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Vaginal Cancer

Dr. HelloDox Care #
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What is vaginal cancer?
Vaginal cancer happens when malignant (cancerous) cells form in the vagina. It is a very uncommon disease. The vagina, also known as the birth canal, is a hollow channel that goes from the opening of your uterus to the outside of your body.


There are two types of vaginal cancer:
Squamous cell carcinoma: This is by far the more common of the two. It happens when cancer forms in the flat, thin cells that line the vagina. This type spreads slowly and tends to stay close to where it starts. But it can move into other organs including the liver, lungs, or bones. Older women are most likely to get this form of the disease. Nearly half of all cases occur in age group of 60 & more.

Adenocarcinoma: This type starts in the glandular cells in the lining of the vagina. These cells make mucus and other fluids.

Of the two main types, Adenocarcinoma, the more likely to spread to other areas. These include the lymph nodes (organs that filter harmful substances in the body) in the groin area and the lungs.

Clear cell carcinoma: This is an even rarer form of adenocarcinoma. It is been linked with women whose mothers took a hormone called diethylstilbestrol (DES) in the early months of pregnancy. Between 1938 and 1971, doctors often prescribed this medication to pregnant women to prevent miscarriage and other problems. Doctors stopped using it in 1971. But just how long do you remain at risk if your mother was given DES? That remains unknown.

Women who haven’t been exposed to it can still get vaginal cancer, but the chances are very small. If DES isn’t a factor, clear cell carcinoma is most likely to happen after menopause.


Vaginal Cancer and HPV (Human Papilloma Virus):
About nine out of every 10 vaginal cancer cases are linked to human papilloma virus, or HPV, infection. This is the most common STI, or sexually transmitted infection. There are two different vaccines to prevent HPV. But once you have it, it will most often go away on its own without treatment. When the infection lingers, though, it can cause cancer.


Other Causes
The following things can also increase your chances of developing vaginal cancer:
Drinking alcohol
Having cervical cancer or pre-cancer
Having HIV
Smoking
Many cases of vaginal cancer aren’t linked to any specific causes.



What are the symptoms for Vaginal Cancer?
These can include pain or abnormal vaginal bleeding. But the disease often doesn’t come with any warning signs. Your doctor might find it during a routine exam or Pap test.

Other symptoms can include feeling a lump in your vagina, pain in your pelvis, and painful sex.

If you notice any of these things, it doesn’t mean you have vaginal cancer. You could just have an infection. But it’s important to get it checked out.


What are the diagnosis and treatment for Vaginal Cancer?
If a pelvic exam shows there might be cancer, your doctor may want to take a closer look with a procedure called colposcopy. She’ll use a lighted magnifying instrument, a colposcope, to check your vagina and cervix for anything abnormal.

She might take tissue samples at the same time. A specialist will study the samples under a microscope. This is called a biopsy.

If she finds cancer, your doctor will choose a treatment based on many factors. These include how close the cancer is to other organs, which type of cancer is present, how advanced it is, whether you’ve had a hysterectomy, and if you’ve had radiation treatment in your pelvic area.

Most likely, your doctor will recommend one of the following courses of action:

Surgery: This is the most common treatment. Your doctor may use a laser to cut out affected tissue or growths. In some cases, she may need to remove all or part of the vagina. Or she’ll perform a hysterectomy. This is when the uterus is taken out. Sometimes the cervix or other organs need to be removed, too.

Many women can have a normal sex life after surgery. Your doctor will need to tell you what’s safe and when. Sex can increase the chance of infection, and it can cause bleeding or strain the surgical site. How you’re healing and what kind of surgery you’ve had will make a difference in the effect on your sex life, too.

Radiation therapy: This treatment uses high-powered X-rays or other forms of radiation to kill the cancer. It might be performed using a machine that sends X-rays into your body from outside. Your doctor might also place a protected radioactive substance inside your body on or near the cancer.

Radiation treatments in the pelvic area can damage the ovaries. This cuts off estrogen production, which leads to menopause symptoms like hot flashes and vaginal dryness. If you’ve already been through menopause, these symptoms likely won’t happen.

