Saturday, July 2, 2011

Rare Cancer in Adulthood - Anal cancer

Anus is a 3 cm muscular ring connected to the end of the rectum with the function of controlling the expulsion of feces.
Anal cancer is a type of cancer arisen from the malignant cells of the anus. It is a rare type of cancer in adulthood affected approximately 5000 men and women in US in 2010.

Symptoms
1. Bleeding
It may be caused by enlarged tumors affecting the capillaries in the anus or the large intestine trying to push waste through the blockage of the tumor.
2. Pain and pressure
As the feces trying to push through the blockage of the tumor or tumor has growth large enough to press onto the nerves.
3. Itching
May be due to infection
4. Lump
As the cancer has growth large enough to form a lump on the surface of the anus. This may be the early stage of the cancer.
5. Change of bowel habit
Due to affect of the tumor.
6. Weight loss
Any unintentional weight loss over 10% is the general symptoms of cancers.
7. Loss of appetite
Another symptom of cancer.
8. Lower back pain
The affect of tumor pressing to the nerve connect to the back.
9. Etc.

Causes and risk factors
1. Human papillomavirus (HPV virus)
In a study of Detection of Multiple Human Papillomavirus Genotypes in Anal Carcinoma by Sonia Ramamoorthy, Yu-Tsueng Liu, Linda Luo, Katsumi Miyai, Qing Lu and John M Carethers, researchers found that the majority of anal cancers in our study associated with pathogenic HPV 16 and/or 18. Other HPV genotypes are present simultaneously with HPV 16 and 18, and might contribute to its pathogenesis.

2. Sexual activity
Anal sexual intercourse and sex with multiple partner can enhance the risk of HPV virus, leading to the disease.

3. Smoking
a. In a study by Epidemiologist Janet Daling, Ph.D., a member of Fred Hutchinson's Public Health Sciences Division, and her team, researchers found that smoking appears to play a significant role in anal-cancer development that's independent of other behavioral risk factors.

b. In a study of tobacco smoking and risk of recurrence for squamous cell cancer of the anus. researcher found that tobacco smoking appears to be associated with anal carcinoma disease recurrence, and is related to increased mortality. This data suggests that patients should be cautioned about tobacco smoking once a diagnosis of anal carcinoma is made in attempt to improve their long-term outcome.

4. Immunosuppression
The weaken immune system due to suppression of medicine insreaces riak of anal cancer as a result of HIV infection.

5. Inflammation
Inflammation caused by begnin anal lesions, such as inflammatory bowel disease (IBD), hemorrhoids, fistulae, hemorrhoids, anal fistulas, cicatrices, etc. enhance the risk of the cancer

6. Age
Risk of the cancer increase after age of 50

7. Etc.

Diagnosis and tests
After recording your family history and a complete physical exams for any lump including anal pap smears similar to those used in cervical cancer to detect the early stage of the anal cancer.
1. Anal pap smears
It is a easy done test similar to cervical pap test by using a small brush or cotton-tipped rod which is inserted into the anus to collect the the cells and examined under microscope.

2. Endo-anal or endorectal ultrasound
It is a test with the use of a probe which is inserted into the rectum to generate high frequency sound waves (ultrasound waves) bouncing off internal tissues or organs. The pattern of echoes bounced off tissues is detected and converted into a picture on a screen of the computer to determine the location, size and stage of the cancer.

3. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details. The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. Unfortunately, CT scan can only review the existence of cancer, but can not tell it is a primary or secondary cancer.

4. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging) is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the tissue, the organ and surrounding areas.

5. Etc.

Grades
The grade of anal cancer is depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise.

Stages
Anal cancer is classified as 5 stages
1. Stage 0
If the cancerous cells have not penetrated into deeper tissue and remain on the surface of the anus.

2. Stage I
In stage I, the cancerous cells are no longer in the surface but have invaded into deep the inside tissue lining but still completely inside the affected anus.
a. Stage IA
The cancer is not ≤ 3 mm (1/8 inch) deep and ≤ 7 mm (1/4 inch) wide.
a.1. Stage IA1:The spreading is not less than 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2:The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b.Stage IB:
The cancer in this stage have invaded the connected tissue of the anus, & less than 5mm (1/5 inch).
b.1. Stage IB1:
Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2:Cancer is ≥ 4 cm (1 3/4 inches) but & less than 5cm (1/5 inch)

3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the affected anus.

4. Stage IIIIn this stage, cancerous cells has spread to the tissues immediately surrounding the affected anus.

5. Stage IV
In this stage, cancerous cells has spread to the tissue immediately outside of the anus to distant parts of the body.

Preventions
A. How to avoid
1. Early diagnosis
If you feel that you have any of above symptoms, you should check with your doctor. In general, cancer disceovered in the early stage can ce treated without risk of colostomy.
2. Practice safe sex
If you have several partners or anal sexual preference, please use any precaution to be infected by sexual transmtting diseases.
3. Vaccine
At 22 December 2010, FDA has approved Gardasil vaccine to prevent anal cancer and pre-cancerous lesions in males and females aged 9 to 26 years to protect against anal cancer.
4. Quit Smoking
As it has been proven as one the risk factor of anal cancer.
5. Etc.

