BREAST LUMP: WHAT SHOULD I DO?

BREAST LUMP: WHAT SHOULD I DO?

Breasts contain tissues of varying consistency due to fatty, glandular and connective tissue. You may feel some lumpiness during changes in your menstrual cycle caused by extra fluid in your breasts. Breast tissue also changes with age, becoming fattier and less dense as you get older. A breast lump is a mass that develops in the breast which may be discovered during self-examination (read our article on Breast Self-Examination Technique).

Causes of breast lumps:

  • Fibroadenoma
  • Fibrocystic disease
  • Breast cysts
  • Milk cyst (galactocele)
  • Mastitis (common during breast feeding)
  • Lipoma
  • Breast cancer

How are breast lumps assessed by the doctors?

Most patients should have a TRIPLE ASSESSMENT which consists of:

  1. Clinical assessment by the doctor
  2. Imaging (ultrasound and/or mammography)
  3. Pathology (cytology and/or histology)

How are breast lumps diagnosed?

Most breast lumps are benign and not cancerous. Proving that a lump is either cancer or not cancer requires some (or all) of the following imaging tests:

 

  1. Mammogram: Mammography uses low dose x-rays to examine the breasts taking either two single images or two tomosynthesis images known as 3-D mammography (read our article on Breast Mammogram – What to Expect). 
  2. Ultrasound: Breast ultrasound uses sound waves to create pictures of the inside of the breasts which may be difficult to see with mammongraphy. It can also help to determine whether a breast lump is solid or fluid. 
  3. Ultrasound-guided or Stereotactic (X-ray guided) biopsy: For this procedure, a thin sampling needle is used to remove some tissue from the breast lump for evaluation under a microscope by a Medical Pathologist to give a definite diagnosis by looking for cancer cells.

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LIVER CANCER: PRIMARY CANCER

LIVER CANCER: PRIMARY CANCER

Primary liver cancer is cancer that starts in the liver and is either Hepatocellular Carcinoma or Intraductal Cholangio Carcinoma.

Source: mayoclinic.org

Risk factors

Most liver cancers occur around the age of 60-85 years. It is common in Asians especially Chinese males. Other risk factors include:

  • Previous infection from Hepatitis B or Hepatitis C
  • Excessive alcohol consumption
  • Severe fatty liver disease
  • Liver scarring (cirrhosis)
  • Iron overload disease such as haemaochromatosis or alpha 1 antitrypsin deficiency
  • Being overweight or obese
  • Family history

Symptoms

Most symptoms come late when the cancer has progressed. These symptoms include:

  • Unexplained weight loss
  • Yellowing of the skin or white of the eyes (called jaundice)
  • Loss of appetite or energy (easily tired)
  • Itching of the whole body
  • Pain or discomfort of the right side of your abdomen
  • Pain or discomfort on the right side of your shoulder
  • Swollen tummy (ascites)

Diagnosis

You will need to do some tests to be able to get the diagnosis of cancer type, to stage the cancer (to see if there is cancer spread outside the liver) and to plan for treatment:

  • Blood tests (blood count, liver function, Hepatitis virus serology, cancer markers)
  • Ultrasound liver (and maybe liver biopsy)
  • MRI / CT scan
  • PET scan

Treatment Options

The treatment depends on many factors such as type and stage of cancer, where the cancer is located, the severity of the disease and how much normal liver function is present. The options include:

  • Surgery (liver resection)
  • Local ablation therapy (Radio Frequency Ablation, Micro Wave Ablation, Cryotherapy or HIFU)
  • Locoregional Chemo / Radio Therapy (Trans Arterial Chemo Embolisation or SIRT)
  • Systemic Chemotherapy
  • Systemic Targeted Cancer Drugs such as Sorafenib (Nexavar) or Lenvatinib (Lenvima)

Prevention

If you have risk factors mentioned above, you should take steps to live a healthier lifestyle.

  • Avoid excessive alcohol intake
  • Take Hepatitis B vaccination
  • Eat healthy and do regular exercise to get into your ideal weight range
  • If you’re are a Hepatitis B or C carrier, do blood tests and liver ultrasound regularly (twice yearly)
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NASOPHARYNGEAL CANCER

NASOPHARYNGEAL CANCER

Nasopharyngeal cancer (also known as NPC) is when a tumour develops in the lining of the nasopharynx which is the area of the upper part of the throat behind the nose. NPC is quite common accounting for around 5% of all cancers in Malaysia. It can start at the age of 35 years with a peak incidence of around 50-60 years.

