Breast cancer
Breast Cancer
This section provides information about breast cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types breast cancer treatments available.
About breast cancer
Breast cancer is the most common type of cancer found in women in the UK. Although it mainly affects older women, it can occur at a younger age. Men can also develop breast cancer. Breast cancers occur when cells in the breast start to grow and multiply abnormally to form a tumour.
Whatever age you are, it’s important that you get to know what’s normal for youa nd your breasts. If you notice any changes in how they look or feel, you should see your doctor as soon as possible. It is also important to go to your Breast Cancer Screening (mammogram) appointments as these can pick up cancers that you may not be able to feel.Here you can find out more about the different types of breast cancer, risk factors,what causes it and how it’s treated.
Facts about breast cancer
- Breast cancer is the most common cancer in the UK
- It affects around 48,000 women in Britain every year
- Breast screening saves around 1,300 lives a year in the UK
Further Reading:
NHS Choices, Breast cancer (female), Introduction http://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Introduction.aspx
Cancer Research UK, Mammograms in breast screening http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/screening/mammograms-in-breast-screening
NHS Choices screening information https://www.nhs.uk/conditions/breast-cancer-screening/
Types of breast cancer
The breast is composed of lobules and ducts. Breast cancer can develop in either of these parts of the breast. They can also be defined as either invasive or non-invasive (also known as in-situ cancer).
Non-invasive breast cancer means the cancer cells are confined to the breast lobules and ducts. This does not always present as a lump and is most commonly found on a mammogram. If non-invasive breast cancer isn’t treated, it can develop into invasive breast cancer. The most common form of non-invasive breast cancer develops from the ducts and is called ductal carcinoma in situ(DCIS). Less commonly, a condition called lobular carcinoma in situ (LCIS) may develop from the breast lobules.
Invasive breast cancer (usually just called breast cancer) means the cancer cells have spread to breast tissue surrounding the ducts and lobules. It can also spread to the lymph glands under your arm. Sometimes invasive cancer cell scan spread to other parts of your body through your lymph glands or bloodstream. Around nine in ten invasive cancers are ductal cancers, and one inten is a lobular cancer. Breast cancers are also classified according to whether they contain receptors for the hormone oestrogen (which is found in both women and men).Cancers with this change are called oestrogen receptor (ER) positive breast cancers, and those without are known as ER negative. Cancers are also classified by another change called HER2 positivity, where too much of a normal protein in the body is present on the surface of the cells. Invasive breast cancers are routinely tested for these changes, as this affects the choice of treatment.
Further reading:
Cancer Research UK – about breast cancer https://www.cancerresearchuk.org/about-cancer/breast-cancer/about
Breast cancer symptoms
Most women notice a lump in their breast before any other symptom of breast cancer. Lumps in your breasts are usually normal, and nine out of ten are not cancerous. It’s still important to get any lumps in your breasts checked by a doctor – the sooner you identify a problem, the easier it is to treat.
Other symptoms which you should report to your doctor are:
- a change in the size or shape of your breast
- dimpled skin on your breasts
- a difference in how your nipple looks
- discharge or blood coming from your nipples
- a rash around your nipples
- a lump or swelling in your armpit
- painful breasts or armpits.
What’s normal for you?
It’s important that you learn what’s normal for you and your breasts throughout the month. For example, some women find that they have normal breast painr elated to their period. Learning what’s normal for you at different stages in your life and as your breasts naturally change will make it much easier for you to spot anything unusual. It is usually best to check your breasts just after your period. If you notice anything unusual, particularly if one breast feels different to the other, get a doctor to check as soon as possible.
Risk factors for breast cancer
While the exact cause of breast cancer isn’t known, there are somethings we know definitely increase the risk.
Getting older
Around four out of five breast cancer cases are diagnosed in women over 50,which is why the NHS recommend you have breast screening every three years between the ages of 50 and 70 through the NHS Breast Screening Programme. After the age of 70 you can ask your GP or local screening service if you wish to continue screening mammograms.
Your hormones
The female hormone oestrogen can stimulate the growth of breast cancer cells.The more oestrogen you’re exposed to, the greater your risk of developing breast cancer. Things like starting your period early and entering menopause late,taking HRT or the pill, not having children or having them later in life mean your body’s been exposed to oestrogen for a longer time frame or in a greater quantity.
Your weight
Weight also has an effect on your risk of breast cancer, especially for women who are overweight or obese after the menopause.
Drinking alcohol or smoking
Both smoking and alcohol intake increase your risk of breast cancer.
Your family history
If a close relative has had breast cancer or ovarian cancer, you might be at greater risk of developing breast cancer too. As breast cancer is the most common type of cancer in women, it’s possible for more than one case in a family to be coincidental. Most breast cancer cases don’t run in the family,although some genes can increase your risk. Depending on your family history you may be referred to a clinical geneticist to discuss genetic testing.
If you’ve had breast cancer before
You have a greater risk of getting breast cancer in either the same breast or your other breast if you’ve had breast cancer before.
Other factors
There are other factors that have been linked to the chance of getting breast cancer too. Things like exposure to radiation and the density of your breasts can also increase your risk of breast cancer.
Further Reading:
NHS Choices – Causes and risk factors https://www.nhs.uk/conditions/breast-cancer/causes/
The stages and grades of breast cancer
When you are diagnosed with breast cancer, your consultant may describe its “stage”. This is a way of categorising the size of the tumour, whether it has spread to your lymph nodes and if the cancer cells have spread to any other part of your body.
The stage of your breast cancer will help to inform the decisions you and your consultant make about your treatment options. There most common staging system is known as TNM staging and describes the size of the tumour (T), the number and location of lymph nodes involved (N) and whether the cancer has spread to become metastatic (M). Cancer may also be described as stage 1 to 4, based on the same criteria. This system is described below.
- Stage 0 | Ductal carcinoma in situ (DCIS) is sometimes called stage 0 (may also be known as Tis).
- Stage 1 | The tumour is less than 2cm and has not spread to any lymph nodes under the arm. There may be very small deposits in the nodes, called micrometastases.
- Stage 2 | The cancer may be larger or have affected some of the lymph nodes under the arm.
- Stage 3 | The tumour may either be attached to skin or other tissues or may have spread to more of the lymph nodes in areas close to the breast. This stage is also used to describe larger tumours with any degree of lymph node involvement.
- Stage 4 | The tumour has spread to other areas of your body. This is called metastasis.
You may also hear the term “grade”. This refers to how the cells look under a microscope. The cancer will be grade from 1 to 3, with 1 being the slowest growing and 3 the more rapidly dividing and abnormal cells. Both stage and grade are used to determine the treatment for your cancer.
Treatment for breast cancer
If you have been diagnosed with breast cancer, there are several treatment options for you to consider. You might need one or a combination of different treatments, which your consultant and breast care nurse will talk you through.
Your treatment options
Treatments may include:
- breast cancer surgery
- chemotherapy
- radiotherapy
- hormone therapy
- targeted therapy
- bisphosphonates
- immunotherapy
As everyone is different, your consultant breast surgeon and oncologist will take a number of things about you into account when deciding which treatment would suit you best. They will consider factors including:
- the type of breast cancer you have
- what stage and grade of your breast cancer and cancer cells
- whether you have gone through the menopause
- your overall health.
Breast cancer surgery
For most people, surgery is the first step in their breast cancer treatment. There are different types of surgery for breast cancer. Your consultant breast surgeon will talk to you about your options and help you to decide on the right treatment for you. For many women, breast conserving surgery may be an option,where the cancer and surrounding tissue are removed, leaving the breast intact.For some women and for men with breast cancer, a mastectomy (removal of the breast) may be offered. The decision depends on the size, position and number of tumours as well as your wishes.For invasive cancers or for larger areas of DCIS, a sentinel node biopsy may be undertaken, where a small number of nodes is removed from under the arm to look for cancerous cells. If the breast cancer is already known to have spread to the nodes then an axillary clearance may be recommended. This is where all of the nodes from under the arm are removed.
Breast reconstruction
Breast reconstruction replaces tissue that is removed during your breast cancer surgery to help recover some of your breast’s shape, and may be performed directly after a partial breast removal (mastectomy) or some time later. If you are likely to require radiotherapy there may be some benefits to delaying there construction, but this is an individual decision to discuss with your surgeon.
After surgery you are likely to be offered other treatments to reduce the risk of the cancer coming back. The treatment you have next depends on the type of breast cancer that you have.
Chemotherapy
Chemotherapy is commonly given after surgery to reduce the risk of thecancer returning anywhere in the body. It is also used for metastatic disease(that has spread away from the breast and is not curable) to control thecancer. This is termed palliative chemotherapy. Chemotherapy is usually giventhrough a vein and is delivered on the day unit, although some treatments maybe given in tablet form. You will need a consultation with your consultant orspecialist nurse before each treatment where your blood results will be checkedand any side effects discussed. Theexact treatment will depend on the type and stage of the breast cancer. Sometimes chemotherapy is used before surgery. This may be done if thecancer is too large to remove or if shrinking the cancer would allow for lessextensive surgery. It may also be offered for some specific types of breastcancer to reduce the risk of spread to other parts of the body.
Radiotherapy
Radiotherapy uses high energy x-rays to reduce the risk of cancer coming back in the breast and sometimes the lymph node areas around the breast. It is a local treatment which means that most of its effect is in the treated area.Radiotherapy treatment is delivered in a course of treatment lasting between one and five weeks. It can be also used on other parts of the body if cancer has spread.
Hormone (endocrine) therapy
This is used for cancers that are hormone or oestrogen (ER) positive. You will usually be offered a tablet to take once daily for five to ten years to reduce the risk of cancer recurrence. Hormone treatment may also be used to treat metastatic disease, or if surgery is felt to be too high risk due to other medical problems. Sometimes your consultant may recommend an injection to stop your ovaries working in addition to giving hormone treatment.
Targeted therapy
Targeted therapy uses either antibodies or other drugs to treat specific types of breast cancer. For HER2 positive breast cancers the drugs trastuzumab and pertuzumab are commonly used in combination with chemotherapy.Other targeted therapies work together with hormone treatments for ER positive breast cancers and are taken in tablet form.
Bisphosphonates and Denosumab
Bisphosphonates are used either to reduce the risk of cancer spreading to the bone, or for cancer that has already spread. Denosumab is an alternative drug for cancer in the bone.
Immunotherapy
This is a relatively newer form of treatment for some types of breast cancer, known as triple negative breast cancers. If your consultant thinks you may benefit from this treatment, they will request special tests on a sample of the cancer to see if it is likely to be effective.
Follow up treatment
After your breast cancer treatment, you will have regular check-ups and annual mammograms. Your follow up will be determined by your individual needs.
Want to know more?
If you would like to read more about breast cancer, treatment or living with breast cancer, please visit macmillan.org.uk or breastcancernow.org
Prostate cancer
Prostate Cancer
This section provides information about prostate cancer care. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of prostate cancer treatments available.
About prostate cancer
Prostate cancer is the most common type of cancer amongst men in the UK. It tends to affect men over 50, though younger men can get prostate cancer too.
Prostate cancer often causes no symptoms, and is often detected following a blood test and rectal examination upon routine screening. It is important to consult your doctor if you have pain or discomfort when you urinate, difficulty emptying your bladder, or notice blood in the urine.
On this page you can find out more about the different types of prostate cancer, the risk factors and how it’s treated.
