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Prostate cancer is one of the most frequent cancers in the male population. This is the most frequent malign tumour in the male urogenital system and the second cause of death from cancer in men after lung cancer, with a mortality rate of 12%.
If there is any suspicion, due to symptoms or high PSA levels, a rectal examination will be performed along with a new serum PSA analysis. If the rectal exam is positive (if a nodule or hardening of the prostrate is detected) a biopsy will be carried out. If the rectal examination is negative, the PSA levels will be assessed, to determine whether to carry out a biopsy or not. The PSA is used as a filter for the general population, in order to enable early diagnosis of prostate cancer.
It is a good tumour marker, because it increases when the prostatic glands break down due to tumour growth. As it is also present in normal prostates and it also increases in the benign growth of the prostate, it must always be interpreted in each patient's individual context. An increase in PSA is not a synonym for prostate cancer, and a rectal examination and ultrasound scan should always be carried out. The final diagnosis is given only by a biopsy.
It is often asymptomatic and the first warning sign is high PSA levels. Patients may also present tiredness, loss of appetite and weight loss. Local alterations are also frequent: urinary obstruction, urinary retention, presence of blood in the urine, urinary infections. In the case of spreading, bone pain is frequent.
The typical profile is a male between 50 and 70 years old, in whom benign prostate growth may coexist.
Diagnosis of prostate cancer is carried out using serum PSA, rectal examination and an ecodirected prostate biopsy.
When prostate cancer is localised and low-risk, it can be treated through extirpation and radiotherapy. In the case of spreading, treatment through radiotherapy and hormones will be assessed, in order to stop tumour growth. Occasionally, if the patient is elderly, the development of the cancer will be closely monitored before extirpation, as in some cases, it poses no short-term threat to their survival.
Rectal examination, determination of serum PSA, prostate biopsy.
Survival rates for prostate cancer depend on the state at the time of diagnosis; it is quite favourable in local states, less so in advanced states and worse once it has spread. Periodic prostate evaluation by primary care doctors is therefore indicated.
Blood smear, making a small prick in a finger, in order to assess cell morphology. This prick is used to conduct a morphological examination of blood cells, allowing a first approximation and examination of possible diagnoses.
A blood smear or peripheral blood test is performed by obtaining a blood sample through a finger prick (a puncture in the fingertip with a very fine needle) or a venipuncture (extraction from a vein), and carefully spreading a drop of blood on a glass slide until it forms a very thin film. The cells are then stained and the morphology of the cells is analysed under an optical microscope.
Microscopic study of a peripheral blood smear allows the cells present in the blood sample to be seen directly and their morphological characteristics analysed (shape, size and cell organelles such as the nucleus or granulation characteristic of some cells, and also inclusions, deposit of substances, and even microorganisms such as parasites or bacteria).
Using this test, we can check if the cells have a normal or altered appearance. If any alterations are detected, they can be described and an overall interpretation of the exam can be drawn. This allows the suspicion of various diseases to be ruled out or confirmed, both blood and non-blood-related conditions. It also allows observation of the effects that other conditions within the body have on blood cells, such as infections, haemorrhages, trauma, etc.
If the blood smear suggests the presence of a blood or bone marrow disease, it may be necessary to conduct bone marrow aspiration and/or biopsy to confirm the diagnosis.
This is a puncture and aspiration of the bone marrow using a fine needle under local anaesthesia. Bone marrow material is aspirated through the needle (in the case of aspiration) or a small, cylindrical sample is obtained from the bone marrow inside the needle (in the case of biopsy).
The area is sterilised with iodine and then local anaesthesia is applied. A fine needle puncture is then performed and the bone marrow (material from inside the bones) is aspirated. It is a simple technique that is usually practised on the hip bone (iliac crest) or the sternum. The aspirated material is subjected to different diagnostic procedures such as smears to assess cell morphology, microbiological cultures, immunophenotyping techniques, cytogenetic and molecular studies.
