Spinal cord Tumor: All you need to know about

The spinal cord tumours specifically occur when abnormal cells grow and form a mass or a lump. The tumour is known as benign (not cancerous) or malignant (cancerous), but both types may be serious and may need urgent treatment. 

Types of Spinal Tumors: 

There are basically three main types of spinal tumors, which are classified on behalf of their location:

Extradural and Intradural (intradural-intramedullary and intradural-extramedullary): Intradural-intramedullary tumors occurs within the dura and spinal cord parenchyma, although Intradural-extramedullary tumors occurs within the dura but outside the spinal cord parenchyma.

Extradural: Extradural tumors occur outside the dura mater lining and are most commonly known as metastatic.

Intradural: Intradural tumors occur inside the dura mater lining and are further subdivided into intramedullary and extramedullary tumors. 

Symptoms of Spinal Tumours:

The most commonly reported symptom of spinal tumors is nocturnal back pain. Other common symptoms may include:

• Muscle weakness
• Sensory loss
• Difficulty walking
• Loss of bowel and bladder control 

Tests & Investigations: Tests as well as investigations carried out in a local hospital or local neuroscience centre. Your healthcare provider will refer you required tests accordingly. If you are taking treatment for any other cancer and your healthcare team find that your symptoms are caused by the cancer spreading to your spine they will perform the tests. Your care team may refer you to a neurosurgeon or spinal surgeon, specialises in operations on the spine.

X-rays of your spine may provide the piece of important information. Apart from this, spinal tumours are usually investigated with the help of MRI scan or a CT scan and possibly by a biopsy or a bone scan.

MRI scan: It mainly uses strong magnetic fields and radio waves in order to produce the pictures of the spine that provide more details than an X-ray.

CT scan: This computerised tomography scan is a specifically X-ray that is able to take pictures of your spine from different angles.

Bone scan: This test is used in order to diagnose the tumours or cancer located in the bone. For this test, a very small amount of a radioactive chemical is injected into your vein.

Biopsy: This is basically an operation in order to remove a small sample of a tumour that is sent to a pathologist for examination. You will be prescribed for a biopsy if your healthcare provider is unsure from the results of your scans what type of tumour you have.

Treatments of Spinal cord tumor: 

There are 4 major types of treatment options for spinal tumours named surgery, radiotherapy, radiosurgery and chemotherapy.

Surgery: In order to treat non-malignant spinal tumours, surgery is most commonly used but it may also be used for the treatment of some malignant tumours. 

Surgery is prescribed in order to remove as much of the tumour as possible without damaging the spinal cord or the nerves surrounding the tumour. Following successful removal of all of a tumour may increase the probability of a good or full recovery. Although it may also reduce the risk of the tumour recurring. Surgery may not be suitable for every individual. Your healthcare provider team will discuss the appropriate treatment options with you.

Radiotherapy: It is basically prescribed in order to treat malignant tumours and tumours that can’t be removed with surgery.

Radiotherapy may also be prescribed following surgery for the treatment of any tumour cells that are difficult to be removed. In case you have had surgery, you will be given time in order to recover before receiving radiotherapy treatment.

Radiotherapy specifically uses X-rays as well as gamma rays in order to damage or destroy the tumour. The treatment also helps by slowing down the growth of tumour and lengthens the time prior to it regrows. Sometimes, the radiotherapy destroyed the tumour completely.

Side Effects of Radiotherapy: 

The commonly reported side effects of radiotherapy may include:

• Inflammation of the skin
• Similar to sunburn
• Bone fractures
• Bone marrow suppression 

Radiosurgery: Likewise radiotherapy, radiosurgery may be prescribed when surgery is not appropriate or as an additional treatment following surgery. This treatment is basically not a surgical and does not involve any cuts. It acts by targeting a higher dose of radiation at the tumour for damaging and destroying the tumour cells. The treatment takes place by a machine named a linear accelerator (LINAC) or gamma knife.

Chemotherapy: It specifically uses drugs to destroy the tumour cells. There are several types of chemotherapy. A few chemotherapy medicines are consumed by mouth and others are recommended to be given via a drip into a vein. 

The drug Temozolomide is recommended as a chemotherapy for treating spinal cord tumor. 

Chemotherapy mainly used for patients with secondary (metastatic) spinal tumours. 

Side Effects of Chemotherapy: The possible side effects of chemo may vary depending on the specific drug used. They include:

• nausea 
• vomiting
• tiredness
• hair loss
• reduced resistance to infection

You should discuss these possible side effects with the specialist providing your treatment.

Steroids: These are prescribed in order to reduce the spine swelling. This relieves pressure on the spinal cord and nerves and reduces the risk of damage to the spinal cord. Steroids are recommended to be given with radiotherapy or surgery. You need to keep taking steroids for a while following your radiotherapy or surgery.

Dexamethasone is one of the most widely used steroid for the spinal cord tumor. 

Steroids may be responsible for causing side effects. Signs and symptoms may include:

• increased appetite
• weight gain
• indigestion
• acne
• stretch marks
• muscle weakness
• diabetes
• sleep disturbance
• feeling restless or agitated

Pain-relief Medications: For people with spinal tumours, pain-relief drugs are used mainly to control back or neck pain. They might be combined with other drugs to control nausea and vomiting. If a morphine-based drug is used it might be combined with a drug to reduce the risk of constipation, which can be a side effect.

Apart from all these, there are some other type of treatment options exists, which are as follows:

• Orthotics
• Physiotherapy
• Occupational therapy
• Bladder and bowel management

Read:- All about skin cancer

Detailed discussion on Skin Cancer

Skin cancer: All cells in the body, including skin cells, repair and are replaced all the time in order to ensure the health of the tissue they form.

In the case of an unbalanced process, growth may become uncontrolled and a collection of abnormal cells may develop in a part of the skin.

Risk Factors: Any individual may develop skin cancer, but it is quite common in older people. The risk is also higher in those people who have:

• Freckled or fair skin.
• Fair hair & blue/green eyes. 
• Had short but intense exposure to UV radiation.
• Actively tanned or used solariums
• Worked outdoors
• A weakened immune system
• Lots of moles on the body or moles with an irregular shape and uneven color. 
• Family history of skin cancer. 
• Certain skin conditions such as sunspots. 

Types of Skin Cancer: 

The 4 main skin cancer are BCC (basal cell carcinoma), SCC (squamous cell carcinoma), melanoma and Merkel cell Carcinoma. 

BCC and SCC are also known as non-melanoma skin cancer or keratinocyte cancers. 

Merkel cell carcinoma and angiosarcoma are the rare non-melanoma skin cancer. They are treated in a different way from BCC and SCC.

Solar Keratoses (Sunspots): These are basically not a skin cancer, but are a warning that you are more likely to get skin cancer.

It is associated with red, flattish scaling areas, and appears on the sun-exposed skin.

Signs: flat, scaly spot that feels rough; often the colour of your skin or red. 

1. BCC - Basal Cell Carcinoma:

Basal cell carcinoma is the most common of all skin cancers. It occurs from the bottom layer of the skin surface and grows gradually over several months. It virtually never spreads to other areas of the body. It can exist in several ways ranging from the red scaly patch of the skin, to pearly lump (prominent blood vessels) on the surface. If it is not treated on time, it will continue to grow and may be responsible for causing ulceration of the skin. 

Signs:

• Occurs on the body that have more exposure to the sun, such as the face, head, neck, shoulders,  lower legs, lower arms but may occur anywhere on the body. 
• May seems as a pearl-coloured lump.
• May bleed and turned inflamed; may appear to heal then turned inflamed again. 

2. SCC - Squamous Cell Carcinoma: 

Squamous cell carcinoma is the second most common type of skin cancer. Unlike BCCs, it has the ability in order to spread to other areas of the body. The risk of this occurring depends on its location, size, and its subtype. It exists on sun-damaged skin as a pink/red lump on the skin which may be tender. Often it may have an ulcerated centre. Generally, they grow rapidly than BCCs.

Signs:

• Occurs on areas of the body most often exposed to the sun, such as the neck, head, hands, forearms and lower legs, but may develop anywhere on the body. 
• May bleed and turned inflamed, and is often tender to touch. 
• Often appears as a thickened, red, scaly or rapidly growing lump. 
• Quite common as you get older. 

3. Melanoma: 

It is basically the most serious form of skin cancer, that arises from the pigment-producing cells in the skin called melanocytes. It is one of the most common causes of death due to skin cancer worldwide.

Cure of melanoma is related to how deep it has spread on the skin when diagnosed. The earlier it is found, the greater the chance of cure. Melanoma mainly arises from a new or changing mole on the skin, although rarely may occur on the palms skin, the soles and even the nails.

