Bile duct cancer starts in a bile duct. The bile ducts are a series of thin tubes that reach from the liver to the small intestine. The major function of the bile ducts is to move a fluid called bile from the liver and gallbladder to the small intestine, where it helps digest the fats in food.
Certain diseases of the liver or bile ducts
Older people are more likely than younger people to get bile duct cancer. Most people diagnosed with bile duct cancer are in their 60s or 70s. Ethnicity and geography In the United States, the risk of bile duct cancer is highest among Hispanic Americans and Native Americans. Worldwide, bile duct cancer is much more common in Southeast Asia and China, largely because of the high rate of infection with liver flukes in these areas.
Being overweight or obese can increase the risk of cancers of the gallbladder and bile ducts. This could be because obesity increases the risk of gallstones and bile duct stones. But there may be other ways that being overweight can lead to bile duct cancers, such as changes in certain hormones.
A radioactive substance called Thorotrast (thorium dioxide) was used as a contrast agent for x-rays until the 1950s. It was found to increase the risk for bile duct cancer, as well as some types of liver cancer, which is why it is no longer used.
A history of bile duct cancer in the family seems to increase a person’s chances of developing this cancer, but the risk is still low because this is a rare disease. Most bile duct cancers are not found in people with a family history of the disease.
When taken together, the data from many different studies show that people with diabetes have a higher risk of bile duct cancer. This increase in risk is not high, and the overall risk of bile duct cancer in someone with diabetes is still low.
People who drink alcohol are more likely to get intrahepatic bile duct cancer. The risk is higher in those who have liver problems from drinking alcohol. Other possible risk factors Studies have found several other factors that might increase the risk of bile duct cancer, but the links are not as clear. These include:
The exact cause of most bile duct cancers is not known, but researchers have found several risk factors that make a person more likely to develop bile duct cancer . There’s a link between this cancer and things that irritate and inflame the bile ducts, whether it’s bile duct stones, infestation with a parasite, or something else.
Getting to and staying at a healthy weight is one important way a person may reduce their risk of bile duct cancer, as well as many other types of cancer. This includes at least 2½ cups of vegetables and fruits every day. Choose whole-grain breads, pastas, and cereals instead of refined grains. Eat fish, poultry, or beans and limit how much processed meat and red meat you eat. Other ways that people may be able to reduce their risk of bile duct cancer include:
Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it’s found early. It is usually found at a very early stage through a Pap test. Cervical cancer is one of the most common cancers in women worldwide and is caused by a virus called human papilloma virus, or HPV.
You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms. Most adults have been infected with HPV at some time.
An infection may go away on its own. But sometimes it can cause genital warts or lead to cervical cancer. That’s why it’s important for women to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.
Scraping a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix. Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex
Gall bladder cancer is very rare in people under 50 and is most often seen in people over 70. It’s more common in women than men. Most cancers of the gall bladder are a type of cancer called adenocarcinoma. They start in the lining of the gall bladder.
The gall bladder is a small pouch that stores and concentrates bile. Bile is a fluid that helps us to digest food. Its main function is to break down fats in food. Bile is made by the liver and stored in the gall bladder. The gall bladder is connected to the small intestine and the liver by the bile ducts.
The cause of most gall bladder cancers is unknown. There are a number of risk factors that may increase your chances of developing this type of cancer.
These include:
Gall stones and inflammation – Gall bladder cancer is more likely to occur in people who have a history of gallstones or in people who have inflammation of the gall bladder (cholecystitis). However, most people who have gallstones or an inflamed gall bladder won’t develop gall bladder cancer.
Polyps - These are non-cancerous (benign) tumours of the gall bladder that increase the risk of developing gall bladder cancer.
Early gall bladder cancer often causes no symptoms and is usually discovered unexpectedly when someone has surgery to remove gallstones. About 1 in 5 gall bladder cancers are found in this way. Most tumours are only discovered at an advanced stage. They can cause a variety of symptoms including
These symptoms may be caused by other problems such as gallstones or an infection of the gall bladder, but it’s important to get them checked by your doctor.
There are a number of commonly used tests to diagnose gall bladder cancer.