This technique serves to study the bone marrow. It is essential for the diagnosis and monitoring of many blood diseases, as well as screening for other conditions. A bone marrow exam enables diagnosis of bone marrow or blood cell diseases such as leukaemia, lymphoma, myeloma, myelodysplastic syndrome, as well as non-haematological diseases that may affect the bone marrow, such as tumours from other origins, deposit diseases, etc. Following treatment of these diseases, bone marrow exams also help to evaluate treatment efficacy.
Aspiration and biopsy are simple techniques that are performed as out-patient procedures (they do not require admission to hospital) and under local anaesthesia and/or sedation. The total duration of the procedure is approximately 30 minutes, and at the end the patient can go home, needing only minor oral analgesia in case of local discomfort. A small bruise may occur at the puncture site, but this is not common.
A procedure that, by introducing a flexible tube (bronchoscope) into the nose or mouth, allows the bronchial tree to be viewed, for diagnostic and/or therapeutic purposes.
There are various diseases or situations that may require this diagnostic test, such as lung cancer, lung transplantation, hemoptysis, diffuse interstitial lung disease, and lung involvement in immunocompromised patients, among others.
To examine the bronchial tree and obtain samples of secretions or tissues for analysis with the aim of gaining an aetiological diagnosis of the causative illness. It can also be a therapeutic test, allowing suction of secretions or clots, extraction of foreign bodies, permeability of the airway in lung tumours and treatment of complications resulting from lung transplant.
With the patient normally lying down and consciously sedated, the bronchoscope is introduced into the airway, administering local anaesthesia in the passageways (larynx, trachea and bronchi). After examining all the bronchi and identifying any possible lesions, samples are taken, which may include: bronchial aspiration, bronchoalveolar lavage, bronchial brushing, transbronchial puncture, bronchial biopsy or transbronchial biopsy.
Minor undesirable effects may appear, such as snoring, cough, fever, localised pain, nausea or sickness and coughing up small amounts of blood, which are usually self-limiting and present no risk to life. Less commonly, major complications may occur, such as haemorrhage, low blood pressure, high blood pressure, pneumothorax (entry of air into the thorax outside the lung). In very rare cases, complications such as arrhythmia or arrest of the heart, respiratory depression or arrest and acute stroke, may be severe and require medical or surgical treatment, including a small risk of death.
Rigid bronchoscopy, CT-guided needle lung biopsy, mediastinoscopy, surgical lung biopsy.
In general, patients with sarcoma and other musculoskeletal tumours are very vulnerable and receive very long treatment. For this reason, health education is essential, for patients, their families or the main carer, and also on discharge. Hygiene, physical position, medication, pain and emotional support will all be included.
It is important to follow a series of advice related to lifestyle and treatment. The most important advice is:
Oral mucositis is the redness or a burning sensation produced by chemotherapy and radiotherapy. It consists of inflammation of the digestive mucous membrane, frequently in mucous membrane in the oral cavity, and may lead to an ulcer, causing pain and/or difficulty eating as well as affecting the quality of life and the patient’s ability to continue with treatment.
Good prevention and early detection are fundamental to avoid complications. To reduce the symptoms of mucositis it is important to follow the following advice:
Before receiving your first cancer treatment
Have a dentist check-up to detect possible conditions and reduce the risk of complications during treatment.
During treatment:
If you notice ulcers in your mouth or any other change (redness, burning sensation, white spots, etc.) that cause pain or stop you from eating properly, consult your nurse and/or day hospital.
If you have a fever which develops call the immediate care line or go to A&E.
Sarcomas are an uncommon type of cancer that account for only 1-2% of all tumours in adults. They also represent a complex entity, given that there are more than 70 types, with differences in terms of their diagnosis, prognosis and treatment. Accordingly, sarcoma patients need to be assessed by multidisciplinary committees with vast experience in this disease.
