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The prostate is a gland in the male reproductive system found below the bladder and in front of the rectum. Prostate cancer is a type of cancer that forms in the tissues of the prostate. Prostate cancer usually occurs in older men. It is the 4th most common cancer worldwide accounting for 7.3% of all cancer. According to Globocon 2020 data, 1.4 million people were diagnosed with prostate cancer worldwide in 2020. In India, 25,700 patients were diagnosed with prostate cancer in 2018 with 17200 death. In the early-stage following, symptoms might be present e.g, Increase frequency of micturition, Urinary urgency, Urinary hesitancy, Nocturia. In the locally advanced stage following symptoms may be present i.e, haematuria, haematospermia, erectile dysfunction, rarely perineal pain. In the advanced stage, the patient may present with bone pain, leg weakness, lower leg swelling. Best Radiation Oncologist in Kolkata https://dranimeshsaha.com/ Ph: +918777427312

Pancreatic tumour is a  tumor that forms in the cells of the pancreas. The two main types of pancreatic tumors are pancreatic exocrine tumors and pancreatic neuroendocrine tumors. Most pancreatic cancers are exocrine tumors, which form in cells that make enzymes to help the body digest food and they are commonly know as pancreatic cancer.  Pancreatic neuroendocrine tumors form in neuroendocrine pancreas cells (such as islet cells). These cells make hormones that help control sugar levels in the blood. Pancreatic neuroendocrine tumors may be benign (not cancer) or malignant (cancer). They are much less common than pancreatic exocrine tumors and have a better prognosis. What is the global burden of Pancreatic cancer? According to Globocon 2018 data, there were there were 10860 new cases of pancreatic cancer diagnosed in 2018 in India with 10528 death. What are the risk factors for developing Pancreatic  cancer? Age- The risk of developing pancreatic cancer increases with age. Most people who develop pancreatic cancer are older than 45. In fact, 90% are older than 55 and 70% are older than 65. However, adults of any age can be diagnosed with pancreatic cancer. Gender- More men are diagnosed with pancreatic cancer than women. Race/ethnicity- Black people are more likely than Asian, Hispanic, or white people to develop pancreatic cancer. People of Ashkenazi Jewish heritage are also more likely to develop pancreatic cancer . Smoking- People who smoke tobacco are 2 to 3 times more likely to develop pancreatic cancer than those who don’t. Obesity, diet, and alcohol- Regularly eating foods high in fat is a risk factor for pancreatic cancer. Research has shown that obese and even overweight people have a higher risk of being diagnosed with and dying from pancreatic cancer. Chronic, heavy alcohol use can also increase the risk of pancreatic cancer, most likely by causing recurrent pancreatitis, which is repeated inflammation of the pancreas.. Diabetes. Many studies have indicated that diabetes increases the risk of developing pancreatic cancer, especially when a person has had diabetes for many years. In addition, suddenly developing diabetes later in adulthood can be an early symptom of pancreatic cancer. However, it is important to remember that not all people who have diabetes or who are diagnosed with diabetes as adults develop pancreatic cancer. Family history. Pancreatic cancer may run in the family and/or may be linked with genetic conditions that increase the risk of other types of cancer. This is called familial pancreatic cancer. You and your family may be at risk if 2 or more first-degree relatives or at least 3 members of the family have been diagnosed with pancreatic cancer. First-degree relatives include parents, children, and siblings. Rare inherited conditions. Members of families with specific, uncommon inherited conditions also have a significantly increased risk of pancreatic cancer, as well as other types of cancer. These conditions include the following: Hereditary pancreatitis (HP) Peutz-Jeghers syndrome (PJS) Familial malignant melanoma and pancreatic cancer (FAMM-PC) Hereditary breast and ovarian cancer (HBOC) syndrome Lynch syndrome People with the following inherited conditions may also have a higher risk of pancreatic cancer: Li-Fraumeni syndrome (LFS) Familial adenomatous polyposis (FAP) Chronic pancreatitis. Pancreatitis is the inflammation of the pancreas. Some research suggests that having chronic pancreatitis may increase the risk of developing pancreatic cancer. Chemicals. Exposure to certain chemicals such as pesticides, benzene, certain dyes, and petrochemicals may increase the risk of developing pancreatic cancer. Bacteria. A common bacterium called Helicobacter pylori, also called H. pylori, causes inflammation and ulcers in the stomach. Infection with H. pylori increases the risk of stomach cancer and pancreatic cancer. However, the risk