In the United States, only about 1% to 2% of bladder cancers are squamous cell carcinomas. Under a microscope, the cells look much like the flat cells that are found on the surface of the skin. Nearly all squamous cell carcinomas are invasive.
Adenocarcinoma: Only about 1% of bladder cancers are adenocarcinomas. The cancer cells have a lot in common with gland-forming cells of colon cancers. Nearly all adenocarcinomas of the bladder are invasive.
Small cell carcinoma: Less than 1% of bladder cancers are small-cell carcinomas, which start in nerve-like cells called neuroendocrine cells. These cancers often grow quickly and typically need to be treated with chemotherapy like that used for small cell carcinoma of the lung.
Sarcoma: Sarcomas start in the muscle cells of the bladder, but they are rare. More information about sarcomas can be found in our documents Sarcoma - Adult Soft Tissue Cancer and Rhabdomyosarcoma.
These less common types of bladder cancer (other than sarcoma) are treated similar to transitional cell cancers, especially for early stage tumors, but different drugs may be needed if chemotherapy is required.
Anal cancer
Anal cancer
Anal cancer is cancer (malignant tumor) that arises from the anus, the distal opening of the gastrointestinal tract. It is a distinct entity in the most common colorectal cancer.
Anal cancer is typically a squamous cell carcinoma arising annals near the squamocolumnar junction, often linked to infection with human papillomavirus (HPV). You can keratinizing (basaloid) or nonkeratinizing (cloacogenic). Other types of anal cancer are adenocarcinoma, lymphoma, sarcoma or melanoma. 2004-2010 collected data, the survival rate relative five US is 65.5%, although individual rates can vary depending on the stage of cancer in the diagnosis and treatment response.
Signs and symptoms
Symptoms of anal cancer may include pain or pressure in the anus or rectum, a change in bowel habits, a lump near the anus, rectal bleeding, itching or discharge. The bleeding can be severe.
Risk factors
Human Papillomavirus: The examination of the tumor tissues of squamous cell carcinoma patients in Denmark and Sweden showed a high proportion of anal cancers to be positive for HPV types are also associated with a high risk of cervical cancer. In another study ,. high-risk types of HPV, particularly HPV-16 were detected in 84 percent of samples examined anal cancer. Based on the study in Denmark and Sweden, Parkin estimated 90% of anal cancers are attributable to HPV.
Sexual activity: Having multiple sex partners due to increased risk of exposure to HPV.
Receptive anal sex, whether male or female, increases the chances of anal cancer sevenfold due to HPV. Those who engage in anal intercourse with multiple partners are 17 times more likely to develop anal cancer than those who do not.
Smoking: Current smokers are several times more likely to develop anal cancer compared with nonsmokers. Epidemiologist Janet Daling, Ph.D., a member of the Division of Public Health Sciences, Fred Hutchinson and his team found that smoking appears to play a significant. role in the development of anal cancer that is independent of other behavioral risk factors, such as sexual activity. More than half of patients with anal cancer-studied were current smokers at the time of diagnosis, compared to a smoking rate of about 23 percent among controls. "Current smoking is a very important promoter of the disease," Daling said. "There's a fourfold increase in risk if you're a current smoker, regardless of whether you are male or female." They explained that the mechanism behind smoking and anal-cancer development is unknown, but researchers speculate that smoking interferes with a process called apoptosis, or programmed cell death, which helps rid the body of abnormal cells that could become cancerous. Another possibility is that smoking suppresses the immune system, which may decrease the body's ability to eliminate persistent infection or abnormal cells.
Immunosuppression, which often is associated with HIV infection.
Benign anal lesions.
A history of cervical, vaginal and vulvar cancers
Pathology
Most anal cancers are squamous cell (epidermoid carcinomas), which arises near the squamocolumnar junction. You can keratinizing (basaloid) or nonkeratinizing (cloacogenic).
Other types of anal cancer are adenocarcinoma, lymphoma, sarcoma or melanoma.
Prevention
Since many, if not most, anal cancers derive from HPV infections, and since the HPV vaccine before exposure to HPV prevents infection by some strains of the virus and has been shown to reduce the incidence of potentially precancerous lesions, scientists assume that HPV vaccination can reduce the incidence of anal cancer.
The December 22, 2010, the Food and Drug Administration of the United States approved the Gardasil vaccine to prevent anal cancer and pre-cancerous lesions in men and women of 9-26 years. The vaccine has been used before to help prevent cervical, vulvar and vaginal cancer, and associated lesions caused by types 6, 11, 16 and 18 in women.
Screening
Anal Pap smears similar to those used in the detection of cervical cancer have been studied for early detection of anal cancer in high risk individuals. In 2011, the HIV clinic at Jackson Memorial Hospital implemented a program to improve access to anal cancer screening for HIV-positive men. Nurses performed anal Pap screening, and men with abnormal results receive further evaluation with high-resolution anoscopy. The program has helped identify many precancerous growths, which allows them to be disposed of safely.