Sarcomas are a set of rare tumours whose origin lies in the soft tissues of the body or the bones.
Soft tissues include muscles, nerves, vessels and fat. These tissues may also form part of organs.
The infrequency of sarcomas makes it necessary to handle clinical cases and their treatment on an individual basis, which generally involves a decision-making process that is shared by several professionals with expertise in this disease and the patients themselves.
The correct diagnosis of a sarcoma and its specific type is the first critical step to be taken, as it will form the basis of the clinical handling of the patient, as well as the precise information about the nature of their disease.
In contrast to many cancers, sarcomas do not usually generate symptoms in their early stages of growth. This is because they develop in areas of the body in which they can progressively grow by pushing against structures and organs.
The first symptom may be a painless lump. The majority of lumps are benign, but if it grows quickly, hurts, is deep and/or measures more than 5 centimetres, it is more likely to be a sarcoma. Sometimes the symptoms may appear as a result of excessive compression of the body’s various tissues and organs.
There is no clear factor that triggers a sarcoma. Certain inherited genetic syndromes may predispose a person to being more likely to develop a type of sarcoma, such as Li–Fraumeni syndrome, neurofibromatosis or familial adenomatous polyposis.
One of the most important steps is to confirm the clinical suspicion of sarcoma and identify its specific type. This requires a biopsy to obtain a fragment of the tumour so it can be studied by Pathological Anatomy.
It is sometimes diagnosed with molecular techniques in association with radiological tests like x-rays, computed tomography (CT), magnetic resonance imaging (MRI) or PET-CT.
The treatment of all sarcoma patients is always agreed by multidisciplinary committees composed of professionals with expertise in sarcomas from a variety of the services of our centre: Medical Oncology, Radiation Oncology, Traumatology, General Surgery, Radiology and Pathological Anatomy.
Given that sarcomas may arise in any part of the body, occasionally other specialists may also participate.
The treatment of sarcoma patients may include:
The most suitable procedure depends on a number of different factors in addition to the specific type of sarcoma. Targeted therapy and immunotherapy play a very important role in certain types of sarcoma. Finally, there are also clinical trials that experiment with new therapies.
The commonest are radiological tests like those described above (x-ray, CT, MRI and PET-CT).
As there is no specific cause of sarcomas, in the majority of cases there are no specific measures that can be taken beyond the usual healthy living habits recommended by the World Health Organization.
Patients with inherited genetic syndromes, however, are advised to undergo monitoring in specialist units.
Genetic predisposition to cancer is an increased risk of developing cancer due to alterations in specific genes. It is not inherited cancer, but a predisposition. Suspected when cancers occur in multiple generations, at young ages, or multiple tumors in one person. Genetic testing uses blood, saliva, or biopsy and guides early detection, prevention strategies, intensive monitoring, and sometimes prophylactic surgeries.
Cancer is characterised by excessive and uncontrolled cell growth that invades and damages tissues and organs. It is a multi-factor illness that is caused by a combination of genetic and environmental factors.
Most cancers are sporadic, but some 5 to 10% of cancer diagnoses involve a hereditary genetic origin. This means that specific genes, called cancer susceptibility genes, present germ cell abnormalities (found throughout the body) that increase the risk of developing cancer.
It's important to point out that cancer is NOT hereditary, but the predisposition to developing it is. Having genes that are associated with cancer susceptibility simply means you have a higher risk of having the disease, not that you will have cancer for sure. This genetic predisposition can be transmitted from parents to offspring, normally following an autosomal dominant inheritance pattern, meaning that there is a 50% chance of passing the gene to descendants.
In some cases, the genetic susceptibility is individual and caused by a combination of multiple genetic differences (a combination of low-risk polymorphisms or allele variants). Identifying a genetic abnormality known to increase the risk of developing cancer in a family allows its members to benefit from early cancer detection and prevention measures, as well as to seek specific, targeted treatments against that type of cancer.