Treatment of gall bladder cancer
Clinical trials for gall bladder cancer
Cancer doctors use clinical trials to assess new treatments. Research is being done into possible new treatments for gall bladder cancer. These include: Using a combination of chemotherapy and radiotherapy (chemoradiation) before or after surgery to remove the cancer Giving chemotherapy with targeted therapies
Kidney cancer is more common in people over 60 and rarely affects people under 40. Usually only one kidney is affected, and it’s rare for cancer to affect the other kidney.
Types of kidney cancer:
Wilms’ tumour (or nephroblastoma) is an uncommon type of kidney cancer that can affect very young children.
There are different types of kidney cancer. About 90% of kidney cancers (9 out of 10) are renal cell cancers (RCC), sometimes called renal adenocarcinoma. They start in the cells that line very small tubes, called tubules, in the kidney cortex.
There are different types of renal cell cancer.
The most common type is clear cell renal cancer. Less common types are papillary, chromophobe and collecting duct renal cancer.
Another type of cancer that can affect the kidneys starts in the cells that line the renal pelvis, where the kidney joins with the ureter. These cancers, sometimes called transitional cell cancers, behave and are treated differently to renal cell cancer.
Kidney cancers that are small don’t usually cause symptoms, because they can’t be felt or seen. Early kidney cancers are often diagnosed by chance when people are having tests or scans for some other reason.
Some possible symptoms are:
Most people with these symptoms won’t have kidney cancer. They can be caused by other more common conditions, such as an infection or stones in the bladder or kidneys. But if you have any of these symptoms, it’s important to get them checked by your doctor.
Having a risk factor doesn’t necessarily mean you’ll get kidney cancer.
Some rare genetic conditions where people have an inherited faulty gene can increase the risk of developing kidney cancer. These include von Hippel-Lindau disease, hereditary papillary renal cell carcinoma (HPRCC) and Birt-Hogg-Dube (BHD) syndrome.Kidney cancers that happen because of an inherited faulty gene are more likely to cause several tumours, affect both kidneys and happen at a younger age.
Exposure to certain materials at work, such as cadmium, lead or asbestos, may affect a person’s risk. An increased risk of kidney cancer has been linked to working with blast furnaces or coke ovens in the steel and coal industries. It has also been linked to working with Trichloroethylene (Tric), a petroleum by-product used in the heavy engineering industry.
Taking steps to improve your health may help reduce your risk of kidney cancer. To reduce your risk, try to:
Cancer that starts in the testicles is called testicular cancer. To understand this cancer, it helps to know about the normal structure and function of the testicles. Testicles (also called the testes; a single testicle is called a testis) are part of the male reproductive system. These 2 organs are each normally a little smaller than a golf ball in adult males and are contained within a sac of skin called the scrotum. The scrotum hangs beneath the base of the penis.
They make male hormones (androgens) such as testosterone.
They make sperm, the male cells needed to fertilize a female egg cell to start a pregnancy, Sperm cells are made in long, thread-like tubes inside the testicles called seminiferous tubules. They are then stored in a small coiled tube behind each testicle called the epididymis, where they mature.
During ejaculation, sperm cells are carried from the epididymis through the vas deferens to seminal vesicles, where they mix with fluids made by the vesicles, prostate gland, and other glands to form semen. This fluid then enters the urethra, the tube in the center of the penis through which both urine and semen leave the body. The testicles are made up of several types of cells, each of which can develop into one or more types of cancer.
It is important to distinguish these types of cancers from one another because they differ in how they are treated and in their prognosis (outlook).
More than 90% of cancers of the testicle develop in special cells known as germ cells. These are the cells that make sperm. The 2 main types of germ cell tumors (GCTs) in men are:
Non-seminomas, which are made up of embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and/or teratoma
Doctors can tell what type of testicular cancer you have by looking at the cells under a microscope. These 2 types occur about equally. Many testicular cancers contain both seminoma and non-seminoma cells. These mixed germ cell tumors are treated as non-seminomas because they grow and spread like non-seminomas.
Seminomas tend to grow and spread more slowly than non-seminomas. The 2 main subtypes of these tumors are classical (or typical) seminomas and spermatocytic seminomas. Doctors can tell them apart by how they look under the microscope.
