My Life My Responsibility: September 2011

It is the most common cancer affecting women where one in 19 women will be diagnosed with breast cancer by the age of 85. About 4,000 women are diagnosed each year, mostly between 35-60 years old with 40% affected below the age of 50. It is rare, but men can also develop breast cancer.

Breasts are made up of milk glands, which consist of lobules. Milk is made in lobules, and tubes called ducts take milk to the nipples. Cancer develops when cells in the breast grow out of control.

If cancer has not spread beyond the breasts, it is referred as pre-invasive breast cancer. The most common types are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). Most breast cancers are diagnosed at invasive stages which consist of several types:

Early breast cancer: confined in the breast but may have spread to one or more lymph nodes in the armpit.
Locally advanced breast cancer: may have spread to places near the breast (skin, muscles, and chest) but not found in other parts of the body.
Metastatic (advanced) breast cancer: cancer cells have spread to other areas of the body like lungs, bones or liver.

What are the risks?

Ageing.
Previously diagnosed with breast cancer or other breast conditions like atypical ductal hyperplasia, ductal carcinoma in situ or lobular carcinoma in situ.
Family history where a relative from either side of the family has / had breast cancer.
Inherited genes which do not work properly. Only 1 in 20 cases are caused by faulty genes.

What are the symptoms?

Change in the nipple: the shape, crusting, a sore or an ulcer, redness. Nipple turning in when it used to stick out.
Change in the skin of the breast including a dimpling, unusual redness or other colour changes.
Changes in shape or size.
A lump, lumpiness or thickening.
Unusual discharge from nipple without squeezing.
Persistent or unusual pain that is unrelated to monthly menstruation cycle that remains after some time, occurring in one breast only.

These symptoms do not necessarily mean breast cancer. They are signs that alert you to have them checked by your doctor immediately. Symptoms of male breast cancer are similar to women’s. In some cases, symptoms may not be present and breast cancer may be found on a screening mammogram.

Also referred to as bowel cancer, it is the second most common cancer affecting about 2,900 Malaysians each year, mostly above the age of 50 but it can occur to anyone. It is the second most common cancer in Malaysian men across all age groups.

The large bowel is part of the digestive system, which works to help food to digest by absorbing water and nutrients and to remove remaining wastes. Bowel cancer can grow from the inner bowel lining or grow from a small raised area (polyp). Polyps are mostly benign (harmless) but can progress to become malignant (cancerous).

What are the risks?

Ageing.
Lifestyle factors, such as eating habits.
Family history where a relative from either side of the family had been diagnosed with bowel cancer before age 55.
Inherited faulty genes which do not work properly. Only 1 in 20 cases are caused by faulty genes.
Inherited genetic condition:
1. Familial adenomatous polyposis (FAP) that causes polyps to form in the bowel. These polyps start off benign but could turn cancerous if not removed. FAP is a rare condition.
2. Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome increases the risk for cancer of the colon or rectum. Not everyone with HNPCC will develop bowel cancer.
If you have an inflammatory bowel disease.

What are the symptoms?

Abdominal pain during a bowel movement.
Anaemia
Blood in the stool or toilet paper.
Complete obstruction of the bowel.
Changes in bowel habits: appearance of stool, constipation or more frequent, smaller bowel movements.
Feeling of fullness in the bowel or rectum.
Feeling that the bowel did not empty completely after a bowel movement.
Rectal or anal pain.
Unexplained weight loss and fatigue.

These symptoms do not necessarily mean colorectal cancer. They are signs that alert you to have them checked by your doctor immediately.

It is the 2^nd most common cancer affecting men and 3^rd most common cancer with 2,100 Malaysians diagnosed each year.

The lungs are roughly cone-shaped and made up of sections called lobes. The left lung has two lobes and the right lung three. The lungs are spongy and fill up most of the chest area. There are a few structures that lie between the lungs such as:

heart and large blood vessels
windpipe (trachea)
oesophagus (carries food from mouth to stomach)
many lymph nodes

Lung cancer usually begins in the lining of an airway and there are many different types of lung cancer, classified according to the type of cell affected.