Treatment
Localized disease
Localized (carcinoma-in-situ) and the precursor condition, anal intraepithelial neoplasia (anal dysplasia or AIN) disease may be minimally invasive ablation methods such as infrared photocoagulation.
Previously, anal cancer was treated with surgery, and in early stage disease (ie, localized cancer of the anus without metastasis to the inguinal lymph nodes), surgery is often curative. The difficulty with surgery has been the need to eliminate the internal and external anal sphincter, with concomitant fecal incontinence. For this reason, many patients with anal cancer have required permanent colostomies.
The current gold standard therapy is chemotherapy and radiotherapy to reduce the necessity of debilitating surgery. This approach "combined modality" has led to the increased preservation of an intact anal sphincter, and therefore improved quality of life after definitive treatment. The survival and cure rates are excellent, and many patients are left with a functional sphincter. Some patients have fecal incontinence after combined chemotherapy and radiation. Biopsies to document disease regression after chemotherapy and radiation were commonly advised, but are not as frequent any longer. Current Chemotherapy continuous infusion of 5-FU for four days with bolus mitomycin given concurrently with radiation. 5-FU and cisplatin is recommended for metastatic anal cancer.
Metastatic or recurrent disease
10 to 20% of patients treated for anal cancer will develop distant metastases after treatment. Metastatic or recurrent anal cancer is difficult to treat, and usually requires chemotherapy. Radiation is also used to alleviate specific locations of disease that may be causing the symptoms. Chemotherapy commonly used is similar to other epithelial squamous cell neoplasms, such as platinum analogs, anthracyclines such as doxorubicin, and antimetabolites such as 5-FU and capecitabine. Hainsworth JD developed a protocol that includes Taxol and Carboplatin along with 5-FU. The average survival rates for patients with distant metastases ranges 8-34 months.
Anal cancer is cancer (malignant tumor) that arises from the anus, the distal opening of the gastrointestinal tract. It is a distinct entity in the most common colorectal cancer.
Anal cancer is typically a squamous cell carcinoma arising annals near the squamocolumnar junction, often linked to infection with human papillomavirus (HPV). You can keratinizing (basaloid) or nonkeratinizing (cloacogenic). Other types of anal cancer are adenocarcinoma, lymphoma, sarcoma or melanoma. 2004-2010 collected data, the survival rate relative five US is 65.5%, although individual rates can vary depending on the stage of cancer in the diagnosis and treatment response.
Signs and symptoms
Symptoms of anal cancer may include pain or pressure in the anus or rectum, a change in bowel habits, a lump near the anus, rectal bleeding, itching or discharge. The bleeding can be severe.
Risk factors
Human Papillomavirus: The examination of the tumor tissues of squamous cell carcinoma patients in Denmark and Sweden showed a high proportion of anal cancers to be positive for HPV types are also associated with a high risk of cervical cancer. In another study ,. high-risk types of HPV, particularly HPV-16 were detected in 84 percent of samples examined anal cancer. Based on the study in Denmark and Sweden, Parkin estimated 90% of anal cancers are attributable to HPV.
Sexual activity: Having multiple sex partners due to increased risk of exposure to HPV.
Receptive anal sex, whether male or female, increases the chances of anal cancer sevenfold due to HPV. Those who engage in anal intercourse with multiple partners are 17 times more likely to develop anal cancer than those who do not.
Smoking: Current smokers are several times more likely to develop anal cancer compared with nonsmokers. Epidemiologist Janet Daling, Ph.D., a member of the Division of Public Health Sciences, Fred Hutchinson and his team found that smoking appears to play a significant. role in the development of anal cancer that is independent of other behavioral risk factors, such as sexual activity. More than half of patients with anal cancer-studied were current smokers at the time of diagnosis, compared to a smoking rate of about 23 percent among controls. "Current smoking is a very important promoter of the disease," Daling said. "There's a fourfold increase in risk if you're a current smoker, regardless of whether you are male or female." They explained that the mechanism behind smoking and anal-cancer development is unknown, but researchers speculate that smoking interferes with a process called apoptosis, or programmed cell death, which helps rid the body of abnormal cells that could become cancerous. Another possibility is that smoking suppresses the immune system, which may decrease the body's ability to eliminate persistent infection or abnormal cells.
Immunosuppression, which often is associated with HIV infection.
Benign anal lesions.
A history of cervical, vaginal and vulvar cancers
Pathology
Most anal cancers are squamous cell (epidermoid carcinomas), which arises near the squamocolumnar junction. You can keratinizing (basaloid) or nonkeratinizing (cloacogenic).
Other types of anal cancer are adenocarcinoma, lymphoma, sarcoma or melanoma.
Prevention
Since many, if not most, anal cancers derive from HPV infections, and since the HPV vaccine before exposure to HPV prevents infection by some strains of the virus and has been shown to reduce the incidence of potentially precancerous lesions, scientists assume that HPV vaccination can reduce the incidence of anal cancer.
