Treatment with medicines

Abnormal vaginal bleeding caused by fibroids may require scraping of the uterine cavity in a procedure known as a D&C. If no malignancy (cancer) is found, this bleeding often can be controlled by hormonal medications. You may be given nonsteroidal anti-inflammatory drugs, oral contraceptives (birth control pills), gonadotropin releasing hormone agonists, or RU-486.

Surgery

Surgery options for treatment have both risks and benefits.
- Myomectomy is the surgical removal of the fibroids only. This can be accomplished through hysteroscopy, laparoscopy, or, less frequently, an open procedure (an incision in your abdomen). The surgical approach depends on the size and location of your fibroid.
- Hysterectomy is the surgical removal of the uterus (and fibroids). It is the most commonly performed surgical procedure in the treatment of fibroids and is considered a cure. Depending on the size of the fibroid, hysterectomy can be performed through your vagina or abdomen.
- Uterine artery embolization, or clotting of the arterial blood supply to the fibroid, is an innovative approach that has shown promising results. This procedure is done by inserting a catheter (small tube) into an artery of the leg (the femoral artery), using special x-ray video to trace the arterial blood supply to the uterus, then clotting the artery with tiny plastic or gelatin sponge particles the size of grains of sand.
- In a laparotomy, an incision is made in the abdomen to reach the uterus. The advantage of this is that large fibroids can be quickly removed. The surgeon is able to feel the uterus, which is helpful in locating myomas that may be deep in the uterine wall. The disadvantage of a laparotomy is that it requires an abdominal incision.

- Papillary thyroid cancer : The papillary type of thyroid cancer is the most common, making up about 80 percent of all thyroid cancer diagnoses. Papillary thyroid cancer can occur at any age, but is most commonly diagnosed in people ages 30 to 50.
- Follicular thyroid cancer : Follicular thyroid cancer also includes Hurthle cell cancer. Follicular thyroid cancer typically occurs in people older than 50. (An estimated 11% of all thyroid cancer cases).
- Medullary thyroid cancer accounts for 5 to 10 percent of thyroid cancer cases. It arises in C cells, not follicular cells. Medullary thyroid cancer is easier to control if it is found and treated before it spreads to other parts of the body.
- Anaplastic thyroid cancer is the least common type of thyroid cancer (only 1 to 2 percent of cases). It arises in the follicular cells. The cancer cells are highly abnormal and difficult to recognize. This type of cancer is usually very hard to control because the cancer cells tend to grow and spread very quickly.
- Thyroid lymphoma : Thyroid lymphoma begins in the immune system cells in the thyroid. Thyroid lymphoma is very rare. It occurs most often in adults age 70 or older.

These rarer types of thyroid cancer are usually more aggressive, with a higher chance of spreading to another part of the body (metastasis).

Symptoms of Thyroid Cancer

- Cough
- Difficulty swallowing
- Enlargement of the thyroid gland
- Hoarseness or changing voice
- Neck swelling
- Thyroid lump (nodule)

The exams and tests may include the following:
- Larger and more anteriorly (front) located nodules can be felt by the examiner.
- A physician will ask about any other medical history and any risk factors for thyroid nodules or cancer, including family history of thyroid cancer or radiation exposure of the head or neck.
- Thyroid stimulating hormone (TSH) levels and levels of thyroid hormone can indicate whether the thyroid is under- or overproducing thyroid hormones.
- Anti-thyroid antibody levels can indicate the presence of autoimmune thyroid inflammation that can be seen with Hashimoto’s thyroiditis.
- Calcitonin levels in the blood can indicate a specific type of thyroid cancer, known as medullary carcinoma of the thyroid.
- Ultrasound : This is a test that uses sound waves to take a picture of the thyroid. An ultrasound can reveal which thyroid nodules are larger than 1-1.5 centimeters, requiring further evaluation for cancer. It includes number of nodules, location of nodules, distinctness of borders, fluid versus solid contents, other nodule contents, such as calcium deposits, or the amount of blood flow.
- Radionuclide scanning : The doctor may order a nuclear medicine scan that uses a very small amount of radioactive material to make thyroid nodules show up on a picture.
- Biopsy : The removal of tissue to look for cancer cells is called a biopsy. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to know whether a nodule is cancerous.