Knowing about the ABCDE warning signs of the melanoma may help you find an initial stage melanoma.

A: Stands for the ASYMMETRY; one half is unlike the other half. 

B: Stands for the BORDER; irregular, scalloped or poorly defined border.

C: Stands for the COLOR; may vary from one part to another; shades of tan & brown, black; sometimes white, red or blue. 

D: Stands for the DIAMETER; while melanomas are usually higher than the 6mm when diagnosed, they may be smaller.

E: Represents EVOLVING; a mole or skin lesion that seems different.

Signs:

• Occurs as a maiden or existing spot on the body that changes shape, size, or color over a few weeks to months. 
• Often has either a flat or raised surface. 
• Probably more than 1 color (blue, brown, black, red, white, pink light grey, or the color of skin). 

4. Merkel cell carcinoma: 

It is mainly a kind of rare cancer associated with skin. Merkel cell carcinoma traditionally believed to arise from the Merkel cells, specialised cells involved in the sensation of “touch”, situated in the basal layer of the skin epidermis. 

Signs:

The initial sign is a fast-growing, painless tumor on the skin. The tumor may be skin-colored and may appear in shades of blue, red, or purple. The maximum Merkel cell carcinomas occur on the face, neck or head, but they may appear anywhere on the body, even on parts not exposed to the sunlight.

Causes of Skin Cancer: 

The major cause of all sorts of skin cancer is overexposure to the Ultraviolet radiation. Approximately 95% of skin cancers are due to UV exposure. When the unprotected skin is exposed to the UV radiation, the structure, as well as behaviour of the cells, may change. 

Sun produced the UV radiation, but it may also come from artificial sources, such as sun beds. 

UV radiation can't be felt or seen and it is not related to the temperature. It may cause:

• sunburn
• premature skin ageing
• damage to skin cells, which may lead to skin cancer.

Treatment of Skin Cancer: 

Skin cancer is treated in different ways. Treatment basically depends on your general health, size, type, and location of the cancer, , any medications you are consuming (these may affect the amount of bleeding as well as healing time), whether the cancer has reached other organs of your body.

In case the biopsy has removed all the cancer, you may be not recommended for any further treatment.

SURGERY: For skin cancer, surgery is one of the most common treatments. The procedure type you have basically depends on the size as well as position of the cancer. 

Maximum small skin cancers are removed by a dermatologist or GP. A surgeon is required in order to treat more complex cases.

Mohs surgery: Mohs surgery is usually performed under the local anaesthetic by a dermatologist. 

It is prescribed for the treatment of skin cancers that have started to spread deep into the skin or recurred. It may also be prescribed for cancers in areas that are difficult to treat, such as close the eye or on the nose, ears and lips. Mohs surgery is more expensive than other types of surgery. 

CURETTAGE & ELECTRODESSICATION: Curettage and electrodessication (or cautery) is prescribed for the treatment of some BCCs and squamous cell carcinoma in situ (Bowen’s disease). It is performed by a dermatologist. 

The healthcare provider will give you a local anaesthetic and then scoop out the cancer using a small, sharp, spoon-shaped instrument addressed as a curette. 

Low-level heat (cautery or electrodessication) will be applied in order to stop the bleeding and destroy any remaining cancer. The wound would heal within a few weeks, leaving a flat, round, small, white scar.

CRYOTHERAPY: Cryotherapy/Cryosurgery, is a way that uses the liquid nitrogen in order to remove some small BCCs & sunspots. 

The healthcare provider, usually a dermatologist, sprays liquid nitrogen onto the sunspot or skin cancer and a small area of skin around it. You may experience a stinging or burning sensation, which may last a few minutes. The liquid nitrogen basically freezes and kills the abnormal skin cells and creates a wound. In a few cases, the procedure may be required to be repeated. 

The treated area will be sore and red. A blister may be formed within a day. 

TOPICAL TREATMENTS: Some skin spots and cancers should be treated with creams or gels. These are known as topical treatments. They may contain immunotherapy or chemo drugs, and are prescribed by healthcare practitioners. You need to use these treatments only on the particular spots or parts that your healthcare professional has asked you in order to treat. Never use leftover cream for the treatment of new spots that have not been assessed by your healthcare provider.

Imiquimod: It is a sort of immunotherapy that causes the body’s immune system in order to destroy cancerous cells. 

It is prescribed in order to treat superficial BCCs, Bowen’s disease (squamous cell carcinoma in situ) and sunspots. 

You should apply it directly to the affected area every night, usually 5 days a week for 6 weeks.

5-fluorouracil (5-FU): The fluorouracil 5 cream is mainly a type of chemo drug. 

It is prescribed for treating superficial BCCs, sunspots &, sometimes Bowen’s disease. 

The fluorouracil cream acts more effectively on the face and scalp. Your healthcare provider or dermatologist will instruct you how to apply the cream and how often. Many people use this cream twice daily for 2 to 3 weeks. Fluorouracil may need to be used for longer for some skin cancers. While using the cream, you will be more sensitive to the ultraviolet radiation and you should stay out of the sun. 

Ingenol mebutate: It should be applied to the affected sunspots once daily for 2-3 days.

Adverse reactions may include skin flaking or scaling, reddening, crusting or scabbing, blisters, and mild swelling. 

These adverse reactions should disappear within the 2 weeks of treatment finishing.

TARGETED THERAPY: Targeted therapy drugs are prescribed in order to treat melanoma and some non-melanoma skin cancers, such as rare cases of advanced basal cell carcinoma.

Dabrafenib (Tafinlar): Dabrafenib may be used (together with MEK inhibitor trametinib) following surgery in patients with stage III melanoma, where it is effective in order to lower the risk of the cancer coming back.

Trametinib (Mekinist): It is prescribed for the treatment of melanoma that has spread or difficult to be removed completely.

Trametinib may also be recommended together with dabrafenib following surgery in patients with stage III melanoma, where it may act by lowering the risk of the cancer coming back.

Some other drugs can be also recommended, these are as follows:

• Cobimetinib (Cotellic)
• Binimetinib (Mektovi)
• Encorafenib (Braftovi)
• Vismodegib (Erivedge)
• Sonidegib (Odomzo)
• Vemurafenib (Zelboraf)

IMMUNOTHERAPY: Checkpoint inhibitors and cytokines are a couple of types of immunotherapy medications that may be prescribed for treating some cases of Merkel cell carcinoma and melanoma. The medicines are designed in order to trigger the immune system to identify and attack cancer cells.

Some major immunotherapy medications are as follows:

• Pembrolizumab (Keytruda)
• Nivolumab (Opdivo)
• Atezolizumab (Tecentriq)
• Ipilimumab (Yervoy)
• Interleukin-2 (IL-2)

PHOTODYNAMIC THERAPY: PDT uses a cream and a light source in order to make your cancer sensitive to light. It is recommended for the treatment of sunspots, superficial BCCs and squamous cell carcinoma in situ/Bowen’s disease. 

Adverse reactions may include swelling and redness, which usually ease following a few days. PDT is commonly responsible for causing stinging, burning or tender feeling in the treatment area, mainly to the face. 

RADIATION THERAPY: Radiotherapy mainly uses radiation (x-rays or electron beams) in order to damage or kill cancerous cells. It is recommended for BCC or SCC in such areas that are hard to treat with the help of surgery, such as the face. Sometimes this therapy is also recommended following surgery in order to block the cancer from coming back or spreading.

REMOVING LYMPH NODES: In case your cancer has spread, your healthcare provider may remove the lymph nodes in an operation that is known as lymph node dissection. This is effective by reducing the chance of the cancer spreading to other organs or coming back. In order to know more, speak to your doctor.

Prognosis: Prognosis indicates expected outcome of a particular disease. Your treating healthcare professional is an appropriate person in order to interact about your prognosis. Maximum BCCs as well as SCCs can be successfully treated, especially if detected early.

Apart from this, most of the non-melanoma skin cancers do not pose a serious risk to your health. 

How can I prevent skin cancer? 

It is believed that sun exposure is the most preventable risk factor for all skin cancers.

Following several things you must need to do:

• Use a broad-spectrum, water-resistant sunscreen with SPF of 30 or more to the entire area not covered by clothes. The potential of “Broad-spectrum” helps in order to protect ultraviolet A (UVA) as well as ultraviolet B (UVB) rays.
• Always wear a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses, where possible.
• Seek shade when appropriate.
• Caution is required near water, snow, and sand because they reflect and intensify the damaging rays of the sun, which may increase the chances of sunburn.
• Vitamin D should be taken through a healthy diet that may include vitamin supplements. Avoid seeking the sun.
• Tanning beds should be avoided. UV light from the sun and tanning beds may be responsible for causing skin cancer as well as wrinkling. 

