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Colon cancer is a type of cancer that originates in the large intestine. Colon cancer is also occasionally identified as colorectal cancer or rectal cancer depending on its origin. The large intestine is the final part of the digestive system, also known as gastrointestinal (GI) system, and it consists of colon and rectum. Colon is the largest portion of the large intestine, comprising four sections: ascending colon, transverse colon, descending colon and sigmoid colon. The sigmoid colon connects to the rectum. Colon is mainly responsible for absorbing remaining fluids and electrolytes before removing the waste products as stool.

Colon cancer usually begins as polyps, benign clumps of cells that form in the inner lining of the colon. Over time, cancer can form in a polyp and grows into the wall of the colon.

Colon cancer is the third most common cancer in the United States and is the third leading cause of cancer-related deaths in men and in women, and the second most common cause of cancer deaths.

The American Cancer Society estimates for colon cancer incidence in the United States for 2021 are:

• About 104,270 new cases will be diagnosed with colon cancer.
• About 52,980 deaths from colon cancer.

Types of colon cancer:

There are there several types of colon cancer, depending where it originates from.

• Adenocarcinomas: the most common type of colon cancer. It originates in the cells in the inner lining of the colon.
• Carcinoid tumors: originates in the hormone-making cells in the intestine.
• Gastrointestinal stromal tumors (GISTs): originates from cells called interstitial cells of Cajal in the wall of the colon. Some of these cells are benign.
• Primary colon lymphomas: originates in cells called lymphocytes and may also develop in the colon or rectum.
• Sarcomas: originates in blood vessels, muscle layers, or other connective tissues in the wall of the large intestine.

What are the risk factors of colon cancer?

• Age: the risk of developing colon cancer increases with age. Most commonly develops after the age of 50.
• Race/ethnicity: African-Americans have higher risk of developing colon cancer.
• Past medical history: people with history of past colon cancer or polyps or inflammatory bowel disease have a higher risk of developing colon cancer.
• Inherited syndromes: about 5% of colon cancer is associated with inherited genetic mutations. The most common are Lynch syndrome (hereditary non-polyposis colorectal cancer, or HNPCC) and familial adenomatous polyposis (FAP).
• Family history of colon cancer
• Diet: diet low in fiber, high in fat and red meat is associated with increased risk of developing colon cancer
• Smoking: risk of developing colon cancer is higher smokers than non-smokers
• Obesity: risk of developing colon cancer is higher for people who are overweight or obese
• Diabetes: risk of developing colon cancer is higher for people with diabetes
• Lack of physical activity: people with sedentary lifestyle are more likely to develop colon cancer
• Previous cancer treatment: radiotherapy for treatment of previous cancer may increase the risk of developing colon cancer

Signs and symptoms of colon cancer:

• Change in bowel habits, such as persistent diarrhea, constipation or change in stool consistency
• Rectal bleeding
• Blood in your stool (dark brown or black in color)
• Persistent abdominal pain or discomfort
• Unrelieved feeling after emptying the bowel
• Weakness and fatigue
• Weight loss

How to diagnose colon cancer?

• Medical history and physical examination, including pelvic examination, followed by further tests and investigations, such as:
• Stool test – a fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
• Colonoscopy with biopsy
• Blood tests
• Imaging tests (CT scan, MRI scan, PET/CT scan) can also be used to find out if the cancer has metastasized (spread) to other areas of the body

Treatment of colon cancer:

After diagnosis, your doctor will establish the stage of your disease. According to your current health status, history, and staging results, your doctor will discuss with you your treatment options. Regular follow-ups with your doctor and periodical monitoring with tests and investigations are highly recommended.

Treatment options include:

1. Surgery: Surgery is often performed to treat early-stage colon cancer. The type of surgery depends on the stage of the cancer and its location.
   • Polypectomy: performed by removing the polyp along with the cancer during a colonoscopy for early-stage colon cancer
   • Local excision: performed by removing small cancers in the inner lining and small amount of surrounding healthy tissue in the colon during a colonoscopy for early-stage colon cancer
   • Hemicolectomy, partial colectomy or segmental resection: performed by removing part of the colon and nearby lymph nodes then reattaching the remaining sections
   • Total colectomy: performed by removing all of the colon
2. Chemotherapy: using chemo drugs to kill cancer cells systemically, which can be taken either intravenously or orally. Chemotherapy may be given after surgery or before surgery.
   • Adjuvant chemotherapy:  is given after surgery to kill the possible remaining cancer cells to lower the chance of cancer recurrence
   • Neoadjuvant chemotherapy: is given before surgery and sometimes with radiation to try to reduce the size of the tumour before removal
3. Radiotherapy: using high-powered energy beams to kill cancer cells. Radiotherapy can be used before surgery, after surgery or during surgery. The two types of radiotherapy used for treating colon cancer are external beam radiation therapy (EBRT) and brachytherapy.
4. Targeted therapy: using certain drugs to target specific abnormalities present within cancer cells.
5. Immunotherapy: using immune cells or certain drugs which alert the immune cells to kill cancer cells.
6. Alternative treatments: using other scientific based alternatives to attack cancer cells.

