Prostate cancer

Prostate Cancer

More than 90 percent of all prostate cancers are discovered while they are either localized (confined to the prostate) or regional (nearby). The five-year survival rate for men diagnosed with prostate tumors discovered at these stages is 99 percent.

In the past 20 years, the five-year survival rate for all stages combined has increased from 67 percent to 99 percent.

Early prostate cancer may not present any symptoms and can only be found with regular prostate examinations by your physician. Do not let fear and anxiety keep you from having the tests you need. These tests can often detect, or help rule out, prostate cancer.

Follow-up visits with your physician are extremely important if you have had an unusual DRE (digital rectal exam), or if your PSA (prostate-specific antigen) level is high. Your physician may order additional tests or suggest repeating the PSA tests.

Listed in the directory below you will find some additional information regarding prostate cancer, for which we have provided a brief overview.

Signs and Symptoms of Prostate Cancer

What are the symptoms of prostate cancer?

There are usually no specific signs or symptoms of early prostate cancer - which is why prostate screening is so important. An annual physical examination, prostate-specific antigen (PSA) blood test, and digital rectal exam (DRE) provide the best chance of identifying prostate cancer in its earliest stages.

The following are the most common symptoms of prostate cancer. However, each individual may experience symptoms differently. Symptoms may include:

• weak or interrupted flow of urine
• urinating often (especially at night)
• difficulty urinating or holding back urine
• inability to urinate
• pain or burning when urinating
• blood in the urine or semen
• nagging pain in the back, hips, or pelvis
• difficulty having an erection

The symptoms of prostate cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

As a man gets older, his prostate may grow bigger and obstruct the flow of urine, or interfere with sexual function. An enlarged prostate gland - a condition called benign prostatic hyperplasia - may require treatment with medicine or surgery to relieve symptoms. This common benign prostate condition, which is not cancer, can cause many of the same symptoms as prostate cancer.

Prostate Cancer Statistics

These statistics are from information published by the Surveillance, Epidemiology, and End Results (SEER) Program, a continuing project of the National Cancer Institute (NCI).

The SEER Program collects cancer data on a routine basis from designated population-based cancer registries in various areas of the country. Trends in cancer incidence, mortality and patient survival in the United States, as well as many other studies, are derived from this data bank.

Goals of the SEER Program include:

> Assembling and reporting, on a periodic basis, estimates of cancer incidence and mortality in the United States.

> Monitoring annual cancer incidence trends to identify unusual changes in specific forms of cancer occurring in population subgroups defined by geographic, demographic, and social characteristics.

> Providing continuing information on changes over time in the extent of disease at diagnosis, trends in therapy, and associated changes in patient survival.

> Promoting studies designed to identify factors amenable to cancer control interventions, such as:

a) environmental, occupational, socioeconomic, dietary, and health-related exposures

b) screening practices, early detection, and treatment

c) determinants of the length and quality of patient survival

Statistics on prostate cancer:

Consider the following statistics related to prostate cancer:

• Prostate cancer is the most common cancer among men, excluding skin cancer.
• American Cancer Society (ACS) estimates for 2007 include 218,890 new cases of prostate cancer in the US.
• Year 2007 estimates include 27,050 deaths occurring from prostate cancer in the US alone, making it the second leading cause of cancer death in men.
• All men are at risk for prostate cancer. The risk increases with age, and family history also increases the risk.
• African-American men have about a 60 percent higher incidence rate of prostate cancer than Caucasian men, and nearly a two-fold higher mortality rate than Caucasian men.

Risk Factors for Prostate Cancer

What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop cancer, while others develop cancer and have no known risk factors.

Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are risk factors for prostate cancer?