Afatinib: Precautions and Warnings

Afatinib is specifically indicated for treating certain sorts of non-small cell lung cancer that has developed to the nearby tissues or to other organs of the body. It belongs to the class of medicines known as kinase inhibitors and acts by blocking the action of a certain naturally occurring substance that helps cancer cells to multiply.

The pills of afatinib should be taken by mouth on an empty stomach at least 1 hour prior to or 2 hours following a meal.

Consume afatinib exactly as instructed. Gulped the afatinib tablets whole with the help of water. Neither crushed nor dissolved the tablets.

Precautions:

• You must ensure that the wholesaler or pharmacy you are purchasing from is genuine & licensed.
• Always choose wholesalers or pharmacies that need a genuine prescription letter. 
• It is always a good idea to check online reviews, prior to making the purchase of afatinib. 
• You should always choose an online pharmacy/wholesaler that has an experienced pharmacist.
• Do not choose a pharmacy/wholesaler that offers afatinib at cheap prices. It may be a trick to attract customers.
• Always go with the reputable pharmacies/wholesalers that hold the certification of WHO-GDP & ISO. 
• You must not provide your personal information such as credit card numbers unless you are sure the site/pharmacy/wholesaler can protect them.
• Never accept afatinib if the packaging seems damaged or puffed up.
• Never accept afatinib if it doesn't look authentic.

Warnings:

• This drug must be administered under the supervision of an experienced health professional.
• The afatinib 40 mg should be discontinued in patients who develop life-threatening bullous, exfoliating lesions or blistering.
• This medicine may be responsible for causing fetal harm if given to a pregnant woman.
• Diarrhea, including severe diarrhea, may occur during treatment with this medicine.
• Patients need to avoid products that contain lactose or any foods known to aggravate diarrhea.
• Hepatic failure has been reported while on treatment with this medicinal product.
• This medicine is used with caution in patients with a history of keratitis, ulcerative keratitis or severe dry eye.

All you need to know about Carmustine Injection

What is Carmustine:

It belongs to a group of anticancer substances known as nitrosourea that act by resisting the growth of cancer cells.

Indication: Carmustine is prescribed as a single agent or in combination therapy with other anticancer medications in certain sorts of cancers, like:

• Multiple myeloma
• Hodgkin’s disease
• Non-Hodgkin’s lymphomas
• Malignant melanoma
• Tumours of digestive system tract or gastrointestinal tract
• Brain tumours; medulloblastoma, glioblastoma, astrocytoma and metastatic brain tumours. 

Dosage: Dosage directly depends on the body size, medical condition and response to treatment. It is usually recommended at least every 6 weeks. As a single agent, the recommended dose in previously untreated patients is carmustine 150 - 200 mg/m2, should be given intravenously every 6 weeks.

Dosage may also depend on whether carmustine is given together with other anti-cancer drugs. Doses can be adjusted according to how you respond to the treatment.

Administration of Carmustine: 

The carmustine 100 mg should always be given to you by a healthcare provider with experience in the use of anticancer medications.

It is given into a vein by a drip over a 1 to 2 hour period. The duration of infusion should not be less than 1  hour in order to avoid the burning and pain at the injected area. The injected area needs to be monitored while administration.

The treatment duration is specified by the healthcare provider and may vary for every patient.

Avoid the use of Carmustine: Do not use this medication:

• in case of the allergic to carmustine or any of the other ingredients of this drug. 
• if you have decreased blood platelets, white blood cells or red blood cells, either as a result of chemo or from other causes.
• in patients with severe kidney function impairment. 
• in patients with less than 18 years. 
• if you are breast-feeding. 

Possible side effects: Like all drugs, carmustine injection may cause side effects, although not everybody gets them.

Inform your healthcare provider immediately if you notice any of the following:

Very common: The most common carmustine side effects are following:

• Ataxia
• Dizziness
• Headache
• Blurred vision
• Retinal bleeding
• Fall in blood pressure
• Inflammation of the veins
• Shortness of breath
• Persistent cough, 
• Chest pain
• Persistent tiredness
• Delayed myelosuppression
• Severe nausea and vomiting
• Inflammation of the iris and optic nerve

Common: Some commonly reported side effects include;

• Acute leukemias
• Bone marrow dysplasias
• Anaemia 
• Anorexia
• Constipation
• Diarrhoea
• Inflammation of the mouth and lips
• Loss of hair
• Flushing of the skin
• Reactions on the injection site

Warnings & Precautions:

1. Interact with your doctor, pharmacist or nurse prior to using carmustine 100 mg injection.
2. Since the major adverse reactions of this medication is delayed bone marrow suppression, your doctor will monitor blood counts weekly for at least 6 weeks following a dose.
3. Notify your doctor if you have symptoms; unusual tiredness, fever, persistent sore throat, enhanced tendency to bruising, throbbing heartbeat. 
4. Prior to and during treatment, your liver as well as kidney function should be tested and observed regularly.
5. Use of carmustine 100 mg may lead to lung damage, an X-ray of the chest region and the lung function tests should be conducted prior to initiating treatment.
6. Your healthcare provider will talk to you about the possibility of lung damage and allergic reactions and their signs. If such signs appear, call your doctor right away.
7. Women, as well as male of childbearing potential, must use effective contraception while on treatment and for at least 6 months after treatment. 
8. Avoid breast-feeding while taking this medicine and up to 7 days after completion of treatment. A risk to the infant/newborn cannot be excluded.

Overdose & Missed Dose: As a healthcare provider will be giving you this medicine, it is unlikely that you will be given an incorrect or missed dose. 

Tell your healthcare provider if you have any concerns about the missed dose and quantity of drug that you receive.

How to store Carmustine:

Keep carmustine injection out of the sight and reach of children.

Store and transport refrigerated (2°C – 8°C). Avoid using this medication after the expiry date. 

FAQ's

What is the best source to buy Carmustine? 

In India, the carmustine price is very reasonable. Buy this cost-effective medication from a WHO-GDP & ISO certified pharma wholesaler company. Prices may vary from branded to non-branded drugs. 

How is Carmustine (BiCNU) supplied? 

Each package mainly includes a vial containing 100mg carmustine and an ampule containing 3mL sterile diluent.

Is use of Carmustine safe?

Carmustine is completely safe in case taken at prescribed dose and duration as instructed by your healthcare practitioner.

Who should not take Carmustine? 

Carmustine should not be taken by individuals who have shown a previous hypersensitivity to this medicine.

Is Carmustine a vesicant?

Carmustine falls under irritants amongst chemo drugs. Although when administered at the high doses it may act as vesicant.

What need to avoid while taking carmustine treatment?

Follow your healthcare provider's instructions regarding any kind of restrictions on foods, beverages, or activity. 

Does Carmustine inhibit DNA replication?

Yes, Carmustine acts in order to prevent DNA replication.

What if I overdose?

You need to seek emergency medical attention or call your healthcare professionals promptly.

What if I miss a carmustine dose?

Call your healthcare practitioner promptly for instructions in case you miss an appointment for your carmustine injection.

NOTE: The piece of information mentioned about "All you need to know about Carmustine Injection" in this article is just for the informational purposes and is not served as a substitute for medical treatment, consultation, diagnosis of an experienced/qualified healthcare practitioner.

All you need to know Pazopanib

Pazopanib(votrient) is specifically a selective multi-targeted receptor TKI (tyrosine kinase inhibitor). This drug is marketed under the brand name Votrient. It prevents the activity of proteins, involved in the growth and spread of cancer cells. The pazopanib 400mg is prescribed for adults to treat:

• advance renal cell carcinoma
• certain forms of soft-tissue sarcoma

Most Common Side Effects of Pazopanib: 

• diarrhoea
• feeling or being sick
• stomach pain
• loss of appetite
• weight loss
• loss of taste
• sore mouth
• headache
• tumour pain
• skin rash
• high blood pressure
• feeling weak or tired
• loss of skin pigment
• changes in hair colour
• unusual hair loss or thinning

Tell your doctor or pharmacist if any of these pazopanib side effects becomes troublesome.

Warnings and Precautions:

• The votrient 400 mg can raise your blood pressure, and it should be checked prior to taking this drug and while you are taking it. 
• If you're scheduled for an operation, votrient 200 mg should be stopped at least 7 days prior to your operation as it may affect the wound healing.
• The pazopanib 400mg is not prescribed for people aged under 18 and children younger than 2 years of age because of safety concerns.
• Avoid taking pazopanib 200mg with food, as it affects the way the drug is absorbed. Consume it at least a couple of hours following a meal or 1 hour prior to a meal.
• Drinking grapefruit juice should be avoided while you are being treated with the pazopanib tablet as it may increase the chance of side effects.
• Do not take this medication during pregnancy. Notify your doctor if you want to get pregnant.
• Don’t breast-feed while on treatment with this medicine. 
• Avoid driving or using machines if you feel weak, dizzy, or tired, or if your energy levels are low. 
• Discuss with your doctor prior to taking pazopanib 200mg, if you have heart and liver disease.