The December 22, 2010, the Food and Drug Administration of the United States approved the Gardasil vaccine to prevent anal cancer and pre-cancerous lesions in men and women of 9-26 years. The vaccine has been used before to help prevent cervical, vulvar and vaginal cancer, and associated lesions caused by types 6, 11, 16 and 18 in women.
Screening
Anal Pap smears similar to those used in the detection of cervical cancer have been studied for early detection of anal cancer in high risk individuals. In 2011, the HIV clinic at Jackson Memorial Hospital implemented a program to improve access to anal cancer screening for HIV-positive men. Nurses performed anal Pap screening, and men with abnormal results receive further evaluation with high-resolution anoscopy. The program has helped identify many precancerous growths, which allows them to be disposed of safely.
Treatment
Localized disease
Localized (carcinoma-in-situ) and the precursor condition, anal intraepithelial neoplasia (anal dysplasia or AIN) disease may be minimally invasive ablation methods such as infrared photocoagulation.
Previously, anal cancer was treated with surgery, and in early stage disease (ie, localized cancer of the anus without metastasis to the inguinal lymph nodes), surgery is often curative. The difficulty with surgery has been the need to eliminate the internal and external anal sphincter, with concomitant fecal incontinence. For this reason, many patients with anal cancer have required permanent colostomies.
The current gold standard therapy is chemotherapy and radiotherapy to reduce the necessity of debilitating surgery. This approach "combined modality" has led to the increased preservation of an intact anal sphincter, and therefore improved quality of life after definitive treatment. The survival and cure rates are excellent, and many patients are left with a functional sphincter. Some patients have fecal incontinence after combined chemotherapy and radiation. Biopsies to document disease regression after chemotherapy and radiation were commonly advised, but are not as frequent any longer. Current Chemotherapy continuous infusion of 5-FU for four days with bolus mitomycin given concurrently with radiation. 5-FU and cisplatin is recommended for metastatic anal cancer.
Metastatic or recurrent disease
10 to 20% of patients treated for anal cancer will develop distant metastases after treatment. Metastatic or recurrent anal cancer is difficult to treat, and usually requires chemotherapy. Radiation is also used to alleviate specific locations of disease that may be causing the symptoms. Chemotherapy commonly used is similar to other epithelial squamous cell neoplasms, such as platinum analogs, anthracyclines such as doxorubicin, and antimetabolites such as 5-FU and capecitabine. Hainsworth JD developed a protocol that includes Taxol and Carboplatin along with 5-FU. The average survival rates for patients with distant metastases ranges 8-34 months.
HIV/AIDS
HIV/AIDS
Infection by HIV and acquired immunodeficiency syndrome (HIV / AIDS) is a spectrum of diseases caused by infection with human immunodeficiency virus (HIV) After the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a long asymptomatic period. As the infection progresses, increasingly interfere with the immune system, making the person more susceptible to common infections such as tuberculosis and opportunistic infections and tumors that usually do not affect people who work the system immune. Later symptoms of the infection are known as AIDS. This stage is often complicated by a lung infection called pneumocystis pneumonia, severe weight loss, a type of cancer known as Kaposi's sarcoma and other AIDS-defining conditions.
HIV is transmitted primarily through sexual intercourse without protection (including anal and oral sex), transfusions of contaminated blood, needles, and from mother to child during pregnancy, childbirth or breastfeeding. Some body fluids, such as saliva and tears do not transmit HIV. Common methods of preventing HIV / AIDS include encouraging safer sex, needle exchange programs, and treatment of those infected. There is no cure or vaccine; However, antiretroviral therapy can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of death and complications of the disease, these drugs are expensive and have side effects. Without treatment, it is estimated that the average survival time after infection with HIV to be in 9-11 years, depending on the subtype of HIV.
Since its discovery, AIDS has caused an estimated 36 million deaths worldwide (as of 2012). In 2013 it led to a 1.34 million deaths. From 2012, approximately 35.3 million people live with HIV worldwide. HIV / AIDS is considered a pandemic outbreak of a disease that is present in a large area and is spreading actively. Genetic research indicates that HIV originated in west-central Africa during the late nineteenth and early twentieth century. AIDS was first recognized by the Centers for Disease Control and Prevention (CDC) in 1981 and their cause HIV-infection was identified in the early part of the decade.
HIV / AIDS has had a major impact on society, both as a disease and as a source of discrimination. The disease also have significant economic impacts. There are many misconceptions about HIV / AIDS, such as the belief that it can be transmitted by nonsexual contact casual ideas. The disease has become the subject of much controversy involving religion. It's called medical care and international politics as well as large-scale financing since it was identified in the 1980s.
Infection by HIV and acquired immunodeficiency syndrome (HIV / AIDS) is a spectrum of diseases caused by infection with human immunodeficiency virus (HIV) After the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a long asymptomatic period. As the infection progresses, increasingly interfere with the immune system, making the person more susceptible to common infections such as tuberculosis and opportunistic infections and tumors that usually do not affect people who work the system immune. Later symptoms of the infection are known as AIDS. This stage is often complicated by a lung infection called pneumocystis pneumonia, severe weight loss, a type of cancer known as Kaposi's sarcoma and other AIDS-defining conditions.