How to prevent colon cancer?

You can reduce your risk of colon cancer by doing the following:

• Opt for a healthy diet
• Limit alcohol consumption
• Stop smoking
• Regular exercise
• Maintain a healthy weight

References:

Mayo Clinic

American Cancer Society

Ovarian cancer is a type of cancer that originates in the ovaries. Ovaries are female productive glands responsible for producing eggs and female hormones estrogen and progesterone.

Ovarian cancer is the fifth leading cause of cancer deaths for females.

The American Cancer Society estimates for ovarian cancer incidence in the United States for 2020 are:

• About 21,750 new cases will be diagnosed with ovarian cancer.
• About 13,940 deaths from ovarian cancer.

Types of ovarian cancer:

There are there main types of cell that make up the ovary. The type of ovarian cancer is determined by the type of cell it originated from.

• Epithelial tumors: originates from the cells in the outer surface of the ovaries (epithelial cell). Cancerous (malignant) epithelial tumors are identified as carcinomas and they are the most common type of ovarian cancer. Here are the subtypes of ovarian carcinomas:
  • Serous carcinomas
  • Clear cell carcinoma
  • Mucinous carcinoma
  • Endometroid carcinoma
• Stromal tumors: originates from the cells in the ovarian connective tissues that produces estrogen and progesterone (stromal cell). The subtypes of malignant stromal tumors include the following:
  • granulosa cell tumors
  • granulosa-theca tumors
  • Sertoli-Leydig cell tumors
• Germ cell tumors: originates from the cells that produce eggs (germ cell). The subtypes of malignant germ cell tumors include the following:
  • Teratomas
  • Dysgerminomas
  • Endodermal sinus tumors
  • Choriocarcinomas

What are the risk factors of ovarian cancer?

• Age: the risk of developing ovarian cancer increases with age. Most commonly develops after menopause.
• Inherited genetic mutations: genetic mutations of the BRCA1 and BRCA2 genes increase the risk of developing breast cancer
• Family history: Women with family history of ovarian cancer, breast cancer or colon cancer have higher risk of developing ovarian cancer
• Reproductive history: early menstruation and late menopause increases the risk of developing ovarian cancer. Women who have children after the age of 35 or women who never carried a full-term pregnancy have higher risk of developing ovarian cancer.
• Taking Hormones: women who use estrogen hormone replacement therapy after menopause have higher risk of developing ovarian cancer compared to women who have never used hormones.

Signs and symptoms of ovarian cancer:

Ovarian cancer may have nonspecific symptoms that can be mistaken for other conditions. Frequently, ovarian cancer is not detected until it has progressed. 

The common signs and symptoms of ovarian cancer include:

• Abdominal bloating
• Pelvic or abdominal pain or discomfort
• Feeling of fullness
• Urinary frequency or urgency

The other less common signs and symptoms of ovarian cancer may:

• Fatigue
• Weight loss
• Constipation
• Changes in menstruation
• Back pain
• Pain during sexual intercourse
• Abdominal swelling from fluid in the abdomen (ascites)

How to diagnose ovarian cancer?

• Medical history and physical examination, including pelvic examination, followed by further tests and investigations, such as:
• Imaging tests: ultrasound, CT scan and MRI scan. PET/CT scan can also be used to find out if the cancer has metastasized (spread) to other areas of the body.
• Biopsy
• Blood tests: tumor marker, CA-125, test along with other blood tests.

Treatment of ovarian cancer:

After diagnosis, your doctor will establish the stage of your disease. According to your current health status, history, and staging results, your doctor will discuss with you your treatment options. Regular follow-ups with your doctor and periodical monitoring with tests and investigations are highly recommended.

Treatment for ovarian cancer is more likely to be successful when the cancer is still in early stage and hasn’t metastasized to other areas.