Facts about prostate cancer
- In the UK, prostate cancer is the most common cancer amongst men[i]
- Over 40,000 new cases of prostate cancer are diagnosed every year[ii]
- About 250,000 men currently live with prostate cancer[iii]
What is prostate cancer?
Only men have a prostate. It’s a gland that’s normally the size and shape of a walnut, and it sits below the bladder and around the urethra – the tube that men pass urine and semen through.
The prostate gland produces some of the fluid that delivers sperm through the urethra.
Prostate cancer is different from other cancers. This is because small areas of cancer in the gland are quite common and can remain inactive for years.
Research suggests that the risk of developing prostate cancer increases with age, and that about 80% of men over 80 may have a small area of prostate cancer[iv]. However, not all cancers are aggressive and many grow slowly and can be monitored.
In some cases the prostate cancer is aggressive and can grow quickly. It can also spread to other parts of the body, most commonly the bones (spine, pelvis, thigh bone (femur) and ribs) or lymph nodes. Though it is not common, prostate cancer can also spread to the lungs, the liver and other organs.
In most cases, prostate cancer is detected in its early stages, before it has spread outside the gland.For some men, prostate cancer is advanced when it is first detected. This may happen for men who have been treated previously for an early or locally advanced prostate cancer, and have a recurrence of the disease.
[i] Prostate Cancer UK, Prostate cancer.http://prostatecanceruk.org/information/prostate-cancer
[ii] Prostate Cancer UK, Prostate cancer
[iii] Prostate Cancer UK, Prostate cancer
[iv] Prostate Cancer UK, Prostate cancer
Types of prostate cancer
There are different types of prostate cancer. These are defined by how developed the cancer is, whether it is only the prostate gland that’s affected, or if the cancer has spread to other parts of the body.
Early prostate cancer
Early prostate cancer – sometimes called localised prostate cancer – is when only the gland is affected, and the cancer hasn’t spread to any surrounding tissues or other parts of the body.
Locally advanced prostate cancer
Locally advanced prostate cancer is where the cancer has spread to tissues around the gland.
Advanced prostate cancer
Advanced or metastatic cancer of the prostate is when the cancer has spread beyond the gland to other parts of the body. These secondary deposits are called metastases.
Causes and risk factors
What causes prostate cancer is not fully understood. But there are a few things which can increase your risk of developing prostate cancer. These are:
Your age
As men get older, their chances of developing prostate cancer increase, and most cases develop in men aged 65 and over.
Your ethnicity
For reasons not yet understood, prostate cancer is more common in African-Caribbean or African men, and less common in Asian men.
Your family history
Men with immediate relatives (a father or brother) who are affected by prostate cancer will be at a slightly increased risk.
Prostate cancer symptoms and diagnosis
Prostate cancer tends to develop slowly, so its symptoms may not show for many years, and might never cause any problems in your lifetime.
But some men have cancer that is more aggressive. This will need treatment to stop the disease or at least delay the cancer spreading outside the prostate gland.
Prostate cancer can cause a range of symptoms, none of which are specific only to prostate cancer.
The signs of prostate cancer only become noticeable when the prostate is enlarged enough to affect the urethra – the tube carrying urine from the bladder to the penis. This means you might notice things like a greater need or effort to urinate, and then a feeling your bladder hasn’t properly emptied.
But these signs don’t mean you have prostate cancer. They could be caused by something else, like benign prostatic hyperplasia (BPH) – where your prostate is enlarged but not affected by cancer.
For some men the first symptoms of prostate cancer are when it has spread beyond the prostate gland to the bones. This may cause symptoms such as back, hip or pelvic pain – but again could be caused by benign conditions such as arthritis.
Whatever pain, discomfort or symptoms you feel, it is always best to discuss these with your GP.
GP tests
Based on your symptoms, your GP can use one of the following tests to help reach the right diagnosis.
Prostate specific antigen (PSA) test
A PSA test is a blood test that measures the total amount of protein produced by the prostate.
All men have a small amount of the PSA protein in their blood, and the amount of this protein increases with age.
Raised levels of PSA can indicate a problem with the prostate, but this alone can’t diagnose prostate cancer. However, other test results, your family history and ethnicity can help assess your risk.
Digital rectal examination (DRE)
This is perhaps the most common way of diagnosing a problem with the prostate gland. The DRE should be done after a PSA test as this examination can raise your PSA levels and, therefore the result may be misleading.
To carry out the DRE your doctor or nurse uses their finger to feel the prostate gland through the wall of your back passage (rectum), feeling for any hard or irregular areas and to estimate the size of the gland.
Urine test for prostatitis
Your GP may also take a sample of your urine to test for prostatitis, which is an infection or inflammation of the prostate gland.
Prostatitis is a common condition that can affect men of any age, but is most common in men aged between 30 and 50. Prostatitis isn’t prostate cancer, nor is it related to an enlarged prostate.
It can however cause a number of symptoms that may be confused with prostate cancer, such as problems passing urine, and pain or discomfort around the testicles, back passage or lower abdomen.
Hospital tests
Further hospital tests may include more advanced tests such as a prostate biopsy, MRI, CT or ultrasound scan, or prostate mapping.
Prostate biopsy
To see if you need a prostate biopsy or not, you may need to have a multi parametric (MP) MRI scan. This is a high-definition MRI scan of your prostate.
A prostate biopsy is a procedure that takes a small piece of your prostate tissue to be examined under the microscope. It’s perhaps the most accurate way of finding out if you have prostate cancer. Your doctor will talk you through the advantages and disadvantages of a biopsy, and any concerns you might have before you decide upon this kind of test.
You may not need a biopsy if other tests (like an MRI, CT or bone scan) show that cancer has spread beyond the prostate.
MRI scan
An MRI scan may be carried out to look for primary disease and to see if any disease has spread beyond the prostate gland.
MRI scanning combines a powerful magnet with a very advanced computer to provide exact and detailed images without the use of x-rays.
Each scan or slice is like a single slice from a loaf of bread – when all the slices are put together a 3-D picture of the body can be obtained. The number of sequences or images depends on the area being scanned.
During the scan you will be asked to lie very still on the MRI table. A two-way intercom ensures that you may speak and listen to the MRI staff during your scan.
A radiographer will carry out the scan.
CT scan
A CT scan can show whether the cancer has spread beyond the prostate to other organs.
A C.T. scan is a special type of x-ray test that takes ‘slice’ pictures of organs and structures in the body.
Each scan or slice is like a single slice from a loaf of bread – when all the slices are put together a 3-D picture of the body can be obtained. The number and width of the slices depends on the area being scanned.
During the scan you will be asked to lie very still on the C.T. table. No equipment will touch you and nothing will close in on you – the scanner is an open hole, rather like a polo mint – it is not a long or enclosed tube.
A radiographer will carry out the scan.
For some scans you will be given an injection, in your arm, of a contrast agent or ‘radio-opaque’ dye. This allows the scanned part of the body to be visualised more clearly.
Bone scan
A bone scan can detect if your cancer has spread outside the prostate to your bones.
This test involves administering a small amount of radioactive material into your body.
The radioactive materials used are normally injected into a vein in your arm, similar to a blood test. Depending upon the type of scan you are having you may have to wait before any imaging is carried out. The waiting time depends upon the type of scan you are having; it varies between a few minutes and a few hours. If the waiting time is more than an hour you may be able to leave the hospital during the interval.
During the scan you will have to lie still on a bed. In order to get good quality images the equipment, a Gamma camera will have to be close to you, you will not, however, have to go into a tunnel. Most investigations take approximately twenty minutes.
Prostate mapping
Prostate mapping uses state-of-the-art MRI imaging techniques with a biopsy under general anaesthetic to give information about the prostate to a high degree of accuracy.
Prostate mapping is a way of diagnosing prostate cancer that can enable a more accurate assessment of the risk of prostate cancer. This is because the test gives important information about the location of any cancer, the number of tumours and their grade. Most importantly, this information is more likely to be accurate when compared to standard diagnostic methods.
The stages of prostate cancer
When you’re diagnosed with prostate cancer, your consultant urologist will tell you the stage of your cancer. This tells you how far the cancer has developed, and if the cancer cells have spread to any other part of your body.
When your consultant urologist talks about the stage of your prostate cancer, they may refer to the TNM (Tumour Nodes Metastases) system.
This is one of the most common methods to label the stages, where each letter describes a feature of the tumour:
- T stage shows how far the tumour has spread in and around the prostate
- N stage measures if the cancer has spread to the lymph nodes
- M stage measures if the cancer has spread (metastasised) to other organs or partsof the body.
T stage
The T stage is usually determined by a digital rectal examination (DRE), but you might also have a magnetic resonance imaging (MRI) scan to see if the tumour has spread around the prostate.
T1
At this first T stage, the cancer can’t be felt by a DRE or seen on scans, and may only be seen under a microscope – this would be localised prostate cancer.
T2
At this second T stage the cancer can be felt by a DRE or seen on scans, but it’s contained within the prostate – this would be localised prostate cancer.
T3
At the third T stage, the cancer can be felt by a DRE or seen in a scan breaking through the capsule of the prostate – this would now be described as locally advanced prostate cancer. There are two sub stages:
- T3a | Where the cancer has broken through the capsule of the prostate, but not spread to the seminal vesicles, the small tubular glands that produce some of the fluid in semen.
- T3b | The cancer has spread to the seminal vesicles.
- T4 | At this fourth T stage, the tumour has spread to nearby organs, such as the bladder, back passage, or pelvic side wall– this is locally advanced prostate cancer.
N stage
The N stage describes whether the tumour has spread to the lymph nodes, which are a common place for cancer to spread, and can be seen with an MRI or CT scan. There are three N stages:
- NX | The state of the lymph nodes can’t be measured.
- N0 | The lymph nodes do not look like they contain cancer.
- N1 | The lymph nodes contain cancer – this may be treated as locally advanced or advanced prostate cancer.
M stage
The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones, and may be measured with a bone scan. There are three M stages:
- MX | The spread of the cancer was not (or could not) be measured.
- M0 | The cancer was measured, and has not spread to other parts of the body.
- M1 | The cancer has spread to other parts of the body – this will be diagnosed and treated as advanced prostate cancer.
Prostate cancer treatments
If you’ve been diagnosed with prostate cancer, there are several treatments for you, to consider after discussion with your consultant. Your BMI Healthcare consultant urologist and prostate cancer care nurse will talk these options through with you.
Active monitoring
If your cancer is slow growing, then active monitoring (also called active surveillance) is a way to track the prostate cancer rather than treat it immediately. The idea is to avoid unnecessary treatment, or to delay a treatment and its side effects.
Watchful waiting
If your prostate cancer isn’t causing you any symptoms or problems, then watchful waiting is a way of keeping an eye on your condition over the long term, to avoid unnecessary treatment unless you get different symptoms.
Prostatectomy
A prostatectomy or radical prostatectomy is an operation to treat prostate cancer by removing the entire prostate and seminal vesicles.
A radical prostatectomy is offered to fit patients whose prostate cancer has not spread out of the gland. It is considered for men who are at risk of dying from their prostate cancer if it is not successfully treated (men who aren’t suitable for active surveillance).
Specialist urological surgeons perform this operation either through open surgery known as open prostatectomy or keyhole surgery known as laparoscopic prostatectomy.