HIV is transmitted primarily through sexual intercourse without protection (including anal and oral sex), transfusions of contaminated blood, needles, and from mother to child during pregnancy, childbirth or breastfeeding. Some body fluids, such as saliva and tears do not transmit HIV. Common methods of preventing HIV / AIDS include encouraging safer sex, needle exchange programs, and treatment of those infected. There is no cure or vaccine; However, antiretroviral therapy can slow the course of the disease and may lead to a near-normal life expectancy. While antiretroviral treatment reduces the risk of death and complications of the disease, these drugs are expensive and have side effects. Without treatment, it is estimated that the average survival time after infection with HIV to be in 9-11 years, depending on the subtype of HIV.
Since its discovery, AIDS has caused an estimated 36 million deaths worldwide (as of 2012). In 2013 it led to a 1.34 million deaths. From 2012, approximately 35.3 million people live with HIV worldwide. HIV / AIDS is considered a pandemic outbreak of a disease that is present in a large area and is spreading actively. Genetic research indicates that HIV originated in west-central Africa during the late nineteenth and early twentieth century. AIDS was first recognized by the Centers for Disease Control and Prevention (CDC) in 1981 and their cause HIV-infection was identified in the early part of the decade.
HIV / AIDS has had a major impact on society, both as a disease and as a source of discrimination. The disease also have significant economic impacts. There are many misconceptions about HIV / AIDS, such as the belief that it can be transmitted by nonsexual contact casual ideas. The disease has become the subject of much controversy involving religion. It's called medical care and international politics as well as large-scale financing since it was identified in the 1980s.
Tuesday, 19 May 2015
Liver Cancer.....
What is liver cancer?
Only cancers that start in the liver are called liver cancer. To understand liver cancer, it helps to know about the normal structure and function of the liver.
On the liver
The liver is the largest internal organ. It is located below the ribs on the right side just below his right lung. It is shaped like a pyramid and divided into right and left lobes. The lobes are segmented.
Unlike most other organs, the liver receives blood from two sources: the hepatic artery supplies the liver with oxygen-rich blood from the heart, and the portal vein carries nutrient-rich blood from the gut.
You can not live without your liver. It has several important functions:
It breaks down and stores many of the nutrients absorbed from the intestine that your body needs to function. Some nutrients must be changed (metabolized) by the liver before they can be used by the rest of the body for energy or to build and repair body tissues.
It makes most of the clotting factors that prevent excessive bleeding when cut or injured.
Bile is secreted into the intestine to help absorb nutrients (especially fats).
Filter and decomposes toxic wastes in the blood, which are then removed from the body.
The liver consists mainly of cells called hepatocytes. It also consists of other types of cells, including the cells that line blood vessels and the cells lining the small tubes called bile ducts of the liver. The bile ducts outside the liver spread and carry bile from the liver to the gallbladder or directly to the intestines.
These different types of cells in the liver can form various types of (non-cancerous) benign malignant (cancerous). These tumors have different causes, are treated differently and have a different prognosis (outlook).
Only cancers that start in the liver are called liver cancer. To understand liver cancer, it helps to know about the normal structure and function of the liver.
On the liver
The liver is the largest internal organ. It is located below the ribs on the right side just below his right lung. It is shaped like a pyramid and divided into right and left lobes. The lobes are segmented.
Unlike most other organs, the liver receives blood from two sources: the hepatic artery supplies the liver with oxygen-rich blood from the heart, and the portal vein carries nutrient-rich blood from the gut.
You can not live without your liver. It has several important functions:
It breaks down and stores many of the nutrients absorbed from the intestine that your body needs to function. Some nutrients must be changed (metabolized) by the liver before they can be used by the rest of the body for energy or to build and repair body tissues.
It makes most of the clotting factors that prevent excessive bleeding when cut or injured.
Bile is secreted into the intestine to help absorb nutrients (especially fats).
Filter and decomposes toxic wastes in the blood, which are then removed from the body.
The liver consists mainly of cells called hepatocytes. It also consists of other types of cells, including the cells that line blood vessels and the cells lining the small tubes called bile ducts of the liver. The bile ducts outside the liver spread and carry bile from the liver to the gallbladder or directly to the intestines.
These different types of cells in the liver can form various types of (non-cancerous) benign malignant (cancerous). These tumors have different causes, are treated differently and have a different prognosis (outlook).
Benign liver tumors
Benign tumors sometimes grow large enough to cause problems, but they do not grow in the near or spread to distant parts of the body tissues. If need be treated, the patient can be cured with surgery.
Benign tumors sometimes grow large enough to cause problems, but they do not grow in the near or spread to distant parts of the body tissues. If need be treated, the patient can be cured with surgery.
Hemangioma
The most common type of benign liver tumor, hemangiomas start in blood vessels. Most hemangiomas of the liver cause no symptoms and need no treatment. But some may bleed and need to be surgically removed.