In general, all men are at risk for prostate cancer. However, there are specific risk factors that increase the likelihood that certain men will develop the disease, including the following:

• age
  Age is a risk factor for prostate cancer, especially men age 50 and older. More than 70 percent of all prostate cancers are diagnosed in men over the age of 65.
• race
  Prostate cancer is nearly 60 percent more common among African-American men than it is among Caucasian-American men. Japanese and Chinese men native to their country have the lowest rates of prostate cancer. Interestingly, when Chinese and Japanese men immigrate to the US, they have an increased risk and mortality rate from prostate cancer, when compared to their native populations. In Japan, the incidence of prostate cancer has increased as Western diets and lifestyles have been adopted.
• diet
  Epidemiological data suggests that the diet consumed in Western industrialized countries may be one of the most important contributory factors for developing prostate cancer. Consider the following information regarding diet and its effect on the risk for prostate cancer:
  • fat
    Studies suggest that men who eat a high-fat diet may have a greater chance of developing prostate cancer.
  • fiber
    Dietary fiber intake may influence circulating levels of testosterone and estradiol, which, in turn, may decrease the progression of prostate cancer.
  • soy protein
    Besides lower fat intake, another major difference between Asian and American diets is the consumption of soy, averaging 35 g a day per capita. Soy contains isoflavones which, in several studies, have been found to inhibit the growth of prostate cancer.
  • vitamin E and selenium
    Vitamin E, an antioxidant, combined with selenium, has been shown to inhibit tumor growth in laboratory animals.
  • carotenoids
    Carotenoids containing lycopenes have been shown to inhibit the growth of human prostate cancer cells in tissue cultures (cells grown in the laboratory). The primary source of lycopenes is processed tomatoes in tomato juice and tomato paste.
  • herbal preparations
    Combination herbal preparations should be used with caution as reported side effects have included venous thrombosis, breast tenderness, and loss of libido. Many herbal preparations have not been studied in men with prostate cancer.
• obesity
  Obesity not only contributes to diabetes and high cholesterol, but has also been associated with some common cancers, including hormone-dependent tumors such as prostate, breast, and ovarian cancer.
• environmental exposures
  Some studies show an increased chance for prostate cancer in men who are farmers, or those exposed to the metal cadmium while making batteries, welding, or electroplating. Additional research is needed in this area to confirm whether this is a true association.
• having a vasectomy, BPH (benign prostatic hyperplasia), or STD (sexually transmitted disease)
  Researchers have looked at whether men who have had a vasectomy, BPH, or those who have been exposed to a sexually transmitted disease are at increased risk for prostate cancer. Some studies suggest a link, while others do not support these claims.
• family history of prostate cancer
  Having a father or brother with prostate cancer more than doubles or triples a man's risk of developing this disease. The risk is even higher for men with several affected relatives, particularly if the relatives were young at the time of diagnosis. Geneticists (physicians and scientists who study inheritance and the causes of genetic disease) divide families into three groups, depending upon the number of men with prostate cancer and their ages of onset, including the following:
  • sporadic - a family with prostate cancer present in one man, at a typical age of onset; sporadic means ‘occurs by chance.'
  • familial - a family with prostate cancer present in more than one person, but with no definitive pattern of inheritance and usually an older age of onset.
  • hereditary - a family with a cluster of three or more affected relatives within any nuclear family (parents and their children), a family with prostate cancer in each of three generations on either the mother or father's side, or a cluster of two relatives affected at a young age (55 or less). Five to 10 percent of prostate cancer cases are considered hereditary.
• genetic factors
  In the center of each cell of the human body, our genetic material - chromosomes - are found. Normally, cells contain 46 chromosomes, or 23 pairs, half of which are inherited from our mother, half from our father. The chromosomes contain the body's blueprint, our genes. Genes code for traits such as eye color and blood type, and also control important regulatory functions in the body such as the rate of cell growth. Some genes, when altered or mutated, give a higher risk for uncontrolled cell growth, which, in turn, can lead to tumor development. These genes have various names, but overall are referred to as "cancer susceptibility genes." Approximately 5 percent to 10 percent of all prostate cancers are known to be attributed to an inherited DNA change, such as the cancer susceptibility gene. Recent research points to findings that suggest there is a set of common DNA variations that lead to a higher risk of inherited prostate cancer in African American men and less than half that percentage in Caucasian men.
  