Treatment options include:

1. Surgery: Surgery is often performed to treat most ovarian cancers. The type of surgery depends on the patient’s health condition and the staging of the ovarian cancer. The types of surgery for treating ovarian cancer include:

• Total hysterectomy (TAH): surgery to remove the uterus and cervix
• Bilateral salpingo-oophorectomy (BSO): surgery to remove both ovaries and fallopian tubes
• Unilateral salpingo-oophorectomy: surgery to remove only one ovary and fallopian tube

In addition, surgical procedures below may also be done:

• Debulking: surgery to remove as much of the tumor as possible
• Omentectomy: surgery to remove the omentum, a fold of fatty tissue in the abdomen
• Lymphadenectomy or lymph node dissection: surgery to remove affected lymph nodes
• Colectomy: surgery to remove the bowel
• Removal of other organs that ovarian cancer has metastasized to

2. Chemotherapy: using chemo drugs to kill cancer cells systemically, which can be taken either intravenously or orally. Chemotherapy for treating ovarian cancer usually involves using two different types of chemo drugs and can be given before surgery to shrink the tumor size or after surgery to kill possible remaining cancer cells. In some cases, intraperitoneal (IP) chemotherapy can also be done by injecting chemotherapy into the abdominal cavity.

1. Hormonal Therapy: using hormones or drugs to block estrogen (i.e. Luteinizing-hormone-releasing hormone (LHRH) agonists, Tamoxifen and Aromatase inhibitors).
2. Targeted therapy: using certain drugs to target specific abnormalities present within cancer cells.

5. Radiotherapy: using high-powered energy beams to kill cancer cells. The most common type of radiotherapy for treating ovarian cancer is external beam radiation therapy (EBRT). Another method is radiotherapy is brachytherapy.
6. Alternative treatments: using other scientific based alternatives to attack cancer cells.

How to reduce the risk of developing ovarian cancer?

• Oral contraceptives (birth control pills): Using oral contraceptives may reduce the risk of developing ovarian cancer for women who are at risk and women with inherited BRCA mutation.

 

References:

Mayo Clinic

American Cancer Society

Liver cancer is a type of cancer that originates in the cells of liver. Liver is the body’s largest internal organ and it is mainly responsible for nutrients breakdown and storage, bile production and excretion, regulation of clotting factors and detoxification of toxins.

Liver cancer is one of the most common cause of cancer deaths worldwide, contributing to over 700,000 deaths per year.

The American Cancer Society’s estimates for primary liver cancer and intrahepatic bile duct cancer in the United States for 2020 are:

• About 42,810 new cases will be diagnosed.
• About 30,160 deaths from primary liver cancer and intrahepatic bile duct cancer.

Types of liver cancer:

• Hepatocellular carcinoma (HCC): is the most common type of liver cancer originating from hepatocytes (main type of liver cells).
• Cholangiocarcinoma (bile duct cancer): is a type of liver cancer that originates in the bile ducts, which are thin tubes that carry bile from the liver to the gallbladder into the small intestine within the liver that carry bile to the gallbladder.
• Angiosarcoma or hemangiosarcoma: is rare and fast-growing type of liver cancer that originates in the blood vessels of the liver
• Hepatoblastoma: is a very rare type of liver cancer that occurs in children, commonly younger than 4 years old.
• Secondary liver cancer (metastatic liver cancer): is a cancer that originates from another part of the body, commonly primary colon, and spreads (metastasize) to the liver

What are the risk factors of liver cancer?

• Gender: men are more likely to develop liver cancer than women. According to the American Cancer Society, liver cancer incidence rates and death rates are higher in men than in women.
• Race/ethnicity: liver cancer is more common in countries in sub-Saharan Africa and Southeast Asia
• Chronic viral hepatitis: people with chronic infection of hepatitis B virus (HBV) or hepatitis C virus (HCV) have higher risk of developing liver cancer.
• Cirrhosis: irreversible scarring of the liver also increases the risk of developing liver cancer.
• Inherited metabolic diseases: people with inherited metabolic diseases, such as hemochromatosis and Wilson’s disease, have higher risk of developing cirrhosis and liver cancer
• Diabetes: people with diabetes have higher risk of developing liver cancer.
• Non-alcoholic fatty liver disease: is a condition, common in obese people, caused by accumulation of fats in the liver increases the risk of developing cirrhosis and liver cancer.
• Aflatoxins: are cancer-causing substances are made by a fungus that grows on crops. Long-term exposure to aflatoxins is a major risk factor for liver cancer.
• Overconsumption of alcohol: prolonged excessive drinking of alcohol can lead to irreversible liver damage and increase risk of developing liver cancer.
• Smoking: smokers and ex-smokers are more likely to develop liver cancer.
• Obesity: people who are very overweight have higher risk of developing liver cancer.