More than 95% of seminomas are classical. These usually occur in men between 25 and 45.
This rare type of seminoma tends to occur in older men. The average age of men diagnosed with spermatocytic seminoma is about 65. Spermatocytic tumors tend to grow more slowly and are less likely to spread to other parts of the body than classical seminomas. Some seminomas can increase blood levels of a protein called human chorionic gonadotropin (HCG). HCG can be detected by a simple blood test and is considered a tumor marker for certain types of testicular cancer. It can be used for diagnosis and to check how the patient is responding to treatment.
These types of germ cell tumors usually occur in men between their late teens and early 30s. The 4 main types of non-seminoma tumors are:
Teratoma Most tumors are a mix of different types (sometimes with a seminoma component as well), but this doesn’t change the general approach to treatment of most non-seminoma cancers.
Embryonal carcinoma: This type of non-seminoma is present to some degree in about 40% of testicular tumors, but pure embryonal carcinomas occur only 3% to 4% of the time. When seen under a microscope, these tumors can look like tissues of very early embryos. This type of non-seminoma tends to grow rapidly and spread outside the testicle.
Embryonal carcinoma can increase blood levels of a tumor marker protein called alpha-fetoprotein (AFP), as well ashuman chorionic gonadotropin (HCG). Yolk sac carcinoma: These tumors are so named because their cells look like the yolk sac of an early human embryo. Other names for this cancer include yolk sac tumor, endodermal sinus tumor, infantile embryonal carcinoma, or orchidoblastoma.
This is the most common form of testicular cancer in children (especially in infants), but pure yolk sac carcinomas (tumors that do not have other types of non-seminoma cells) are rare in adults. When they occur in children, these tumors usually are treated successfully. But they are of more concern when they occur in adults, especially if they are pure. Yolk sac carcinomas respond very well to chemotherapy, even if they have spread. This type of tumor almost always increases blood levels of AFP (alpha-fetoprotein).
This is a very rare and aggressive type of testicular cancer in adults. Pure choriocarcinoma is likely to spread rapidly to distant organs of the body, including the lungs, bones, and brain. More often, choriocarcinoma cells are present with other types of non-seminoma cells in a mixed germ cell tumor. These mixed tumors tend to have a somewhat better outlook than pure choriocarcinomas, although the presence of choriocarcinoma is always a worrisome finding. This type of tumor increases blood levels of HCG (human chorionic gonadotropin).
Teratomas are germ cell tumors with areas that, under a microscope, look like each of the 3 layers of a developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer). Pure teratomas of the testicles are rare and do not increase AFP (alpha-fetoprotein) or HCG (human chorionic gonadotropin) levels. More often, teratomas are seen as parts of mixed germ cell tumors.
There are 3 main types of teratomas:
Carcinoma in situ of the testicle
Testicular germ cell cancers can begin as a non-invasive form of the disease called carcinoma in situ (CIS) orintratubular germ cell neoplasia. In testicular CIS, the cells look abnormal under the microscope, but they have not yet spread outside the walls of the seminiferous tubules (where sperm cells are formed). Carcinoma in situ doesn’t always progress to invasive cancer.
It is hard to find CIS before it does become an invasive cancer because it generally does not cause symptoms and often does not form a lump that you or the doctor can feel. The only way to diagnose testicular CIS is to have a biopsy (a procedure that removes a tissue sample and looks at it under a microscope). Some cases are found incidentally (by accident) when a testicular biopsy is done for another reason, such as infertility.
Experts don’t agree about the best treatment for CIS. Since CIS doesn’t always become an invasive cancer, many doctors in the United States consider observation (watchful waiting) to be the best treatment option.
When CIS of the testicle becomes invasive, its cells are no longer just in the seminiferous tubules but have grown into other structures of the testicle. These cancer cells can then spread either to the lymph nodes (small, bean-shaped collections of white blood cells) through lymphatic channels (fluid-filled vessels that connect the lymph nodes), or through the blood to other parts of the body.
Stromal tumors
Tumors can also develop in the supportive and hormone-producing tissues, or stroma, of the testicles. These tumors are known as gonadal stromal tumors. They make up less than 5% of adult testicular tumors but up to 20% of childhood testicular tumors. The 2 main types are Leydig cell tumors and Sertoli cell tumors.