Staging of Prostate Cancer

What is staging of prostate cancer?

When prostate cancer is diagnosed, tests will be performed to determine how much cancer is present, and if the cancer has spread from the prostate to other parts of the body. This is called staging, and is an important step toward planning a treatment program.

What are the different stages of prostate cancer?

As defined by the National Cancer Institute (NCI), the stages of prostate cancer include the following:

Stage I	tumor cells are found in less than 5 percent of prostate tissue removed, and the cells are not very aggressive in nature sometimes referred to as stage A
Stage II	tumor cells are found in less than 5 percent of prostate tissue removed, and the cells are more aggressive in nature or the tumor is larger in size, but is confined to the prostate gland sometimes referred to as Stage B
Stage III	the tumor has grown through the capsule which surrounds the prostate gland, and may involve seminal vesicles (tubes that carry sperm) sometimes referred to as Stage C
Stage IV	the tumor has spread to other structures beyond the seminal vesicles to any other organ or structure sometimes referred to as Stage D1 or D2
Recurrent	the cancer has come back (recurred) after treatment; it may recur in the prostate or in another part of the body sometimes referred to as Stage D3

Grading of Prostate Cancer

What is grading of prostate cancer?

Another step in the diagnostic process is grading the cancer cells - taking a measurement of how fast the tumor is likely to grow and spread. Grading is done in the laboratory with cells taken from the prostate gland during biopsy. The cancer cells are measured by how closely they look like normal cells.

What is the Gleason System for grading cancer?

According to the National Comprehensive Cancer Network (NCCN), one way of grading prostate cancer is the Gleason System. This grading system is based on a number range from 2 to 10. The lower the number, the lower the grade, and the slower the cancer is growing. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly than low-grade tumors, and are more likely to spread to other parts of the body.

• Grades under 6 mean that the cancer cells look similar to your normal cells, and the cancer is likely to be less aggressive.
• Grade 7 is in the intermediate range. This means that the cancer cells do not look like normal cells, and are more likely to be aggressive and grow faster.
• Grades 8 to 10 indicate that the cancer cells are more likely to be very aggressive in growth.

Diagnostic and Evaluation Procedures

Procedures used to evaluate prostate problems:

In addition to an annual physical examination that includes blood, urine, and possibly other laboratory tests, the National Cancer Institute and the American Cancer Society suggest consulting your physician about these recommendations for the evaluation of the prostate gland:

• DRE (digital rectal examinations)
  As recommended by your physician, DREs are usually conducted annually for men over the age of 50. Men in high-risk groups, such as African-Americans, or those with a strong family history of prostate cancer should consult their physicians about being tested at a younger age.
• PSA (prostate-specific antigen)
  PSA is a blood test that measures the level of prostate specific antigen. PSA is a substance produced by the prostate gland, which may be found in higher amounts in men who have prostate cancer. As recommended by your physician, the PSA test is usually done annually for men over the age of 50. Men in high-risk groups, such as African-Americans, or those with a strong family history of prostate cancer, should consult their physicians about being tested at a younger age or more often.

What are some other prostate cancer evaluation procedures?

If the DRE or PSA are unusual, your physician may repeat the tests or request an ultrasound and other procedures. These evaluation tools may include:

• transrectal ultrasound (TRUS) - a test using sound wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions such as gland enlargement, nodules, penetration of tumor through capsule of the gland, and/or invasion of seminal vesicles; may also be used for guidance of needle biopsies of the prostate gland and/or guiding the nitrogen probes in cryosurgery.
• computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• radionuclide bone scan - a nuclear imaging method that helps to show whether the cancer has spread from the prostate gland to the bones. The procedure involves an injection of radioactive material that helps to locate diseased bone cells throughout the entire body, suggesting possible metastatic cancer.
• lymph node and/or prostate biopsy - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

The diagnosis of cancer is confirmed only by a biopsy.