A prognosis is a medical opinion as to the likely course and outcome of a disease. In other words, the prognosis is the chance that a patient will recover or have a recurrence (return of the cancer). There are many factors that can affect a person’s prognosis, which include:
- The type and location of the cancer.
- The stage of the disease (the extent to which the cancer has metastasized, or spread).
- Its grade (how abnormal the cancer cells look, and how quickly the cancer is likely to grow and spread).
- The person’s age, general health, and response to treatment.

Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer, papillary and follicular, are the most curable. In younger patients, both papillary and follicular cancers have a more than 97% cure rate if treated appropriately. Both papillary and follicular cancers are typically treated with complete removal of the lobe of the thyroid that harbors the cancer, in addition to the removal of most or all of the other side.
The bottom line is that most thyroid cancers are papillary thyroid cancer, and this is one of the most curable cancers of all cancers that humans get. Treated correctly, the cure rate is extremely high.
Medullary cancer of the thyroid is significantly less common, but has a worse prognosis. Medullary cancers tend to spread to large numbers of lymph nodes very early on, and therefore require a much more aggressive operation than the more localized thyroid cancers, such as papillary and follicular. This cancer requires complete thyroid removal plus a dissection to remove the lymph nodes of the front and sides of the neck.
The least common type of thyroid cancer is anaplastic which has a very poor prognosis. Anaplastic thyroid cancer tends to be found after it has spread and is incurable in most cases.

The thyroid gland contains mainly 2 types of cells — thyroid follicular cells and C cells (also called parafollicular cells). The follicular cells use iodine from the blood to make thyroid hormone, which helps regulate a person’s metabolism. C cells (parafollicular cells) make calcitonin, a hormone that helps regulate how the body uses calcium.

Different cancers develop from each kind of cell. The differences are important because they affect how serious the cancer is and what type of treatment is needed.
A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin. A swollen thyroid is called a goiter. Most goiters are caused by not enough iodine in the diet.
Lumps or bumps in the thyroid gland are called thyroid nodules. Most thyroid nodules are benign, but about 1 in 20 is cancerous. People can develop thyroid nodules at any age, but they are most common in older adults.

Thyroid nodules can be benign or malignant:

- Benign nodules are not cancer. Cells from benign nodules do not spread to other parts of the body.
- Malignant nodules are cancer. They are generally more serious and may sometimes be life threatening. Cancer cells can invade and damage nearby tissues and organs.

Causes of Thyroid Cancer

The following conditions have been cited in various sources as potentially causal risk factors related to Thyroid cancer:
- Cancer begins with an alteration to the structure of DNA that is found in all human cells. This is known as a genetic mutation.
- Age : most people are over 40.
- Gender : women 3 times more than men.
- Race : Caucasians are more likely than African Americans.
- Iodine deficiency.
- Radiation exposure.

Staging for Chronic Myelogenous Leukemia (CML)

CML is divided into 3 groups that help predict outlook. Doctors call these groups phases instead of stages. The phases are based mainly on the number of immature white blood cells – myeloblasts (“blasts”) — that are seen in the blood or bone marrow.

Chronic Phase
- Patients in this phase typically have less than 10% blasts in their blood or bone marrow samples.
- These patients usually have fairly mild symptoms (if any) and usually respond to standard treatments.

Accelerated Phase
Patients are considered to be in accelerated phase if any of the following are true:
- The bone marrow or blood samples have more than 10% but fewer that 20% blasts.
- High blood basophil count (basophils making up at least 20% of the white blood cells).
- Increased white blood cell counts that do not go down with treatment
very high or very low platelet counts that are not caused by treatment
new chromosome changes in the leukemia cells.

