Most prevalent cancers in South African adults

Prostate cancer

Prostate cancer is a malignant tumour that begins in the prostate gland. Some prostate cancers grow very slowly and may not cause symptoms or problems for years. This is why screening tests for this form of cancer are so important.

Screening and diagnostic tests

Caught in its early stages, whilst still confined to the prostate gland, prostate cancer can be cured. CANSA recommends that men over age 50, or age 40 with a family history of prostate cancer, should talk to a doctor about testing for prostate cancer as part of their health check-up.

The best available ways to detect the presence of prostate cancer is by:

• Doing a prostate specific antigen (PSA) blood test
• Digital rectal examination (DRE) and subsequent prostate biopsy

Treatment for prostate cancer

The main treatments for prostate cancer are surgery, radiotherapy and hormone therapy. Sometimes chemotherapy is also used. Metastatic prostate cancer can be successfully treated, allowing men with prostate cancer to live a good healthy life for several years.

For more information on prostate cancer, look at the prostate cancer fact sheet on CANSA’s website at

www.cansa.org.za/files/2017/07/Fact-Sheet-Prostate-Cancer-NCR-2012-web-July-2017.pdf

Colorectal cancer

Colorectal cancer is cancer that occurs in the colon and rectum (sometimes called colon cancer for short).

According to the Mayo Clinic, many people with colorectal cancer experience no symptoms in the early stages of the disease. When the symptoms start it will vary, depending on where exactly the cancer is and how big it is.

Screening and diagnostic tests
Screening

Men and women over 50 should have colon cancer screening tests. Screening options for patients with an average risk for colon cancer includes:

• Faecal occult blood test (testing for trace of blood in the faeces) every year – if tests show occult blood, the doctor will do a colonoscopy
• Flexible sigmoidoscopy (see details below) every 5 to 10 years or colonoscopy every 10 years

If you have a family history of colorectal cancer, you may need earlier (before age 50) or more frequent testing.

Diagnostics

On your first visit, your doctor will ask about your symptoms and if you have a family history of colorectal cancer.

These two tests are also commonly used to confirm a diagnosis of colorectal cancer:

• Sigmoidoscopy: A device called a sigmoidoscope is used, which is a thin, flexible tube attached to a small camera and light. The sigmoidoscope is inserted into the rectum and then up into the large bowel. The camera relays images to a monitor which allows the doctor to check for any abnormal areas.
• Colonoscopy: It is similar to a sigmoidoscopy except doctors use a longer tube, called a colonoscope, to examine the entire large bowel.
• In certain instances, the doctor may recommend a capsule endoscopy. A capsule endoscopy uses a tiny wireless camera to take pictures of your digestive tract. The camera sits inside a vitamin-size capsule you swallow. As the capsule travels through your digestive tract, the camera takes thousands of pictures that are transmitted to a recorder you wear on a belt around your waist.

Treatment for colorectal cancer

• Most people with early colorectal cancer have surgery when the surgeon is able to remove all of the cancer without any further treatment required.
• Radiotherapy and chemotherapy may be recommended and given together for rectal cancer.
• Some biological therapies can be used to treat colon or rectal cancer.

For more information on colorectal cancer, look at the colorectal cancer fact sheet on CANSA’s website.

Lung cancer

Lung cancer is a disease characterised by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary lung cancers, are carcinomas that derive from epithelial cells.

There are three types of lung cancer: small cell lung cancer, non-small cell lung cancer and mesothelioma.

Diagnostic tests

Early stage lung cancer doesn't cause signs and symptoms. Doctors use the following ways and tests to diagnose lung cancer:

• Medical history
• Sputum cytology
• Biopsy
• Certain imaging tests - such as a CT or PET CT scan

Treatment for lung cancer

Treatment depends on several factors, including:

• The type of lung cancer
• The size and position of the cancer
• How far advanced the cancer is (the cancer stage)
• The patient’s overall health

Deciding what treatment is best can be difficult. The cancer team will make recommendations and advise the patient to decide on their treatment.

Treatment options may include any of these and combinations of these treatments:

• Surgery
• Radiotherapy
• Chemotherapy
• A combination of the above

For more information on lung cancer, look at the lung cancer fact sheet on CANSA’s website.

Cancer with unknown origin

(Also known as cancer of an unknown primary).