How Does Pazopanib Works: This multiple kinase inhibitor mainly acts by limiting the growth of tumor by targeting angiogenesis via inhibition of the enzymes including VEGFR (vascular endothelial growth factor receptor), PDGFR (platelet derived growth factor receptor), c-KIT and FGFR. 

How to take Pazopanib: Always take this drug exactly as your doctor has told you. Check with your healthcare professionals if you are not sure.

How much to take: The usual recommended dose is two 400 mg tablets (800 mg pazopanib) consumed once a day. This is the maximum recommended dose per day. Your healthcare provider may need to reduce your dose if you get adverse reactions.

When to take: Don’t take pazopanib together with food. Consume it at least a couple of hours following your meal, or 1 hour prior to a meal.

For instance, you could consume it a couple of hours following breakfast or 1 hour prior to lunch. Consume your pills at about the same time every day.

Tablets should be swallowed whole with the help of water, one after the other. Do not crush or break the tablets as this affects the way the drug is absorbed and may increase the chance of adverse reactions.

If you take more Pazopanib than you should: If you take excess pills, contact a doctor or pharmacist in order to seek the appropriate medical advice. 

If you forget to take Pazopanib: Avoid the consumption of double dose in order to make up for a missed or forgotten dose. Just consume your very next dose at about the usual time.

What is the Best Price of Pazopanib: The pazopanib cost will be very reasonable if you choose to buy this medication from any WHO-GDP & ISO certified wholesaler company. 

Cancer Treatment—Premium Hospitals in India at your Convenience

Cancer mortality in India has been doubled from 1990 to 2016, and breast cancer is on the rise. According to the Indian Council of Medical Research (ICMR), it could further increase by 12% in the next five years. Now, this is the alarming data that needs to be discussed seriously in the upcoming years. 

The best hospitals in India for Cancer Treatment

Over the years, India has developed its cancer care facilities, but public cancer facilities are still inadequate. That is why this unfortunate disease causes mental, physical, and financial stress on the patients and family members. We are presenting a list of the best cancer hospitals in India that you could seek for good cancer treatment.

1. Fortis Malar Private Hospital 

Also known as Malar Hospital in Chennai, it is considered as one of the best multi-speciality cancer hospitals in the country. With a 25-year old legacy of providing premium-quality cancer treatment, Fortis Malar Hospital is constantly delivering innovative ways of treating cancer with the help of its qualified and experienced team of doctors. 

Benefits you get 

• Top-class blood cancer treatment
• An individualized treatment plan is provided by a multidisciplinary tumor board
• Comes with a success rate of 77% in radiation oncology
• You will be provided with a relationship manager for help

Address

No. 52, 1st Main Road, Gandhi Nagar, Adyar, Chennai, Tamil Nadu 600020

2. Tata Memorial Govt. Hospital

In most cases, cancer treatment is quite expensive. Acquiring a good treatment would take a lot of money. However, Tata Memorial Government Hospital comes with one of the least expensive cancer treatments with top-quality medical services in India. Established in 1941, this premium cancer treatment institute has also grown in terms of research and treatment over the years. 

Benefits you get

• Free Cancer Treatment 
• Less expensive
• Provides premium counseling for patients
• Avoids unnecessary tests
• Advanced treatment and extensive research on cancer treatment
• Offers digital Mammography, anesthesia delivery systems, and Surgical Microscopes

Address

Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra 400012

3. Kidwai Memorial Institute of Oncology Govt. Hospital

Established in 1973, this hospital is considered one of the top cancer hospitals in India. It offers affordable and quality based cancer treatment. Here, anti-cancer drugs are sold 60% cheaper than the market price.  

Benefits you get

• Surgical instruments are disposed of using gamma radiation by radiation sterilization plant
• Counseling is provided to the patient and family members
• Advanced technologies like Clinac-1800 (Linear Accelerator)is used to treat cancer
• CCX-100 autoanalyzer with a gamma camera

Address

Dr. M.H, Marigowda Road, Bengaluru, Karnataka 560029

4. AIIMS (New Delhi)

AIIMS is one of the oldest public cancer hospitals in India. Three types of technologies, such as surgery, radiotherapy, and chemotherapy, are used for treating cancer at minimal rates. 

Benefits you get

• AIIMS department of oncology consists of 46 patent beds, 5 private wards, 3 major operation theatres
• Every year they perform 4000 minor and major cancer surgical procedures
• Teaching and research is being made on various cancers in order to provide doctors with better insight

Address

Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi 110029

5. Apollo Hospitals Private Hospital

Apollo Hospital offers comprehensive cancer treatment in the field of radiation and surgical oncology. This leading healthcare institute features advanced technologies to treat various cancers. 

Benefits you get

• With 125 surgical and radiation cancer specialists, it offers 9 world-class cancer centers in India
• Stem cells and bone marrow transplantation is being offered
• This premium health institute has completed over 55 successful robotic surgeries
• Personal guidance is provided to the patient and family members
• Affordable proton therapy that kills cancer cells is available here

Address

Plot No. 64, Vanagaram-Ambattur Road, Ayanambakkam, Kil Ayanambakkam, Chennai, Tamil Nadu 600095

6. Columbia-Asia Hospital

The department of surgical oncology of Columbia-Asia Hospital comes with advanced medical facilities that can be used for detecting the early as well as advanced stages of cancer. 

Benefits you get

• Screening is provided for various cancers like Colon cancer. 
• Guidance is provided to the patient and the family members
• Cancer treatments like gastrointestinal tract tumors, head and neck tumors, pediatric malignancies, etc. are being done here

Address

26/4 Brigade Gateway, Beside Metro, Malleshwaram, Bengaluru, Karnataka 560055

7. Basavatarakam Indo-American Cancer Hospital

Founded by N T Rama Rao in 1989, this premium health institute aims to provide accurate diagnosis and treatment for cancer patients at lower costs. Also, it offers reasonable charges for medication. 

Benefits you get

• Monitors patient condition and family condition carefully to help them
• This premium cancer institute comes with 9 operation theatres, 1 isolation room, 1 medical ICU, 6 linear accelerators, and 4 surgical ICUs.
• Experienced oncologists

Address

Road No. 10, IAS Officers Quarters, Nandi Nagar, Banjara Hills, Hyderabad, Telangana 500034

8. Yashoda Cancer Institute

Founded by Dr. G Surender Rao in 1989, Yashoda Cancer institute brings 16,000 new cancer patients every year. It always provides accurate cancer care and treatment. 

Benefits you get

• They can detect cancer in the early stage with their cutting-edge medical equipment
• Dedicated CT scan facility
• Best post-operative care is being provided by the surgical observation unit

Address

16 – 10 – 29, Nallakunta Cross Rd, Malakpet, Hyderabad, Telangana 500036

9. Adyar Cancer Institute

This Chennai-based government cancer care facility provides cancer treatment at a nominal cost. They also provide free lodging and boarding to almost 60% of patients.

Benefits you get

• Free and affordable cancer treatment
• Cancer treatment is provided to over 15,000 patients annually
• Cutting-edge technologies such as rapid arc therapy and linear accelerator are used

Address

W. Canal Bank Road, Gandhi Nagar, Adyar, Chennai, Tamil Nadu 600020

10. Rajiv Gandhi Cancer Institute and Research Centre

In 2017, the India Today Group awarded this cancer hospital the most trusted hospital in oncology. Their 360-degree cancer treatment and oncology services include bone marrow transplant, surgeries related to medical oncology.

Benefits you get

• For treating prostate cancer, they use SONABLATE 500 cutting edge technology 
• They have Fully equipped technology for treating lung cancer
• Reasonable medicine pricing

Address

Sir Chotu Ram Marg, Rohini Institutional Area, Sector 5, Rohini, New Delhi 110085

Disclaimer: This article is solely for informative purposes. We have no intention of promoting these hospitals and don’t urge the readers to solely avail treatment from the above-mentioned hospitals. Our intention is to inform readers about some of the services available in these top-notch hospitals.

Testicular cancer and its Treatment

What is Testicular Cancer? 

The testicular cancer occurs when cells in the testicle grow in order to form a tumor. This is rare. More than 90 % of testicular cancers develop in the germ cells, which involves in producing sperm. 