Leydig cell tumors
These tumors develop from the Leydig cells in the testicle that normally make male sex hormones (androgens like testosterone). Leydig cell tumors can develop in both adults and children. These tumors often make androgens (male hormones) but sometimes produce estrogens (female sex hormones).
Most Leydig cell tumors are benign. They usually do not spread beyond the testicle and are cured with surgery. But a small portion of Leydig cell tumors spread to other parts of the body and tend to have a poor outlook because they usually do not respond well to chemotherapy or radiation therapy.
Sertoli cell tumors
These tumors develop from normal Sertoli cells, which support and nourish the sperm-making germ cells. Like the Leydig cell tumors, these tumors are usually benign. But if they spread, they usually don’t respond well to chemotherapy and radiation therapy.
Secondary testicular cancers
Cancers that start in another organ and then spread to the testicle are called secondary testicular cancers. These are not true testicular cancers – they are named and treated based on where they started.
Lymphoma is the most common secondary testicular cancer. Testicular lymphoma occurs more often than primary testicular tumors in men older than 50. The outlook depends on the type and stage of lymphoma. The usual treatment is surgical removal, followed by radiation and/or chemotherapy.
In boys with acute leukemia, the leukemia cells can sometimes form a tumor in the testicle. Along with chemotherapy to treat the leukemia, this might require treatment with radiation or surgery to remove the testicle.
Cancers of the prostate, lung, skin (melanoma), kidney, and other organs also can spread to the testicles. The prognosis for these cancers tends to be poor because these cancers have usually spread widely to other organs as well. Treatment depends on the specific type of cancer.
Signs and symptoms of testicular cancer
If you have any of these signs or symptoms, see your doctor without delay. Many of these symptoms are more likely to be caused by something other than testicular cancer.
But if a tumor is the cause, the sooner it is found, the sooner you can start treatment and the more effective it is likely to be.
· Lump or swelling in the testicle
Most often, the first symptom of testicular cancer is a lump on the testicle, or the testicle becomes swollen or larger. (It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other.) Some testicular tumors might cause pain, but most of the time they do not. Men with testicular cancer can also have a feeling of heaviness or aching in the lower abdomen or scrotum.
· Breast growth or soreness
In rare cases, germ cell tumors can make breasts grow or become sore. This occurs because certain types of germ cell tumors secrete high levels of a hormone called human chorionic gonadotropin (HCG), which stimulates breast development.
Some Leydig cell tumors can make estrogens (female sex hormones), which can cause breast growth or loss of sexual desire.
· Early puberty in boys
Some Leydig cell tumors can make androgens (male sex hormones). Androgen-producing tumors may not cause any specific symptoms in men, but in boys they can cause signs of puberty at an abnormally early age, such as a deepening voice and the growth of facial and body hair.
Symptoms of advanced testicular cancers
Even if testicular cancer has spread to other parts of the body, many men might not have symptoms right away. But some men might have some of the following symptoms:
A number of non-cancerous conditions, such as testicle injury or inflammation, can cause symptoms similar to those of testicular cancer. Inflammation of the testicle (known as orchitis) and inflammation of the epididymis (epididymitis) can cause swelling and pain of the testicle. Both of these also can be caused by viral or bacterial infections.
Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes imaging tests done to find the cause of infertility can uncover a small testicular cancer.
A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.
But having a risk factor, or even several, does not mean that you will get the disease. Just as having no risk factors doesn’t mean you won’t get the disease. And some people who get the disease may not have had any known risk factors. Even if a person with testicular cancer has a risk factor, it’s often very hard to know how much that risk factor contributed to the cancer.
Scientists have found few risk factors that make someone more likely to develop testicular cancer. Even if someone has one or more risk factors for this disease, it’s impossible to know for sure how much that risk factor contributes to developing the cancer. Also, most boys and men with testicular cancer do not have any of the known risk factors. Risk factors for testicular cancer include:
These are discussed in more detail below.