Cancer cells usually look like the cells of the type of tissue in which it originally began. For example, breast cancer cells may spread to the lung but the cancer cells in the lung will always look like breast cancer cells.

Sometimes doctors find cancer which has spread to a particular part of the body but cannot find where in the body the cancer first began to grow. This type of cancer is called ‘a cancer of unknown origin’.

Diagnostic tests

A variety of tests are done to try and find where the primary cancer started in the body and to get information about where the cancer has spread. If the doctors can find the primary cancer, the cancer is no longer a cancer of unknown origin and the treatment is then based on the type of primary cancer that was identified.

Cancers of unknown primary (CUP) are usually found due to the signs or symptoms a person is having. Tests that may assist in diagnosing a cancer of unknown origin include:

• Urine analysis
• Blood chemistry studies
• Complete blood count
• Faecal occult blood test (testing if there are microscopic or invisible blood in the stool or faeces)
• Histologic study (tissue tests)
• Immunohistochemistry study (determining tissue elements by using specific antibodies that can be seen through staining)
• Reverse transcription–polymerase chain reaction test (determining the cancer DNA)
• Cytogenetic analysis (study of chromosomes and their abnormalities)
• Light and electron microscopy (studying biological specimens)
• Computerised tomography scan (CT scan or CAT scan)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan
• Mammogram
• Endoscopy
• Tumour marker test (testing for substances found at higher than normal levels in the blood, urine or body tissue of some people with cancer)
• Octreoscan (a test that can indicate the extent of tumours and show where they are)

Treatment for cancer of unknown primary

Treatment may include:

• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy
• Targeted therapy
• Other drugs including bisphosphonates, denosumab and octreotide

For more information on cancer with origin unknown, look at the cancer with origin unknown, fact sheet on CANSA’s website.

Karposi sarcoma

Kaposi sarcoma is a cancer that develops from the cells that line lymph or blood vessels. It usually appears as tumours on the skin or on mucosal surfaces such as inside the mouth, but tumours can also develop in other parts of the body, such as in the lymph nodes, lungs or digestive tract. The most common type of Kaposi sarcoma is epidemic or AIDS-related Kaposi sarcoma. This type of Kaposi sarcoma develops in people who are infected with HIV, the virus that causes AIDS.

Diagnostic tests

• The doctor will ask about your medical history, sexual activity and other possible exposures, symptoms and about any skin tumours you have noticed
• Physical exam
• Biopsy
• Chest X-ray
• Bronchoscopy
• Gastrointestinal endoscopy

Treatment for Kaposi sarcoma

Today treatment for Kaposi sarcoma is more effective than it used to be. For patients with immune system problems, the most important treatment is keeping the immune system healthy and any related infections under control. Some of the other treatments used for Kaposi sarcoma are:

• Local therapy
• Radiation therapy
• Chemotherapy
• Biologic therapy (immunotherapy)

Find out more about Kaposi sarcoma.

Breast cancer

Many awareness campaigns exist for breast cancer. This, as it is still the most prevalent cancer in South African women. Treatment for early-stage breast cancer is very effective. This is why it is so important to find the cancer as early as possible.

Screening and diagnostic tests

The World Health Organization (WHO) states the following about breast health:

• Early diagnosis remains an important early detection strategy.
• Mammography screening is the only screening method that has proven to be effective.
• Research has shown that regular breast self-examination may play an important role in finding breast cancer compared with finding a breast lump by chance. The practice of breast self-examination has been seen to empower women, helping them to take responsibility for their own health. Therefore, breast self-examination is recommended for raising awareness among women at risk.

Treatment for breast cancer

When deciding on the best treatment, doctors will consider:

• The stage and grade of the cancer (how big it is and how far it has spread)
• General health of the person
• Whether the person is menopausal

The main treatments for breast cancer are:

• Surgery: Surgery may involve the removal of just the cancerous lump (tumour), known as breast-conserving surgery, and surgery to remove the whole breast, which is called a mastectomy. In many cases, these procedures may be followed by reconstructive surgery.
• Radiotherapy: Treatment that uses high levels of radiation to kill cancer cells or prevent them from growing and dividing.
• Chemotherapy: Treatment that uses medicine to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
• Hormone therapy: Also called hormone-blocking therapy and it is often used to treat breast cancers that are sensitive to hormones.
• Biological therapy is also called targeted therapy – more recently developed forms of medicine that work differently from chemotherapy. Biological therapy involves the use of living organisms, substances derived from living organisms, or laboratory-produced versions of such substances to treat disease. 