Blast Phase
- Bone marrow and/or blood samples from a patient in this phase have more than 20% blasts.
- The blast cells often spread to tissues and organs beyond the bone marrow. These patients often have fever, poor appetite, and weight loss.

Blood clotting is poor – As immature white blood cells crowd out blood platelets, which are crucial for blood clotting, the patient may bruise or bleed easily and heal slowly.

Affected immune system – The patient’s white blood cells, which are crucial for fighting off infection, may be suppressed or not working properly. The patient may experience frequent infections, or his immune system may attack other good body cells.

Anemia – As the shortage of good red blood cells grows the patient may suffer from anemia – this may lead to difficult or labored respiration (dyspnea) and pallor (skin has a pale color caused by illness).

Other symptoms – Patients may also experience nausea, fever, chills, night sweats, flu-like symptoms, and tiredness. If the liver or spleen becomes enlarged the patient may feel full and will eat less, resulting in weight loss. Headache is more common among patients whose cancerous cells have invaded the CNS (central nervous system).

Surgery

Surgical resection (cutting away) of the tumor generally is indicated for cancer that has not spread beyond the lung. Surgery may not be possible if the cancer is too close to the trachea or if the person has other serious conditions (such as severe heart or lung disease) that would limit their ability to tolerate an operation. Thoracotomy, which is performed throught the chest wall, and median sternotomy, which is performed by cutting through the breastbone, are standard methods used for lung cancer surgery.
After surgery, potential side effects include:
- Pain: One of the most common side effects associated with surgery. Some surgery for lung cancer requires cutting through the ribs and/or cutting a nerve. This can take several months to heal.
- Infection: Infections at the site of the wound and inside the body are another possible side effect. Antibiotics give by a doctor are able to treat most infections.

Radiation Therapy

Radiation therapy (also called radiotherapy) may be effective for the treatment of lung cancer. It uses high-energy rays, similar to X-rays, but stronger, to kill or shrink cancer cells. Radiation therapy is usually spaced over a number of weeks or months because the doses needed to kill cancer cells cannot be given all at once. The number of treatments a patient receives depends on the type and extent of the tumor, as well as the radiation dosage and how the patient is affected by the treatment. It has many uses in lung cancer:
- As primary treatment.
- Before surgery to shrink the tumor.
- After surgery to eliminate any cancer cells that remain in the treated area.
- To treat lung cancer that has spread to the brain or other areas of the body.
Besides attacking the tumor, radiotherapy can help to relieve some of the symptoms it causes such as shortness of breath. Most often, radiation therapy is delivered by the external beam technique, which aims a beam of x-rays directly at the tumor.

SIDE EFFECTS :
- Fatigue.
- Eating problems.
- Hair Loss.
- Skin reactions.

Staging of non-small cell lung cancer

The primary tumor (T) is classified according to the following categories:
TX: Tumor cannot be evaluated or tumor is proven by the presence of cancer cells in the sputum or bronchial washings, but it cannot be seen during imaging or bronchoscopy (“occult” tumor)
T0: No evidence of primary tumor.
Tis: Carcinoma in situ.
T1:Tumor 3 centimeters (< 3 cm) or less in greatest dimension, surrounded by lung or pleura, and not located in the main stem bronchus.
T2: Tumor more than 3 centimeters (> 3 cm) in greatest dimension, or tumor involving the main stem bronchus, 2 cm or more from the carina, or tumor invading the visceral pleura, or tumor with incomplete lung expansion or obstructive lung infection that does not involve the entire lung.
T3: Tumor of any size that directly invades the chest wall, diaphragm, pleura, or pericardium, or tumor that involves the main stem bronchus less than 2 centimeters (< 2 cm) from the carina (ridge between the right and left main stem bronchi), or tumor that is associated with complete lung collapse or obstructive lung infection involving the entire lung.
T4: Tumor of any size that invades the heart, great vessels (aorta, superior or inferior vena cava, pulmonary artery, or pulmonary vein), trachea, esophagus, vertebral body, or carina, or separate tumor nodules in the same lung lobe, or tumor associated with a malignant pleural effusion.