The most common type of benign liver tumor, hemangiomas start in blood vessels. Most hemangiomas of the liver cause no symptoms and need no treatment. But some may bleed and need to be surgically removed.
Hepatic adenoma
Hepatic adenoma is a benign tumor of the hepatocytes (the main type of liver cells). Most cause no symptoms and need no treatment. But some eventually cause symptoms, such as pain or lump in the abdomen (stomach area) or blood loss. Because there is the risk that the tumor may break (leading to severe loss of blood) and a small risk that over time could become liver cancer, most experts usually advise surgery to remove the tumor, if possible.
The use of certain medications can increase the risk of these tumors. Women have a greater chance of having one of these tumors if they take birth control pills, although this is rare. Men who use anabolic steroids may also develop these tumors. Adenomas may shrink when the drugs are stopped.
Hepatic adenoma is a benign tumor of the hepatocytes (the main type of liver cells). Most cause no symptoms and need no treatment. But some eventually cause symptoms, such as pain or lump in the abdomen (stomach area) or blood loss. Because there is the risk that the tumor may break (leading to severe loss of blood) and a small risk that over time could become liver cancer, most experts usually advise surgery to remove the tumor, if possible.
The use of certain medications can increase the risk of these tumors. Women have a greater chance of having one of these tumors if they take birth control pills, although this is rare. Men who use anabolic steroids may also develop these tumors. Adenomas may shrink when the drugs are stopped.
Focal nodular hyperplasia
Focal nodular hyperplasia (FNH) is like a tumor composed of several cell types (hepatocytes, bile duct cells, and connective tissue cells) growth. Although FNH tumors are benign, it can be difficult to distinguish from true liver cancers, and doctors sometimes remove them when the diagnosis is unclear. If you have symptoms of an FNH tumor can be removed surgically.
Both hepatic adenomas and FNH tumors are more common in women than in men.
Focal nodular hyperplasia (FNH) is like a tumor composed of several cell types (hepatocytes, bile duct cells, and connective tissue cells) growth. Although FNH tumors are benign, it can be difficult to distinguish from true liver cancers, and doctors sometimes remove them when the diagnosis is unclear. If you have symptoms of an FNH tumor can be removed surgically.
Both hepatic adenomas and FNH tumors are more common in women than in men.
Types of primary liver cancer
A cancer that originates in the liver is called primary liver cancer. There are more than one type of primary liver cancer.
A cancer that originates in the liver is called primary liver cancer. There are more than one type of primary liver cancer.
Hepatocellular carcinoma (HCC)
This is the most common form of liver cancer in adults. It is also sometimes called hepatoma. On May 4 cancers that start in the liver are this type.
Hepatocellular cancer (HCC) can have different growth patterns:
Some begin as a single tumor that grows larger. Only late in the disease did not spread to other parts of the liver.
A second type seems to start as many small cancer nodules throughout the liver, not just a single tumor. This is seen most often in people with cirrhosis (chronic liver damage) and is the most common pattern seen in the United States.
Under the microscope, doctors can distinguish several subtypes of HCC. Very often these subtypes do not affect treatment or prognosis (outlook). But one of these subtypes, fibrolamellar is important to recognize. This type is rare, making up less than 1% of HCC. This type is more common in women under 35 years of age, and often the rest of the liver is not diseased. This subtype generally has a better prognosis than other forms of HCC.
Intrahepatic cholangiocarcinoma (cancer of the bile ducts)
About 10% to 20% of cancers that start in the liver are intrahepatic cholangiocarcinoma. These cancers start in the cells lining the small bile ducts (tubes that carry bile from the gallbladder) within the liver. (Most cholangiocarcinomas actually start in the bile ducts outside the liver.)
Hemangiosarcoma and Angiosarcoma
These are rare cancers that begin in cells that line the blood vessels of the liver. People who have been exposed to vinyl chloride or to thorium (Thorotrast) emissions are more likely to develop these cancers. See "What are the risk factors for liver cancer?" Some other cases are believed to be caused by exposure to arsenic or radio, or an inherited condition called hereditary hemochromatosis. In about half of all cases, there is no probable cause can be identified.
These tumors grow rapidly and are usually too widespread to be surgically removed at the time found. Chemotherapy and radiation therapy may help slow the disease, but these cancers are often very difficult to treat. These cancers are treated as other sarcomas.
This is the most common form of liver cancer in adults. It is also sometimes called hepatoma. On May 4 cancers that start in the liver are this type.
Hepatocellular cancer (HCC) can have different growth patterns:
Some begin as a single tumor that grows larger. Only late in the disease did not spread to other parts of the liver.
A second type seems to start as many small cancer nodules throughout the liver, not just a single tumor. This is seen most often in people with cirrhosis (chronic liver damage) and is the most common pattern seen in the United States.