Open prostatectomy
In this operation, the whole of the prostate gland and the seminal vesicles are removed through a single large abdominal opening. This is major surgery and involves a long recuperation period, with urinary incontinence and impotence as potential side effects. To regain full continence, men would be advised to do pelvic floor exercises. Such advice would be given to you at point of consultation with your urologist surgeon.
Laparoscopic prostatectomy
Using keyhole surgery techniques, five small abdominal incisions are made, through which a small camera and light provide a magnified view of the internal organs.
The prostate gland and seminal vesicles are removed using small surgical instruments, which enter the abdominal cavity through the small incisions. The major advantage of this method is that there isn’t a large wound, which means a much shorter recuperation period.
External beam radiotherapy
This therapy uses high energy X-ray beams to treat the prostate cancer. External beam radiotherapy creates beams that aim to kill the cancer cells and halt their growth. This therapy might be used on its own or to complement permanent seed brachytherapy or temporary brachytherapy (internal radiotherapy).
Permanent seed brachytherapy
This procedure implants tiny radioactive seeds into your prostate gland, and then the radiation from the seeds destroys cancer cells in the prostate. This treatment might be given on its own or with external beam radiotherapy or hormone therapy. Note that permanent seed brachytherapy may also be referred to as low dose rate brachytherapy.
Hormone therapy
Hormone therapy can help to manage prostate cancer by stopping the male hormone testosterone from reaching the prostate cancer cells. While it does not cure the cancer, hormone therapy can keep it under control and manage symptoms, sometimes for several years. Hormone therapy might be given on its own, or combined with other treatments such as external beam radiotherapy or brachytherapy.
Enhancing your recovery
The following lifestyle changes can help make your therapies, treatments and recovery a success:
- Give up smoking – research shows that smokers are more likely to suffer complications during and following surgery
- Eat healthily to maintain an ideal weight – if you’re overweight, you have a greater chance of developing complications
- Exercise regularly – speak to your GP who can recommend appropriate exercises.
Possible complications
A prostatectomy or radical prostatectomy is major surgery with associated side effects and possible complications. These include:
- Pain – a possibility with any operation
- Bleeding during or after surgery
- Infection in the surgical wound, which may need treatment with antibiotics
- Discomfort or pain in the groin.
With all surgical methods there is a post-operative risk of urinary incontinence and impotence.
Many skilled specialist urologists practice nerve sparing prostatectomy where they aim to cut the prostate gland out protecting these important nerve pathways to minimise the chances of these side effects occurring. All prostate cancer specialists at BMI healthcare offer a range of prostatectomy treatments.
Recovery
Whatever type of surgery you have, a urinary catheter will be necessary after the operation, and is removed usually 2 to 3 weeks after surgery.
In total it takes about 3 weeks to recover from laparoscopic surgery and 3 months to recover from open prostatectomy.
Your consultant will run through your post-operative recovery in detail including advice on working, driving, lifting etc. before you leave the hospital.
Post-operative cancer checks
After your surgery, the prostate gland and seminal vesicles are taken away for histology.
While the aim of a prostatectomy is to remove the cancer, occasionally (around 7%) there are cancerous cells left behind indicating that additional treatment such as radiotherapy or hormone therapy is required to completely eradicate it.
The PSA level is also monitored post operatively at each outpatient appointment. Initially you will be seen every 3 months for a year, then every 6 months for 5 years and then annually until 15 years after your surgery.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.
You should check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book any diagnostic tests or surgery
Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about prostate cancer care, treatment or living with prostate cancer, please visit prostatecanceruk.org
Bladder cancer
Bladder Cancer
This section provides information about bladder cancer. This includes incidence, causes and risk factors, symptoms, how it is diagnosed and the different types of bladder cancer treatments available.
About bladder cancer
Around 10,400 people are diagnosed with bladder cancer each year in the UK. It’s the 8th most common cancer in the UK, and the 4th most common cancer in men[i].
The bladder is part of the body’s system that filters waste and produces urine, called the urinary system (or urinary tract). This system is made up of the kidneys where waste is processed, the ureter tubes that draw urine from the kidneys, the bladder that stores urine and the urethra that carries urine from the body.
The bladder sits in the lower part of your pelvis, the lower stomach area in between your hip bones, and it is made up of a number of layers. The inside of your bladder has a special type of lining called the transitional epithelium that stretches as the bladder fills up and stops urine being absorbed back into the body.
Just below the transitional epithelium is a thin layer of connective tissue called the lamina propria. Underneath this layer is muscle tissue called the muscularis propria, then around this is a layer of fatty connective tissue that separates the bladder from body organs like the prostate and kidneys.
Bladder cancer is where a growth of abnormal tissue known as a tumour develops in the bladder lining, and in some cases spreads into the surrounding bladder muscles.
The bladder cancer treatment will depend on how far the cancer has grown into these layers.will depend on how far the cancer has grown into these layers.
Facts:
- Around 10,000 people in the UK are diagnosed with bladder cancer every year[ii]
- Of these, 8 out of 10 (80%) are diagnosed with early bladder cancer[iii]
- Smoking is one of the most common causes of bladder cancer[iv]
- Bladder cancer becomes more common as people get older[v].
[i] Cancer Research UK, Bladder cancer risks and causes. http://www.cancerresearchuk.org/cancer-help/type/bladder-cancer/about/bladder-cancer-risks-and-causes#risk
[ii] Macmillan Cancer Support, Bladder cancer. http://www.macmillan.org.uk/Cancerinformation/
Cancertypes/Bladder/Aboutbladdercancer/Typesofbladdercancer.aspx
[iii] Macmillan Cancer Support, Bladder cancer
[iv] Macmillan Cancer Support, Bladder cancer
[v] Macmillan Cancer Support, Bladder cancer
Types of bladder cancer
There are different types of bladder cancer, divided into non-invasive and invasive stages, dependent on how far it has invaded or what type of cancer cell it comes from.
Some bladder cancers begin at a non-invasive stage that only affects the inner lining of the bladder –called early (superficial) bladder cancer.
Some non-invasive cancers develop into invasive bladder cancer, which is a more advanced stage, where the tumour grows into the bladder’s muscle wall.
Transitional cell bladder cancer (TCC)
Also known as urothelial carcinoma, TCC is the most common type of bladder cancer, with about 90% of cancers in the UK being diagnosed as transitional cell[vi].
The cancer starts as transitional cells in the bladder lining (called the urothelium), which are all bunched together when the bladder is empty, and stretched into a single layer when the bladder is full.
Carcinoma in situ (CIS)
This is a non-invasive bladder cancer that appears as a flat, red area in the bladder. CIS can grow quickly –if it’s not treated effectively, there’s a risk that it will develop into an invasive bladder cancer.
Papillary cancer
Papillary bladder cancer is a form of early bladder cancer, and shows as mushroom-shaped or leaf-shaped growths (fronds). Some people may have papillary and CIS cancers.
Rarer types of bladder cancer
Some rare bladder cancer types include squamous cell cancer, small cell bladder cancer and adenocarcinoma. While squamous cell cancers start a type of cell in the bladder lining, adenocarcinoma starts from glandular cells –but both types of bladder cancer are usually invasive.
It’s also possible to have a cancer of the bladder muscle or other tissues around the bladder structure, rather than the bladder lining. Cancers that begin in the bladder muscle are called sarcomas and are very rare.
[vi] Cancer Research UK, Types of bladder cancer.http://www.cancerresearchuk.org/cancer-help/type/bladder-cancer/about/types-of-bladder-cancer
Causes and risk factors
What causes bladder cancer is not fully understood. But there are a few things which can increase your risk.
Smoking
Smoking cigarettes greatly increases risk of bladder cancer. In fact, about 1 in 3 cases of bladder cancer may be caused by smoking. The longer that someone smokes, and the more cigarettes they smoke, the greater the risk of bladder cancer.
Your age
Bladder cancer usually takes a long time to develop and it is more common in older people. Most people with bladder cancer are between 50 and 80 years old, and it’s rare in people under 40.
Your sex
More men than women get bladder cancer, which may just be because more men than women have smoked in the past few decades, also possibly because more men have been exposed to chemicals at work[vii].
Your family history
If you have a close relative who has had bladder cancer, your risk of developing bladder cancer is slightly increased.
Your ethnicity
Your ethnic background also relates to your risk of bladder cancer. Black men have about half the risk of bladder cancer compared to white men, while black women have around two thirds the risk compared to white women, and the risk for Asian men and women is even lower[viii].
Exposure to chemicals at work
Chemicals used in dye factories (many of which are now banned), and other processing industries have been attributed to causing some bladder cancers.However, it can take up to 25 years following exposure to these chemicals for bladder cancers to develop[ix].
Infection
Repeated urinary infections and untreated bladder stones are linked with cases of some rarer types of bladder cancer called squamous cell cancer. Also people who are paralysed have more bladder infections and a higher risk of bladder cancer.
Previous cancer treatment
If you’ve had radiotherapy to the pelvis to treat another cancer, or treatment with a chemotherapy drug called cyclophosphamide, this can increase your risk of bladder cancer[x].
[vii] Macmillan Cancer Support UK, Bladder cancer causes and risk factors. http://www.macmillan.org.uk/Cancerinformation/Cancertypes
/Bladder/Aboutbladdercancer/Causes.aspx
[viii] Macmillan Cancer Support UK, Bladder cancer causes and risk factors. http://www.macmillan.org.uk/Cancerinformation/Cancertypes
/Bladder/Aboutbladdercancer/Causes.aspx
[ix] Macmillan Cancer Support UK, Bladder cancer causes and risk factors.
[x] Macmillan Cancer Support UK, Bladder cancer causes and risk factors.
Bladder cancer symptoms and diagnosis
The common symptoms of bladder cancer are blood in your urine, burning sensations when you pass urine, and pain in the lower part of your stomach or back.
Whatever pain, discomfort or symptom you feel, it is always best to get things checked out by your GP.
Blood in the urine (haematuria)
Finding blood in your urine is the most common symptom of bladder cancer. It can happen suddenly and may come and go. Your urine may look pink, red or even brown, or you may see threads or clumps of blood in it.
However, sometimes blood in the urine can’t be seen and may be picked up through a simple urine test called a non-visible or microscopic haematuria. This test for non-visible blood is often performed if you have urinary symptoms –for example, pains when you pass urine.
If you see blood in your urine, it’s important to get it checked by your GP straight away.
Urinary symptoms
Sometimes, people with a bladder cancer may feel a burning sensation when they urinate, or the need to urinate more often. These symptoms can be caused by an infection rather than cancer, and some people may need tests so a proper diagnosis can be made.
Pain in the lower stomach or back
Lower abdominal and back pain can be a symptom of many different conditions. But, if you experience these or any other symptoms, it’s important to get them checked by your GP. The earlier the cancer is diagnosed, the more likely it is for the bladder cancer treatment to succeed.
GP tests
Based on your symptoms, your GP can use one of the following tests to reach the right diagnosis, and is likely to begin by asking you about your general health and then examining you. You might be asked to give a urine sample to be sent away for analysis to see if you have a urine infection –if you have a bladder cancer, the urine may reveal some cancer cells.
Your GP may also want to examine you internally. And, because the bladder is close to the prostate in men and the womb in women, your doctor may need to put a gloved finger into the rectum (back passage) or vagina to see if everything feels normal.
