Skin Cancer
Skin cancer is often a misunderstood disease, despite being one of the most common types
of cancer. It is particularly prevalent in sunny regions of the world, affecting a significant
number of people in places like Australia and South Africa. There are three major types of
skin cancer: melanoma, squamous cell carcinoma, and basal cell carcinoma, and each of these has different characteristics and levels of severity.
Melanoma is perhaps the most well-known type of skin cancer. It is also the most aggressive,
often spreading quickly and becoming deadly if not detected early. The disease starts in the
skin but it doesn't stay there for long. Once it has metastasized, it can quickly progress to
stage four, which was considered a death sentence before the advent of immune therapy.
This is why early detection is vitally important.
Squamous cell carcinoma is another type of skin cancer that is common in sunny regions. This cancer is often detected by dermatologists during routine skin checks, where they identify and remove small skin lesions before they can develop into tumours. Despite being common, this form of skin cancer is less aggressive than melanoma and can often be managed effectively if caught early.
The third major type of skin cancer is basal cell carcinoma. While still a cancer, it is less
aggressive than both melanoma and squamous cell carcinoma. It typically remains localized,
infiltrating the area around the initial tumour for a long time before progressing to a later
stage. This slow progression means that early detection can often lead to successful
treatment.
Despite the severity and prevalence of skin cancer, it is one of the easier cancers to screen
for, because the disease's initial symptoms are visible on the skin. A dermatologist or
general practitioner can perform a full-body skin check, mapping any lesions and monitoring
them over time for changes. If a lesion changes or grows, a biopsy can be performed to
determine if it is cancerous.
Yearly follow-ups are crucial in the early detection of skin cancer. During these appointments,
a dermatologist can monitor any existing lesions and check for new ones. In some cases, a
cancerous lesion can develop and become dangerous in as little as six months, so regular
checks are essential. It is also important to find a dermatologist who can map lesions, as this
allows for more effective monitoring over time.
Despite the relative ease of screening for skin cancer, it remains one of the top four most
common cancers in both men and women in South Africa. This suggests that not enough
people are getting regular skin checks, which is something that needs to change. Regular skin checks should be a routine part of everyone's healthcare regimen, particularly for people
who spend a lot of time in the sun, such as cyclists and runners.
Unfortunately, having a friend check your skin is not a reliable alternative to a professional
examination. Even doctors without dermatological training can miss signs of skin cancer, as
the disease requires a trained eye to spot. Therefore, it is always best to have skin checks
performed by a dermatologist or a general practitioner with experience in detecting skin
cancer.
Skin cancer is a common but highly treatable disease if caught early. Regular
skin checks and early detection are the keys to successful treatment, so be sure to
incorporate these into your healthcare routine. Remember, the sun is not your skin's friend,
so take precautions, get regular checks, and stay safe.
Prostate Cancer
Understanding prostate cancer, its diagnosis, and treatment options can be a complex
endeavor due to the ever-evolving nature of medical research. In the past five years alone,
our comprehension of this disease has significantly changed, leading to new approaches in
screening and treatment.
The Basics of Prostate Cancer
Prostate cancer is a significant concern, particularly for South African men, who have a
lifetime risk of approximately one in 15. The risk increases if a close relative, such as a father
or brother, has had prostate cancer, particularly at a younger age. Additionally, black men
appear to have a higher risk of developing prostate cancer. These factors hint at a strong
genetic component in the disease's onset.
Screening for Prostate Cancer
The screening process for prostate cancer has been subject to considerable debate due to
the limitations of the primary screening tool, the Prostate Specific Antigen (PSA) blood test.
PSA levels can increase not only in prostate cancer but also in benign prostate hyperplasia
and prostatitis, making it an imperfect tool for cancer-specific screening.
Though PSA testing can detect prostate cancer, it is often late in the disease's progression. A PSA test's sensitivity, or its ability to accurately identify the presence of cancer, is only
around 21% at a PSA cut-off value of four. Lowering the cut-off value to three nanograms per
milliliter increases the sensitivity to approximately 36%, but it also increases the rate of false
positives.
The "Swiss Cheese" Approach to Screening
Given the limitations of PSA testing, a multifaceted approach to screening, referred to as the
"Swiss cheese" approach, can be more effective. The first layer of this approach is
considering genetic factors. If your father, brother, or other close relatives had prostate
cancer, you need to prioritize screening.
The next layer involves the PSA test and monitoring its velocity or rate of change over time.
Cancer will generally cause a consistent increase in PSA levels over time, which can help identify its presence. The third layer is a manual prostate exam, typically performed by a
urologist.
Advanced Screening Methods
Further screening layers can include ultrasound and magnetic resonance imaging (MRI). An
MRI, in particular, can provide a detailed view of the prostate, helping to detect cancer early.
However, due to cost constraints, an MRI may not be a feasible option for annual prostate
cancer screening for everyone.
Managing Prostate Cancer
If a diagnosis of prostate cancer is made, it's important to remember that treatment has
significantly improved over the years. In the past, the primary treatment option was an open
prostatectomy, a surgical procedure with significant potential side effects, including damage
to the nerves controlling erections. Today, robotic surgery offers a less invasive alternative with fewer risks. These advancements mean that prostate cancer, once detected, can often be treated effectively, preserving overall health and quality of life.
Ultimately, understanding prostate cancer requires a nuanced understanding of the disease
and its screening processes. While no single test can provide a definitive diagnosis, a
combined approach, taking into account genetic factors, PSA levels, and medical imaging,
offers the best chance of early detection and successful treatment.
Did you know?
Approximately 30% of men in their 50s and up to 70% of men in their 70s have prostate
cancer, according to autopsy studies. However, these men typically die from other causes,
not prostate cancer. This underscores the importance of effective screening and treatment
strategies to manage this prevalent health issue.
In our next blog post (Part 3) we will take an in-depth look into colon cancer, as well as the two main cancers affecting women, namely breast cancer and cervical cancer.
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