There are different genes associated with an increased risk of falling ill with cancer. Among the most frequent and well known are the genes:
The genes APC and MUTYH, linked with familial adenomatous polyposis –the formation of a large number of adenomatous polyps (non-malignant tumours) in the colon– and colon cancer.
There are different clinical criteria that may arouse the suspicion that an individual has a hereditary genetic abnormality that predisposes them to certain kinds of cancer, such as:
When these criteria are detected, they are referred to the genetic assessment unit specialising in cancer, where the need to perform a genetic study to rule out the possibility of a hereditary predisposition to cancer will be determined. This multi-disciplinary unit is staffed by physicians who are specialists in hereditary cancer and genetic counsellors. Here, an individual risk assessment, genetic tests, and follow-up for the carriers of the gene are carried out.
There are different syndromes that involve a genetic predisposition to developing cancer. For example, there are different genes that can make someone have a genetic predisposition to breast cancer. The most common are:
The genetic predisposition to developing colon cancer can be divided into two types: polyposic and non-polyposic.
There are different types of polyposis colon cancer. Familial adenomatous polyposis (FAP) presents the highest risk for developing colon cancer. It is characterised by hundreds or thousands of polyps in the colon, and sometimes also throughout the entire digestive tract. These polyps are not malignant lesions, but they can degenerate and develop into cancer. Thus, individuals with FAP end up developing colon cancer if these polyps are not removed. Pathogenic alterations in the APC gene are responsible for this condition. In addition, carriers of APC gene mutations are also at risk for other tumours or conditions (hepatoblastoma, thyroid tumours, and desmoid tumours).
The main syndrome entailing a predisposition to non-polyposis colon cancer is Lynch syndrome. This syndrome entails a high risk of developing colon and endometrial cancer, along with a risk of developing ovarian, bile duct, urinary tract, and gastric cancer. It is caused by mutations in the genes that are in charge of DNA repair, specifically, those tasked with mismatch repair, namely MLH1, MSH2, MSH6, PMS2, and EPCAM.
We can also find a genetic predisposition to endocrine tumours. Pheochromocytomas and paragangliomas are rare tumours that are caused by a hereditary genetic abnormality in 40% of cases. These can be caused by abnormalities in the succinate-dehydrogenase-encoding genes (SDHx), RET gene (MEN2 syndrome),MEN1 gene,NF1 gene (neurofibromatosis type 1) or FH gene, among others.
A genetic diagnosis is usually done with a blood sample, but a saliva sample or skin biopsy can also be used. DNA (present in the nucleus of our cells) is extracted from this sample for analysis.
There are different techniques for carrying out genetic studies. Currently, at our centre, we perform gene panel studies. This entails analysing different genes linked with the genetic predisposition to cancer to rule out any abnormality in them; this is also called gene sequencing.
When a genetic abnormality is found in a family, a predictive study is carried out. This kind of study determines if an individual also presents the genetic abnormality detected in the family.
Depending on the genetic change found, different measures for early detection and prevention can be recommended. For example, individuals with a mutated BRCA1/2 gene should begin to undergo an annual breast check-up, with a breast MRI and a mammogram, from the time they are 25–30 years old. Individuals with Lynch syndrome should get annual colonoscopies from the age of 25 onward.
Depending on the type of genetic disorder, risk reduction surgeries can also be an option. For example, in individuals diagnosed with FAP, depending on the number of polyps they have, a prophylactic colectomy (removal of the colon) can be performed to reduce their risk of developing colon cancer.
Follow-up and prevention measures are determined on an individual basis in the corresponding specialist's medical consultation. Additionally, at the medical office in charge of hereditary cancer, a reproductive genetic assessment is offered, depending on the genetic abnormality.
A rare chronic blood disease that is slow to develop. It is characterised by increased platelet production and is associated with greater risk of thrombosis (clotting) and bleeding. Patients with essential thrombocythemia are usually asymptomatic and it is detected during routine blood tests. There is currently no cure for this condition and treatment is targeted at preventing complications.