Hospital tests
If the doctor thinks your symptoms could be due to a cancer, they will refer you to a hospital where you will see a consultant urologist, a specialist in diseases of the urinary tract.Further hospital tests might require a blood or urine test, and may include advanced tests such as a cystoscopy, intravenous urogram, MRI, CT or ultrasound scans.
Cystoscopy
The main test used to diagnose bladder cancer, where a consultant or specialist nurse uses a cystoscope (a thin tube with a camera and light at the end) to examine inside your bladder. This is usually done under local anaesthetic using a flexible cystoscope.
You may be asked to drink plenty of fluids before your cystoscopy and also asked to provide a sample of urine, which is checked for infection.
The consultant specialist gently passes the cystoscope into your urethra and inside the bladder to examine the whole entire lining of the bladder and urethra. This only takes a few minutes.
After this test, you may notice some burning or mild pain as you pass urine for the first couple of days or notice blood in your urine. This should clear up after a day or so, and you should drink lots of fluids to help flush out your bladder.
After the cystoscopy, the doctor will be able to tell you if they have seen a bladder tumour. They will then arrange for you to come into hospital to have a procedure under general anaesthetic. This will involve having another cystoscopy, but the doctor will pass instruments through the cystoscope under a general anaesthetic to take a small piece of tissue taken (biopsy), or to remove the tumour.
Intravenous urogram (IVU)
An intravenous urogram (IVU) is also sometimes called an intravenous pyelogram (IVP) and is an X-ray to examine your entire urinary system. The IVU can show what is causing your symptoms, and check the health of your urinary tract.
CT scan
A CT urogram is a scan to examine the whole of your urinary tract and see if any blood is coming from the bladder or anywhere else.
Ultrasound scan
An ultrasound test bounces sound waves off the inside of your body to create a picture of your organs, and can be used to check for blockages in the tubes (the ureters) that pass urine between the kidney and bladder.
MRI scan
An MRI scan uses magnets to create a picture inside the body, and can be used to see if a cancer has spread.
Stages of bladder cancer[xi]
The stage of a bladder cancer gives an idea of how quickly it might grow, and can be determined after the biopsy is examined under a microscope. This will influence the type of treatment you’re offered after surgery.
The most commonly used staging system is the TNM system, where each letter (T, N and M) describes a feature of the cancer:
- T is the size of the tumour (cancer).
- N is whether it has spread to the nearby lymph nodes (sometimes called glands).
- M is whether the cancer has spread to other parts of the body (metastases).
Stages of non-invasive bladder cancer
Non-invasive bladder cancer is labelled under three stages –CIS, Ta or T1:
- Carcinoma in situ (CIS)
Sometimes described as a flat tumour, where cancer cells are only in the inner layer of the bladder lining. - Ta
Cancer appears as a mushroom-shaped growth (papillary cancer) growing within the inner layer of the bladder lining. - T1
Cancer growing into the layer of connective tissue beneath the bladder lining. - T2a
Cancer has grown into the superficial muscle. - T2b
Cancer has grown into the deeper muscle. - T3
Cancer has grown through the muscle into the fat layer. - T3a
Cancer in the fat layer can only be seen under a microscope (called a microscopic invasion). - T3b
Cancer in the fat layer can be seen on tests, or felt by your doctor during an examination under anaesthetic (macroscopic invasion). - T4
Cancer has spread outside the bladder. - T4a
Cancer has spread to the prostate, womb (uterus) or vagina. - T4b
Cancer has spread to the wall of the pelvis or abdomen.
N stages of bladder cancer[xii]
The N stages describe whether cancer has spread to the nearby lymph nodes, and there are four of these stages in bladder cancer. The N stages are:
- N0
No cancer in any lymph nodes. - N1
Cancer is present in one lymph node in the pelvis (your lower stomach, between the hip bones). - N2
Cancer is in more than one lymph node in the pelvis. - N3
Cancer is in one or more lymph nodes in the groin.
Lymph nodes can be examined and staged using a CT scan or MRI scan, or may be found if you need surgery to remove your bladder.
Grades of bladder cancer
Your consultant specialist may also talk to you about the grade of your cancer. This means how well developed the cells look under the microscope:
- Grade 1 or low-grade
Cancer cells look like normal bladder cells, are usually slow-growing and less likely to spread. - Grade 2 or intermediate-grade
Cancer cells look more abnormal and grow slightly more quickly than grade 1 cancers. - Grade 3 or high-grade
Cancer cells look very abnormal and are likely to grow more quickly. Carcinoma in situ (CIS) is always classed as high-grade.
[xi] Cancer Research UK, Bladder cancer stage and grade http://www.cancerresearchuk.org/about-cancer/type/bladder-cancer/treatment/bladder-cancer-stage-and-grade
[xii] Cancer Research UK, Bladder cancer stage and grade http://www.cancerresearchuk.org/about-cancer/type/bladder-cancer/treatment/bladder-cancer-stage-and-grade
Bladder cancer treatments
If you’ve been diagnosed with bladder cancer, there are several treatments for you to consider. Your BMI Healthcare consultant urologist and cancer care nurse will be able to talk through your options with you.
Treatment for early (superficial) bladder cancer
The main bladder cancer treatment is surgery. There may be one or more bladder cancers, which can be removed with surgery using a cystoscope.
Some people may only require surgery to cure their cancer, but non-invasive bladder cancer can return to the bladder lining and may start to grow into the muscle (invasive bladder cancer). Because of this, you may be given treatment after surgery to reduce the risk of this happening.
Treatment after surgery
Depending on your risk of the cancer returning, you may have the inside of your bladder treated with chemotherapy.
During and after treatment, you’ll have regular cystoscopies to check the lining of your bladder, and any new tumours can usually be successfully removed with further surgery.
Occasionally, people with a very high risk of the cancer becoming invasive may be advised to have an operation to remove the bladder (cystectomy), but this is usually only suggested after other treatments have already been tried.
Treatment for invasive and advanced bladder cancer
The treatment for invasive and advanced bladder cancer will depend on the stage of the cancer, its size and your health.
Treatment might be given with the aim of curing the cancer. But if a cure isn’t possible, treatment can help to control the cancer and relieve the symptoms.
People with bladder cancer at invasive and advanced stages are usually given treatment with the aim to cure the cancer or control it over a long time.
Surgery, radiotherapy and/or chemotherapy are the main treatments used for invasive and advanced bladder cancer.Surgery usually involves removing the bladder (cystectomy), so you will pass urine in a different way. Alternately, radiotherapy uses high-energy rays to destroy the cancer cells, and means you will keep your bladder. Radiotherapy causes side effects, and some people may have long-term side effects.
Your consultant specialist can suggest the best treatment for you, based upon your general health and the size and spread of the tumour.
Paying for your treatment
You have two options to pay for your bladder cancer treatment –your costs may be covered by your private medical insurance, or you can pay for yourself.
Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.
Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about bladder cancer, treatment or living with bladder cancer, please visit cancerresearchuk.org.
Kidney cancer
Kidney Cancer
This section provides information about kidney cancer care. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of kidney cancer treatments available.
About kidney cancer
Your kidneys are part of your urinary system, which filters waste and extra water from your blood by turning them into urine.
If you have kidney cancer, the cells in your kidneys begin to grow abnormally. Rather than the cells multiplying as and when they’re needed, the process becomes uncontrolled in cancer.
Kidney cancer facts
- Usually kidney cancer only affects one kidney [1]
- Kidney cancer is most common in people over 50, more often men [2]
- In the UK, over 10,000 people are diagnosed with kidney cancer each year [3]
What is kidney cancer?
The most common type of cancer is called renal cell carcinoma (RCC). In the UK, it makes up more than eight out of ten (80%) kidney cancer cases.4 This is when cancerous cells develop in the lining of your kidney’s tubules – tiny tubes that help to filter the blood and make urine.
1 Macmillan, Kidney cancer. http://www.macmillan.org.uk/Cancerinformation/Cancertypes/
Kidney/Aboutkidneycancer/Typesofkidneycancer.aspx
2 NHS Choices, Kidney cancer introduction. http://www.nhs.uk/conditions/cancer-of-the-kidney/Pages/Introduction.aspx
3 Cancer Research UK, Risks and causes of kidney cancer http://www.cancerresearchuk.org/cancer-help/type/kidney-cancer/about/risks-and-causes-of-kidney-cancer
4 Cancer Research UK, Types of kidney cancer http://www.cancerresearchuk.org/cancer-help/type/kidney-cancer/about/types-of-kidney-cancer
Types of kidney cancer
There are a few different types of renal cancer:
- clear cell
- papillary (types 1 and 2)
- chromophobe
- oncocytic
- collecting duct.
Less common types of kidney cancer include:
- transitional cell cancer, which develops in the kidney’s lining
- Wilm’s tumour, which is a rare kidney cancer that affects children.
Causes and risk factors
The exact cause of kidney cancer isn’t completely understood, but there are a number of factors that can put you at risk, including: [5]
- if you’re very overweight or obese (a BMI above 25)
- smoking
- having kidney disease
- faulty genes or inherited conditions
- your family history
- high blood pressure
- drinking alcohol
- if you’ve had thyroid cancer
- having had radiotherapy for another type of cancer
- having had a hysterectomy
- some mild painkillers.
5 Cancer Research UK, Risks and causes of kidney cancer. http://www.nhs.uk/conditions/cancer-of-the-kidney/Pages/Introduction.aspx
Kidney cancer symptoms and diagnosis
Symptoms of kidney cancer include:
- blood in your urine
- feeling a lump in your kidney area
- feeling tired
- losing your appetite
- losing weight
- a high temperature and sweating
- pain in your side below the ribs. [6]
The two main symptoms are finding blood in your urine, or feeling a lump or swelling around your kidneys.
Most people who notice these symptoms do not have kidney cancer. But you should get them looked into by a doctor or kidney consultant so you can treat any problems early.
Diagnosing kidney cancer
Because kidney cancer doesn’t always have obvious symptoms, the condition’s often first picked up during a routine check-up.
If you or your GP notices any symptoms of kidney cancer, you’ll need to have a few tests including a blood test and urine sample. Following these tests, you might need a few further tests at a hospital.
- An ultrasound scan lets the consultant see inside your kidneys.
- Computerised tomography (CT) scans and intravenous pyelograms (IVP) take detailed images inside your body. You’ll need to drink a special dye or have an injection to make the CT scan clearer.
- A cystoscopy uses a tube called a cystoscope to look inside your bladder, which is part of the same body system as your kidneys.
- A magnetic resonance imaging (MRI) scan can show if you have a tumour and what size it is.
Stages of kidney cancer
After your tests, your consultant will tell you what stage your kidney cancer is at by looking at a sample of your cancer cells under a microscope. This describes how big your tumour is and how far it’s spread. This will influence the type of treatment you’re offered.
- Stage 1: The cancer is smaller than 7cm and is only inside your kidney
- Stage 2: The cancer is bigger than 7cm, but still only in your kidney
- Stage 3: The cancer has grown into one of the major veins near your kidney called the adrenal gland. But there’s no more than one lymph node with cancer cells in it
- Stage 4: The cancer has grown into the tissue that surrounds the kidney and more than one lymph node has cancer cells in it. Stage 4 might also mean the cancer has spread to another part of your body like the lungs, bones, brain, liver or another kidney. This is classed as advanced kidney cancer, sometimes called secondary cancer or a metastasis.