CANSA’s fact sheets hold more information on breast cancer in women (and men).

Cervical cancer

Treatment for cervical cancer

Cervical cancer is a disease in which cells in the cervix becomes malignant (cancerous). Worldwide, cervical cancer is the third most common type of cancer in women and in South Africa it is the second most common type. It is less common in developed countries than in developing countries because of the routine use of Pap smears to detect the cells that are affected by this form of cancer.

According to the World Health Organization (WHO), virtually all cases of cervical cancer are linked to genital infection with human papillomavirus (HPV), the most common viral infection of the reproductive tract. There are vaccinations available against HPV and it is recommended that prepubescent girls are vaccinated against HPV.

Remember that all females and males on Discovery Vitality who are between nine and 25 years old, will earn Vitality points for having the HPV vaccination. If you are a member of a scheme administered by Discovery Health, you can claim for vaccinations from the available funds in your Medical Savings Account.

Screening and diagnostic tests

• Pap smear: A very important factor in the prognosis (outcome) of cervical cancer is how early the cancer is detected. Regular pelvic examinations and Pap smear screening improve the chances of any abnormality or precancerous lesions being discovered.
• Human papillomavirus (HPV) screening test: a laboratory test used to check cells that were collected from the cervix for certain types of HPV infection.
• Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas.
• Biopsy: A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer, often referred to as cone biopsy.
• Pelvic examination: An examination of the vagina, cervix, uterus, fallopian tubes, ovaries and rectum.

Treatment for cervical cancer

Treatment for cervical cancer depends on:

• The stage of the cancer
• The size of the tumour
• The woman’s age and general health
• The woman’s desire to have children in the future

According to the University of Maryland Medical Center, treatment of early-stage cervical cancer may include:

• Cervical conisation: Removing a cone-shaped piece of tissue from the cervix and cervical canal.
• Endocervical curettage: Scraping of the cervix to remove abnormal cells
• Loop electrosurgical excision procedure: Using a thin, low-voltage electrified wire loop to cut out abnormal tissue
• Cryosurgery: Killing pre-cancerous and cancerous cells by freezing them.
• Total hysterectomy (removal of the uterus)
• Internal radiation therapy (brachytherapy)

Treatment for more advanced cervical cancer may include:

• Hysterectomy: the uterus and much of the surrounding tissues, including lymph nodes, are removed
• Radiation therapy
• Chemotherapy
• Biological therapy

More information on cervical cancer and HPV.

Cancer of the uterus

The most common type of uterine cancer is also called endometrial cancer because it forms in the lining of the uterus, called the endometrium. Treatment is most effective when uterine cancer is found early.

Screening and diagnostic tests

• Endometrial biopsy: A small amount of uterine tissue is removed through a thin, flexible tube inserted through the cervix and into uterus.
• Dilation and curettage (D&C): If an endometrial biopsy does not give enough tissue or if a uterine cancer diagnosis is not definite, the doctor can do a D&C. Hysteroscopy: A thin, telescope-like device with a light (hysteroscope) is inserted through the cervix and into uterus. The doctor then looks at the uterus and the openings to the fallopian tubes. Small pieces of tissue can be removed. Hysteroscopy may be done with a D&C.

One or more of the following tests may be used to find out if you have uterine cancer and if it has spread. These tests also may be used to find out if treatment is working.

• Imaging tests, which may include:
• • Ultrasound
  • Computed axial tomography scans (CT or CAT)
  • Transvaginal ultrasound exam

Treatment for uterus cancer
Uterine cancer is treated by one or a combination of treatments, including surgery, radiation therapy, chemotherapy and hormone therapy.

• Surgery may include:
• • Hysterectomy: Removal of the uterus
  • Total hysterectomy: Removal of the uterus, ovaries and fallopian tubes
  • Lymph node dissection: Removal of lymph nodes in the pelvis and lower abdomen

Find out more about cancer of the uterus here.

References include

• www.cancer.org
• www.cansa.org.za
• www.cansa.net
• www.mayoclinic.org