There are mainly a couple of types of germ cell cancers (GCTs), Seminoma & Non-seminoma. 

Seminoma: Seminoma generally grow slowly and respond very well to chemotherapy radiation therapy.

Non-seminoma: Although, Non-seminoma comparatively grows rapidly and is less responsive to those treatments.

This Non-seminoma has a few sub-types such as: choriocarcinomas, embryonal carcinomas, teratomas and yolk sac tumors. 

Apart from this, there are also rare testicular cancers that usually don’t form in the germ cells.

Leydig cell tumors develop from the Leydig cells, involved in producing the testosterone.

Sertoli cell tumors start from the Sertoli cells that support normal sperm growth.

Who is at Risk?

• Male with a father or brother who had testicular cancer. 
• Male with the history of testes that don’t drop prior to birth. 
• Male with germ cell neoplasia in situ (GCNIS). 

What are the Symptoms of Testicular Cancer?

Initially, the signs and symptoms of testicular cancer may be difficult to notice. Symptoms of a testicular tumor may include:

• A lump which may be painless in the testicle.
• Testicle swelling, with or without pain. 
• A feeling of weight in the testicles. 
• Pain in the testicle, groin or scrotum. 
• Changes or tenderness in the breast tissues of male. 

Interact with your doctor as soon as you notice any of these signs and symptoms. If you do have symptoms, your doctor performs a physical exam, an ultrasound and a tumor marker blood test.

You may be referred to a urologist for good care. Testicular cancer is not diagnosed with a standard biopsy (tissue sample) prior to the surgery.

The testicular cancer can be precisely diagnosed and staged after the tumor is surgically removed. At that point, your doctor will study the tissue in order to learn the exact type of cancer, where it is located and how aggressive it is.

What are the Stages of Testicular Cancer?

Stage 0: It can be considered as a warning that cancer could grow. 

Stage I (IA, IB, IS): This stage indicates that the cancer is found only in the testicle and has not spread to anywhere else in the body.

Stage II (IIA, IIB, IIC): In this stage the cancer has spread to 1 or more lymph nodes in the belly.

Stage III (IIIA, IIIB, IIIC): This stage shows the cancer has spread beyond the lymph nodes in the belly. Cancer may exist far away from the testicles, such as distant lymph nodes or the lungs.

Treatment of Testicular cancer: 

For treating testicular cancer a doctor's team, such as a urologist, oncologist or a radiation oncologist, will work together in order to find the precise treatment plan for each and every patient. The treatment plan will be based on the diagnosis as well as health of the particular patient. 

Surveillance is a specific way to look for the change with normal check-ups and is basically performed for men with Stage 0 as well as Stage I cancers.

In case your cancer gets worse, then the surgery in order to remove the testicle is the best treatment. After surgery, patients will be monitored to make sure they are well or not. 

Male patients with stage II & III testicular cancer may be recommended for comparatively more treatment, like radiation therapy, chemotherapy or the removal of tumors that have spread to the beyond lymph nodes. Radiation is preferred when the seminoma cells are detected, but in some non-seminoma cancer cells it is not effective. Chemotherapy is recommended for any testicular cancer that has spread beyond the testis, or if tumor markers rise after orchiectomy. 

On behalf of the diagnosis of testicular cancer, other surgical options can be recommended. Testis-sparing surgery (TSS) is basically an option for men or children who have a benign tumor. For Testis-sparing surgery, tumor markers must need to be negative.

A surgery known as RPLND (retroperitoneal lymph node dissection) is sometimes an option for male patients with cancers that may return. This surgery helps in order to remove the lymph nodes in the abdomen and must be performed by an experienced surgeon. 

Testicular cancer medication: 

In order to treat testicular cancer there are several drugs that are approved by the FDA (Food and Drug Administration). There are common drug combinations used in testicular cancer. The individual drugs used in combinations mainly are approved by FDA. However, the drug combinations usually are not approved but are widely used.

Bleomycin Sulfate: This medication is believed to work by preventing the making of DNA. The bleomycin IP 15 units is recommended to be given intravenously, by intramuscular injection, or under the skin. 

The common adverse reactions due to bleomycin injection include rash, fever, weight loss and vomiting.

Cisplatin: For patients with testicular cancer, cisplatin 50 mg chemotherapy medication should be given by injection into a vein. This platinum-based antineoplastic family of medicine functions in part by binding to DNA and inhibiting its replication. 

The common adverse reactions include vomiting, bone marrow suppression, hearing problems and kidney problems. 

Cosmegen (Dactinomycin): Dactinomycin, also known as actinomycin d, is a chemotherapy medication should be given by injection into a vein. It is shown to have the ability in order to inhibit the transcription. 

The common adverse reactions due to dactinomycin 0.5 mg include mouth ulcers, bone marrow suppression, vomiting, hair loss, infections, liver problems and muscle pains. 

Etopophos (Etoposide Phosphate): Etopophos a chemotherapy medication can be used either by mouth or injection into a vein. This topoisomerase inhibitor family of medication is believed in order to work by damaging DNA. 

The common adverse reactions include fever, low blood cell counts, hair loss, vomiting, loss of appetite and diarrhea. 

Ifex (Ifosfamide): Ifosfamide (IFO) a chemo drug should be administered by injection into a vein. This nitrogen mustard class of drug works by disrupting the duplication of the DNA as well as creation of the RNA. 

The common adverse reactions include hair loss, blood in the urine, vomiting, kidney problems and infections. 

Vinblastine Sulfate: Vinblastine a chemotherapy medication should be given by injection into a vein. Vinblastine believed to work by blocking cell division. 

The common adverse reactions include change in sensation, weakness, headaches, loss of appetite and constipation. 

Drug Combinations Used in Testicular Cancer: Drugs in combinations usually work better than single drugs because different drugs kill cancer cells in different ways.

Each of the drugs in this combination is approved by the FDA in order to treat cancer or conditions related to cancer.

BEP: BEP (Bleomycin, Etoposide Phosphate, Cisplatin). is used to treat:

• Testicular germ cell tumors that are malignant.

JEB: JEB (Carboplatin (JM8), Etoposide Phosphate, Bleomycin) is used in children to treat the following malignant extracranial germ cell tumors:

• Testicular germ cell tumors.

PEB: PEB (Cisplatin (Platinol), Etoposide Phosphate, Bleomycin) is used in children to treat:

• Testicular germ cell tumors that are malignant.

VeIP: VeIP (Velban, Ifosfamide, Cisplatin (Platinol), is used in order to treat:

• Advanced testicular cancer.

VIP: VIP (Etoposide (VP-16), Ifosfamide, Cisplatin (Platinol) is used to treat:

• Testicular cancer that is advanced. It is often recommended in those patients who cannot take bleomycin sulfate.

What is the Risk for Return?

Testicular cancer may come back but the chances are quite rare, at about 5 % or less. Apart from this, the risk of cancer growing in the other testicle is also quite less. Still, it is necessary to learn how to do a testicular self-exam. Also, regular follow-up visits with your urologist can be helpful.

How often, and for how long follow-up care is required is based on your diagnosis.

If your cancer returns, the healthcare provider will want to find and treat it quickly. Additional treatment options depend on the type of cancer and location.

Disclaimer: Above mentioned information is not a tool for the self-diagnosis or a substitute for professional medical advice. Please discuss with your urologists or health care provider about your health concerns. Always interact with a healthcare provider prior to starting or stopping any treatments, including medications.

Read:- Treatment of childhood liver cancer

Treatment of Childhood Liver Cancer

What is childhood liver cancer? 

It is when malignant cells start forming in the tissues of the liver. It is mostly determined by the symptoms like abdominal pain or a lump in the abdomen, swelling in the abdominal region, nausea, vomiting, and loss of appetite.

There are certain diseases, which act as risk factors for childhood liver cancer. They are: 

1. Aicardi Syndrome 
2. Glycogen storage disease 
3. Trisomy 18
4. Hemi hyperplasia

A CT scan, serum tumor marker test, or a complete blood count test can diagnose the condition. Other than that, abdominal X-ray, MRI, and biopsy are also helpful in this case.

Standard treatment procedures for Childhood Liver Cancer- 

1. Surgery 

Partial hepatectomy, liver transplant, or resections of metastases are the commonly approached options. Surgery is applicable in both advanced and primary cases. A number of tests are carried out before surgery to figure out the size of the primary tumor, the level of alpha-fetoprotein in blood, or whether there's more than one tumor. If the patient is eligible for a transplant, he/she will have to wait for an organ donor that matches the requirements. In some cases, chemotherapy is given before surgery to shrink the tumor. Surgical procedures have their own drawbacks, like the chance of infection, pain, or bleeding. However, doctors will calculate the risk factors and then go for it so that the patient's life is not put at high risk.