The regional lymph nodes (N) are clinically divided into the following categories:
NX: Regional lymph nodes cannot be assessed.
N0: Regional lymph nodes contain no metastases.
N1: Metastasis to same-side peribronchial (around the bronchi) and/or hilar (pit in the lungs where vessels enter and exit) lymph nodes and nodes within the lungs that are involved by direct spread of the primary tumor.
N2: Metastasis to same-side mediastinal and/or subcarinal (under the carina, or tracheal ridge) lymph nodes.
N3: Metastasis to opposite-side mediastinal or hilar nodes or to same- or opposite-side scalene (neck/upper rib) or supracalvicular (above collarbone) lymph nodes.

The state of metastasis (M) is defined as follows:
MX: Distant metastases cannot be assessed.
M0: No distant metastases are found.
M1: Distant metastases are present (this also includes separate tumor nodules in a different lobe of lung on either side).

The TNM system—which includes the overall features of the tumor, lymph nodes, and metastatic status—places lung cancer growth at a particular stage.
Stage Ia: T1, N0, M0
Stage Ib: T2, N0, M0
Stage IIa: N1, M0
Stage IIb: T2, N1, M0 or T3, N0, M0
Stage IIIa: T1-2, N2, M0 or T3, N1-2, M0
Stage IIIb: T(any), N3, M0 or T4, N(any), M0
Stage IV: T(any), N(any), M1

Staging of small cell lung cancer

:
Small cell lung cancer is classified as either limited stage or extensive stage.
- Limited stage: the tumor is found in one lung and in nearby lymph nodes.
- Extensive: the tumor has spread beyond one lung or to other organs.

History and Physical Examination

The history and physical examination may reveal the presence of symptoms or signs that are suspicious for lung cancer. Cyanosis, a bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood, suggests compromised function due to chronic disease of the lung.

Chest X-ray

It is used to detect enlarged lymph nodes in the chest or a localized mass in the lungs.

CT Scan

It may be performed on the chest, abdomen, and/or brain to examine for both metastatic and lung tumors. CT scans are X-ray procedures that combine multiple images with the aid of a computer to generate cross-sectional views of the body. A CT scan exposes the patient to a minimal amount of radiation. The most common side effect is an adverse reaction to intravenous contrast material that may have been given prior to the procedure. This may result in itching, a rash, or hives that generally disappear rather quickly.

Magnetic resonance imaging (MRI scan)

is a diagnostic method in which hydrogen ions within the body (and/or specific body parts) are excited by exposure to a magnetic field. The resulting signals are processed by a computer to create an image of the chest to define the location and extent of lung involvement.

Bronchoscopy

It is a visual examination of the windpipe and lung branches performed by a pulmonologist (respiratory disease specialist) using a flexible scope. If the bronchoscopy is still unrevealing, or “negative,” a needle biopsy may be performed.

Needle biopsy

Fine needle aspiration (FNA) uses a slim, hollow needle that is attached to a syringe. The needle is inserted into the suspicious mass and it is pushed back and forth to free some cells, which are aspirated (drawn up) into the syringe and are smeared on a glass slide for analysis.

Bone scan

It may also be performed to rule out suspicions of metastasis to the bones. Metastasis is the process wherein cancerous cells break away from the original tumor, travel, and grow within other body parts.

Positron emission tomography (PET)

It combines the technology of CT scan with the technology of PET (positive emission tomography) scan. PET scans involve injecting a sugar-based radiopharmaceutical, which travels through the body and collects in organs and tissues. The PET scan is used to detect cancer cells in the body and the CT scan provides detailed images that can determine the location and size of the cancer.