This type of therapy also can irritate healthy tissue. Your vagina might get swollen and tender. Sex may be painful.

Chemotherapy (“Chemo”): This kills or stops the growth of cancer cells using medications. You might take them by mouth or get them through an IV. If you have squamous cell vaginal cancer, your doctor might prescribe a chemo treatment in lotion or cream form.

Many patients lose their sex drive when they get chemo. Plus, the physical side effects, like nausea, hair loss, and changes in body weight can cause feelings of insecurity. Knowing that the physical side effects will improve when treatment stops can help a lot.


Can you Prevent Vaginal Cancer?
The best way to guard against it is to avoid being exposed to HPV. There are two vaccines, Gardasil and Gardasil 9, available to prevent vaginal cancer. Gardasil protects you from the four most common types of HPV. Gardasil 9 covers nine types of HPV.

If you don’t want the vaccine, you might try the following lifestyle changes. Studies show they may help to reduce your risk of vaginal cancer:
Wait to have sex until your late teen years or beyond
Don’t have sex with more than one partner
Don’t have sex with someone who has more than one partner
Use condoms during sex
Get regular Pap exams
If you smoke, stop. If you don’t smoke, don’t start.

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Urethral Cancer

Dr. HelloDox Care #
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What Is Urethral Cancer?
When you use the bathroom, urine moves from your bladder through a tube called the urethra. The urethra goes through the prostate and the penis in men. In women, the tube is shorter and ends just above the opening to the vagina. If you have urethral cancer, cells in the area grow abnormally and out of control. Doctors don’t know what causes this rare form of cancer.

Who are at Risk?
People over age 60 are at high risk. Your risk might be higher, if you have had bladder cancer, frequent urinary tract infections, or sexually transmitted diseases that lead to an inflammation of the urethra.
Urethral cancer has been linked to human papilloma virus, especially HPV 16. The HPV vaccine protects against type 16. Doctors recommend it for girls and boys at ages 11 or 12. But females can get the vaccine through age 26 and males through age 21.


What are the symptoms of Urethral Cancer?
You may not have any symptoms at first. Over time, you might notice it is hard for you to pee. Maybe you have a weak urine flow or can’t hold it when you do have to go. Or perhaps you go to the bathroom more often, especially at night. You might see blood in the toilet or notice a discharge from your urethra. A swollen spot or a painless lump may appear in your groin or penis. These aren’t always signs of cancer, but can be signs of something else. See your doctor to know for sure.


Types of Urethral Cancer:
There are three types; squamous cell carcinoma, transitional cell carcinoma, and adenocarcinoma.

Squamous cell carcinoma: In women, it starts in the part of the urethra near the bladder. In men, it forms in the cells that line the urethra in the penis. This is the most common kind of urethral cancer.

Transitional cell carcinoma: In women, cancer cells grow near where the urethra opens. In men, they grow where the tube passes through the prostate.

Adenocarcinoma: In this form of the disease, cancerous cells begin to grow in the glands around the urethra.

How Is It Diagnosed?
If you have problems when you pee or any of the symptoms listed above, see your doctor. He’ll ask questions about your medical history and do a physical exam. This may include a pelvic and rectal exam. Your doctor might order blood tests and ask for a urine sample to look for abnormal cells. He may recommend a cystoscopy. That’s where he uses a tool called a cystoscope to examine the inside of your urethra. He may do a biopsy. That means he’ll take cells from the urethra and bladder and look at them under a microscope to see if they’re cancerous.

If your doctor finds that you have urethral cancer, he will order more tests to see if cancer has spread to other parts of your body. (Cancer cells can move to other parts of your body through tissue, blood, and the lymph system). These tests may include chest X-rays, a CT scan of the pelvis and abdomen, or a magnetic resonance imaging test (MRI) of the pelvis.

A procedure called urethrography can help your doctor see if there is cancer in tissue close to the urethra. This is a series of X-rays your doctor performs after he injects ink into the urethra and bladder.