2. Watchful Observation 

It is also quite useful because there are changes in symptoms disappearing or changing at times. Doctors monitor the health of the patients carefully for a significant period before taking any action. It is also used for Hepatoblastoma, where the tumor has already been removed by surgery.

3. Chemotherapy

It is one of the most commonly prescribed treatment options that use drugs to kill cancer cells or stop their growth within the body. Drugs are either administered orally or intravenously into the bloodstream. Sometimes, combination chemotherapy also opts for better results (use of more than one anti-cancer drug at the same time)

There are multiple chemo drugs that are effective for childhood liver cancer. Some of them are stated as follows: 

1. Gemcitabine- Categorized as an ant metabolite, Gemcitabine is a cytotoxic chemotherapy drug that is either prescribed alone or with Docetaxel for better impact.
2. Oxaliplatin- For Hepatoblastoma, Oxaliplatin is given in combination with other anti-cancer drugs like Cisplatin and Vincristine. This platinum-based medication is given as an injection into the vein twice every 14 days.
3. Cisplatin- It is an antineoplastic cytotoxic chemotherapy drug that is classified as an alkylating agent. Being the most common platinum-based chemotherapy medicine, Cisplatin 50 mg has shown remarkable effects on the case of childhood liver cancer.
4. 5 Fluorouracil- This chemotherapy drug is also an antimetabolite that is available in the market as Fluorouracil cream and injection. While the cream or topical is used for treating skin cancer and similar conditions, in the case of childhood liver cancer, it is given as an injection.
5. Capecitabine- When administered in the body, Capecitabine gets converted to Fluorouracil to target the cancer cells and prevent them from forming new DNA. This is how Capecitabine 500 mg is helpful for destroying liver cancer cells in the body.

Chemotherapy has certain side effects like:

• Nausea and vomiting
• Hair loss 
• Mouth sores
• Loss of appetite 
• Fatigue 
• Diarrhea 
• Increased chances of infections
• Easily bruising and bleeding

4. Radiation Therapy 

There are two types of radiation therapy that are used for treating childhood liver cancer: External radiation therapy and internal radiation therapy. They are the use of high-energy X-rays or radioactive needles to destroy the cancer cells. The former is used to treat Hepatoblastoma that can't be dealt with surgical procedures. It is also used for relieving the symptoms at times.

The side effects of radiation therapy are: 

• skin color change in areas where the radiation beam is given 
• blistering and peeling of skin 
• loss of appetite
• diarrhea 
• nausea and vomiting

5. Ablation 

It is a process by which affected tissues are removed and destroyed. It's divided into two categories- radiofrequency ablation and percutaneous ethanol injection. Both are useful for treating recurrent Hepatoblastoma. Although serious complications are not seen in this treatment procedure, fever, liver infection, and abdominal pain have been noticed in some cases.

6. Targeted therapy

It is a new type of drug treatment that targets the cancer cells in the body to destroy them. It can aim at specific abnormalities or simply target the blood vessels to slow down the growth of malignant cells.

Certain important targeted therapy drugs are: 

1. Lenvatinib- Lenvima or Lenvatinib is first-line therapy for childhood liver cancer. It is administered orally that acts upon the cancer cells with its anti-angiogenic activities. Lenvatinib 4mg and Lenvatinib 10 mg target the blood vessels to destroy the cancer cells.
2. Sorafenib- Sorafenib 200 mg is a kinase inhibitor. It simply works by blocking the effect of abnormal proteins on the cancer cells or destroy them.
3. Regorafenib- This multikinase inhibitor is specifically known to target the VEGFR-TIE2 tyrosine kinase to stop the growth of cancer cells. The normal dosage is 160mg - four Regorafenib 40 mg tablets per day.

The common side effects of targeted therapy are diarrhea and constipation, shortness of breath, fatigue, dryness of skin, and cold-like symptoms. However, these aren't persistent and go away easily.

7. Immunotherapy

Here, the immune system of the patient is given a boost by the use of drugs like Atezolizumab to fight the cancer cells from within. 

Atezolizumab 60mg is a PD-L1 inhibitor that is used commonly for conducting immunotherapy in patients. It's given intravenously once at an interval of 2, 3, 4 weeks, depending on the condition.

Conclusion

Liver cancer cases that are connected to the Hepatitis B virus-like Hepatocellular Carcinoma can be approached with antiviral drugs. In some cases, patients also participate in a clinical trial. With the advancement of medical science, newer and better treatment methods are coming to the surface to cure childhood liver cancer with lesser side effects.

Inoperable Lung Cancer

                    

The phrase "Inoperable lung cancer" makes a lung cancer diagnosis even quite terrifying. But the cancer inoperable doesn't mean that it can not respond to any other type of lung cancer treatment. 

If any patients have been diagnosed with lung cancer, he'll or she'll surely want to know about several things, including what type of lung cancer I have, what are the treatment options, and about survival rates. And if your doctor has given you words that you have inoperable cancer, literally you’ll want to know about this frightening term as well.

Doctors specifically use the term “inoperable cancer” when they cannot operate with the intent in order to cure the cancer. Here, cancer can not be cured by surgery, rather some other lung cancer treatment options can be effective. 

Why Lung Cancer May Be Inoperable: 

Below mentioned are a few reasons why lung cancer might be termed inoperable:

• Your cancer has spread.
• The location of lung cancer. 
• The health of the patient.

When Inoperable lung cancer spreads to outside your lungs. It’s basically known as unresectable lung cancer.

Types of Inoperable Lung Cancer: 

Inoperable lung cancer basically categorized into two types, based on the size of the affected cells:

Non-small-cell lung cancer (NSCLC): Up to about 85% of lung cancer cases are NSCLC. It has three subtypes:

• Adenocarcinoma
• Squamous cell carcinoma
• Large-cell (undifferentiated) carcinoma.

Small-cell lung cancer (SCLC): This kind of cancer almost occurs due to cigarette smoking. Approximately 70% of cases are usually diagnosed after the cancer has spread. SCLC often grows faster than non-small cell lung cancer, meaning it responds well to radiation therapy and chemotherapy.

Treatment Options: 

In Inoperable lung cancer, you can't have surgery. But it doesn't mean that you can't do anything with your cancer. Several treatment options like radiation therapy, chemotherapy, targeted therapy, and immunotherapy are able to fight it, even when the operation can not be performed. 

Radiation therapy: Your healthcare provider uses high-energy X-rays or other radiation in order to kill cancerous cells or prevent them from growing. Patients with Non-Small Cell Lung Cancer, may direct the energy at a certain part of the body from the outside with the help of a machine (known as external) or implant the radioactive seed, wire, or needle in the body just near the cancer (known as internal). The external radiation therapy is often used for small cell lung cancer.

Chemotherapy: Several medications are able to kill cancerous cells or can prevent from dividing. You may be recommended pills in order to swallow or have injections.

Chemotherapy medications used in order to treat NSCLC. The chemo medications most used for NSCLC include:

• Cisplatin
• Carboplatin
• paclitaxel
• Albumin-bound paclitaxel (nab-paclitaxel, Abraxane)
• Docetaxel (Taxotere)
• Gemcitabine (Gemzar)
• Vinorelbine (Navelbine)
• Etoposide (VP-16)
• Pemetrexed (Alimta)

Targeted therapy: Targeted therapy basically uses medicines or antibodies that are able to attack specific cancerous cells. It leaves comparatively less harm to the healthy cells than either chemo or radiation. It’s mainly recommended for the NSCLC.

Several mutations are able to be treated with targeted therapy medicines. These include:

Tyrosine kinase inhibitors: Tagrisso (osimertinib), Tarceva (erlotinib 150 mg), and Iressa (gefitinib 250 mg), Ofev (nintedanib 150 mg), Gilotrif (afatinib 40 mg), Afinitor (everolimus 10 mg). 

ALK rearrangements: Xalkori (crizotinib), Zykadia (ceritinib), Alectinib (alencensa), and Alunbrig (brigatnib). 

ROS1 rearrangements: Xalkori (crizotinib), Lorbrena (lorlatinib), Rozlytrek (entrectinib), and Zykadia (ceritinib).

Immunotherapy: Immunotherapy is also known as biologic therapy. It helps in order to boost, direct or restore your immune system in order to fight cancer.

Checkpoint inhibitors:

• Atezolizumab (Tecentriq)
• Durvalumab (Imfinzi)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

Bladder Cancer And Its Treatment

Bladder Cancer: Bladder cancer occurs when the healthy cells in the bladder lining change and grow in an uncontrolled way, forming a mass addressed as a tumor.