Under the microscope, doctors can distinguish several subtypes of HCC. Very often these subtypes do not affect treatment or prognosis (outlook). But one of these subtypes, fibrolamellar is important to recognize. This type is rare, making up less than 1% of HCC. This type is more common in women under 35 years of age, and often the rest of the liver is not diseased. This subtype generally has a better prognosis than other forms of HCC.
Intrahepatic cholangiocarcinoma (cancer of the bile ducts)
About 10% to 20% of cancers that start in the liver are intrahepatic cholangiocarcinoma. These cancers start in the cells lining the small bile ducts (tubes that carry bile from the gallbladder) within the liver. (Most cholangiocarcinomas actually start in the bile ducts outside the liver.)
Hemangiosarcoma and Angiosarcoma
These are rare cancers that begin in cells that line the blood vessels of the liver. People who have been exposed to vinyl chloride or to thorium (Thorotrast) emissions are more likely to develop these cancers. See "What are the risk factors for liver cancer?" Some other cases are believed to be caused by exposure to arsenic or radio, or an inherited condition called hereditary hemochromatosis. In about half of all cases, there is no probable cause can be identified.
These tumors grow rapidly and are usually too widespread to be surgically removed at the time found. Chemotherapy and radiation therapy may help slow the disease, but these cancers are often very difficult to treat. These cancers are treated as other sarcomas.
Hepatoblastoma
This is a very rare kind of cancer that develops in children, usually in children under 4 years old. Hepatoblastoma cells are similar to fetal liver cells. About 2 in 3 children with these tumors are successfully treated with surgery and chemotherapy, but the tumors are more difficult to treat if they have spread outside the liver.
This is a very rare kind of cancer that develops in children, usually in children under 4 years old. Hepatoblastoma cells are similar to fetal liver cells. About 2 in 3 children with these tumors are successfully treated with surgery and chemotherapy, but the tumors are more difficult to treat if they have spread outside the liver.
Secondary liver cancer
Most of the time when cancer is found in the liver that did not start there but has spread (metastasized) from another part of the body such as the pancreas, colon, stomach, breast or lung. Because this cancer has spread from its original site (primary), it is a secondary liver cancer. These tumors are named and treated according to their primary site (where they started). For example, cancer that started in the lung and spread to the liver is called lung cancer spread to the liver, not liver cancer, and treated as lung cancer.
In the United States and Europe, the tumors (metastasis) of secondary liver are more common than primary liver cancer. The opposite is true for many areas of Asia and Africa.
Most of the time when cancer is found in the liver that did not start there but has spread (metastasized) from another part of the body such as the pancreas, colon, stomach, breast or lung. Because this cancer has spread from its original site (primary), it is a secondary liver cancer. These tumors are named and treated according to their primary site (where they started). For example, cancer that started in the lung and spread to the liver is called lung cancer spread to the liver, not liver cancer, and treated as lung cancer.
In the United States and Europe, the tumors (metastasis) of secondary liver are more common than primary liver cancer. The opposite is true for many areas of Asia and Africa.
Breasr Cancer
What is breast cancer?
Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can grow into (invade) tissues or spread (metastasize) to distant areas of the body around. The disease occurs almost exclusively in women, but men can do it, too.
The normal breast
To understand breast cancer, it helps to have some basic knowledge about the normal structure of the breasts, as shown in the following diagram.
The female breast is composed mainly of lobules (milk-producing glands), ducts (small tubes that carry milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, vessels blood and lymph vessels).
Most breast cancers begin in cells that line the ducts (ductal cancer). Some start in the cells that line the lobules (lobular cancer), while a small number start in other tissues.
The (lymph) lymphatic system of the breast
The lymphatic system is important to understand because it is a form of breast cancer can spread. This system has several parts.
Lymph nodes are small groups of immune system cells (cells that are important in fighting infections) that are connected by lymphatic vessels, bean-shaped. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune cells. The breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.
Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and either above or below the collarbone (supraclavicular or infraclavicular nodes).
If cancer cells have spread to lymph nodes, there is a greater likelihood that the cells could have also entered the bloodstream and spread (metastasize) to other parts of the body. The more lymph nodes in breast cancer cells, it is likely that cancer can be found in other organs as well. Because of this, the search for cancer in one or more lymph nodes often affects the treatment plan. However, not all women with cancer cells in their lymph nodes develop metastases, and some women may have cancer cells in the lymph nodes and later develop metastases.
Benign breast lumps
Most breast lumps are not cancerous (benign). Still, some may need a biopsy (sample and viewed under a microscope) to prove they are not cancer.
Fibrosis and cysts
Most lumps turn out to be caused by fibrosis and / or cysts, benign changes in breast tissue that occur in many women at some point in their lives. (This is sometimes called fibrocystic changes and used to be called fibrocystic disease.) Fibrosis is the formation of scar (fibrous) tissue, and cysts are fluid-filled sacs. These conditions are most often diagnosed by a doctor based on the symptoms, such as breast lumps, swelling and tenderness or pain. These symptoms are often worse just before the menstrual period of women is about to begin. Your breasts may feel lumpy and, sometimes, you may notice a discharge from clear or slightly cloudy nipple.