B. Diet
1. Omega 3 fatty acids
In a study of The Effects of Omega-3 Fatty Acids on Cancer, researcher found that that omega-3 fatty acids may affect tumor behavior by competing with omega-6 fatty acids for the enzymes that metabolize them to their bioactive products or by influencing the genes for these enzymes; however, other evidence suggests an effect on intracellular redox state and the integrity of membrane lipids.

2. Carrot
In a study from the University of Newcastle upon Tyne (UK) and the University of Southern Denmark (Odense) used a rat model to study the effect of carrots and falcarinol on tumor development, researchers found that found a diet rich in carrots provides anticancer benefits due to the activity of the chemical falcarinol.

3. Soy
In laboratory studies, saponins have shown the ability to inhibit the reproduction of cancer cells and slow the growth of tumors in several different tissues.

4. Grape
Grape contains high amount of resveratrol which in some clinical studies of resveratrol, researchers found that resveratrol demonstrated an ability to reduce tumors already in existence, prevent cellular damage, and work to increase the effectiveness of chemotherapy.

5. Garlic
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.

6. Etc.

C. Nutritional Supplements
1. Antioxiadant - Free radical scavengers
Vitamin A, C, E are free radical scavengers enhanced the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth. For more information of how antioxidants help to treat cancer, click here

2. Transferrin
In a study of Transferrin Binding Protein Nanoparticles to Treat Cancer, researcher found that the use of this technique (laboratory invented a “print” technology, able to exact size and shape of human Zaochu meet the expectations of the nano-particles.) to produce a kind of preclusion can be combined with human transfer the biocompatibility of ferritin nanoparticles, which can safely and accurately identify the spectrum of cancer, in addition to B cell lymphoma,....

3. Phytochemicals
Phytochemicals are under active research for possible benefits immune system, and as anti-cancer agents. Flavonoids found abundant in berry, inhibit caner cell in vitro study.

4. Beta -carotene
In some laboratory, animal, and human studies, researchers found that vitamin A, certain retinoids may also inhibit cancer development.

5. Zinc
In Zinc and Cancer - Seminar by Belinda Hope indicated that epidemiologic studies suggest zinc deficiency may be associated with increased cancer risk and one way to do this is to improve general immunity using nutrients such as zinc.

6. Etc.

Treatments
A. In conventional medicine
1. Surgery
a. Depending to the location and size of the tumor, if the cancer is small, the chance of cure is higher, as it can be removed with out affect the anusfunctions.
b. In case of infeasibility, abdominoperineal resection may be necessary with the removal of the anus, rectum, and part of the sigmoid colon as an opening is made in the surface of the abdomen to collect body feces in a disposable bag outside of the body (colostomy)
c. Risks and side effects
Surgical and anesthesia risks


3. Radiotherapy
a. By using high-energy x-rays or other types of radiation, radiation therapy kills lung cancer cells and keep them from growing or regrowing. Depending to stage, grade and location of the affected area. Radiation may be used in situations when surgery isn't an option.
b. Risks and side effects
b.1.. Fatigue
b.2. Chest pain
b.3. Heart problem
b.4. Short of breath
b.5. Skin discoloration or pinkness, irritation.
b.6. Etc.

4. Chemotherapy
a. Chemotherapy is most use to treat with advance stage of the cancer, as it has spread to a distant parts of the body by using drugs such as adriamycin, cis-platinum, cyclophosphamide, etc. taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells.
b. Risks and side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigueb.
5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

B. Herbal medicine
1. Allium tuberosumIn a study of A Pilot Study on Anticancer Activities of Chinese Leek researchers found that Chinese leek extract inhibited cancer cell growth and induced apoptosis in vitro. Oral administration of leek extract significantly reduced lung metastases in the present animal model.

2. Red clover
3. Allium sativum
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.

4. Green tea
Leaves of Camellia sinensis, in some clinical studies researchers suggested that the polyphenols in green tea, may play an important role in the prevention of cancer by killing cancerous cells and stopping their progression.

5. Etc.

C. Traditional Chinese medicine
1. Dong ling Cao (Rabdosime Rubescentis)
In laboratory animals study, reported by Joe Hing Kwok Chu, Dong ling Cao's components rubescensine A and B inhibit Ehrlich-Ascites tumor, sarcoma180 and esophageal carcinoma.

2. Yi Yi Ren and other herbs
In clinical study with(100ml was equal to 50g crude drug), oral administration, 20~40ml, 3 times daily, Yi Yi Ren combined with Teng Liu, He Zi An Ling Tiao was used to treat alimentary tract cancers. 168 cases of patients were treated, 1 dose every day, taken in three times.After treatment, the appetite and general condition were improved. And this formula had certain therapeutic effects on 30 cases out of 36 cases who took over three months’ treatment.

3. Bai Hua She She Cao
The Sanjiv Kumar YADAV, Shao Chin LEE(Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.

4. Jiu Zi (Chinese leek)
In a study of A Pilot Study on Anticancer Activities of Chinese Leek researchers found that Chinese leek extract inhibited cancer cell growth and induced apoptosis in vitro.

5. Etc.

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