How Is It Treated?
Most often it is treated through surgery. But that depends on where the cancer is located. Sometimes, doctors can get rid of it just by removing the tumor. Other times, the urethra and bladder may be taken out. Your surgeon will need to make a new place for your body to store urine and build another way for the body to release it. After surgery, you may need to wear a bag outside your body to collect the urine.
The vagina or part of or all of the penis might also be removed. Plastic surgery may be performed to reconstruct the reproductive organs.

Your doctor may use radiation or chemotherapy (“chemo”), either with or without surgery, to kill cancer cells. He may also use something called “active surveillance” to monitor cancer. This means you’re not given treatment right away. Instead, your doctor will perform tests often to see if cancer gets worse. If it does, he’ll develop a treatment plan.

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Testicular Cancer

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Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.

Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 35.

Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments or a combination.

Testicular cancer care at Mayo Clinic

Symptoms
Signs and symptoms of testicular cancer include:

A lump or enlargement in either testicle
A feeling of heaviness in the scrotum
A dull ache in the abdomen or groin
A sudden collection of fluid in the scrotum
Pain or discomfort in a testicle or the scrotum
Enlargement or tenderness of the breasts
Back pain
Cancer usually affects only one testicle.

When to see a doctor
See your doctor if you detect any pain, swelling or lumps in your testicles or groin area, especially if these signs and symptoms last longer than two weeks.

Causes
It's not clear what causes testicular cancer in most cases.

Doctors know that testicular cancer occurs when healthy cells in a testicle become altered. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes some cells develop abnormalities, causing this growth to get out of control — these cancer cells continue dividing even when new cells aren't needed. The accumulating cells form a mass in the testicle.

Nearly all testicular cancers begin in the germ cells — the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn't known.

Risk factors
Factors that may increase your risk of testicular cancer include:

An undescended testicle (cryptorchidism). The testes form in the abdominal area during fetal development and usually descend into the scrotum before birth. Men who have a testicle that never descended are at greater risk of testicular cancer than are men whose testicles descended normally. The risk remains elevated even if the testicle has been surgically relocated to the scrotum.

Still, the majority of men who develop testicular cancer don't have a history of undescended testicles.

Abnormal testicle development. Conditions that cause testicles to develop abnormally, such as Klinefelter syndrome, may increase your risk of testicular cancer.
Family history. If family members have had testicular cancer, you may have an increased risk.
Age. Testicular cancer affects teens and younger men, particularly those between ages 15 and 35. However, it can occur at any age.
Race. Testicular cancer is more common in white men than in black men.
Prevention
There's no way to prevent testicular cancer.

Some doctors recommend regular testicle self-examinations to identify testicular cancer at its earliest stage. But not all doctors agree. Discuss testicular self-examination with your doctor if you're unsure about whether it's right for you.

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Skin Cancer

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Skin cancer is the most common type of cancer diagnosed in the United States and can be broken down into squamous cell cancers, basal cell cancers, and melanomas, as well as some less common cancers. Symptoms may include a sore that doesn't heal, a new spot on the skin, or a mole that is changing. When doctors suspect skin cancer during an exam, a biopsy is needed to make the diagnosis. Treatment options depend on the type and stage, with surgery to remove cancer being the most common approach. With melanomas and advanced squamous cell carcinomas, other treatments such as immunotherapy, chemotherapy, or radiation may be needed. Luckily, there are many simple things you can do to lower your risk.

At the current time, skin cancer is considered an epidemic in the United States, accounting for 50 percent of all cancers. Roughly 80 percent of skin cancer-related deaths are due to melanoma.

Your Skin
Many people do not think of the skin as an organ, but like other organs, it has a discrete structure and many important functions. Since treatment options for skin cancer often depend on the depth of cancer, it's helpful to understand the three basic layers of the skin.

Epidermis

The epidermis is the top layer of skin and serves several functions, including protecting the interior of your body from the environment. Cells in this layer include the following, which give rise to the most common skin cancers—squamous cell carcinoma, basal cell carcinoma, and melanoma:

Squamous cells lie just below the outer surface of the skin.
Basal cells lie beneath the squamous layer and produce new skin cells.
Melanocytes are located in the basal cell layer of the skin and produce melanin, the pigment that gives skin its color.
Dermis

The dermis is the middle layer of skin made up of collagen and elastin. It contains hair follicles, oil-producing glands (sebaceous glands), nerves, and blood vessels.