Small cell lung cancer: Makes up 15% of all lung cancers, this type tends to start in the middle of the lungs. It is strongly linked with cigarette smoking. Types of small cell lung cancer are small cell carcinoma, mixed small cell/large cell carcinoma and combined cell carcinoma. It is usually treated with chemotherapy combined with radiotherapy.
Non-small cell lung cancer: Makes up around 75-80% of lung cancers, usually affecting the main bronchi and smaller airways. The cancer can spread into the chest wall and lymph nodes. Types include squamous cell carcinoma, adenocarcinoma, large cell carcinoma and bronchio-alveolar cell carcinoma.
Mesothelioma: It is cancer of the cells of the pleural membrane around the lungs and is strongly linked to asbestos exposure. However, it could take up to 25-50 years from exposure to development of cancer.

What are the risks?

Smoking
- about 1 in 10 smokers develop lung cancer
- more than 90% of lung cancers are attributed to smoking
- smoking at a young age increases the risk of developing lung cancer
- second hand smoke could cause lung cancer
Work-related risks
- exposure to asbestos
- exposure to processing of steel, nickel, chrome and coal gas
- radiation, especially for miners who breath in air contaminated

What are the symptoms?

A new cough
Breathlessness
Coughing up blood
Chest pain
Difficulty swallowing (often seen in people with advanced cancer)
Fatigue
Hoarseness
Shortness of breath
Weight loss

These symptoms do not necessarily mean lung cancer. They are signs that alert you to have them checked by your doctor immediately.

It is the 3^rd most common cancer, accounting for 11% of all cancers in women. Over 1100 women are diagnosed with cervical cancer in Malaysia each year. Risk of cervical cancer increases after 30 years old and peaks at ages 60–69 years old.

The cervix

Part of the female reproductive system and the lower part of the uterus (womb) connecting to the vagina.
Shaped like an upside down pear located at the top of the vagina.
Produces moistness to lubricate the vagina and mucus to help sperm travel up to the Fallopian tube to fertilise an egg from the ovary. At childbirth, the cervix widens to allow the baby to pass down into the birth canal.

Cervical cancer is a malignant tumour in the tissues of the cervix. There are 2 main types of cervical cancer, named after the type of cell they originated from.

Squamous cell carcinoma: Starting in the squamous or skin-like cells of the cervix, it is the most common cancer and accounts for 80% of all cervical cancers.
Adenocarcinoma: It starts higher in the cervix and is more difficult to diagnose with Pap test. It develops from the glandular cells and is a less common type of cancer.

Cervical cancer is either microinvasive or invasive:

Microinvasive: cancer cells have broken through the boundary between epithelium and stroma but have not spread more than 5mm into the cervix tissue.
Invasive: cancer cells have spread into the stroma beyond 5mm and may have spread to nearby tissues like vagina, rectum or bladder.
Cancer can also spread to other parts of the body through the lymphatic system.

What are the risks?

Human Papillomavirus (HPV) infection
- An infection commonly affecting the surface on any part of the body, including the skin, vagina and cervix.
- There are more than 100 types of virus but only some affect the genital area.
- Most women will be infected with HPV at some time in life but the infection usually clears up on its own.
- HPV shows no symptoms and women only find out about it if it shows up on a Pap smear.
- Only a few types of HPV cause cervical cancer.
Smoking – chemicals in cigarettes may damage the cells of the cervix and increase risk of developing cervical cancer.

What are the symptoms?

Bleeding after intercourse
Excessive tiredness
Leg pain or swelling
Lower back pain
Pain during intercourse
Vaginal bleeding between periods
Vaginal bleeding after menopause

These symptoms do not necessarily mean cervical cancer. They are signs that alert you to have them checked by your doctor immediately.

It is the 5th most common cancer affecting about 1,000 Malaysians every year. NPC is the 3rd most common cancer in men aged 15-49. It is less common in men and women under 30 years old but incidences increase between 30-60 years old.