6 Cancer Research UK, Symptoms of kidney cancer http://www.cancerresearchuk.org/cancer-help/type/kidney-cancer/about/symptoms-of-kidney-cancer
Kidney cancer treatments
The type of treatment you’re offered depends on the type of kidney cancer you have, what stage it’s at and whether the cancer has spread.
Surgery
Surgery is the main kidney cancer treatment that’s contained to the kidney. In stage 1 and 2 kidney cancers, surgery can often remove the cancer. Sometimes, stage 3 kidney cancer can be treated by surgery too.
During surgery, surgeons will try to remove the tumour and leave as much of your kidney as possible.
But if the cancer is too large – bigger than 7cm – your surgeon may remove the whole kidney.
Radiofrequency ablation (RFA)
If you are not fit for surgery and you have an early-stage cancer, your consultant might recommend that you have radiofrequency ablation. This treatment uses heat made by radio waves to remove cancer cells from your body. This type of kidney cancer treatment means no incision is needed.
Freezing therapy
Also called cryotherapy, this is when a surgeon freezes the cancer cells in your kidney by using a cryotherapy probe to get rid of them. It’s an option for people who can’t have surgery because of other medical problems.
For some people, kidney cancer comes back after surgery. If this happens, your consultant might recommend you have the cancer removed with surgery. Or you might be recommended certain medicine to try and lower the chance of the cancer returning.
Systemic therapy
Systemic therapy uses anti-cancer medication to treat cancer cells in the body. It’s often given as a tablet, but may also be delivered into the bloodstream via a drip. If the kidney cancer is at an advanced stage (metastatic), this therapy may be suggested by a consultant, but this does depend upon the type of kidney cancer.
After treatment
You’ll have regular check-ups following your treatment. How often and for how long depends on the kind of treatment that you had.
At follow-up appointments, your doctor will ask how you’re feeling and examine you. You might also need a blood test, chest X-ray, CT scan, ultrasound or a combination.
If you’re worried or spot any new symptoms between appointments, you should tell your consultant as soon as you can.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy. If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.
Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and hospital charges for your diagnostics and procedure.
Want to know more?
If you’d like to read more about kidney cancer, treatment or living with kidney cancer, please visit cancerresearchuk.org.uk.
Lung cancer
Lung Cancer
This section provides information about lung cancer care. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of lung cancer treatments available.
About lung cancer
Your lungs are an important part of your respiratory system, which your body uses to breathe. Lung cancer starts in your lungs as your cells grow abnormally.
If you have cancer in your lungs that has spread from another part of your body like your breast, it is still breast cancer and you should read the information about your type of primary cancer.
Lung cancer facts
- In the UK, around 43,500 people are diagnosed with lung cancer every year [1]
- Lung cancer is most common in 70 to 74-year-olds [2]
- Smoking causes around nine out of ten lung cancer cases. [3]
What is lung cancer?
When lung cancer starts in your lungs, it’s called primary lung cancer. There are a few different types of primary lung cancer, which are put into two main groups:
- small cell lung cancer
- non-small cell lung cancer.
When cancer spreads into your lungs from somewhere else in your body, it’s called secondary lung cancer. If you’ve had another type of cancer and you’ve been diagnosed with lung cancer, ask your consultant where it started. [4]
1 Cancer Research UK, Lung cancer risks and causes http://www.cancerresearchuk.org/cancer-help/type/lung-cancer/about/lung-cancer-risks-and-causes
2 NHS Choices, Introduction to lung cancer http://www.nhs.uk/conditions/cancer-of-the-lung/Pages/Introduction.aspx
3 NHS, Lung cancer myths and facts http://www.nhs.uk/Livewell/Lungcancer/Pages/
Lungcancermythsandfacts.aspx
4 Cancer Research UK, Types of lung cancer http://www.cancerresearchuk.org/cancer-help/type/lung-cancer/about/types-of-lung-cancer
Types of lung cancer
Small cell lung cancer and non-small cell lung cancer are the two main groups of primary lung cancer.
Small cell lung cancer
Small cell lung cancer is sometimes called oat cell cancer. Under a microscope, the cancer cells look small and filled by the nucleus, which is where it gets its name. Around three out of twenty-five lung cancer cases are small cell lung cancer.[5] It’s often caused by smoking. It’s unusual for someone who’s never smoked to get small cell lung cancer.
Non-small cell lung cancer
In the UK, non-small cell lung cancer makes up around 87 out of 100 lung cancer cases. [6] There are three different types, although sometimes diagnosing which type you have isn’t possible if not many cells were taken during a biopsy or if the cells are undeveloped. If this is the case, your consultant will tell you that you have undifferentiated non-small cell lung cancer. Because this group of cancers tend to behave in a similar way, it won’t usually influence the type of treatment you need. The three types of non-small cell lung cancer are:
Squamous cell cancer: This cancer is usually caused by smoking and develops in the cells lining your airways. It’s the most common type of primary lung cancer.
Adenocarcinoma: This type of lung cancer is becoming more common in the UK. It develops in the lining of your airways from a type of cell that produces mucus.
Large cell carcinoma: Under a microscope, the cells look large and rounded.
Secondary lung cancer: If your lung cancer has spread from elsewhere in your body, your choice of treatment will depend on where those cancer cells came from. So if you had breast cancer, the cancer cells in your lungs are breast cancer cells will be treated with treatments for breast cancer.
Mesothelioma: This type of cancer is quite rare but becoming more common. It affects the tissue that protects your lungs called the pleura. Many cases are caused by exposure to asbestos at work, which is why it’s thought give times as many men as women get this type of cancer.
5 Cancer Research UK, Types of lung cancer http://www.cancerresearchuk.org/cancer-help/type/lung-cancer/about/types-of-lung-cancer (simplified fraction from 12 out of 100).
6 Cancer Research UK, Types of lung cancer http://www.cancerresearchuk.org/cancer-help/type/lung-cancer/about/types-of-lung-cancer
Causes and risk factors
Smoking is the biggest cause of lung cancer. It is estimated that around nine out of ten cases are because of smoking.[7]
This includes a small number of people who get lung cancer from breathing in second-hand smoke. Other risk factors include:
- getting older
- exposure to radon gas
- exposure to chemicals like asbestos, silica and diesel exhaust
- air pollution
- having lung disease
- a family history of lung cancer
- previous cancer treatment
- low immunity from illnesses like HIV and AIDS, or from taking immunosuppressant drugs.
7 NHS, Lung cancer myths and facts
Lung cancer symptoms and diagnosis
Symptoms of lung cancer include:
- a cough that doesn’t go away
- feeling breathless or wheezy
- aches and pains when you cough or breathe
- coughing up phlegm with blood in it
- a loss of appetite
- losing weight
- feeling tired.
If you notice any of these symptoms have lasted for three weeks or more, you should see a doctor or respiratory consultant. They’ll look into your symptoms and might run a few tests with you to check your breathing.
Diagnosing lung cancer
To properly diagnose you, you might need to have X-rays and routine blood tests. Usually your doctor or respiratory consultant will arrange these. You may then need to have some other tests at a hospital. These include:
CT scans give detailed pictures of the inside of your body by taking X-rays.
A bronchoscopy is when a doctor uses a small, flexible tube called a bronchoscope to look down your throat and into your airway.
Biopsy means you’ll have a sample of cells taken from your lungs during a bronchoscopy and looked at more closely.
Stages of lung cancer
After your tests, your doctor or respiratory consultant will tell you what stage your lung cancer is at. This describes how big your tumour is, and if it has spread. This will influence the type of lung cancer treatment you’re offered.
- Stage 1, localised: The cancer’s small and only in one part of the lung
- Stages 2 and 3, locally advanced: The cancer’s larger and may have spread to the tissue around your lungs. Cancer cells might also be found in the lymph nodes
- Stage 4, metastatic cancer: The cancer’s spread elsewhere in your body.
You can read more about the stages of lung cancer on Cancer Research UK’s website.
Lung cancer treatments
The type of treatment you’re offered depends on the type of lung cancer you have and whether the cancer has spread. The most common lung cancer treatments are surgery, chemotherapy, radiotherapy or a combination.
- Chemotherapy uses drugs to interrupt the growth of the cancer cells
- Radiotherapy uses high-energy rays to get rid of cancer cells
- Surgery is mostly used for non-small cell lung cancer.
Follow-up treatment
You’ll need regular check-ups. Your doctor or respiratory consultant will examine you, listen to your chest and ask how you are and whether you’ve noticed any new symptoms.
How often you have check-ups depends on what treatment you had. Straight after chemotherapy, radiotherapy or surgery you’re likely to need an appointment every two to six weeks, then at regular intervals.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.
Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about lung cancer, treatment or living with lung cancer, please visit cancerresearch.org.uk.
Gynaecological cancer
Gynaecological Cancer
This section provides information about upper gastrointestinal cancer care. This includes its risk factors, symptoms, how it is diagnosed and the different types of upper gastrointestinal cancer treatments available.
About gynaecological cancers
Gynaecological cancer is any cancer that starts in a woman’s reproductive organs.
Gynaecological cancers begin in different places within a woman’s pelvis, which is the area below the stomach and in between the hip bones, namely the fallopian tubes, ovaries, uterus, cervix, vagina, and vulva.
Gynaecological cancers are named for the part of the body where the cancer starts.
Types of gynaecological cancer
Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus. (The uterus is also called the womb.)
Ovarian cancer begins in the ovaries, which are located on each side of the uterus.
Uterine cancer begins in the uterus, the pear-shaped organ in a woman’s pelvis where the baby grows when she is pregnant.
Vaginal cancer begins in the vagina, which is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.
Vulvar cancer begins in the vulva, the outer part of the female genital organs.
Gynaecological cancer symptoms and diagnosis
There is no way to know for sure if you will get a gynaecological cancer. That’s why it is important to pay attention to your body and know what is normal for you, so you can recognize the warning signs or symptoms of gynaecological cancer.
If you have vaginal bleeding that is unusual for you, talk to a doctor right away. Any vaginal bleeding after menopause needs to be reported to your doctor. If you have not yet gone through menopause but notice that your periods are heavier, last longer than normal for you, or if you’re having unusual bleeding between periods, talk to your doctor.
You should also see a doctor if you have any other warning signs that last for two weeks or longer and are not normal for you. Symptoms may be caused by something other than cancer, but the only way to know is to see a doctor.
Signs and symptoms are not the same for everyone, and each gynecologic cancer (cervical, ovarian, uterine, vaginal, and vulvar cancers) has its own signs and symptoms.
Gynaecological cancer treatments
Gynaecological cancers may be treated with surgery, chemotherapy, and radiation.
If your doctor says that you have a gynaecological cancer, ask to be referred to a gynaecological oncologist—a doctor who has been trained to treat cancers of a woman’s reproductive system. This doctor will work with you to create a treatment plan.
Types of Treatment
Gynaecological cancers are treated in several ways. It depends on the kind of cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation. Women with a gynecologic cancer often get more than one kind of treatment.
- Surgery: Doctors remove cancer tissue in an operation.
- Chemotherapy: Using special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both.
- Radiation: Using high-energy rays (similar to X-rays) to kill the cancer.
Different treatments may be provided by different doctors on your medical team.
Gynecologic oncologists are doctors who are trained to treat cancers of a woman’s reproductive system.
Upper Gastrointestinal cancer
Upper Gastrointestinal Cancer
This section provides information about upper gastrointestinal cancer care. This includes its risk factors, symptoms, how it is diagnosed and the different types of upper gastrointestinal cancer treatments available.