Treatments for Prostate Cancer

There are many different treatments for prostate cancer that involve the clinical care of a physician or other healthcare professional

• Expectant Therapy
• Surgery
• Radiation Therapy
• Hormone Therapy
• Chemotherapy
• Angiogenesis Inhibitors
• Herbal Remedies
• Clinical Trials

Lung Cancer

The diagnosis of lung cancer can be devastating. If it happens to you or a loved one, you'll want accurate information and answers to your questions in terms you can understand.

Use the resources below as a starting point in your research to understand what cancer is, how lung cancer symptoms present themselves, and how lung cancer is diagnosed and treated.

Lung Cancer Risk Factors

According to the American Cancer Society, 87 percent of all lung cancer cases involve tobacco. Cigarette smoking, cigar smoking and secondhand smoke can all contribute to both non-small cell lung cancer and small cell lung cancer.

All cancers form at the cellular level in our bodies. Under normal circumstances, cells grow, divide, and produce more cells to keep the body functioning properly. Sometimes though, cells keep dividing and producing when new cells are not needed. These extra cells form a tumor, which can be either benign or malignant.

• Benign tumors are not cancer. They are usually harmless, and when removed, rarely return. They do not spread to other parts of the body, and aren't usually life threatening.
• Malignant tumors are cancer.

The cells inside of them are abnormal and divide and grow without control. They can destroy normal tissue around the tumor, and the cells from a malignant tumor can breakaway and spread to other parts of the body by entering the bloodstream or the lymphatic system. This process of spreading is called metastasis, which is how cancer travels from a primary tumor to other sites within the body, creating secondary tumors.

Lung Cancer Types

Two kinds of cancer can affect the lungs: non-small cell cancer and small cell cancer. They are identified by how they look under a microscope, and are distinguishable by how they grow and spread. Treatment programs differ, depending on which cancer a person has.

Non-small cell lung cancer is more common than small cell cancer, and tends to grow and spread more slowly than small cell cancer. This cancer is further divided into three types. They are named after the cells affected:

• squamous cell carcinoma (also called epidermoid carcinoma)
• adenocarcinoma
• large cell carcinoma

Small cell lung cancer, also sometimes referred to as oat cell cancer, is less common than non-small cell cancer. It will often spread to other parts of the body, creating secondary tumors.


Lung cancer has several causes, most revolving around tobacco use. According to the American Cancer Society, 87 percent of all lung cancers cases involve tobacco use

Cigarette smoke contains many carcinogens, as well as other toxins. Cigarette smoke that is breathed into the lungs damages the body's cells, and over time, those cells can become cancerous. The factors which appear to influence whether a person will develop lung cancer are:

• age the person was when they starting smoking
• the number of pack years they've smoked
• how deeply the smoke was inhaled

Smoking cessation is the best thing a person can do to reduce his risk of getting lung cancer..

Other causes of lung cancer include:

• Radon is an invisible, odorless and tasteless radioactive gas that can be present in soil and rocks. People who work in mines are often exposed to radon gas, which may also be found in the foundations of homes in some parts of the United States. Radon causes damage to the lungs which can lead to lung cancer.

• Asbestos is the name of a group of minerals that have the naturally occurring characteristic of a fibrous composition. When these fibers break apart and become airborne, they can be inhaled. They then lodge in the lungs, damaging cells and increasing the risk of lung cancer.

• Pollution is suspected to increase the chance of getting lung cancer, especially breathing in the by-products from the combustion of diesel and fossil fuels. The links are not clear, but research is underway in this area.

• Lung Disease such as tuberculosis (TB) appears to increase the risk of lung cancer. The cancer tends to form in the areas of the lung which have scar tissue from TB.

• Personal history of lung cancer. If a person has had lung cancer once, it is more likely to recur. However, that risk is diminished if a person quits smoking.