Signs and symptoms of liver cancer:

• Involuntary weight loss
• Loss of appetite or feeling of fullness after a small meal
• Persistent general weakness and/or fatigue
• Nausea and vomiting
• Enlarged liver (hepatomegaly)
• Upper abdominal pain or pain near the right shoulder blade
• Swelling or fluid build-up in the abdomen (ascites)
• Yellow discoloration of the skin and eyes (jaundice)

How to diagnose liver cancer?

• Imaging tests: ultrasound, CT scan, MRI scan, angiogram. Bone scan can also be used to see if the cancer has metastasized (spread) to the bones. PET/CT scan can be used to find out if liver cancer has metastasized (spread) to other areas of the body.
• Liver biopsy:
  • Needle biopsy
  • Laparoscopic biopsy
  • Surgical biopsy
• Blood tests: to detect any liver abnormalities

Treatment of liver cancer:

After diagnosis, your doctor will establish the stage of your disease. According to your current health status, history, and staging results, your doctor will discuss with you your treatment options. Regular follow-ups with your doctor and periodical monitoring with tests and investigations are highly recommended.

Treatment options include:

1. Surgery: surgical resection (removal of the tumor with surgery) with partial hepatectomy or a liver transplant
2. Ablation: treatment that destroys liver cancer cells without removing the liver tumour. Types of ablation are the following:

• Radiofrequency ablation (RFA): uses high-energy radio waves to heat the tumour and destroy the cancer cells
• Microwave ablation (MWA): uses the energy from electromagnetic waves to heat the tumour and destroy the cancer cells
• Cryoablation (cryotherapy): uses cold gasses to freeze the tumour and kill the cancer cells
• Ethanol (alcohol) ablation: uses concentrated alcohol to inject into the tumor and damage cancer cells

3. Embolization therapy: treatment that decreases blood supply to the liver tumour by injecting substances directly into an artery in the liver. Types of embolization therapy include:

• Trans-arterial embolization (TAE)
• Trans-arterial chemoembolization (TACE)
• Drug-eluting bead chemoembolization (DEB-TACE)
• Radioembolization (RE)

4. Radiotherapy: using high-powered energy beams to kill cancer cells. It is not recommended for patients with severe liver damage.
5. Targeted therapy: using certain drugs to target specific abnormalities present within cancer cells.
6. Immunotherapy: using immune cells or certain drugs which alert the immune cells to kill cancer cells.
7. Chemotherapy: destroys cancer cells either systemically by administering chemo drugs intravenously or orally, or regionally by putting chemo drugs directly into the hepatic artery
8. Alternative treatments: using other scientific based alternatives to attack cancer cells.

How to prevent liver cancer?

• Prevention and treatment of hepatitis B and C infections
• Limit smoking and alcohol consumption
• Maintain a healthy weight
• Limit exposure to cancer-causing substances
• Treatment of diseases that increase the risk of liver cancer

References:

Mayo Clinic

American Cancer Society

 

 

Pancreatic cancer is a type of cancer that originates in the pancreas. Pancreas is an organ located behind the stomach that is responsible for releasing enzymes that help with digestion (exocrine function) and produces hormones, including insulin and glucagon, that help manage the blood sugar (endocrine function).

Pancreatic cancer accounts for about 7% of cancer deaths in the US. The American Cancer Society’s estimates for pancreatic cancer incidence in the United States for 2020 are:

• About 57,600 cases will be diagnosed.
• About 47,050 deaths from pancreatic cancer.

Types of pancreatic cancer:

Exocrine pancreatic cancer: the most common type of pancreas cancer that originates from exocrine cells of the pancreas. Exocrine cells are responsible for secretion of pancreatic enzymes into the ducts of the pancreas.

• Pancreatic adenocarcinoma (pancreatic exocrine cancer): the most common type of pancreatic cancer, which originates from the cells that line the ducts of the pancreas
• Less common types of exocrine pancreatic cancer include: adenosquamous carcinomas, squamous cell carcinomas, signet ring cell carcinomas, undifferentiated carcinomas, giant cell tumour

Endocrine pancreatic cancer: less common type of pancreatic cancer that originates from endocrine cells of the pancreas. Endocrine cells are responsible for secretion of hormones into the blood vessels.

• Also known as pancreatic neuroendocrine tumors (PNETs), islet cell tumors or pancreatic endocrine cancers
• Types of neuroendocrine tumour include: insulinoma, glucagonoma, gastrinoma, somatostatinoma, VIPomas and PPomas

What are the risk factors of pancreatic cancer?