About upper gastrointestinal cancers
Upper gastrointestinal (GI) cancers include cancer of the oesophagus, stomach, small bowel, pancreas, liver or biliary system. We provide expert diagnosis, treatment and care for all types of upper GI cancer.
Types of upper gastrointestinal cancer
Oesophageal cancer
Oesophageal cancer is cancer of the gullet, the tube that connects the stomach to the mouth. There are two main types: squamous cell carcinoma and adenocarcinoma.
Stomach cancer
About 95 per cent of stomach cancers are adenocarcinoma, meaning they start in the glands of the stomach lining. We’re able to provide specialist care for all stomach cancers.
Pancreatic cancer
The pancreas is part of the digestive system and sits in the upper part of the abdomen. There are various types of pancreatic cancer, the most common being ductal adenocarcinoma.
Gallbladder cancer
Gallbladder cancer is a rare form of upper GI cancer that most commonly occurs in people over 70.
Upper gastrointestinal cancer symptoms and diagnosis
Symptoms of upper gastrointestinal cancer
During your consultation, your consultant will discuss any symptoms you are experiencing and advise on the most appropriate diagnostic tests. Symptoms will vary depending on the type of cancer you have but common symptoms of upper GI cancers may include:
- unexplained weight loss
- loss of appetite
- difficulty swallowing
- abdominal pain
- changes in bowel habits
It is important to remember that these symptoms can be related to other health conditions but it is important to rule out cancer quickly.
Diagnosis
There are a number of different tests used to diagnose upper GI cancers. Your consultant will advise you on the most appropriate tests, which may include:
- MRI scan
- PET-CT scan
- EUS (endoscopic ultrasound)
- ERCP (endoscopic retrograde cholangiopancreatography)
- Biopsy
Upper gastrointestinal cancer treatments
If you are diagnosed with a form of upper GI cancer, your consultant will discuss your treatment options with you. At Sheffield Oncology you will be looked after by a multidisciplinary team, including expert consultants, Clinical Nurse Specialists (CNSs), allied health professionals and other cancer specialists. This team will work together to create a treatment plan tailored to your medical needs.
The treatments we offer for upper GI cancers include:
- chemotherapy
- radiotherapy
- surgery
Bowel cancer
Bowel Cancer
This section provides information about bowel cancer care. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of bowel cancer treatments available.
About bowel cancer
Bowel cancer is the fourth most common type of cancer in the UK[i]. It’s also the second biggest cause of cancer deaths, with over 16,000 people dying from bowel cancer each year.
On average, about one in 16 people will develop bowel cancer in their lifetime, with the risk slightly higher for men[ii].
Here you can find out more about the different types of bowel cancer, the risk factors, what causes it and your options for treatment.
Facts about bowel cancer
- Bowel cancer is the fourth most common cancer in the UK
- There’s around 236,000 people currently living in the UK have had a diagnosis of bowel cancer
- 95% of bowel cancer cases occur in people aged 50 and over
- 56% of cases of bowel cancer occur in men and 44% of cases occur in women[iii].
What is bowel cancer?
The bowel is the engine of our digestive system, which processes everything we eat and converts it into energy. It also gets rid of any solid waste matter from the body.
The bowel is divided into the small bowel (also called the small intestine) and the large bowel, which is made up of the colon and the rectum.
Confusingly, the large bowel is actually the shortest part of the bowel, measuring about 5 feet long, while the small bowel is about 20 feet long [iv].The reason it’s called a small bowel is simply because it’s narrower than the large bowel. You might sometimes hear bowel cancer referred to as colorectal or colon cancer. Nearly all bowel cancers begin in the large bowel, so when people talk about bowel cancer, they usually refer to cancer of the large bowel.
It’s important to know that the symptoms of bowel cancer do not necessarily mean that you have bowel cancer – they could also be other conditions.
Bleeding from your bottom, blood in your poo, loose bowel movements over a long period of time, unexplained weight loss, tiredness and pains or lumps in your tummy are all possible symptoms of bowel cancer.
If you are experiencing any of these symptoms, you should make an appointment with your doctor.
[i] Bowel Cancer UK, Bowel cancer statistics, http://www.bowelcanceruk.org.uk/information-resources/bowel-cancer-facts-figures/
[ii] Bowel Cancer UK, Bowel cancer statistics, http://www.bowelcanceruk.org.uk/information-resources/bowel-cancer-facts-figures/
[iii] Bowel Cancer UK, Bowel cancer statistics, http://www.bowelcanceruk.org.uk/information-resources/bowel-cancer-facts-figures/
[iv] Cancer Research UK, The bowel http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/the-bowel
Types of bowel cancer
There are several different types of bowel (colorectal) cancer.
Adenocarcinomas
Over 95% of diagnosed bowel cancers are adenocarcinomas. When doctors refer to bowel cancer, this is usually the type of cancer they refer to.
An adenocarcinoma is a cancer that has started in the large bowel, within the gland cells that line the bowel wall. These glands usually produce a slimy lubricant called mucus that eases stools (waste matter) through the colon and towards the rectum.
There are two rarer types of adenocarcinoma, called mucinous and signet ring tumours. Mucinous tumours are where cancer cells are contained within pools of mucus, while signet ring tumours have mucus inside the cancer cells. Only about 1 to 2% of bowel cancers are of these types, which are treated the same way as adenocarcinomas of the large bowel[v].
Squamous cell cancers
This is a rare type of bowel cancer, which affects the squamous cells that make up the bowel lining, along with the mucus gland cells.
Carcinoid tumours
Another rare type of bowel cancer, a carcinoid tumour (also called a neuroendocrine tumour) is a slow growing cancer that forms in hormone producing tissues, often within the digestive system.
Around 4 to 17% of diagnosed carcinoid tumours start in the rectum, while 2 to 7% begin in the large bowel. Because this type of cancer behaves differently to colorectal cancer, it is treated differently[vi].
Sarcomas
Sarcomas are cancers of supporting cells in the body, like bone or muscle. The special term for sarcomas found in the large bowel are leiomyosarcomas, which means the cancer began in the smooth muscle. Sarcomas are treated differently to adenocarcinomas of the large bowel.
Lymphomas
Lymphomas are cancers of the lymphatic system. Only about 1% of cancers diagnosed in the large bowel are lymphomas, and they are treated differently to other colorectal cancers.
[v] Cancer Research UK, Types of bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer
[vi] Cancer Research UK, Types of bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer
Causes and risk factors
In the UK around 41,600 people are diagnosed with bowel cancer each year[vii],and there are several known risk factors that may cause bowel cancer:
Your age
The single biggest risk factor associated with bowel cancer is age. Over 80% of bowel cancers are diagnosed in people over 60 years of age. Research seems to suggest that many bowel cancers can be prevented through changes in our diets and lifestyle.
Your family history
If you have several relatives who have been diagnosed with bowel cancer, especially if they are in different generations, this can indicate a strong family history of bowel cancer.
One or more relatives who were diagnosed with bowel cancer at a young age can also indicate a strong family history; for instance, if a parent, brother or sister, son or daughter was diagnosed before the age of 45 years old[viii].
If you have a strong family history of bowel cancer, see your doctor, who may refer you to a specialist genetics service. They will look into your family background and ask about your relatives’ health – a blood test may also be part of this investigation.
If the geneticist agrees you have an above average risk of bowel cancer, you will be referred to a bowel specialist who will discuss regular tests (called screening) to monitor you for early signs of bowel disease.
An inherited condition
Two inherited conditions can increase your risk of bowel cancer. These are called familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC, also called Lynch syndrome). These are rare conditions that increase the risk of bowel cancer but together FAP and HNPCC are only responsible for about 5% of bowel cancer cases.
Your ethnicity
If you have Ashkenazi Jewish background then you may have a higher risk of bowel cancer, thought but not confirmed, to be attributed to a gene that is more common in this group – affecting 10% of Ashkenazi Jews.
If you have benign bowel polyps
Benign growths in the bowel, called polyps or adenomas, are not in themselves cancerous. However, polyps can sometimes develop into a bowel cancer over time. In fact, most bowel cancers develop from a polyp, and at least 25% of us will have at least one polyp by the age of 50, and 50% will have polyps by the age of 70[ix].
If you have ulcerative colitis or Crohn’s disease
Ulcerative colitis and Crohn’s disease are diseases that cause bowel inflammation, and having either of these conditions can increase your risk of bowel cancer. About 1% of bowel cancer cases are connected with ulcerative colitis.
The reason for this increased cancer risk is due to the fact that these diseases damage the bowel lining, which means the cells needs to repair themselves more than usual increasing the risk of a cancerous cell developing.
If you’ve had bowel cancer before
If you’ve already had bowel cancer, you have a greater risk of getting bowel cancer again. Research also shows that people who’ve had lymphoma, testicular or womb cancer may have an increased risk of bowel cancer, which could be a result of genetic changes or an effect of the previous cancer treatment.
If you have diabetes
People with diabetes have an increased risk of bowel cancer, but research has not identified the cause of this increased risk.
If you’ve been exposed to radiation
There are other factors that have been linked to the chance of getting bowel cancer too. It’s estimated that around 1% of bowel cancers are linked to radiation exposure through radiotherapy treatment or tests such as X-rays and CT scans[x].
If you have concerns about any of these risks, a specialist can talk to you about how often you may need screening.
[vii] Cancer Research UK, High risk groups for bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/risks/high-risk-groups-for-bowel-cancer
[viii] Cancer Research UK, Types of bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer
[ix] Cancer Research UK, Types of bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer
[x] Cancer Research UK, Types of bowel cancer
Bowel cancer symptoms and diagnosis
It’s important to know that many of the symptoms of bowel cancer do not necessarily mean that you have bowel cancer – they could also be other conditions.
But, if you are experiencing any one of the following symptoms, you should arrange to see your GP as soon as possible.
- Bleeding from your anus and/or blood in your poo
- Changes in your bowel movements that last for 3 weeks or more, especially if there is loose or runny poo
- Unexplained weight loss or extreme tiredness
- Pain or lumps felt in your tummy.
If the symptoms do indicate bowel cancer, remember that early detection can make a big difference. Over 90% of people who are diagnosed in the early stages of the disease are successfully treated.
The stages and grades of bowel cancer
When you’re diagnosed with bowel cancer, your doctor will tell you the stage of your cancer.
What cancer stages mean
The stage of a cancer simply means how big it is and whether or not it has spread. When your bowel cancer is diagnosed, the tests and scans you have will give you some information about the stage of your cancer.
Defining the stage of your cancer is important to determine what type of treatment you will have.
Tumour, Node and Metastasis stages of bowel cancer
The Tumour, Node, Metastasis (TNM) stages of bowel cancer refers to the size of a primary tumour (T stages), whether any lymph nodes contain cancer cells (N stages), and whether the cancer has spread to another part of the body, which is called metastasis (M stages).
Tumour size stages (T)
There are 4 stages of tumour size in bowel cancer:
- T1 – the tumour is only in the inner layer of the bowel
- T2 – the tumour has grown into the muscle layer of the bowel wall
- T3 – the tumour has grown into the outer lining of the bowel wall
- T4 – the tumour has grown through the outer lining of the bowel wall.