The nasopharynx is situated behind the nose and below the brain, connecting the nose to the windpipe. On its sidewall, a tube connects it to the ear. The nasopharynx is made up four areas:

Nose and sinuses
The nasal cavity of the large, air-filled space located behind the nose. The nose and upper respiratory tract function to warm, moisten and filter the air we breathe. Paranasal sinuses are air-filled spaces within the head that helps lighten the weight of the skull. The four (4) types of sinuses are:
- Frontal sinuses – behind the forehead.
- Ethmoid sinuses – between the eyes.
- Sphenoid sinuses – at the base of the skull.
- Maxillary sinuses – under the eyes within the maxillary (cheek) bones.
Mouth (oral cavity)
- The tongue is the largest organ in the mouth and is made of muscular tissue.
- The roof of the mouth is formed by the hard palate.
- The soft palate is an arch of muscle behind the hard palate, going into the throat.
- Includes the lips, gums, cheeks, floor or the mouth and jaw.
Throat (pharynx)
The throat is the tube running from the back of the nose to the oesophagus and trachea, consisting of three parts:
- Nasopharynx – the open cavity behind the nose and above the soft palate.
- Oropharynx – area from the soft palate and base of the tongue to the back of the mouth, including the tonsils.
- Hypopharynx or Laryngopharynx – the lowest part of the back of the throat behind the voice box.
Halfway down the neck, the throat branches into two tubes:
- Oesophagus – tube that carries food into the stomach.
- Trachea – tube that brings air into and out of the lungs.
Voice box (larynx)
- The voice box is located on top of the trachea.
- It houses the vocal cords (glottis), which vibrate on air coming up from the lungs to allow sound production required for speech.
- Above the vocal cords is the supraglottis that contains the epiglottis, which is a small cartilage flap preventing food from going into the trachea.
- The area below the glottis is the subglottis.

What are the risks?

Age – more common in people aged 55 and above
Chewing betel nut
Diet: A recent study in Singapore identified salted soy beans, canned pickled vegetables, Szechuan vegetables and salted vegetables as high–risk foods. The cooking of such foods releases toxic substances called nitrosamines into the fumes that we breathe.
Epstein Barr Virus (EB virus) – This virus has been found to be associated with NPC.
Geography and race: NPC incidence among Chinese and other Southeast Asians are 10 -50X higher than other countries. Moderately elevated numbers are associated in Malays.
Genetic factors may play an important role in NPC. Blood tests can identify certain people at risk from NPC. At present, these tests are not commercially available.
Human Papillomavirus (HPV)
Inhalation of sulphuric acid mist, asbestos fibers, dry–cleaning solvents, some types of paint or nickel
Smoking
Sex – men are 3 times more likely to develop the cancer

What are the symptoms?
NPC often does not present any symptoms at the early stage. However, there are a few indications:

The most common presentation (90%) is a lump in the neck. That is a swollen lymph node penetrated by cancer cells.
Nose bleed, blocked nostrils, mucus secretion.
Loss of hearing, pain and buzzing in the ear and noise discharge.
Hoarseness of voice and difficulty in swallowing.
Paralysis on one side of the face.

ORAL CANCER SYMPTOMS

Mouth pain
White or red patch on gums, tongue or lining
A change in speech or difficulty pronouncing words
Difficulty swallowing food or feeling that food is ‘stuck’
A lump in the neck
Loose teeth or dentures that no longer fit well

PHARYNGEAL CANCER SYMPTOMS

Throat pain
Sore throat or cough that won’t go away
Coughing up phlegm with blood
Difficulty swallowing
A change in the sound of voice or hoarseness
Feeling that air supply is blocked
Dull pain around the breastbone
Lump in the neck
An earache

LARYNGEAL CANCER SYMPTOMS

Swelling in the neck or throat
A change in the sound of voice or hoarseness
Lump in the neck
Difficulty swallowing
A persistent sore throat

NASAL AND PARANASAL CANCER SYMPTOMS

Persistent blocked nose, particularly in one nostril
Decreased sense of smell
Nosebleeds
Mucus drainage in the back of nose or throat
Frequent headaches or feeling of sinus pressure
A bulging or watery eye
Complete or partial loss of eyesight
Double vision
A lump on the face, in the nose or mouth
Loose or painful teeth
Pressure or pain in the ear

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My Life My Responsibility

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ORAL CANCER SYMPTOMS

PHARYNGEAL CANCER SYMPTOMS

LARYNGEAL CANCER SYMPTOMS

NASAL AND PARANASAL CANCER SYMPTOMS