Subcutaneous Tissues

The subcutaneous tissue contains fat, connective tissue, and larger blood vessels; the amount of this tissue varies depending on a person's weight.

Types
There are three common types of skin cancer and more than 100 less common types. Together, basal cell carcinoma, and squamous cell carcinoma are referred to as non-melanoma skin cancers.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common form of skin cancer, accounting for 75 percent to 80 percent of these cancers. The lifetime risk of developing a basal cell carcinoma is around 30 percent. It was once found mostly in middle-aged or older people, but is increasingly being found in younger people. It is the most common skin cancer among Hispanics.

Basal cell carcinoma usually begins on areas exposed to the sun, such as the face, neck, and hands. It is slow-growing cancer that rarely spreads to other parts of the body, but people with a history of BCC are at higher risk for getting a second case.

Cancer originates in the basal cell layer of the epidermis (the stratum basale). The basal cells there mutate and begin to replicate uncontrollably. As the cancerous cells grow, they can spread into the dermis, nearby lymph nodes, and may eventually invade bones. If not treated, they can damage the surrounding tissue, causing disfigurement.

Treatments are very effective when these cancers are found and treated promptly.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) accounts for 16 percent to 20 percent of skin cancers and occurs twice as often in men as in women. These are the most common type of skin cancers found in blacks.

Unlike basal cell carcinomas, these cancers may spread (metastasize) if they become large. It usually occurs on the face, ear, neck, lips, and backs of the hands. SCC can also begin within scars or skin ulcers on other places on the body. As with basal cell carcinoma, the available treatments are very effective if the tumor is detected while it is small and thin.

Squamous cell carcinomas have the strongest association with sun exposure.

Melanoma

Melanoma is the most feared type of skin cancer. Though less common than basal cell and squamous cell cancer, it is responsible for the majority of deaths from the disease as a whole. Melanoma may arise in normal skin but often begins in an existing mole. It is found most frequently on the back in men, on the legs in women, and on the palms of the hands, soles of the feet, and under the fingernails or toenails of people of both sexes with darker skin colors. That said, these cancers may occur anywhere, including areas of the skin that have never been exposed to the sun.

The incidence of melanoma has been rising dramatically in the United States for the last three decades. While melanoma in general is 20 times more common in whites, the incidence of cases that occur under the nails is similar for people of all skin color. In addition, the survival rate in those diagnosed is lower in blacks.

The prognosis of melanoma is good when found early, but drops precipitously when it spreads to distant lymph nodes or organs, such as the bones, the lungs, the liver, and the brain. Newer treatments, however, are making a difference in survival, and even some advanced melanomas can now be controlled with these options.

Rare Types

The other types of cancer that can arise in the skin or skin-related structures are far less common. A few of these include:

Merkel cell carcinoma: Merkel cell carcinomas are rare skin cancers most often found around the eye in middle-aged people. For unknown reasons, these cancers are increasing. They tend to be aggressive and spread rapidly to other parts of the body.
Kaposi's sarcoma: This cancer is caused by the Kaposi sarcoma herpesvirus, and is usually found in people with HIV/AIDS or who are immunosuppressed for other reasons, such as an organ transplant. It presents as large red, blue, or brown splotches around the body along with swelling that can be severe. Fortunately, it often responds well to HIV medications.
Sebaceous gland carcinoma: These cancers originate in sebaceous glands and occur most often in older women, around the eye.
Dermatofibrosarcoma protuberance: These cancers begin as a hard nodule that originates in the dermis and spreads rapidly. They are related to a gene mutation that results in overproduction of a protein known as a platelet-derived growth factor.
Skin Metastases and Other Cancers That Occur in the Skin

Sometimes, cancers that arise in other areas of the body may spread (metastasize) to the skin. Cancers most commonly associated with skin metastases include breast cancer, colon cancer, and lung cancer. When other cancers spread to the skin they are not classified as skin cancer. In fact, though cancer may now be affecting the skin, its cells are clearly identifiable as belonging to instigating cancer when examined under a microscope. Treatment for cancer at play, rather than skin cancer, is needed.