Lung Cancer Symptoms

Early diagnosis of lung cancer can be difficult because symptoms don't often present themselves aggressively until the disease is in advanced stages. If you experience any of the symptoms listed below, schedule a visit with your doctor to check them out.

Lung cancer is the leading cause of cancer-related death in the United States. The majority of lung cancer cases are caused by cigarette smoking, killing upwards of 162,500 people in the U.S. alone in 2006.

Symptoms of Lung Cancer

• A habitual cough which worsens over time
• Constant chest pain
• Coughing up blood
• Shortness of breath, wheezing, or hoarseness
• Continual problems with bronchitis or pneumonia
• Fatigue
• Swelling of the face and neck
• Loss of appetite
• Unintentional weight loss

Diagnosing Lung Cancer

A doctor will evaluate several factors when diagnosing lung cancer.
A patient's smoking history, exposure to occupational hazards and family history will be taken into account. A chest x-ray will be taken, and if cancer is suspected, sputum cytology(looking at the cells under a microscope from a deep-cough sample) will also be done.

• Chest X-Ray Chest x-rays are radiographic studies used for diagnosing unusual masses within the lungs.

• CAT Scan / CT Scan CAT scans are used to detect abnormalities in structures of the body. Computed tomography is a noninvasive procedure, meaning no entry of the body is necessary.

To confirm the presence of cancer, the doctor will want a biopsy of lung tissue to review under a microscope.

There are several ways to do the biopsy.

• Bronchoscopy A bronchoscope(a thin, lighted tube) is inserted into the lungs through the nose or mouth and down the windpipe. A small sample of tissue can be obtained using this tool.

• Needle Aspiration A needle is inserted into the the tumor through the chest to obtain the sample.

• Thoracentesis This method uses a needle to remove a sample of the fluid which surrounds the lungs to check for cancer cells.

• Thoracotomy This is a major surgical procedure in which the chest is opened to look for the presence of cancer.

Staging Lung Cancer

If cancer is present, the doctor will want to determine whether it has spread to other parts of the body, what is known as staging. Lung cancer often spreads to the brain or bones. Staging helps the doctor decide on a plan for treatment.

Lung Cancer Staging Methods

• CAT or CT Scan (computed tomography) A computer connected to an x-ray machine takes a series of detailed pictures of particular areas inside the body.

• MRI (magnetic resonance imaging) A powerful magnet linked to an x-ray machine takes detailed pictures of areas of interest inside the body.

• Radionuclide Scanning This type of scan can see other areas of the body that the cancer may have spread to. The person swallows a mildly radioactive liquid which, when scanned, will reveal the level of radioactivity in certain organs, which will help identify abnormal areas.

• Bone Scan This scan will show whether the cancer has spread to the bones. A mildly radioactive is injected into a vein, and it will collect in abnormal bone areas, which will be detectable on the scan.

• Mediastinoscopy/Mediastinotomy This procedure is done under general anesthesia, and will help the doctor find out whether the cancer has spread to the lymph nodes. A lighted viewing instrument, called a scope is inserted through a small incision in the neck(mediastinoscopy) to view the center of the chest and nearby lymph nodes. If the incision is made in the chest, the procedure is called mediastinotomy. A small tissue sample is taken in either of these two procedures.

Lung Cancer Stages Defined

The particulars of lung cancer stages from About.com Lung Diseases.

How Lung Cancer is Staged

When diagnosed with lung cancer, a stage of the lung disease is identified to describe the severity and indicate the extent of its progression. This staging of lung cancer is used by healthcare professionals to determine the choice of treatment that will best rid the body of the lung cancer.

