Posted on 2017-02-27   11:38:29



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Different Screening Tests for Common CANCERS in India

Cancer is a general name for a group of diseases where normal cells due to some reason become abnormal and grow in an uncontrolled fashion. Untreated cancers cause serious illness, disability and death. Not all growths (tumors) are cancerous. They can be benign (not cancerous) or malignant (cancerous). Benign tumors’ are slow-growing and not as dangerous as malignant tumors’ which usually grow rapidly and may spread to other body sites.  Cancer screening is looking for cancer before a person has any symptoms. Screening tests can help find cancer at an early stage, before symptoms appear. When abnormal tissue or cancer is found early, it may become easier to treat and cure.

Cancer Statistics in India

  • Estimated number of people living with the disease: around 2.5 million
  • Every year, new cancer patients registered: Over 7 lakh
  • Cancer-related deaths: 5,56,400
  • Deaths in the age group between 30-69 years 
    • Total: 3,95,400 (71% of all cancer related deaths)
    • Men: 2,00,100
    • Women: 1,95,300

The top five cancers in men and women account for 47.2% of all cancers; these cancers can be prevented, screened for and/or detected early and treated at an early stage . This could significantly reduce the death rate from these cancers.

 

 Men

 Women

 1

 LIP,ORAL CAVITY

BREAST

 2

LUNG

CERVIX

3

STOMACH

COLORECTUM

4

COLORECTUM

OVARY

5

PHARYNX

LIP,ORAL CAVITY

Screening for Lung Cancer

As per the guidelines of The American Cancer Society, if you meet all the following criteria, you should go for lung cancer screening 

1.Your age is between 55 and 74 years
2.You have a 30-pack-year smoking history (calculated as number of packs of cigarettes multiplied by the number of years you have been smoking)
3.You are either still smoking or have quit in the last 15 years
4. You are in fairly good health (you should not have symptoms of lung cancer or serious medical problems or metal implants or prior history of lung cancer treated)

There are no recommended guidelines for lung cancer screening in India.

 For lung cancer, three tests have been studied for use as screening tests:

1. Chest X-ray: It is an X-ray of the organs and bones inside the chest.

2. Sputum cytology: This is a procedure where a sample of sputum (mucus coughed up from lungs) is viewed under a microscope by a pathologist to look for cancer cells.

3. Low-dose spiral/ helical CT scan: This involves a CT scan with low-dose radiation to make a series of detailed pictures of the organs inside the body.

Of these three tests, chest X-ray and sputum cytology have been found to have a low sensitivity for detection of lung cancer. Only low-dose spiral/ helical CT scan has been recommended to be used in high-risk patients for lung cancer screening.[39]

Low Dose Computed Tomography (Low Dose CT or LDCT) is better than plain X-ray of the chest at finding small abnormalities in the lungs. LDCT uses a much lower dose of radiation than a normal chest CT. Screening is to be done every year till the age of 74 years or till symptoms appear.

Though screening can detect lung cancer better than X-ray chest, one must remember that not all lung cancers are found by LDCT screening and not all lesions detected by LDCT are cancer.

 Breast Cancer Diagnosis Screening

 1.Self Breast Examination:   Self breast examination is suggested for every women above age 20 years to look for early signs of breast cancer. It should be done monthly to check if there are any unusual changes in breast.

2.Physical Examination: a doctor examines your breasts and under arm tissues for any lumps by palpation. Nipples are examined for any suspected discharge, skin changes and retraction.

Imaging Tests

3.Mammogram: A mammography machine uses low-dose x-rays to take images of your breast. First the machine compresses each breast and takes x-ray images on film. This is commonly used for early detection of breast cancer.

4.Digital mammogram: A mammogram that stores the electronic images of each breast in a digital, computer-readable format. This is different than a standard film mammogram, where the images are created directly on film.

5.Diagnostic mammogram: Additional mammogram views beyond those done in a routine mammogram may sometimes be necessary to evaluate an abnormal mammogram or a breast abnormality.

6.Breast Ultrasound: In this procedure, a device sends high frequency sound waves through your breast. The sound signals received from tissues are converted into pictures on computer screen. These images allow the doctor to look for any abnormality. Breast ultrasound can differentiate whether a lump is a cyst (filled with fluid) or solid tissue.

6.MRI Scan: In this procedure, a high-powered magnet and a computer is used to scan and to create detailed images of the breast and surrounding organs. Breast MRIs are recommended only in specific cases where mammogram information is insufficient.

7.Biopsy:

Fine needle aspiration biopsy/cytology (FNAB/FNAC): After a positive physical examination or mammogram, a small piece of tissue/fluid is taken from an abnormal looking area of the breast and examined for cancer cells using a thin needle and a syringe without using anesthesia.

Core needle breast biopsy: A larger, hollow needle is inserted into the breast lump and cylindrical piece of breast tissue (core) is taken out for histopathological examination to confirm cancer. A core biopsy provides more breast tissue for examination than FNA.

Stereotactic breast biopsy: Doctor uses computerized pictures to reach the exact location of the abnormal breast tissue (guided biopsy) to remove a piece of breast tissue for examination. This is performed under local anesthesia.