Lymph node stages (N)
There are 3 stages that describe cancer cells in the lymph nodes:
- N0 – there are no lymph nodes containing cancer cells
- N1 – 1 to 3 lymph nodes close to the bowel contain cancer cells
- N2 – there are cancer cells in 4 or more nearby lymph nodes
Metastasis stages (M)
There are 2 stages of cancer spread (metastasis):
- M0 – the cancer has not spread to other organs
- M1 – the cancer has spread to other parts of the body
Number stages of bowel cancer
The number system uses the TNM stages to group bowel cancers. There are 5 main stages in this system.
When you’re diagnosed with bowel cancer, your consultant bowel surgeon will tell you what stage cancer you have. This describes the size of the tumour, and whether it’s spread to any other part of your body.
- Stage 0 or carcinoma in situ (CIS)
Stage 0 or CIS colorectal cancer means there are cancer cells just within your inner bowel lining, so there is little risk of any cancer cells having spread. - Stage 1
Cancer cells have grown through the inner lining of the bowel, or into the muscle wall, but no further. There is no cancer in the lymph nodes (T1, N0, M0 or T2, N0, M0) - Stage 2
This stage is divided into 2a and 2b
Stage 2a
The cancer has grown into the outer covering of the bowel wall, but there are no cancer cells in the lymph nodes (T3, N0, M0)
Stage 2b
The cancer has grown through the outer covering of the bowel wall and into tissues or organs next to the bowel (T4). No lymph nodes are affected (N0) and the cancer has not spread to another area of the body (M0). - Stage 3
Stage 3 is divided into 3 stages
Stage 3a
The cancer is still in the inner layer of the bowel wall or has grown into the muscle layer, and between 1 and 3 nearby lymph nodes contain cancer cells (T1, N1, M0 or T2, N1, M0)
Stage 3b
The cancer has grown into the outer lining of the bowel wall or into surrounding body tissues or organs, and between 1 and 3 nearby lymph nodes contain cancer cells (T3, N1, M0 or T4, N1, M0)
Stage 3c
The cancer can be any size, has spread to 4 or more nearby lymph nodes, but there is no cancer spread to any other part of the body (any T, N2, M0) - Stage 4
This means your cancer has spread to other parts of the body (such as the liver or lungs) through the lymphatic system or bloodstream (any T, any N, M1).
BMI Healthcare bowel screening clinics
Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16% [xi].
At BMI Healthcare, we offer specialised bowel screening at our clinics across the country. Because our specialists are highly experienced, you’ll get expert advice and excellent care.
There are a number of screening options. These are reviewed on a personal patient-by-patient basis through a personal discussion with a specialist consultant. Examples of screening methods are:
- Stool testing
- Colonoscopy
- Virtual colonography (CT Scan).
The age at which screening should start depends largely on family history and the number and age of affected relatives.
What are the benefits of bowel cancer screening?
Screening for early bowel cancer can increase the survival of patients. Several international guidelines state that regular colonoscopies should begin at age 50 for people at average risk of colon cancer.
BMI Healthcare welcome referrals of people who wish to be screened, this includes adults who are at an increased risk – for example, those with a strong family history of bowel cancer, or people over 50 years of age. At point of screening, your specialist nurse or consultant will decide which screening method is most appropriate.
What to do next
If you’re 60 to 69, you fall into the age range for the NHS bowel cancer stool testing kit, which you’ll get in the post every two years. Over 55s are also starting to be invited for a bowel scope screening, which looks at your lower bowel and rectum. If you fall into these age ranges, you should accept bowel cancer screening invitations.
If any of the following apply to you, you can contact one of our bowel cancer screening clinics to talk about your concerns:
- If you’re worried about bowel cancer but not eligible for the NHS screening programme
- If you have a strong family history of bowel cancer or polyps
- If you’re worried about any other abdominal or bowel problems
We will make sure you are seen as quickly as possible to talk through the best screening and treatment options for you.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.
If you visit a BMI clinic for bowel cancer screening, please check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own bowel cancer treatment the cost of the procedure will be explained and confirmed in writing at time of booking.
Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge.
[xi] Cancer Research UK, Types of bowel cancer, Cochrane Database of Systematic Reviews, 2006. Screening for colorectal cancer using the faecal occult blood test: an update
Bowel cancer treatments
If you’ve been diagnosed with bowel cancer, there are several treatment options for you to consider. You might need one or a combination of different treatments, which your colorectal consultant, and specialist nurse can talk through with you.
There are several factors that your BMI Healthcare consultant will consider when planning the best cancer treatment for you, these include:
- The type and size of the cancer
- Your health and fitness for treatment
- Whether the cancer has spread – this is called the cancer stage
- What the cancer cells look like under the microscope – this is called the cancer grade.
As you talk to your consultant, it is a good idea to take notes and write down any questions you have.
You can also take a close friend or relative with you when you see your specialists so they can help you remember everything that is said in your meeting.
Treating colon cancer
For cancer of the colon, surgery is the most common primary treatment. A specialist colorectal (bowel) surgeon will discuss with you the type of bowel cancer operation you need.
Keyhole surgery (also called laparoscopic surgery) is now more common as results are equal to conventional surgery, with a much faster recovery time as the procedure is far less invasive.
However, in some instances keyhole surgery might not be an option, and you may first be offered chemotherapy, though this treatment is less common for bowel cancer.
Chemotherapy is treatment with special drugs that aim to get rid of cancer by killing cells that divide rapidly – one of the main properties of most cancer cells. The chemotherapy drugs circulate in the bloodstream around the body and work by disrupting cancer cell growth.It’s given either to try to cure your cancer, to help you to live longer or to reduce your symptoms.
After your bowel surgery, unless the cancer is detected in its early stages, chemotherapy is often recommended as a follow-up treatment.
Your oncologist (a specialist in cancer treatment and care) can discuss your treatment plan, including any other possible therapies.
Treating rectal cancer
Treating cancer of the rectum often involves a short course of radiotherapy and chemotherapy (together called chemoradiation) before your surgery to help shrink the cancer and reduce the risk of cancer returning to the rectum.
Chemotherapy drugs make cancer cells more sensitive to radiotherapy, and are given shortly before radiotherapy.
Radiotherapy uses high-energy rays to kill cancer cells. Doctors don’t often use it to treat cancer in the large bowel (colon cancer). But they often use it to treat cancer that started in the back passage (rectum).
Having chemoradiation (chemotherapy and radiotherapy together) can make the side effects of the two different treatments worse. Your doctor or specialist nurse will talk to you about chemoradiation treatment and its potential side effects.
You may also need a temporary or permanent colostomy, which your surgeon will discuss with you before your surgery.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.
Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own treatment the cost of any surgery and treatment will be explained and confirmed in writing at time of booking.
Ask the hospital for a quote beforehand, and ensure that this includes both the consultants’ fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about bowel cancer, treatment or living with bowel cancer, please visit bowelcanceruk.org.uk
Liver cancer
Liver Cancer
This section provides information about liver cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of liver cancer treatments available.
About liver cancer
Your liver is the second largest organ in your body and one of the most complex. It’s divided into two lobes and sits just beneath your right lung. It has many roles.
Your liver:
- stores nutrients until your body needs them
- converts fat to energy
- produces bile to help with digestion
- produces proteins
- helps your blood to clot
- makes cholesterol – important for your cell walls
- makes substances for the product of bone and tissue
- breaks down harmful substances to be passed as waste.
If you have liver cancer, the cells in your liver grow and multiply in an irregular way, rather than multiplying as and when they’re needed. In cancer the process of creating new cells becomes uncontrolled. This then prevents the liver from performing its functions.
Liver cancer facts
- In the UK, around 4,300 primary liver cancer cases are diagnosed each year
- Liver cancer is more common in men than in women
- Almost nine out of ten cases are in people aged 55 and over.[1]
What is liver cancer?
Primary liver cancer means the cancer started in your liver’s cells. Secondary liver cancer means the cancer started elsewhere in your body and has spread to the liver. Primary liver cancer is still a less common cancer in the UK with around 4,300 cases being diagnosed each year.
This section is just about primary liver cancer. If you have secondary liver cancer, you should read information about the type of primary cancer that spread to your liver.
1 Cancer Research UK, Risks and causes of liver cancer http://www.cancerresearchuk.org/cancer-help/type/liver-cancer/about/risks-and-causes-of-liver-cancer
Types of liver cancer
There are four main types of primary liver cancer:
- hepatocellular carcinoma (HCC) – the most common type of liver cancer
- cholangiocarcinoma – cancer that starts in the bile ducts
- angiosarcoma – extremely rare with only around 10 cases diagnosed each year
- hepatoblastoma – another rare form of liver cancer, most commonly diagnosed in very young children.
Hepatocellular carcinoma is the most common type of primary liver cancer. It’s most common in people whose liver is damaged due to cirrhosis. Cirrhosis means that the liver is scarred from previous damage, possibly due to an infection such as hepatitis B or C, long-term alcohol abuse and some inherited diseases. This type of cancer is more likely to affect men and the risk increases with age.
A rarer subtype of hepatocellular carcinoma is called fibrolamellar carcinoma. This type of liver cancer is more common in young people.
Causes and risk factors
The exact cause of liver cancer isn’t understood, but there are a number of factors that can put you at risk including [2]:
- cirrhosis – the scarring of your liver, usually due to damage caused by a virus, alcohol or a hereditary disease
- smoking
- hepatitis B or C infection
- regularly drinking more than 5 units of alcohol each day
- non-alcoholic fatty liver disease (NAFLD)
- low immunity
- a family history of liver cancer
- diabetes
- gallbladder removal
- obesity.
2 Cancer Research UK, Causes and risk factors http://www.nhs.uk/Conditions/Cancer-of-the-liver/Pages/Causes.aspx
Liver cancer symptoms and diagnosis
Symptoms of liver cancer can be vague and don’t usually appear until the disease is at an advanced stage. They can include:
- unexplained weight loss
- poor appetite for over a week
- feeling very full after eating even small amounts
- feeling sick or vomiting
- a swollen tummy (abdomen)
- jaundice, which means your skin and eyes look yellow
- itchy skin
- feeling weak and tired.
Most people who notice these symptoms don’t have liver cancer. But you should get them looked into by a doctor so you can treat any problems early.
Diagnosing liver cancer
Your doctor will want to examine you, and ask questions about your health and symptoms. If they think you need further tests, you’ll need to see a liver specialist.
At BMI Healthcare, our consultants and liver specialists may want to run some further tests.
- Blood tests to check your general health and how well your liver is working
- An ultrasound scan lets your consultant see inside your liver
- A CT scan that looks for signs of cancer in your liver and other parts of your body
- An MRI scan helps detect cancer in your liver or elsewhere in your body
- Biopsy removes a sample of tissue so it can be looked at under a microscope. It’s the only way to clearly tell between a cancerous or non-cancerous growth
- Laparoscopy is a small operation that lets your consultant surgeon look at your liver using a thin, flexible tube with a camera on the end called a laparoscope.
Stages of liver cancer
After the tests have been carried out to diagnose your cancer, your consultant specialist will see you with the results. They will be able to tell you what stage your liver cancer is at. This will influence the type of treatment you are offered.
- Stage 1: The cancer is small and hasn’t spread
- Stage 2 or 3: The cancer has spread into nearby areas
- Stage 4: The cancer has spread to other parts of your body. This is called metastatic or secondary liver cancer.[3]
3 Macmillan, Staging of primary liver cancerhttp://www.macmillan.org.uk/Cancerinformation/Cancertypes/
Liver/Symptomsdiagnosis/Staging.aspx
Liver cancer treatments
The type of treatment you’re offered depends on the type and stage of your liver cancer. Some people might need one type of treatment, whereas others might need a few different ones.
