Loading...

© drnikunjchauhan.com
developed by Netifi.

Know Your Cancer

Breast Cancer

Risk Factors: Age, Family history, BRCA mutations, obesity, hormonal therapy, late pregnancy, radiation exposure

Investigations:

  • Mammography for women older than 35 years
  • Ultrasound for younger women than 35 years
  • MRI case on case basis
  • Core biopsy and IHC for receptor status of ER, PR, HER2
  • Staging with PET-CT/CECT TAP & bone scan
  • (Locally advanced cases requires staging)

Treatment:

  • Individualized as per IHC receptor status
  • ER/PR positive - Hormonal therapy as an adjuvant
  • HER2 positive - anti-HER2 targeted therapy (Trastuzumab) as adjuvant & maintenance + Chemotherapy
  • Triple negative - Neoadjuvant or adjuvant (early) Chemotherapy
  • Early Stage: Surgery (lumpectomy + radiation/mastectomy), axillary lymph node dissection or sentinel node biopsy
  • Locally Advanced Stage: Neoadjuvant treatment than surgery + radiation

Oral Cavity Cancer

Risk Factors: Tobacco (chewable), alcohol, poor oral hygiene

Investigations:

  • Clinical examination, biopsy, CT/MRI, PET-CT

Treatment:

  • Early
    • Surgery
    • Adjuvant Radiation
  • Locally Advanced
    • Surgery with reconstruction
    • Adjuvant chemoradiation
    • Neoadjuvant chemotherapy case basis

Colon cancer

Risk Factors: Family history, IBD (Inflammatory Bowel Disorders), obesity, low fiber diet

Investigations:

  • Colonoscopy & biopsy
  • CEA levels
  • Contrast enhanced CT Thorax + Abdomen + Pelvis for staging

Treatment:

  • Localized
    • Surgery (Colectomy with principal lymphadectomy as per part of affected colon)
    • Adjuvant Chemotherapy
  • Metastatic
    • Chemotherapy, targeted therapy, palliative care
    • Surgery (Metastatectomy when feasible to remove all lesions) on case basis

Rectal Cancer

Risk Factors: Family history, IBD (Inflammatory Bowel Disorders), obesity, low fiber diet

Investigations:

  • Colonoscopy & biopsy
  • MRI pelvis (important for making all decision making)
  • CEA levels
  • Contrast enhanced CT Thorax + Abdomen + Pelvis for staging

Treatment:

  • Early - Surgery
    • Removal of rectum as per affected part
    • Whole or part of rectum
  • Locally Advanced
    • Neoadjuvant chemoradiation followed by surgery
    • Adjuvant Chemotherapy

Cervical Cancer

Risk Factors: HPV (Human Papilloma Virus) chronic infection, multiple partners, smoking

Investigations:

  • Clinical examination & Punch biopsy
  • MRI / CT Pelvis & Abdomen

Treatment:

  • Early
    • Surgery (radical hysterectomy) when cancer confined to cervix
  • Advanced
    • Chemoradiation, brachytherapy when cancer spreads beyond cervix

Ovarian Cancer

Risk Factors: BRCA mutations, infertility, endometriosis.

Investigations:

  • Ultrasound
  • CA-125 levels
  • CT/MRI
  • Biopsy only indicated if chemotherapy planned first

Treatment:

  • Early
    • Surgery
    • Adjuvant chemotherapy
  • Advanced
    • Cytoreductive surgery
    • HIPEC on case basis
    • Neoadjuvant or adjuvant chemotherapy on case basis

Uterine Cancer

Risk Factors: Obesity, diabetes, estrogen therapy.

Investigations:

  • Endometrial biopsy
  • Ultrasound followed by MRI pelvis & abdomen

Treatment:

  • Early
    • Surgery
      • Hysterectomy, lymphadenectomy
    • Vaginal brachytherapy on case basis
  • Advanced
    • Surgery
    • Radiation
    • Chemotherapy

Esophageal Cancer

Risk Factors: Smoking, alcohol, GERD (Reflux esophagitis / Hyperacidity), Barrett's esophagus.

Investigations:

  • Endoscopy & biopsy
  • PET-CT

Treatment:

  • Early
    • Endoscopic resection for very early cancer
    • Surgery - Esophagectomy
  • Advanced
    • Chemoradiation followed by esophagectomy

Stomach Cancer

Risk Factors: H. Pylori chronic infection, smoking, salty diet

Investigations:

  • Endoscopy & biopsy
  • CECT Abdomen & pelvis
  • PET-CT for staging

Treatment:

  • Early
    • Surgery
      • Gasterctomy with lymphadenectomy
  • Advanced
    • Perioperative Chemotherapy than Surgery (Gastrectomy & Lymphadenectomy)

Sarcoma Cancer

Risk Factors: Radiation, genetic syndromes

Investigations:

  • MRI
  • Core Biopsy through the plane which can be excised
  • CECT Thorax , Adbomen & Pelvis / PET-CT for staging

Treatment:

  • Early
    • Surgery
    • Radiation ( Before or after surgery )
    • Chemotherapy case basis
  • Advanced
    • Chemotherapy

Urinary Bladder Cancer

Risk Factors: Smoking, occupational exposure, chronic infections

Investigations:

  • USG followed by CECT Abdomen & Pelvis
  • Urine cytology
  • Cystoscopy & TURBT followed by intravesical therapy
  • PET-CT

Treatment:

  • Non-muscle invasive
    • TURBT intravesical therapy
  • Muscle-invasive
    • Radical cystectomy
    • Chemotherapy

Kidney Cancer

Risk Factors: Smoking, obesity, hypertension, hereditary

Investigations:

  • Ultrasound
  • Urine cytology
  • CECT Thorax, Abdomen & Pelvis

Treatment:

  • Localized
    • Nephron sparing surgery for tumors smaller than 4 cm
    • Radical nephrectomy
  • Advanced
    • Targeted therapy
    • Immunotherapy

Testicular Cancer

Risk Factors: Undescended testis, family history

Investigations:

  • Ultrasound
  • Tumor markers (AFP, HCG, LDH)
  • CECT Thorax, Abdomen & Pelvis
  • Semen analysis

Treatment:

  • High Inguinal Orchiectomy through groin
  • Localized
    • Surveillance or Chemotherapy
  • Advanced
    • Chemotherapy
    • Retroperitoneal lymph node dissection

Gallbladder Cancer

Risk Factors: Gallstones, chronic cholecystitis, obesity

Investigations:

  • Ultrasound
  • CECT Thorax, Abdomen & Pelvis
  • CA 19-9 levels
  • Core biopsy
  • PET-CT

Treatment:

  • Early
    • Surgery (Radical cholecystectomy & lymphadenectomy)
  • Advanced
    • Chemotherapy
    • Palliative care

Liver Cancer

Risk Factors: Cirrhosis, hepatitis B/C infection, alcohol, NASH

Investigations:

  • Ultrasound
  • Liver function tests (LFTs)
  • AFP levels
  • CECT thorax, abdomen & pelvis /MRI
  • Core biopsy

Treatment:

  • Includes management of cirrhosis & cancer into consideration
  • Early
    • Resection
    • Transplant
    • Ablation
  • Advanced
    • TACE
    • Systemic therapy (Targeted, Immunotherapy)

Pancreatic Cancer

Risk Factors: Smoking, chronic pancreatitis, diabetes, hereditary

Investigations:

  • CECT Abdomen & Pelvis
  • MRCP / ERCP
  • Endoscopic Ultrasound & biopsy (EUS & FNAB)
  • CA 19-9 levels
  • PET-CT

Treatment:

  • Management of jaundice - Stenting when Bilirubin very high
  • Localized
    • Surgery (Whipple operation - Removal of Head of pancreas, duodenum & gall bladder with bile duct followed by reconstruction to establish continuity of GI tract)
    • Chemotherapy
  • Advanced
    • Chemotherapy

Skin Cancer - Nonmelanoma & Melanoma

Risk Factors: UV exposure, fair skin, family history

Investigations:

  • Clinical examination
  • Biopsy

Treatment:

  • Localized
    • Wide excision with margins
    • Lymphadenectomy
  • Advanced
    • Immunotherapy, targeted therapy (Melanoma)
    • Radiation (Nonmelanoma)

Lung Cancer

Risk Factors: Smoking, radon exposure, pollution

Investigations:

  • CECT Thorax
  • Core biopsy - Transthoracic / Bronchoscopic
  • PET-CT
  • Molecular testing to detect mutation

Treatment:

  • Early
    • Surgery
    • Adjuvant Chemotherapy / targeted
  • Advanced
    • Chemotherapy
    • Targeted Therapy
    • Immunotherapy

Laryngeal Cancer

Risk Factors: Smoking, Alcohol, HPV

Investigations:

  • Laryngoscopy & biopsy
  • CT/MRI

Treatment:

  • Early
    • Radiation
    • Laryngoscopic laser surgery
  • Advanced
    • Total laryngectomy & permanent tracheostomy
    • Adjuvant Chemoradiation
    • Voice rehabilitation - TEP, Electrolarynx, Esophageal speech

Thyroid Cancer

Risk Factors: Goiter, hereditary, radiation exposure

Investigations:

  • Thyroid function test
  • USG thyroid & neck
  • FNAC (Needle cytology)
  • CECT neck - advanced cases
  • Laryngoscopy to check vocal cord function
  • Caltinonin & CEA levels (Medullary carcinoma)

Treatment:

  • Early
    • Lobectomy
  • Advanced
    • Hemi / Total Thyroidectomy on case basis
    • Radioactive iodine

Gastrointestinal Stromal Tumor (GIST)

Risk Factors: Genetic mutations (e.g. KIT, PDGFRA)

Investigations:

  • USG followed by CECT Abdomen & Pelvis

Treatment:

  • Early
    • Surgery
  • Advanced
    • Surgery followed by Targeted therapy (e.g. imatinib)