Main Causes of Oral Cancers are:

  • Genetic (common in Southern Chinese)
  • Family history
  • Smoking
  • Salted fish or preserved vegetables
  • Wood dust or industrial fumes (formaldehyde)
  • Epstein-Barr Virus

Symptoms & Signs of NPC

  • Tinnitus which is a buzzing sound in one ear (early sign)
  • Decreased hearing in one ear
  • Blocked or recurrent infection in one ear
  • Blocked or congested nose
  • Swollen gland in the neck
  • Recurrent nose bleeds
  • Headache or double vision (late sign)

CT, MRI & PET Scans helps to localise the NPC to help doctors plan treatment.

Treatment of NPC

Nasopharyngeal cancer is treated by a team of doctors and health professionals which include the ENT surgeon, Dietician and Oncologist. Treatment requires:

  • Intensive Modulated Radiotherapy (IMRT)
  • Concurrent Chemo-Radiotherapy
  • Neck dissection or Naso-pharyngectomy surgery (required if chemo-radiotherapy fails)
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SALIVARY GLAND CANCER

SALIVARY GLAND CANCER

There are 3 major salivary glands on each side of our face which make saliva which is important for our oral health. Saliva contains enzymes which help in the process of digesting food as well as antibodies to prevent infections of the mouth. It also helps to lubricate our mouth and throat to allows us to swallow dry or hard foods easily and prevent sore or dry throat after talking too much.

The salivary glands are:

  • The parotid gland is the largest salivary gland and is situated just in front of the ear and accounts for around 70% of all salivary cancers
  • The sub-mandibular gland is smaller and is situated just below the jaw.
  • The sublingual gland is the smallest and is situated under the floor of the mouth and below either side of the tongue.

Symptoms & Signs of Salivary Gland Cancer

  • Mass or Swelling at the neck region
  • Difficulty opening mouth or swallowing
  • Change in voice
  • Numbness or weakness in the face
  • Pain on one side of the face

Treatment of Salivary Gland Cancer

Salivary Gland cancer is treated by a team of doctors and healthcare professionals which include the ENT surgeon, Cosmetic & Plastic Surgeon, Speech Therapist and Oncologist. Treatment may involve:

  • Surgery & reconstruction
  • Radiotherapy
  • Chemotherapy
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ORAL CANCER

ORAL CANCER

Oral cancer is when a tumour develops in the lining of the mouth. The tumour can be on the surface of the tongue, the insides of the cheeks, the roof (palate) or floor of the mouth, the gums or the lips. Oral cancers are NOT very common accounting for around only 2-3% of all cancers. They are usually found in older adults over the age of 50 years.

Main Causes of Oral Cancers are:

  • Tobacco smoking
  • Betel nut chewing
  • Ill-fitting dentures
  • Human Papilloma Virus
  • Spicy hot foods
  • Excessive alcohol consumption
  • Unexplained bleeding in the mouth

Symptoms & Signs of oral cancer

  • Ulcer in the mouth which is NOT painful and NOT healing
  • Mass or swelling
  • Neck swelling
  • Unexplained loose tooth which does NOT heal
Treatment of Oral Cancer

Oral cancer is treated by a team of doctors and health professionals which include the ENT surgeon, Dentist, Maxillo-Facial surgeon, Speech Therapist and Oncologist. Treatment may involve:

  • Surgery & reconstruction
  • Radiotherapy
  • Chemotherapy

How to self-examine yourself for Oral Cancer

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VOLUMETRIC MODULATED ARC THERAPY (VMAT)

VOLUMETRIC MODULATED ARC THERAPY (VMAT)

VMAT is the latest arc therapy technique which delivers more tightly focused treatment to tumours in a significantly shorter time. Using VMAT, single or multiple radiation beams sweep in uninterrupted arc(s) around the patient. VMAT technique provides the oncologists with greater freedom of choice on how an optimum dose can be delivered to cancer cells.

How VMAT works

Using VMAT, radiation is precise targeted at the intended area allowing oncologists to preserve more of the surrounding healthy normal tissue. VMAT treatment which consists of one or several arcs, enables the radiation to remain on while the linear accelerator movements occur. During VMAT treatment, the shape and intensity of the radiation beams changes as the machine rotates. The radiation beam comes from an infinite number of angles, thereby reducing the dose to the surrounding tissue while increasing the dose to the cancer cells.

As such, with VMAT treatment, the duration of the procedure is shortened and the patient spends less time on the treatment table. The simplest treatment can be completed as fast as 2 minutes while more complex cases may take up to only 5 minutes.

What equipment is used?

A medical linear accelerator is used in delivering VMAT. The machine is about the size of a small car approximately 10 feet in height and 15 feet in length.

Types of Cancers which can be treated with VMAT

Most cancer types can benefit from VMAT treatment. Every case is unique but VMAT treatment is typically used for cancers of the :

  • Prostate
  • Lung
  • Head and lung
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