Urothelial carcinoma is known as the most common type of bladder cancer.

Squamous cell carcinoma, small cell carcinoma, and adenocarcinoma are often less common types.

Urothelial carcinoma also developed in the ureters, that bring urine from the kidney to the bladder, and responsible for spreading to the kidneys. Bladder cancer can also be described as the non-muscle-invasive or the muscle-invasive. 

Symptoms of Bladder Cancer

In bladder cancer, sometimes doesn’t have many signs or symptoms and is detected when a urine test is performed. Apart from this, most patients with bladder cancer do have some signs and symptoms. 

These symptoms can include:

• Blood in the haematuria 
• Changes in the bladder habits 
• Pain in one side of a lower abdomen or back.

What are the risk factors?

Studies represent that the people with certain risk factors have higher chances to develop bladder cancer. These factors include:

• Smoking
• Older age
• Being male
• Chemical exposure at work
• Chronic infections
• Long-term catheter use
• Previous cancer treatments
• Diabetes treatment
• Personal or family history

How Does Bladder Cancer Start And Spread: Inside the lining of a bladder is the urothelium, which is made of urothelial cells (also called transitional cells). If urothelial cells make the excess copies of themselves and grow out of control, this is a bladder cancer. 

After forming in urothelium, the tumors generally grow into the bladder wall. Then cancerous cells travel through lymph or blood in order to form new tumors in other parts of the body. This is known as metastasis. 

PHASES OF BLADDER CANCER: 

Patients with bladder cancer are grouped into 3 main categories, depending on the stage of cancer. Treatment goals as well as management of these groups are different. 

Non-muscle invasive bladder cancer: Stages 0 and 1 belong to the non–muscle-invasive. It is known as the early bladder cancer. In this, the tumor has not spread to the thick layer of the muscle in the bladder wall. The purpose of treatment for non-muscle-invasive cancer are to: 

• Decrease the risk of cancer coming back after it is being treated successfully. 
• Resist the cancer from progressing to an advanced stage.

Muscle-invasive bladder cancer: Basically stages 2, 3, and early stage 4 are the muscle-invasive. Local control therapy such as radiation or surgery, combined with the chemotherapy, is required in order to prevent the spread of cancerous cells away from the bladder. The purpose of the treatment for muscle-invasive cancer are to:

• Cancer's stage in order to confirm that it is muscle-invasive, but has not metastasized. 
• Determine the best local treatment options. 

Metastatic bladder cancer: In this, the cancer has spread to organs and lymph nodes far from the bladder. These cancers are difficult in order to cure. The major purpose of care for metastatic bladder cancer is to assist you live as comfortably as possible.

Diagnosing of Bladder Cancer: 

Diagnosis is performed with the help of several existing ways:

General Tests: General tests may include:

• blood and urine tests
• an internal examination: in this the healthcare provider slides a gloved finger into the rectum or vagina in order to know for anything unusual. 

Main Tests: In order to diagnose the bladder cancer, your doctor may arrange:

• an ultrasound: a scan that uses soundwaves to create pictures of your organs. 
• a cystoscopy: the doctor inserts a tube with a light and camera through the urethra to view the bladder; a flexible cystoscopy can be done with local anaesthetic, while a rigid cystoscopy is done under general anaesthetic in hospital and may include a biopsy. 
• MRI and CT scans: these basically involve an injection of dye into the body.

Further Tests: In order to check if cancer has spread to other parts of the body, you may have:

• a radioisotope bone scan
• x-rays 
• an FDG-PET scan

Treatment Options For Non-muscle Invasive Bladder Cancer: 

Once tumor found after close examination of the bladder, your doctor may choose to perform a transurethral resection of bladder tumor (TURBT) as a first step in your treatment. 

TURBT: It is generally the initial treatment for non-muscle invasive bladder cancer. It is basically a procedure which is used both for diagnosis as well as treatment. By using this procedure doctors remove the tumor which is generally reserved for the non-aggressive cancer.

Patients with the non-muscle invasive cancer located only in the bladder can be recommended in order to receive immunotherapy or chemotherapy drugs after a TURBT via intravesical therapy. There are numerous intravesical therapy bladder cancer treatment options:

Bacille Calmette-Guerin (BCG): This vaccine is an immunotherapy drug. This therapy is used in order to boost the body’s natural defenses to fight cancer. The onco-BCG is a first-line treatment for carcinoma that has not spread outside the bladder. It is effective in order to prevent bladder cancer recurrences following TURBT.

Mitomycin C: Mitomycin is basically a chemotherapeutic agent used to kill cancer cells. It is mainly given to patients at doctor’s offices, outpatient clinics or hospitals.

The mitomycin injection is easily absorbed into the bladder and has helped with preventing tumor recurrence. 

The mitomycin 40 mg has been used more often immediately after TURBT or sometimes within 24 hours after the initial TURBT treatment.

Thiotepa (Tepadina): Thiotepa is used as intravesical chemotherapy in bladder cancer. The thiotepa is recommended to be used prophylactically in order to prevent seeding of the tumor cells at the cystoscopic biopsy; as a therapeutic agent in order to prevent recurrence after cystoscopic resection of the bladder tumor (transurethral resection of bladder tumor) or as an adjunctive agent at the time of biopsy. 

Cisplatin: The cisplatin 50 mg specifically belongs to the platinum-based antineoplastic family of medications. It works in part by binding to the DNA and inhibiting its replication. 

Intercalating Agents (Doxorubicin, Valrubicin and Epirubicin): These agents are known for good absorption into the bladder, and systemic toxicity is very rare. Doses can vary from 3 times a week to once in a month.

Gemcitabine: This is used for more advanced bladder cancer. In patients who received previous therapy without cure, gemcitabine therapy may be helpful.

Atezolizumab: This medication is used for the locally advanced or metastatic urothelial carcinoma  after the failure of cisplatin-based chemotherapy.

The use of atezolizumab is considered as a first-line treatment for the metastatic bladder cancer in patients who can not receive cisplatin-based chemotherapy and have high levels of PD-L1. 

Laser-Ablation Therapy: This involves using a laser in order to burn cancer cells. Patients for this type of therapy have low-grade papillary tumors as well as a history of the low-grade, low-stage tumors.

List of ovarian cancer medications

Often detected in its later stages when it spreads to the stomach and pelvis, ovarian cancer is the type that occurs in the egg-producing female organs. While most cases do not have any symptom in the early stages, it becomes fatal and complicated to treat during the advanced stage. The very non-specific symptoms include loss of appetite and unusual weight loss. Patients who are experiencing a shift in bowel movement, discomfort in the pelvis area, and frequent urge to urinate need to consult a doctor immediately. 

Medications used for treating Ovarian Cancer

1. Melphalan

Melphalan is single-agent chemotherapy that is prescribed for the treatment of ovarian cancer in adults. It works by destroying the cancer cells and slowing down their further growth in the body. Melphalan 50 mg is given as an intravenous infusion over certain intervals. The dosage can be modified based on the condition of the patient. During the course of treatment, patients must avoid getting pregnant or breastfeeding. It can also interfere with the normal menstrual cycle. The average retail Melphalan price is $675.95, but one can get it at a wholesale rate from several pharmacies. 

2. Gemcitabine hydrochloride

This antineoplastic cytotoxic chemotherapy medication is given in combination with Carboplatin to treat ovarian cancer that has relapsed within 6 months of finishing the last treatment. It is administered intravenously once every 3 to 4 weeks as per the condition of the patient's demands. There are certain moderate side effects like skin rashes, itching, nausea, vomiting, diarrhea, and temporary hair loss that can be managed easily in the gap between two doses where the body is given time to recover.  

3. Carboplatin

It is prescribed in combination with Paclitaxel as an initial treatment of Ovarian Cancer. At this stage, cancer must still be restricted to the ovaries for the treatment to take effect fully. Carboplatin 450mg is infused intravenously once every 4 weeks. The infusion takes about 30 minutes, and then the patient needs to stay back at the hospital for a few hours to let the doctor monitor the immediate after-effects. Usually, 6 cycles of treatment (24 weeks) can yield results, but in certain advanced cases, it can continue longer. The carboplatin price for a single vial of 45mL is 2769 INR.  

4. Olaparib

For the treatment of advanced ovarian cancer, Olaparib is given in combination with other drugs like Bevacizumab to conduct maintenance therapy in patients. It is also effective for patients who have received 2 to 3 lines of chemotherapy prior to this. For refractory conditions, Olaparib is prescribed with Rucaparib to shrink the tumor. The medication is effective in patients where cancer has a specific genetic mutation – BRCA. 

