Cancer

What is Cancer?

Cancer is a disease that results from abnormal growth and division of cells that make up the body's tissues and organs. Under normal circumstances, cells reproduce in an orderly fashion to replace old cells, maintain tissue health and repair injuries.

However, when growth control is lost and cells divide too much and too fast, a cellular mass or "tumour" is formed.

If the tumour is confined to a few cell layers and it does not invade surrounding tissues or organs, it is considered benign. By contrast, if the tumour spreads to surrounding tissues or organs, it is considered malignant, or cancerous. In order to grow further, a cancer develops its own blood vessels and this process is called angiogenesis. When it first develops, a malignant tumour may be confined to its original site.

If cancerous cells are not treated they may break away from the original tumour, travel, and grow within other body parts, the process is known as metastasis.

Oesophageal cancer

Oesophageal cancer (also called cancer of the oesophagus) is a malignant tumour that grows in the lining of the oesophagus. The oesophagus (the gullet) is the tube that carries food from the mouth down into the stomach using a series of muscular movements.

Types of oesophageal cancer

Two types of cancer, squamous cell carcinoma and adenocarcinoma, make up 90% of all oesophageal cancers. Oesophageal cancer can occur in any section of the oesophagus. Most cancers in the top part of the oesophagus are called squamous (meaning scaly) cell cancers.

Most cancers at the end of the oesophagus that joins the stomach are adenocarcinomas. Adenocarcinomas are often found in people who have a condition called Barrett's.

Liver Cancer

Liver cancer is cancer that begins in the cells of your liver. The liver is an organ about the size of a football that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

The most common form of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of cells in the liver can develop cancer, but these are much less common. Hepatocellular cancers usually occur in people who have cirrhosis of the liver.

Signs and Symptoms

Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)

Diagnosis

Tests and procedures used to diagnose liver cancer include:

• Blood tests that may reveal liver function abnormalities.
• An ultrasound, Computerised Tomography (CT) scan and Magnetic Resonance Imaging (MRI).
• Removing a sample of liver tissue for testing. During a liver biopsy, a sample of tissue is removed from your liver and examined under a microscope. Your doctor may insert a thin needle through your skin and into your liver to obtain a tissue sample. Liver biopsy carries a risk of bleeding, bruising and infection.

Once liver cancer is diagnosed, your doctor will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CT, MRI and bone scan.

Liver Metastasis

When the original cancer is in an organ other than the liver and then spreads to the liver it is called a liver metastasis. Most often surgery is not an option if the cancer has spread to the liver. However, it has been found that for some types of cancer such as colon or endocrine organs removal of the metastasis from the liver can result in prolonged survival or even a cure if the primary is completely removed and there is no spread to any other organs in the body.

Surgery

You may require surgery (hepatectomy) to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumour is small and your liver function is good.

Whether this is an option for you also depends on the location of your cancer within the liver.

Pancreatic Cancer

Pancreatic cancer begins in the tissues of your pancreas — an organ in your abdomen that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.

Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may not appear until pancreatic cancer is quite advanced and surgical removal isn't possible.

Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. When signs and symptoms do appear, they may include:

• Upper abdominal pain that may radiate to your back
• Yellowing of your skin and the whites of your eyes (jaundice)
• Loss of appetite
• Weight loss
• Depression
• Blood clots

Diagnosis

If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:

• Imaging tests used to diagnose pancreatic cancer include ultrasound, Computerised Tomography (CT) scan and Magnetic Resonance Imaging (MRI).
• An endoscopic ultrasound uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through a thin, flexible tube (endoscope) down your oesophagus and into your stomach in order to obtain the images. A biopsy may also be taken.
• Endoscopic Retrograde Cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts in your pancreas. During ERCP, an endoscope is passed down your throat, through your stomach and into the upper part of your small intestine. A dye is then injected into the pancreatic and bile ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. A tissue or cell sample (biopsy) can be collected during ERCP.
• A biopsy is a procedure to remove a small sample of tissue from the pancreas for examination under a microscope. A biopsy sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.

Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent (stage) of the cancer. Your cancer's stage helps determine what treatments are available to you.

Surgery

Surgery may be an option if your pancreatic cancer is confined to the pancreas. If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple’s resection (pancreatoduodenectomy). The Whipple’s procedure involves removing the head of your pancreas, as well as a portion of your small intestine (duodenum), your gall bladder and part of your bile duct. Part of your stomach may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.

Whipple’s resection surgery carries a risk of infection and bleeding. After the surgery, some people experience nausea and vomiting that can occur if the stomach has difficulty emptying (delayed gastric emptying). Expect a long recovery after a Whipple’s resection. You'll spend several days in the hospital and then recover for several weeks at home.

Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your spleen may also need to be removed. Surgery carries a risk of bleeding and infection.