Some examples of this include inflammatory breast cancer, which often begins with redness and a rash on the breast); Paget's disease, a form of breast cancer that begins on the skin of the nipples; and cutaneous T cell lymphomas (including mycosis fungoides and Sezary syndrome), which often begin as flat, red patches of skin that are extremely itchy.

Symptoms
Signs and symptoms of skin cancer may include any change that is noted on the skin, such as:

A sore that doesn't heal
A mole that is changing
Scaly, crusty appearing lesions
Pink, white, or flesh-colored lumps that appear dome-like
Itching
Some refer to the ABCDE (and F) mnemonic to help them recognize when a skin change could be skin cancer:

A stands for asymmetry: A mole or sore that is asymmetric.
B stands for borders. The borders of a melanoma may be irregular, notched, or blurry.
C stands for color. Melanomas often have more than one color or hue.
D stands for diameter. A mole that is larger than a pencil eraser is more likely to be a melanoma.
E stands for either elevation or evolution. The mole may be elevated (often irregularly) and is often evolving (changing) over time.
F: Though an unofficial qualifier, many add this to represent a skin change that is "funny" looking.
What Are the Most Common Skin Cancer Symptoms?
Causes and Risk Factors
We don't know exactly what causes skin cancer, though we have identified several risk factors. Some of these include:

Sun exposure (especially extensive and/or unprotected)
Pale skin
Red or blonde hair
Light eyes (green or blue eyes)
Skin that rarely tans and burns easily
Family and/or personal history of skin cancer
Having one of several genetic syndromes, such as xeroderma pigmentosum
Having many moles (more than 50) or having atypical moles (nevi)
Scars from burns or previous skin infections
A weakened immune system
Use of some medical treatments and medications, such as radiation therapy for cancer and ultraviolet light for psoriasis
Frequent exposure to chemicals such as tar and vinyl chloride
Exposure to arsenic in drinking water
Smoking (increases the risk of squamous cell carcinoma)

Causes and Risk Factors of Skin Cancer
Diagnosis
Diagnosing skin cancer begins with a careful history (paying attention to symptoms and risk factors) and a physical exam. Based on the appearance of the skin lesion, a doctor may recommend a biopsy, as it can sometimes be difficult to know whether an abnormality is cancer or not based on its visible appearance. This can be even more challenging in non-white populations.

A biopsy can be done in one of several ways, including:

Shave biopsy: The most common if a basal cell or squamous cell carcinoma is suspected), this procedure involves numbing the skin and shaving off a piece of the lesion. A punch biopsy may also be done.
Incisional biopsy: An incision is made and part of an abnormality is removed to be viewed by a pathologist.
Excisional biopsy: In this case, the entire abnormality is removed, along with an area of surrounding tissue, for a pathologist's evaluation. This is done if a melanoma is suspected.
If a skin cancer (melanoma and sometimes squamous cell carcinoma) is advanced, further tests are done to stage the disease and search for the presence of metastases. These may include a sentinel node biopsy, CT scans, a PET scan, or other tests depending on the location of the skin cancer.

How Skin Cancer Is Diagnosed
Treatments
The treatments for skin cancer will depend on many factors, such as the type of cancer, the size and depth, and more.

Surgically removing the tumor is the most common treatment. A special surgery called Mohs surgery involves removing successive pieces of tissue and checking the margins for any evidence of cancer so that the least amount of surgery to completely remove the tumor is done. With melanomas, a large area of surrounding tissue is removed.

For more advanced tumors that have spread to lymph nodes or other regions of the body, treatments such as immunotherapy, chemotherapy, targeted therapy, and radiation therapy may be needed.