• Gender: risk of developing pancreatic cancer is higher with age
• Race/ethnicity: African Americans have slightly higher risk of developing pancreatic cancer than Caucasians
• Family history of pancreatic cancer
• Inherited genetic syndromes: such as BRCA1 or BRCA2 gene mutation, Lynch syndrome, FAMMM syndrome, Peutz-Jeghers syndrome
• Chronic pancreatitis: is a chronic inflammation of the pancreas, often associated with heavy alcohol consumption and smoking
• Smoking: risk of developing pancreatic cancer is twice as high for smokers than non-smokers
• Obesity: risk of developing pancreatic cancer is higher for people who are overweight
• Diabetes: risk of developing pancreatic cancer is higher for people with diabetes
• Chemicals: heavy exposure to chemicals, such as those used in dry cleaning and metal working industries, can increase the risk of developing pancreatic cancer

Signs and symptoms of pancreatic cancer:

Pancreatic cancer can be asymptomatic at early stages. Signs and symptoms of more advanced stages of pancreatic cancer may include the following:

• Yellow discoloration of the skin and eyes (jaundice)
• Dark-colored (brown-colored) urine
• Light-colored or oily stools (steatorrhea)
• Itchy skin
• Abdominal pain or back pain
• Involuntary weight loss and loss of appetite
• Nausea and vomiting
• Liver enlargement (hepatomegaly) or gallbladder enlargement
• Blood clots, often in the legs (deep vein thrombosis or DVT)
• Diabetes
• Fatigue

How to diagnose pancreatic cancer?

• Imaging tests: ultrasound, endoscopic ultrasound (EUS), CT scan and MRI scan. PET/CT scan can also be used to find out if the cancer has metastasised (spread) to other areas of the body.
• Biopsy
  • Percutaneous (through the skin) biopsy
  • Endoscopic biopsy
  • Surgical biopsy
• Blood tests: such as liver function tests (LFTs), tumour markers (i.e. CA 19-9, CEA)

Treatment of pancreatic cancer:

After diagnosis, your doctor will establish the stage of your disease. According to your current health status, history, and staging results, your doctor will discuss with you your treatment options. Regular follow-ups with your doctor and periodical monitoring with tests and investigations are highly recommended.

Treatment options include:

1. Surgery:

• • Whipple procedure (pancreaticoduodenectomy): the most common type of surgery for pancreatic cancer done by removing the head of the pancreas
  • Distal pancreatectomy: surgery done by removing the tail of the pancreas
  • Total pancreatectomy: surgery done by removing the entire pancreas, gallbladder, common bile duct, spleen, portions of the small intestine and stomach
  • Palliative surgery: surgery done to relieve symptoms or complications caused by bile duct blockage. The two main types include stent placement and bypass surgery.

2. Ablation: treatment that destroys cancer cells without removing the tumour. Types of ablation are the following:

• • Radiofrequency ablation (RFA): uses high-energy radio waves to heat the tumour and destroy the cancer cells
  • Microwave ablation (MWA): uses the energy from electromagnetic waves to heat the tumour and destroy the cancer cells
  • Cryosurgery (cryotherapy or cryoablation): uses cold gasses to freeze the tumour and kill the cancer cells
  • Ethanol (alcohol) ablation: uses concentrated alcohol to inject into the tumor and damage cancer cells

3. Embolization therapy: treatment that decreases blood supply to the tumour by injecting substances directly into an artery. Types of embolization therapy include:

• • Arterial embolization
  • Chemoembolization
  • Radioembolization

4. Radiotherapy: using high-powered energy beams to kill cancer cells. The most common type of radiotherapy for treating pancreatic cancer is external beam radiation therapy (EBRT).
5. Chemotherapy: using chemo drugs to kill cancer cells systemically, which can be taken either intravenously or orally. Chemotherapy for pancreatic cancer treatment can be given before surgery (neoadjuvant), after surgery (adjuvant) or without surgery.
6. Targeted therapy: using certain drugs to target specific abnormalities present within cancer cells.
7. Immunotherapy: using immune cells or certain drugs which alert the immune cells to kill cancer cells.
8. Alternative treatments: using other scientific based alternatives to attack cancer cells.

How to prevent pancreatic cancer?

You can reduce your risk of breast cancer by doing the following:

• Stop smoking
• Limit alcohol consumption
• Eat healthy diet
• Regular exercise
• Maintain a healthy weight
• Limit exposure to certain chemicals that increases the risk of developing pancreatic cancer

References:

Mayo Clinic

American Cancer Society