5. Cisplatin

So far, Cisplatin qualifies as the most active drug for the treatment of Ovarian Cancer. It is a chemo drug that is administered intravenously at certain intervals (weeks). To treat advanced conditions, Cisplatin is also given at a high dose in combination with Vinblastine, Ifosfamide, and Etoposide. Before receiving Cisplatin 50 mg, your doctor will provide you with IV fluids for about 8 to 12 hours. For IP chemotherapy, the drug will be injected directly into the abdominal cavity. If you have a hearing impairment and bone marrow suppression, the medication can worsen the conditions. 

6. Niraparib

Patients who have responded fairly to platinum-based chemotherapy can benefit from this medication to slow down the progression rate of ovarian cancer. It is a highly selective oral PARP 1 and PARP 2 inhibitor that is also prescribed as maintenance therapy for recurrent conditions. The dosage for first-line maintenance treatment is determined based on the body weight and platelet count of the patient. For a supply of 100mg 30 capsules, the cost of Niraparib is $7588. 

7. Paclitaxel

It is prescribed in both primary and advanced stages of ovarian cancer. Doctors can also prescribe it with the chemo drug Carboplatin. It is administered as an infusion in the veins. Few patients can have allergic reactions as a result of this. To prevent that, your doctor can prescribe a few medications after transfusion. Paclitaxel 100 mg is given every 3 weeks, but the recent clinical studies show that it had worked more efficiently when the time span was reduced to one week. However, it entirely depends upon the extent of the disease. Paclitaxel price is 5000 INR for a vial of 16.7mL.

Final Words

Ovarian cancer has a better chance of getting completely cured if diagnosed and treated in the initial stages. As it spreads, the chances become slim, and the situation gets deadlier. So far, there have been different drug regimens for the treatment of this condition. Minor side effects are common and can be managed easily since they're not persistent. 

Erlotinib 150 mg medication guide for patients.

Erlotinib is a small molecule medication that inhibits the tyrosine kinase, a kind of enzyme associated with the EGFR (Human Epidermal Growth Factor Receptor).

The drug is indicated for adults and can be prescribed if you have advanced age non-small cell lung cancer. It can also be useful if your previous chemotherapy has not worked to stop your disease.

Erlotinib can also be recommended together with the other treatment named gemcitabine, if you have a cancer of pancreas at the metastatic stage. 

Here are some guidelines for patients who are taking Erlotinib:-

• Your doctor must know about if you are pregnant or plan to become pregnant. It may be harmful to an unborn baby when taken during pregnancy. If you become pregnant use adequate contraception while on treatment, and for at least 14 days after taking the last tablet.

• Erlotinib is known to interact with grapefruit juice so you need to avoid drinking this whilst taking this tablet. Always consume this drug exactly as your doctor has instructed you. 

• The tablet of erlotinib should be consumed at least 1 hour prior to or 2 hours after ingestion of food. The usual dose is 1 tablet of erlotinib 150 mg every day if you have non-small cell lung cancer.

• The usual daily dose is 1 tablet of erlotinib 100 mg, if you have metastatic pancreatic cancer. It is given together with the treatment of gemcitabine. 

• If you take excess erlotinib than you should, contact your pharmacist immediately. You may have increased adverse reactions and your healthcare provider may interrupt your treatment.

• Contact your doctor as soon as possible if you suffer from any side effects. In some cases your healthcare provider may need to reduce your dose of erlotinib or interrupt the treatment. 

• The blood levels can also be impacted by the smoking of cigarettes. Be sure in order to inform your doctor if you're currently smoking, or if you quit smoking while consuming this medicine, as the dose you take may be required to be adjusted.

• Erlotinib 150 mg is available through select specialty wholesalers or pharmacies. The erlotinib price may vary from innovator brand name to generic version. The strip of 10 tablets of Brand name TARCEVA 150 MG Tablets can be grabbed at around ₹35300.

Chronic Lymphocytic Leukemia: Causes, Symptoms, treatments and Medications

Recent stats suggest that out of the total number of Leukemia cases, Chronic Lymphocytic Leukemia or CLL will account for a quarter of it. Most people with this condition live up to 10-20 years after getting diagnosed and getting proper treatment. However, there are some cases where disease progression is rapid, and the patients live only up to a few years. 

Causes of CLL: 

It usually starts due to a certain genetic mutation in the blood-producing cells that leads to the production of ineffective and abnormal lymphocytes. Unlike normal lymphocytes, they don’t die. Instead, they continue multiplying and starts accumulating in the blood and specific organs gradually, which causes complication. The process also interferes with the healthy cells in the bone marrow, and as a result, the production of normal blood cells gets affected. 

The risk factors may include exposure to certain chemicals like herbicides and insecticides. Having a family history of blood or bone marrow cancer may increase your chances too. 

Symptoms

• Swollen glands in the armpits, neck, and groin
• Unusual bruising and bleeding often
• Night sweats
• Shortness of breath and pale skin
• Anaemia 
• Unusual weight loss

These are some of the recognizable symptoms. If you face any of these, it is recommended to contact your healthcare professional and get a checkup done. 

Relation between Chronic Lymphocytic Leukemia and Myeloma 

Both the conditions—Multiple Myeloma and CLL consist of overlapping epidemiologic features. Even though they are seen to be originating from the mature B cells, the chances of these two cases coinciding are quite rare. In Multiple Myeloma, the plasma cells are affected, whereas, in CLL, the lymph nodes, liver and spleen are affected, which ultimately causes the bone marrow to stop functioning. 

Although both CLL and Myeloma are blood cancers, the latter is formed in the bone marrow and responsible for the subset of WBC to form a distinctive protein that causes cancer to grow and spread. They have parallel as well as divergent features. 

The common features include stage-dependent anaemia and immunodeficiency. Not only that, but both diseases respond to alkylating agents. 

Treatment of Chronic Lymphocytic Leukemia 

Although there are different options available, one must also have to keep in mind that there are side effects of each one of them. The upsides and downsides are measured with respect to various medical tests conducted, and then the doctor prescribes which way to go.

1. Radiation Therapy 

If the condition has been diagnosed in a localized stage and the only thing to deal with is an enlarged spleen or swollen lymph nodes, you can opt for low-dose radiation therapy. This treatment of Leukemia is safe and shows much lesser side effects. 

2. Surgery

Also referred to as Splenectomy, one may go with this option to remove the enlarged spleen. However, this is not advisable for an advanced stage condition. 

3. Stem Cell Transplant 

If it is a high-risk condition, stem cell transplant could be considered as an option for early treatment. 

4. Drug Therapy: Chemo and Targeted 

Chemotherapy and targeted therapy are two of the most commonly approached treatment options. The drugs can either be prescribed alone or in combination with other medications to yield the best results. Mention may be made of the following drugs in this respect:

Ibrutinib: It is classified as a Bruton’s Tyrosine Kinase that can inhibit the B-cell lymphoma 2 protein. It is prescribed alone or in combination with Rituximab. The typical dosage for this condition is 420mg per day, i.e., three Ibrutinib 140 mg tablets per day. However, it may be decreased depending upon the extent of the condition and response from the body. 

Alemtuzumab: It has been approved as both first-line and second-line treatment for Chronic Lymphocytic Leukemia. The drug is administered into the body as an injection in the vein. Doctors can prescribe it alone or with Rituximab. This targeted cancer drug can be classified as a monoclonal antibody. 

Venetoclax: It is a B-cell Lymphoma-2 oral inhibitor that is prescribed as a targeted drug alone or in combination with Obinutuzumab and Rituximab. High-risk older patients may also benefit from the combination of Venetoclax and Ibrutinib. The starting dose is 20mg daily for a week, which then ramps up to Venetoclax 100 mg to 400mg per day. The average treatment time is 24 months. 

Obinutuzumab: This is an antineoplastic cytotoxic drug that acts as an anti CD20 monoclonal antibody. It is a chemotherapy drug that is given to the patient as an intravenous infusion through a dedicated line. The B cells have CD20 proteins with which the drug binds to destroy them by engaging the adaptive immune system. 

These are some of the medications that have shown to slow down disease progression in CLL patients and helped to increase the survival rate over the years. Even though there are side effects to this, they are not consistent and easily manageable. 

Conclusion 

Typically, out of 10, 7 patients suffering from CLL have a survival rate of 5 years or more after getting diagnosed. The length of survival time also depends on your overall health condition, medical history and the extent of the disease. If the diagnosed patient has been in a healthy condition for most of their lives, the chances of survival are more for them. The treatment options do not guarantee a surefire cure; they are only for managing the condition and treating the symptoms so that they don’t get worse over time.  

Read:-  Venetoclax for Chronic Lymphocytic Leukemia