What Are Your Skin Cancer Treatment Options?
Prevention and Early Detection
There are many things you can do to prevent skin cancer or at least reduce your risk. Being careful in the sun is important, but includes more than just wearing sunscreen; using other methods of protection (such as wearing clothing and hats, and avoiding mid-day sun) should be practiced as well. Some occupational exposures may increase risk, and gloves are recommended when working with many different chemicals and substances.

Not all skin cancers can be prevented, and early detection then becomes the goal. Self-skin checks should be considered, especially for those who have any risk factors for the disease. Some people who have significant risk factors or genetic syndromes associated with a higher risk may want to consider regular visits with their dermatologist.


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Penile Cancer

Dr. HelloDox Care #
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Penile cancer starts on the skin cells of the penis and can work its way inside.

It’s rare. But it can be treated, especially if it’s found early on.

In the U.S., doctors find it in about 2,100 men each year. If you or someone you love has it, you’ll want to know what your options are.

Causes
Experts don’t know exactly what causes this disease.

Not being circumcised may make it more likely. If bodily fluids get trapped in the foreskin and aren’t washed away, they may contribute to the growth of cancer cells.

Some research suggests that men who are exposed to certain strains of HPV (human papillomavirus) may also be more likely to get penile cancer.

This type of cancer is more common in men over age 60, in smokers, and in those who have a weakened immune system.

Symptoms
Changes in the penis skin are the most common symptom of penile cancer. They can show up on the foreskin of uncircumcised men, or on the penis tip (the glans) or shaft.

Warning signs of the disease can include:

Changes in thickness or color of skin on the penis
A lump on it
A rash or small “crusty” bumps on it; it can look like an unhealed scab.
Growths on the penis that look bluish-brown
Smelly discharge underneath the foreskin
A sore on the penis, which may be bleeding
Swelling at the end of the penis
Lumps under the skin in the groin area
Most men with these symptoms don’t have penile cancer. Instead, it’s an infection or an allergic reaction. Even so, it’s important to get any unusual symptoms on or near your penis checked out right away. Early treatment is best.

Diagnosis
Your doctor will give you a physical exam, talk with you about your symptoms, and may recommend other tests, such as:

A biopsy. The doctor will take a small sample of tissue from a skin lesion on the penis. Lab tests will check it for cancer cells.

Imaging tests, like X-rays, CT scans, ultrasounds, and magnetic resonance imaging (MRI). These look inside your body for tumors or other signs that cancer has spread.

Treatments
If your cancer is in the early stages, your treatment may include:

A medicine that goes on your skin as a cream
Cryotherapy, a procedure that uses an extremely cold liquid or a device to freeze and destroy tissue that contains cancer
Mohs surgery, in which doctors remove affected skin, one layer at a time, until they reach normal, healthy tissue
Lasers to cut and destroy areas that contain cancer
Circumcision, which is surgery to remove the foreskin. You would have this procedure if you only had cancer in your foreskin.
If your cancer is advanced or has a high risk of spreading, treatment may involve any of the above, and/or:

Surgery to remove some or all o your inguinal lymph nodes if your cancer has spread to them
Radiation and/or chemotherapy to rid your body of cancer cells
A penectomy, which is surgery to remove some or all of your penis
Most treatments for early-stage penile cancer don’t affect your ability to have sex, but chemotherapy and radiation may. Talk to your doctor about possible side effects.

Clinical Trials
Scientists are looking for new ways to treat early and advanced penile cancer in these studies, which test new drugs to see if they're safe and if they work. Clinical trials often are a way for people to try new medicine that isn't available to everyone. Your doctor can tell you if one of these studies might be a good fit for you.

Dr. Sandeep Jagtap
Dr. Sandeep Jagtap
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Dr. Pavan Prakash Pargaonkar
BHMS, Family Physician, 6 yrs, Pune
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Dr. Manish Pathak
MDS, Dentist Periodontist, 10 yrs, Pune
Dr. Manish Jawale
Dr. Manish Jawale
MD - Homeopathy, Homeopath, 17 yrs, Pune
Dr. AMITRAJ MHETRE
Dr. AMITRAJ MHETRE
MBBS, Pediatrician, 8 yrs, Pune
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