One of the main risk factors for testicular cancer is a condition called cryptorchidism, or undescended testicle(s). This means that one or both testicles fail to move from the abdomen (belly) into the scrotum before birth. Males with cryptorchidism are several times more likely to get testicular cancer than those with normally descended testicles.
Normally, the testicles develop inside the abdomen of the fetus and they go down (descend) into the scrotum before birth. In about 3% of boys, however, the testicles do not make it all the way down before the child is born. Sometimes the testicle remains in the abdomen. In other cases, the testicle starts to descend but remains stuck in the groin area.
Most of the time, undescended testicles continue moving down into the scrotum during the child’s first year of life. If the testicle has not descended by the time a child is a year old, it probably won’t go down on its own. Sometimes a surgical procedure known as orchiopexy is needed to bring the testicle down into the scrotum.
The risk of testicular cancer might be a little higher for men whose testicle stayed in the abdomen as opposed to one that has descended at least partway. If cancer does develop, it is usually in the undescended testicle, but about 1 out of 4 cases occur in the normally descended testicle. Because of this, some doctors conclude that cryptorchidism doesn’t actually cause testicular cancer but that there is something else that leads to both testicular cancer and abnormal positioning of one or both testicles.
Orchiopexy may reduce the risk of testicular cancer if it is done when a child is younger, but it is not as clear if it is helpful if the child is older. The best time to do this surgery is not clear. Experts recommend that orchiopexy be done soon after the child’s first birthday for reasons (such as fertility) that are not related to cancer.
Having a close blood relative (father or brother) with testicular cancer increases the risk that you will get it, too. But only a small number of testicular cancers occur in families. Most men with testicular cancer do not have a family history of the disease.
Some evidence has shown that men infected with the human immunodeficiency virus (HIV), particularly those with AIDS, are at increased risk. No other infections have been shown to increase testicular cancer risk.
It isn’t clear how often carcinoma in situ (CIS) in the testicles progresses to cancer. In some cases, CIS is found in men who have a testicular biopsy to evaluate infertility or have a testicle removed because of cryptorchidism Since we don’t know how often CIS becomes true (invasive) cancer, it isn’t clear if treating CIS is a good idea. Some experts think that it may be better to wait and see if the disease gets worse or becomes a true cancer. This could allow many men with CIS to avoid the risks and side effects of treatment. When CIS is treated, radiation or surgery(to remove the testicle) is used.
A personal history of testicular cancer is another risk factor. About 3% or 4% of men who have been cured of cancer in one testicle will eventually develop cancer in the other testicle.
About half of testicular cancers occur in men between the ages of 20 and 34. But this cancer can affect males of any age, including infants and elderly men.
Race and ethnicity
The risk of testicular cancer among white men is about 4 to 5 times that of black men and that of Asian-American men. The risk for American Indians falls between that of Asians and whites. The reason for these differences is not known. Worldwide, the risk of developing this disease is highest among men living in the United States and Europe and lowest among men living in Africa or Asia.
Several studies have found that tall men have a somewhat higher risk of testicular cancer, but some other studies have not. Most studies have not found a link between testicular cancer and body weight.
Prior injury or trauma to the testicles and recurrent actions such as horseback riding do not appear to be related to the development of testicular cancer.
Most studies have not found that strenuous physical activity increases testicular cancer risk. Being physically active has been linked with a lower risk of several other forms of cancer as well as a lower risk of many other health problems.
It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other. You should also be aware that each normal testicle has a small, coiled tube called the epididymis that can feel like a small bump on the upper or middle outer side of the testis.
Normal testicles also contain blood vessels, supporting tissues, and tubes that carry sperm. Some men may confuse these with abnormal lumps at first. If you have any concerns, ask your doctor.
A testicle can get larger for many reasons other than cancer. For example, fluid can collect around the testicle to form a benign condition called a hydrocele. Or the veins in the testicle can dilate and cause enlargement and lumpiness around the testicle. This is called a varicocele.
If your testicle seems larger, have a doctor examine you to be sure you have one of these conditions and not a tumor. The doctor may order an ultrasound exam. This is an easy and painless way of finding a tumor.
If you choose to examine your testicles regularly, you will become familiar with what is normal and what is different. Always report any changes to your doctor without delay.