Intraductal papillomas and fibroadenomas
Benign breast tumors such as fibroadenomas or intraductal papillomas are abnormal growths, but they are not cancerous and do not spread outside the breast to other organs. They are not life threatening.
But some benign breast conditions are important because women with these conditions have an increased risk of developing breast cancer.
Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can grow into (invade) tissues or spread (metastasize) to distant areas of the body around. The disease occurs almost exclusively in women, but men can do it, too.
The normal breast
To understand breast cancer, it helps to have some basic knowledge about the normal structure of the breasts, as shown in the following diagram.
The female breast is composed mainly of lobules (milk-producing glands), ducts (small tubes that carry milk from the lobules to the nipple), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, vessels blood and lymph vessels).
Most breast cancers begin in cells that line the ducts (ductal cancer). Some start in the cells that line the lobules (lobular cancer), while a small number start in other tissues.
The (lymph) lymphatic system of the breast
The lymphatic system is important to understand because it is a form of breast cancer can spread. This system has several parts.
Lymph nodes are small groups of immune system cells (cells that are important in fighting infections) that are connected by lymphatic vessels, bean-shaped. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune cells. The breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.
Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and either above or below the collarbone (supraclavicular or infraclavicular nodes).
If cancer cells have spread to lymph nodes, there is a greater likelihood that the cells could have also entered the bloodstream and spread (metastasize) to other parts of the body. The more lymph nodes in breast cancer cells, it is likely that cancer can be found in other organs as well. Because of this, the search for cancer in one or more lymph nodes often affects the treatment plan. However, not all women with cancer cells in their lymph nodes develop metastases, and some women may have cancer cells in the lymph nodes and later develop metastases.
Benign breast lumps
Most breast lumps are not cancerous (benign). Still, some may need a biopsy (sample and viewed under a microscope) to prove they are not cancer.
Fibrosis and cysts
Most lumps turn out to be caused by fibrosis and / or cysts, benign changes in breast tissue that occur in many women at some point in their lives. (This is sometimes called fibrocystic changes and used to be called fibrocystic disease.) Fibrosis is the formation of scar (fibrous) tissue, and cysts are fluid-filled sacs. These conditions are most often diagnosed by a doctor based on the symptoms, such as breast lumps, swelling and tenderness or pain. These symptoms are often worse just before the menstrual period of women is about to begin. Your breasts may feel lumpy and, sometimes, you may notice a discharge from clear or slightly cloudy nipple.
Intraductal papillomas and fibroadenomas
Benign breast tumors such as fibroadenomas or intraductal papillomas are abnormal growths, but they are not cancerous and do not spread outside the breast to other organs. They are not life threatening.
But some benign breast conditions are important because women with these conditions have an increased risk of developing breast cancer.
Bile Duct Cancer
What is Bile Duct Cancer?
Bile Duct Cancer begins in a bile duct. To understand this cancer, it helps on the normal biliary tract and what they know to do.
About the bile ducts
The bile ducts are a series of thin tubes, the distance from the liver to the small intestine. The main function of the bile duct is a liquid, the bile from the liver and gall bladder into the small intestine, where it helps to digest the fats in the food to move.
Different parts of the biliary tree have different names. In the liver, it begins so many small tubes (called ductules) which collects bile from the liver cells. The Ductuli come together to form small channels, which then merge into larger ducts and finally the left and right hepatic ducts. All of these channels in the liver are called intrahepatic bile ducts.
The left and right hepatic ducts exit from the liver or to the common hepatic duct to form in a region called the hilum. Further down, the gallbladder (a small organ that stores bile) of the common hepatic duct joins the cystic duct called by a small canal. The combined channel called the common bile duct. The bile duct passes through a part of the pancreas before the junction with the pancreatic duct and opens into the first portion of the small intestine (duodenum) to the ampulla father.
Types of bile duct cancer by location
Cancer can develop in any part of the bile duct system and on the basis of their position (see picture below), are divided into 3 types:
Intrahepatic bile duct cancer
Perihilar (also hilar) bile duct cancer
Distal bile duct cancer
Cancers in these different areas may cause different symptoms.
Intrahepatic bile duct cancer
To develop in the smaller bile duct branches in the liver These cancers. You can sometimes find cancers that are confused to start frequently treated in the liver cells, which are called hepatocellular carcinomas and in the same way. Only about 1 in 10 bile duct cancer are intrahepatic.
Perihilar (also hilar) bile duct cancer
These cancers develop on the hilum, where the left and right hepatic ducts have joined forces and are straight out of the liver. These are also referred to Klatskin tumors. They are the most common type of bile duct cancer, more than half of all cancers bile duct. These cancers are grouped with distal bile duct cancer such as extrahepatic bile duct cancer.
Distal bile duct cancer
These cancers are found later in the bile duct, closer to the small intestine. How perihilar cancers, these extrahepatic bile duct cancer, as they start outside the liver. Distal bile duct cancer form 2 to 3 every 10 bile duct cancer.