Surgery
Surgery is the most effective treatment for primary liver cancer that hasn’t spread. This involves a liver transplant or a liver resection and means removing the cancer from your liver. The liver has the ability to repair itself. Even if up to 80% of the liver is removed it will start to regrow in a short space of time.
Radiofrequency ablation (RFA)
This treatment uses radio waves to heat up and attack cancer cells. This procedure can be carried out under local or general anaesthetic.
Microwave ablation
This is a recent treatment. It’s similar to radiofrequency ablation but it uses microwaves instead of radio waves to heat up the cancer cells and attack them. This treatment may not be possible if your tumour is too close to another organ such as the bowel.
Percutaneous ethanol injection (PEI)
By injecting alcohol (ethanol) into the cancer in your liver the tissue is dehydrated, which stops the blood supply to the cancer. It’s most suitable for people who only have a few small tumours. This is most often carried out under a local anaesthetic and you will often have more than one session of treatment. The number of sessions will depend on the size of your tumour.
Chemoembolisation
Sometimes called transarterial chemoembolisation (TACE), this treatment gives chemotherapy directly to your liver. The consultant specialist will also inject a substance into the blood vessel to cut off the blood supply to the tumour (embolisation). This reduces the supply of oxygen and food to the tumour and can help to shrink it.
Chemoembolisation generally helps to manage the symptoms of liver cancer rather than cure it.
Radioembolisation
Radioembolisation is another recent treatment. It’s similar to chemoembolisation but uses radiation to attack the cancer cells. Like chemoembolisation, this treatment is generally used to manage symptoms rather than cure. This treatment may also be called selective internal radiation therapy (SIRT).
Biological therapy
Biological therapies, sometimes known as targeted therapies, are treatments that act on processes in the cells. They can interfere with the growth of some types of cancer cells. They can also slow the growth of new blood vessels to the tumour.
Chemotherapy
Depending on the type and size of your tumour your consultant specialist might recommend chemotherapy. Chemotherapy drugs can be given intravenously (injected into a vein), by taking tablets, or by injecting the drugs directly into the liver. Chemotherapy can help to slow down the cancer’s growth and control your symptoms.
Radiotherapy
Radiotherapy is only occasionally used to treat liver cancer. This is because radiation can damage healthy liver cells. It’s sometimes used if the cancer has spread to other areas of the body to help treat the area and control symptoms like pain.
After treatment
You’ll have regular check-ups following your liver cancer treatment. How often and for how long depends on the kind of treatment that you had.
At follow-up appointments, your doctor will ask how you’re feeling and examine you. You might also need blood tests, a CT or MRI scan, an ultrasound scan or a combination of these.
If you’re worried or spot any new symptoms between appointments, you should tell your doctor as soon as you can.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.
Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.
Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about liver cancer, treatment or living with liver cancer, please visit cancerresearchuk.org.uk.
Pancreatic cancer
Pancreatic Cancer
This section provides information about pancreatic cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of pancreatic cancer treatments available.
About pancreatic cancer
Your pancreas is a large gland that’s part of your digestive system. It sits just behind your stomach and creates digestive enzymes to break down food. It also makes insulin to keep your blood sugar levels stable.
Normally, your body replaces the cells in your body as it needs to. If you have pancreatic cancer, the cells in your pancreas grow and multiply in an irregular way. Rather than multiplying as and when they’re needed, in cancer the process of creating new cells becomes uncontrolled.
Facts about pancreatic cancer
- In the UK, around 8,800 people are diagnosed with pancreatic cancer each year[1]
- Around half of all pancreatic cancer cases are in people over 75[2]
- One in three pancreatic cancer cases can be linked to smoking.[3]
What is pancreatic cancer?
The pancreas looks a bit like a leaf – thicker at one end (the head) and narrower at the other (the tail). You can get pancreatic cancer in the head, the tail or the body (the bit in between) of the pancreas. Your symptoms will differ depending on which part of the pancreas is affected.
The majority of pancreatic cancers – around three out of four – start in the head of the pancreas.
References
1 Cancer Research UK, Pancreatic cancer risks and causes http://www.cancerresearchuk.org/about-cancer/type/pancreatic-cancer/about/pancreatic-cancer-risks-and-causes
2 Cancer Research UK, Pancreatic cancer risks and causes http://www.cancerresearchuk.org/about-cancer/type/pancreatic-cancer/about/pancreatic-cancer-risks-and-causes
3 Cancer Research UK, Pancreatic cancer risks and causes http://www.cancerresearchuk.org/about-cancer/type/pancreatic-cancer/about/pancreatic-cancer-risks-and-causes
Types of pancreatic cancer
There are a few different types of pancreatic cancer, although the most common types are exocrine cancers.
Exocrine cancers
This type of cancer starts in the exocrine part of the pancreas that produces digestive juices. There are several types of exocrine pancreatic cancers, but more than eight out of ten are adenocarcinomas. Most of these are a ductal adenocarcinoma, which means the cancer starts in the lining of the pancreas ducts.
Other types of exocrine cancer are rare but include:
- cystic tumours
- cancer of the acinar cells
- endocrine tumours.
Endocrine pancreatic tumours
This type of cancer is quite rare. It starts in the endocrine part of the pancreas, which is where hormones like insulin are made and released into the blood. You may also hear this type of cancer called pancreatic neuroendocrine tumours (PNETS) or islet cell tumours.
Around one in three of endocrine pancreatic tumours produce hormones. They’re usually non-cancerous (benign) but can produce unexpected symptoms because of the hormones.
Two in three pancreatic tumours don’t produce hormones or symptoms. These are most often cancerous (malignant).
Rare types of pancreatic cancer
There are other types of pancreatic cancer, but these are rare. They’re usually treated differently to common exocrine cancers and include:
- pancreatoblastoma mainly develops in children and is sometimes linked to genetic conditions
- sarcomas of the pancreas is a very rare cancer of the connective tissue
- lymphoma is cancer of the lymphatic system. Because your lymphatic system runs through your whole body, the cancer can occur anywhere.
Causes and risk factors
The exact cause of pancreatic cancer isn’t understood, but there are a number of factors that can put you at risk including:
- smoking
- smokeless tobacco, like chewing tobacco
- age
- obesity and lack of exercise
- diet, one high in red and processed meats and low in fresh fruit and vegetables may increase your risk
- long-term heavy drinking.
Some of the following medical conditions may also increase your risk of pancreatic cancer:
- chronic inflammation of the pancreas or hereditary pancreatitis
- stomach ulcers
- helicobacter pylori infection
- diabetes
- family history of pancreatic cancer.
Pancreatic cancer symptoms and diagnosis
In the early stages pancreatic cancer rarely causes symptoms. When symptoms do occur they are often vague but can include:
- pain in your stomach or back
- jaundice – yellowing of your skin and eye whites
- weight loss.
There are other possible symptoms you might experience if you have pancreatic cancer, including:
- itching caused by jaundice
- loss of appetite
- feeling or being sick
- change in bowel habit
- fever and shivering
- indigestion
- blood clots.
It’s important to remember that other health conditions can cause symptoms similar to pancreatic cancer. But if you do notice any of these symptoms, you should get them looked into by your doctor so you can treat any problems early.
Diagnosing pancreatic cancer
If you are worried about any symptoms you may have your first port of call would be your GP. Your doctor may want to examine you, and ask questions about your health and symptoms. Your doctor will also check the whites of your eyes and your look at your skin to check if there are signs of jaundice. A urine test and blood tests may also be requested. If your doctor thinks you need further tests, you will be referred to a specialist consultant.
At BMI Healthcare, our consultants may want to run the following tests:
- blood tests to check your general health
- an ultrasound scan lets your consultant look at your pancreas and liver for cysts or other abnormalities
- an endoscopic ultrasound is an ultrasound scan from inside your body. Your consultant will use a flexible tube called an endoscope to look at areas that might be cancerous. A biopsy may also be taken
- a CT scan gives a detailed picture of inside your body and can help to show where your cancer is and if it has spread
- an MRI scan uses magnetic waves to build up a detailed picture of inside your body
- ERCP test (endoscopic retrograde cholangiopancreatography) This test uses an endoscope to take an X-ray of your pancreas and gallbladder. The doctor may also use this test to take a biopsy. An endoscopic ultrasound is now used more often to diagnose pancreatic cancer and an ERCP may be used to drain bile or place stents if jaundice is a problem
- laparoscopy is similar to an endoscopy. It lets your specialist look at your pancreas using a thin, flexible tube with a camera on the end called a laparoscope.
Stages of pancreatic cancer
After your tests, your doctor or pancreatic consultant will tell you what stage your pancreas cancer is at by looking at a sample of your cancer cells under a microscope. This describes how big your tumour is and how far it’s spread. This will influence the type of treatment you’re offered.
- Stage 1: The cancer is contained to the pancreas and hasn’t started to spread
- Stage 2: The cancer has started to grow into the tissue around the pancreas. It might also be in duodenum or bile duct
- Stage 3: The cancer is no longer contained to the pancreas – it may also be in the nearby large blood vessels or lymph nodes
- Stage 4: The cancer has spread to other areas of your body, like your liver or lungs.
For more information about each stage, please read Cancer Research UK’s article about the stages of pancreatic cancer.
Pancreatic cancer treatments
The type of treatment you’re offered depends on the type and stage of your pancreatic cancer, plus your overall health.
However, treatment for the different types of exocrine pancreatic cancer is generally the same, and surgery is most often the main treatment.
Surgery to remove pancreatic cancer
This is a common treatment for stage 1 and stage 2 pancreatic cancer. Your surgeon will only do this if you’re fit enough and they think it will be possible to remove all the cancer.
Surgery to relieve your symptoms
Pancreatic cancer is often diagnosed too late for surgery to be an effective option to remove the cancer. But surgery can help to relieve symptoms like jaundice or sickness.
Relieving symptoms with stents
A stent is a small tube used to relieve blockages. Your consultant will guide the stent into a blocked bile duct to help it stay open. This will enable bile to drain and help to improve any symptoms of jaundice.
Sometimes pancreatic cancer can block the top of your small bowel. If this happens, food can’t pass along the bowel and so it builds up in the stomach. This build up makes you sick – but bypass surgery can help to alleviate these symptoms.
Chemotherapy
If you have had surgery to remove your cancer you might need chemotherapy to lower the risk of the cancer coming back. Or if your cancer is advanced, you might need chemotherapy to shrink the cancer and relieve your symptoms.
Radiotherapy
It’s quite uncommon to use radiotherapy to treat pancreatic cancer, but it may be offered in certain situations to help shrink the tumour or relieve symptoms instead of surgery.
After treatment
You’ll have regular check-ups following your treatment. How often and for how long depends on the kind of pancreatic cancer treatment that you had.
At follow-up appointments, your doctor will ask how you’re feeling and examine you and you may need a combination of tests which can include blood tests, a CT scan or ultrasound scan.
If you’re worried or spot any new symptoms between appointments, you should tell your doctor or liver consultant as soon as you can.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.
Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.
Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about pancreatic cancer, treatment or living with pancreatic cancer, please visit cancerresearchuk.org.uk.