of developing pancreatic cancer is not as high as the risk of developing stomach cancer. What are the symptoms of Pancreatic  cancer? Pancreatic cancer is a “silent disease” because there are not many noticeable symptoms early on. As the cancer grows, symptoms may include: Yellow skin and eyes, darkening of the urine, itching, and clay-colored stool. Pain in upper abdomen or upper back Painful swelling of an arm or leg due to a blood clot Burning feeling in stomach or other gastrointestinal discomforts Stomach bloating Floating stools with a particularly bad odor and an unusual color due to the body not digesting fats well Weakness Loss of appetite Nausea and vomiting Chills and sweats Fever Unexplained weight loss What are the investigations done in a patient with Pancreatic  cancer? Clinical examination A full blood count, biochemical profile and CA 19.9 USG abdomen as an initial investigation CT scan of chest, abdomen and Pelvis Whole body PET-CT scan in selected cases Biopsy or cytology to confirm the diagnosis- Can be done under Endoscopic Ultrasound guidance (EUS), Endoscopic retrograde cholangiopancreatography (ERCP) guidance or CT guided. Pancreatic cancer patients often presents with jaundice. Often stent need to be placed under ERCP or PTBD to relieve the jaundice. What are the stages of oesophageal cancer? Stage I- When the cancer is confined to submucosa of oesophagus and/ or  spread to 1-2 lymph nodes Stage II- When the cancer is confined within  the muscle layer (muscularis propria) of oesophagus and/or spread to 1-2 lymph nodes. When cancer has spread beyond the muscle layer without any lymph nodal spread. Stage III- When cancer has spread beyond the muscle layer with spread to 1-2 lymph nodes. Cancer confined to oesophagus with 3-6 lymph nodal spread is also included in stage III. Stage IVA- When cancer has spread outside oesophagus to surrounding organs or has spread to 7 or more lymph nodes. Stage IVB- When cancer has spread to distant organs. What is the treatment of oesophageal cancer? Treatment of oesophageal cancer patients depends on various factors e.g., stage of the disease, age of the patient, other medical comorbidities, and general fitness. Treatment of Stage I- Very early stage oesophageal cancer can be cured with endoscopic mucosal resection (EMR). Other wise, most patients at this stage is treated with surgery. If there is spread to 1-2 lymph nodes, then chemotherapy or chemo radiotherapy can be considered before surgery. If a patient is not fit for surgery then Radical Radiotherapy or Chemo-radiotherapy would be the preferred option. Treatment of

What is Prostate cancer? According to the definition of National Cancer Institute(NCI) prostate cancer is a type of cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men. What is the global burden of Prostate cancer? It is the 4th most common cancer worldwide accounting for 7.1% of all cancer. According to Globocon 2018 data, 1.3 million people was diagnosed with prostate cancer worldwide in 2018. In India 25,700 patients were diagnosed with prostate cancer in 2018 with 17200 death. What causes prostate cancer? Androgens (male hormones), such as testosterone, promote prostate cell growth. Having higher levels of androgens might contribute to prostate cancer risk in some men. Family history- The relative risk of having prostate cancer doubles if one first degree relative diagnosed with prostate cancer before the age of 70 years. The risk is 4 times higher if two relatives are diagnosed and if one under the age of 65 years. Germline mutations in BRCA2 gene increase the risk of developing prostate cancer by up to 5 times. Other inherited gene mutation- DNA repair genes like CHEK2, ATM, PALB2, RAD51D, MSH2, MSH6, MLH1, and PMS2. Tumour suppressor genes like RNASEL (formerly HPC1). Ethnicity- Men of Afro-Caribbean descent having a higher risk of prostate cancer cancer and earlier onset of disease than caucasions What is prostate cancer screening? Cancer screening  means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread. Two tests that are commonly used to screen for prostate cancer are a blood test called Prostate specific antigen(PSA) and digital rectal examination. According to American cancer society, the discussion about screening should take place at: Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65). Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age). If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test: Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years. Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher. If a patient have a  PSA of ≥4.0 ng/mL, he needs further evaluation to confirm presence of prostate cancer. What are the symptoms of prostate cancer? In early stage following symptoms might be present e.g, Increase frequency of micturition, Urinary urgency, Urinary hesitancy, Nocturia. In locally advanced stage following symptoms may be present Haematuria, haematospermia, erectile dysfunction, rarely perineal pain. In advanced stage patient may present with bone pain, leg weakness, lower leg swelling. What are the investigations done in a suspected patients of prostate cancer? Clinical examination including digital rectal examination. Serum PSA Transrectal ultrasound(TRUS) guided biopsy from prostate to confirm the diagnosis. Multi-parametric MRI (mp MRI) of pelvis. Bone scan CT Scan in selected cases. Choline C-11 PET-CT scan or PSMA PET-CT scan in selected cases. What are the different stages or risk groups of Prostate cancer? When the cancer is confined to prostate gland it is called localised prostate cancer. When it has spread outside pelvis to any distant organs or lymph nodes; it is called metastatic prostate cancer. Localised prostate cancer can be divided into three risk groups based on Serum PSA, Gleason’s score (This  is a grading system for prostate cancer. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations) and extent of tumour within prostate gland. These risk groups are low risk, intermediate risk and high risk. What is the treatment of Prostate cancer? Treatment of localised prostate cancer- Treatment options for low risk prostate cancer includes the following: Active surveillance, Surgery with Radical prostatectomy or Radical radiotherapy which can be in the form of external beam radiotherapy (EBRT) or seed brachytherapy with Radioactive Iodine. Treatment options for intermediate risk prostate cancer includes the following: Active surveillance (selected cases ), Surgery, Seed Brachytherapy, EBRT +/- 6 months of hormone therapy, High dose rate(HDR) brachytherapy +/- 6 months of hormone therapy. Treatment options for high risk patients includes the following: Surgery in very well selected cases, EBRT+ 3 years of hormone therapy, EBRT+HDR brachytherapy + 3 years of hormone therapy, Watchful waiting in very elderly unfit patients with limited life expectancy. Decision regarding choice of treatment depends on many factors including patient’s factor, treatment factor, tumour factor, patient’s preference and local expertise. Surgery and Radiotherapy is equally effective in most localised prostate cancer. Recent advance in surgical technique includes Robotic assisted laparoscopic prostatectomy. After surgery some patients might need radiotherapy based on post-operative PSA level. This is to reduce the risk of recurrence. EBRT is currently dose with Intensity modulated radiotherapy (IMRT) technique ( Volumetric arc therapy or Rapid arc) with use Image guided radiotherapy(IGRT). With this technique prostate cancer can be targeted precisely with mimimal dose to surrounding critical organ like rectum, urinary bladder, bowel. Recently hypofractionated course of radiotherapy (Giving larger dose per session for fewer session) has shown to be equally effective compared to conventional fractionation radiotherapy. This 4 weeks course of radiotherapy is becoming standard in most radiotherapy centres. Treatment of metastatic prostate cancer- Primary modality of treatment in metastatic prostate cancer patients is combination of chemotherapy and hormone therapy. Selected patients may need palliative radiotherapy for symptom control. What is the prognosis of Prostate cancer? Overall prognosis of prostate cancer is better than other cancer.

Best Radiation Oncologist in Kolkata According to definition of National Cancer Institute (NCI) Glioma is a tumour of the brain that begins in glial cells (cells that surround and support nerve cells). Apart from brain it can also originate in spinal cord.  What is the global burden of Glioma? According to GLOBOCON 2018 data, Brain tumour is the 10th  most common tumour which comprises 2.4% of all cancer worldwide. In 2018, there was 28142 new cases diagnosed in India with 24000 death from brain tumour. About 33 percent of all brain tumors are gliomas. What causes Glioma? There is no definitive cause for developing glioma but there are some suggested risk factors which can predispose an individual for developing glioma. Gliomas can affect all ages, but they are most often seen in adults. Gliomas are slightly more common in men than women. More common in Caucasians than African Americans. Inherited cancer syndrome- A number of inherited cancer syndrome with different chromosomal  abnormality can give rise to increased risk of brain tumour for example Neurofibromatosis type 1 can be associated with Astrocytoma or optic nerve glioma, Neurofibromatosis type 2 can be associated with Astrocytoma, Tuberous sclerosis can be associated with Sub ependymal giant cell astrocytoma, Li-Fraumeni syndrome can be associated with Astrocytoma, Turcot’ syndrome can be associated with Glioblastoma. Exposure to ionising radiation- Exposure to therapeutic doses or high-dose radiation is the most firmly established environmental risk factor for glioma. First evidence of this has come from the Hiroshima and Nagasaki atomic bomb survivors who showed higher incidence of glioma. Previously, fungal infection of scalp used to get treated by low dose radiation which had led to higher incidence of glioma in those patients. Child Cancer Survivor Study (CCSS) has shown that there is  increased risk of brain tumor in children treated with therapeutic radiation particularly patients with Acute lymphoblastic leukaemia.  