Types of bile duct cancer by cell type
Bile duct cancer can also in species depending on how to divide the cancer cells under a microscope.
Almost all bile duct cancer are called cholangiocarcinomas. Most of these are adenocarcinomas, the cancers that begin in glandular cells. Bile duct adenocarcinomas develop from the mucous glands cells. The interior of the pipeline
Other types of bile duct cancer are much rarer. This includes sarcomas, lymphomas and small cell lung cancer. This document is not to discuss these types of bile duct cancer.
The remainder of this document refers only to cholangiocarcinomas.
Benign bile duct tumors
Not all bile duct tumors are malignant. Bile duct hamartomas and bile duct adenomas are examples of benign (non-cancerous) tumors that are not explained further in this document.
Other cancers in the liver
The most common form of cancer that starts in the liver - much more common than intrahepatic bile duct cancer - is hepatocellular carcinoma, which developed from liver cells. Hepatocellular carcinoma is discussed more liver cancer in our document.
Cancers that begin in some other organs can spread to the liver. These are called secondary liver cancer or liver metastases. Your attitude and treatment are not the same as cancer in the liver (eg hepatocellular carcinoma) or bile ducts (as cholangiocarcinoma) begins, but on where the cancer depend started. For this reason it is important to know if an adenocarcinoma in the liver in the bile ducts of the author (and is a cholangiocarcinoma), or whether it started in another organ (such as the colon) and then spread to the liver.
Bile Duct Cancer begins in a bile duct. To understand this cancer, it helps on the normal biliary tract and what they know to do.
About the bile ducts
The bile ducts are a series of thin tubes, the distance from the liver to the small intestine. The main function of the bile duct is a liquid, the bile from the liver and gall bladder into the small intestine, where it helps to digest the fats in the food to move.
Different parts of the biliary tree have different names. In the liver, it begins so many small tubes (called ductules) which collects bile from the liver cells. The Ductuli come together to form small channels, which then merge into larger ducts and finally the left and right hepatic ducts. All of these channels in the liver are called intrahepatic bile ducts.
The left and right hepatic ducts exit from the liver or to the common hepatic duct to form in a region called the hilum. Further down, the gallbladder (a small organ that stores bile) of the common hepatic duct joins the cystic duct called by a small canal. The combined channel called the common bile duct. The bile duct passes through a part of the pancreas before the junction with the pancreatic duct and opens into the first portion of the small intestine (duodenum) to the ampulla father.
Types of bile duct cancer by location
Cancer can develop in any part of the bile duct system and on the basis of their position (see picture below), are divided into 3 types:
Intrahepatic bile duct cancer
Perihilar (also hilar) bile duct cancer
Distal bile duct cancer
Cancers in these different areas may cause different symptoms.
Intrahepatic bile duct cancer
To develop in the smaller bile duct branches in the liver These cancers. You can sometimes find cancers that are confused to start frequently treated in the liver cells, which are called hepatocellular carcinomas and in the same way. Only about 1 in 10 bile duct cancer are intrahepatic.
Perihilar (also hilar) bile duct cancer
These cancers develop on the hilum, where the left and right hepatic ducts have joined forces and are straight out of the liver. These are also referred to Klatskin tumors. They are the most common type of bile duct cancer, more than half of all cancers bile duct. These cancers are grouped with distal bile duct cancer such as extrahepatic bile duct cancer.
Distal bile duct cancer
These cancers are found later in the bile duct, closer to the small intestine. How perihilar cancers, these extrahepatic bile duct cancer, as they start outside the liver. Distal bile duct cancer form 2 to 3 every 10 bile duct cancer.
Types of bile duct cancer by cell type
Bile duct cancer can also in species depending on how to divide the cancer cells under a microscope.
Almost all bile duct cancer are called cholangiocarcinomas. Most of these are adenocarcinomas, the cancers that begin in glandular cells. Bile duct adenocarcinomas develop from the mucous glands cells. The interior of the pipeline
Other types of bile duct cancer are much rarer. This includes sarcomas, lymphomas and small cell lung cancer. This document is not to discuss these types of bile duct cancer.
The remainder of this document refers only to cholangiocarcinomas.
Benign bile duct tumors
Not all bile duct tumors are malignant. Bile duct hamartomas and bile duct adenomas are examples of benign (non-cancerous) tumors that are not explained further in this document.
Other cancers in the liver
The most common form of cancer that starts in the liver - much more common than intrahepatic bile duct cancer - is hepatocellular carcinoma, which developed from liver cells. Hepatocellular carcinoma is discussed more liver cancer in our document.
Cancers that begin in some other organs can spread to the liver. These are called secondary liver cancer or liver metastases. Your attitude and treatment are not the same as cancer in the liver (eg hepatocellular carcinoma) or bile ducts (as cholangiocarcinoma) begins, but on where the cancer depend started. For this reason it is important to know if an adenocarcinoma in the liver in the bile ducts of the author (and is a cholangiocarcinoma), or whether it started in another organ (such as the colon) and then spread to the liver.
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