Surgical (open) biopsy: Occasionally, surgery may be recommended to take out a part or whole breast lump to check for cancer. This is performed under anesthesia.

8.Nipple discharge cytology (nipple discharge exam): A sample of fluid or discharge from the nipple is examined under the microscope to look for cancer cells. Even if the nipple discharge cytology result is negative, the surgeon may go in for other tests if there is a clinical suspicion.

 

Screening  for Cervical Cancer

Cervical screening by the Pap test or other methods is highly effective at detecting and preventing cervical cancer, although there is a serious risk of overtreatment in young women up to the age of 20 or beyond, who are prone to have many abnormal cells which clear up naturally. There is a considerable range in the recommended age at which to begin screening around the world. According to the 2010 European guidelines for cervical cancer screening, the age at which to commence screening ranges between 20–30 years of age, "but preferentially not before age 25 or 30 years", depending on the burden of the disease in the population and the available resources

Diagnosis & Screening For Oral Cancer

 1. Medical history, General physical examination and Oral examination

A thorough history is taken before the examination regarding duration and frequency of tobacco use in any form like cigarette, beedi, chewing pan, gutka, khaini etc and of alcohol consumption. 
2. Oral examination: A careful examination of entire inner cavity of the mouth which includes the roof of mouth, back of the throat, and inside of cheeks and lips is then carried out. The doctor looks for red or white patches or any other abnormal areas over head, neck or face. He/she also examines for any lumps, swelling or any other problem with the nerves of mouth or face. If any abnormal area is found during examination, it is confirmed by further tests which are detailed below.

3. Invasive tests:

Brush cytology: In this test, the suspected area/lesion is  brushed  and the cells  are looked at under microscope for abnormal cells by a pathologist.

Fine Needle Aspiration Cytology (FNAC): In this test, a thin needle which is attached to a syringe is used to draw few cells from the suspected lump or swelling. These cells are smeared onto a glass slide, then stained and examined under microscope by a pathologist to examine for abnormal cells. FNAC is generally used to diagnose metastatic carcinoma of head and neck, in the cervical region. It is hardly ever utilized as a first line diagnostic modality.

4.Biopsy: A small piece of tissue is taken from suspicious area using a punch biopsy instrument. Sometimes it may be done under the guidance of endoscopy, if the lesion is not easily accessible. This tissue is processed in the laboratory and examined for presence or absence of cancer.

5. Imaging tests: Imaging tests are done to confirm the diagnosis, document the extent of spread of disease, staging etc. The most common diagnostic imaging tests are X-rays, CT scan, MRI and PET scan.

6. Other tests:
Human Papillomavirus (HPV) Testing: Oral cancers with HPV infection are on the rise. Doctors may test the biopsy sample for the presence of HPV infection as the possible cause. 

 

Screening for Colorectal Cancer

Regular screening can help in early detection of colorectal cancer, when it is likely to be curable. In addition, some polyps can be detected and removed before they turn into colorectal cancer.

The various tests recommended to be used in screening for colorectal cancer include:

1.Faecal occult blood test (FOBT) using guaiac-based test or immunochemical test: Stool sample is tested for presence of blood, which may come from a polyp or cancer

2.Flexible sigmoidoscopy: A flexible tube with light source at the end is inserted into the rectum and lower colon to look for polyps or cancer

3.Colonoscopy: A longer flexible tube is inserted to examine the entire colon up to the rectum for any polyps or growth

4.CT colonography: This is a special type of CT scan of the colon and rectum to look for small polyps

Screening is recommended for high-risk individuals, i.e. those with a close relative having colorectal cancer or polyps or patients having inflammatory bowel disease or patients with an inherited syndrome that increase the risk of colorectal cancer. FOBT should be done every 1-2 years, flexible sigmoidoscopy every 5 years and colonoscopy every 10 years in high-risk individuals.

Screening for Prostate Cancer

Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in a man’s blood sample. Another way to find prostate cancer early is the digital rectal exam (DRE).

If the results of either one of these tests are abnormal, further tests are performed to see if there is a cancer. The  prostate cancer found as a result of screening with the PSA test or DRE, will probably be at an earlier, more treatable stage than if no screening were done.

However, neither the PSA test nor the DRE is 100% accurate. Sometimes these tests give abnormal results even when a man does not have cancer (false-positive result), or give  normal results even when a man does have cancer (false-negative result). Unclear test results can cause confusion and anxiety. False-positive results can lead some men to undergo  an unnecessary  prostate biopsy (with small risks of pain, infection, and bleeding). And false-negative results can give a false sense of security.

Another important  issue is that even if screening detects a cancer, doctors often can’t be sure if the cancer is truly dangerous and requires immediate treatment. In fact, some prostate cancers grow so slowly that they would probably never cause problems. But these men may still be treated with either surgery or radiation which can have urinary, bowel, and/or sexual side effects that can seriously affect a man’s quality of life.

A deadly disease like cancer needs some special attention, it’s important to keep a proper check of your body and if you find anything unusual you should prefer consulting a doctor instead of assuming it as a general daily disorder, because prevention is important than cure. Kill the disease before it decides to enter your body.