Allergies and Atopic disease- INTERPHONE study has shown that history of allergic disease reduces the risk of developing brain tumour. A meta-analysis published in European journal of neurology in 2011 also confirmed the protective effect of allergic disease in brain tumour. Cellular phones- There are conflicting report of association of brain tumour with use of cellular phone. In 2011, the International Commission for Non-Ionizing Radiation Protection Standing Committee reviewed the evidences and could not found any firm correlation between cellular phone use and brain tumour. Using the UK million-woman study cohort, Dr Benson analyzed 791,710 women between 50 and 64, and found no significant risk brain tumour with greater than 10 years of cellular phone use. What are the different types of Glioma? According to World health organization (WHO) 2007 classification, Glioma can be divided four different grade. Grade I and II comprises ‘ low grade’ glioma and grade III and IV comprises ‘high grade’ glioma. Grade IV glioma or Glioblastoma multiformae is the most common type of glioma comprising almost 45% of all glioma. In 2016, WHO has introduced different molecular markers in brain tumour classification. These molecular markers not only help in classifying and grading brain tumour but also help in making treatment decisions and deciding on prognosis of brain tumour patients. Some of the important molecular markers include- IDH 1&2 mutation, ATRX loss, TP53 mutation, IP/19Q codeletion, MGMT methylation etc.  What are the symptoms of Glioma? Headache Convulsion Changes in mental state Loss of consciousness Progressive weakness of arm and/ or leg Visual problems- Loss of vision or double vision What are the investigations done in a patient with Glioma? In a suspected patients of brain tumour complete Neurological examination should be done by a doctor. CT scan of brain is usually the first investigation a doctor would normally suggest. MRI Brain is one of the most important investigation done to diagnose brain tumour. Stereotactic biopsy or radiologically guided needle biopsy or radiologically guided open biopsy and/or resection or elctrophysiologically guided resection from brain tumour is done to confirm the diagnosis. Magnetic resonance spectroscopy is needed in selected cases with diagnose the type of brain tumour. Some molecular tests are done on s biopsy sample to confirm the type of brain tumour, decide on treatment as well as to know the prognosis of the patients for example IDH 1 & 2, TP53, ATRX, 1P/19Q codeletion, MGMT methylation. MRI spine is usually done if there is symptoms (Back pain, progressive limb weakness) suggestive of glioma involving spine. In  skull base tumours certain other investigation should be done which include 1. Audiological testing, 2. Auditory-evoked brainstem responses testing, 3. Vestibular testing, 4. Prosthetic assessment  to establish the need for ocular, aural or skull bone replacement, 5 Speech and language therapy assessment, 6. Dietetic assessment. What is the treatment of Glioma? In most cases of glioma surgical resection of the tumour is the main treatment. Sometimes glioma is localted in some critical area of brain, In that case either biopsy and/ or surgery is not possible or too risky. For example, 1. Brainstem glioma- Any attempt of biopsy or surgery can lead to death of the patient, 2. Optic nerve glioma- any attempt of biopsy or surgery can lead blindness of the patients. These patients are dignosed based on their scan findings and are treated with radiotherapy or combination of radiotherapy and chemotherapy.  Treatment of low grade glioma- Some patient of small and asymptomatic  low grade glioma can be simply observed without immediate treatment. These patients can be treated at progression with surgery and/ or radiotherapy. In most patients of low grade glioma, surgery should be considered if the tumour in operable. If the tumour is not operable, these patients can be treated with radiotherapy. Grade I glioma (Pilocystic astrocytoma, Dysembryoplastic neuroepithelial tumors)  is much more common in children and potentially cured with surgery. These patients usually don’t need any further treatment after surgery. After surgery for grade II glioma (Astrocytoma, Oligodendroglioma) patients might need adjuvant radiotherapy based on certain factors e.g. type of tumour, extent of surgical resection, age of the patient etc. Radiotherapy is given over a

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