It is included within the group of chronic myeloproliferative disorders, which are a type of blood cancer that is slow to develop. Its cause is not known, although there are mutations known to be associated with the condition in 80% of cases. It is not hereditary, but some families may have several members affected by it.
It is characterised by increased platelet production and is associated with greater risk of clotting in the arteries and veins, or in some cases with bleeding.
It is a chronic illness that cannot currently be cured, with a normally benign evolution. It can be effectively controlled over long periods and generally has little impact on daily activities and work. Patients with this condition have increased risk compared to the general population of developing other blood diseases, such as acute leukaemia or myelofibrosis.
Many patients show no symptoms, either when they are initially diagnosed or as the condition evolves. Different combinations of symptoms may appear, such as tiredness, itching, night time sweating, aching bones and headaches.
The severity of symptoms varies a lot depending on the patient.
It is considered a rare disease, with a low incidence of 1.5-3 cases per 100,000 inhabitants. It mainly affects people aged 60-70 years and to a lesser extent young people. It is more common in women
It is normally diagnosed through blood tests that show a sustained increase in platelet count.
A bone marrow biopsy can be performed for diagnosis, which, together with the analysis, will allow the determination of risk factors for the progression of the disease, which in turn guide treatment.
It is usually associated with genetic mutations that support diagnosis.
Administering antiplatelets or drugs to reduce the number of platelets is not always indicated.
The aim of treatment is to prevent complications due to clotting and bleeding, as well as controlling the symptoms related to this condition. Depending on the risks and symptoms, the haematologist will therefore determine when to start treatment.
There are special circumstances, such as pregnancy, in which a multidisciplinary approach is required.
It is usually controlled by analysis.
The most important thing is to prevent clotting complications associated with this condition by controlling cardiovascular risk factors (high blood pressure, dyslipidaemia, smoking, obesity, sedentary lifestyle) and following the treatment recommended by your haematologist.
A rare slow-growing chronic blood cancer. It is mainly characterised by increased production of red blood cells, associated with greater risk of clotting, both in veins and in arteries. It has non-specific symptoms, such as increased facial redness and bodily itching. Although there is currently no cure, it can be effectively controlled.
It is included within the group of chronic myeloproliferative disorders. Its cause is not known, although there are known mutations associated with it in the JAK2 gene that occur in 98% of cases. It is not hereditary, but some families may have several members affected by it.
It is characterised by increased production of red blood cells (the number of white blood cells and platelets may also go up) and is associated with increased risk of clotting in arteries or veins.
It is a chronic disease, which cannot currently be cured. It can be effectively controlled over long periods and generally has little impact on daily activities and work. Patients with this condition have increased risk compared to the general population of developing other blood diseases, such as acute leukaemia or myelofibrosis.
There may initially be no symptoms. Facial redness is characteristic of this condition. Patients often present with tiredness, headaches, dizziness and itching (particularly after showering). They may also experience abdominal pain due to increased spleen size.
It mainly affects patients around 60 years old and is a little more common in men than in women.
Mainly done through an analysis revealing high levels of haemoglobin and haematocrits. The number of platelets and white blood cells may also be elevated. A molecular test is also sometimes conducted (JAK2 gene mutation). Other tests may sometimes be needed to complete the diagnosis, such as a bone marrow biopsy.
Treatment aims to prevent complications and control symptoms. It is based on decreasing excess red blood cells by phlebotomies (blood extractions performed in the blood bank). Except for some contraindications, patients require antiplatelets (acetylsalicylic acid). Other drugs to reduce red blood cells may also be indicated.
The most important thing is preventing clotting complications associated with this condition by controlling cardiovascular risk factors (high blood pressure, dyslipidaemia, smoking, obesity, sedentary lifestyle) and following the treatment recommended by your haematologist.
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