Nonsmall Cell Lung Cancer

Stage 0 Lung Cancer
The lung cancer is localized; it is found only in a local area and only in the first few layers of cells. The lung cancer has not penetrated the surface lining of the lungs.
Five-Year Survival Rate = 70 - 80%

Stage I Lung Cancer
The lung cancer is confined to the lungs and surrounded by normal tissue.
Five-Year Survival Rate = 50%

Stage II Lung Cancer
The lung cancer has spread to nearby lymph nodes.
Five-Year Survival Rate = 30%

Stage III Lung Cancer
The lung cancer has spread to the chest wall, diaphragm, or other nearby organs or blood vessels.The lung cancer may have spread to lymph nodes in the mediastinum or the other side of the chest or neck
Five-Year Survival Rate = 5 - 15%

Stage IV Lung Cancer
The lung cancer has spread to more distant sites in the body.
Five-Year Survival Rate = Less than 2%

Small Cell Lung Cancer

Limited Stage Lung Cancer
The lung cancer is confined to one of the lungs, the mediastinum and nearby lymph nodes.
Five-Year Survival Rate = 15 - 30%

Extended Stage Lung Cancer
The lung cancer has spread to other lung tissues or other areas of the body.
Five-Year Survival Rate = 0 - 2%

Source: Cancer Free by Sidney J. Winawer, M.D., and Moshe Shike, M.D.
Updated: 01/21/06

Treating Lung Cancer

Surgical Treatments for Non Small Cell Lung CancerSurgery may be chosen as the best course of treatment, especially if the cancer is detected in its early stages and hasn't spread to other areas of the body. There are four types of surgery used for non small cell lung cancer:

• Resection - This surgery removes a small part of the lung where the tumor is. The procedure is referred to as a wedge resection if a small triangular slice of tissue is taken, or a segmental resection when the tissue sample is a little larger.

• Sleeve Resection - A surgical procedure that removes part of the bronchus.

• Lobectomy - Removal of an entire lobe (section) of the lung is done with this procedure.

• Pneumonectomy - A pneumonectomy removes the entire lung.

Some tumors are inoperable, or the person may not be up to surgery for other medical reasons.

Non-Surgical Lung Cancer Treatments

• Chemotherapy involves using anti-cancer drugs to kill cancer cells in the body, or to keep existing cells from dividing. Even after surgery, some cells may remain, and chemotherapy may be added to the treatment plan. Most chemotherapy is given either by injection into a vein (IV) or by catheter. A few drugs are given in pill form.

• Radiation Therapy treats the cancer by using high energy rays to kill cancer cells. It can be used before surgery to shrink tumors, or after surgery to kill any remaining cancer cells. Sometimes it is used in combination with chemotherapy as a primary treatment plan instead of surgery. Most radiation therapy is administered by a machine (external radiation) with the rays aimed directly at the tumor. There is another form of radiation treatment(internal radiation), in which a small capsule of radioactive material is implanted near or in the tumor.

• Laser Therapy uses a highly accurate pinpoint of laser light to kill cancer cells.

• Photodynamic Therapy (PDT) - this therapy involves using a laser. A special chemical is injected into the bloodstream. This chemical travels to cells all over the body, and is absorbed by them. In normal cells, the chemical leaves quickly, but it remains for a longer time in cancer cells. A laser is then aimed at the cancer which activates the chemical. The chemical then kills the cancer cell it is in. This therapy can be used to relieve symptoms of lung cancer, such as bleeding, or blocked airways. It's also an option for treating very small tumors which may not be suitably treated in more conventional ways.

Watchful Waiting - like the name implies, this treatment involves closely monitoring the patient's condition, watching for symptoms to appear or change in nature

Side Effects of Lung Cancer Treatments

Side effects from lung cancer treatments vary from person to person, and are often temporary. Doctors and nurses can explain possible side effects of a particular treatment plan, and ways to alleviate discomfort during and after treatment.Lung cancer surgery is a major operation. Air and fluid tend to collect in the chest after surgery, so it is important to do things such as coughing, turning over, and breathing deeply to help remove the excess air/fluid. Soreness in the chest and arm and shortness of breath are common side effects of lung surgery. It takes weeks or even months to regain strength and energy after this procedure.

Chemotherapy Side Effects

Chemotherapy side effects depend on the types of drugs used and how much was given. Chemotherapy affects normal cells as well as cancerous cells. Common side effects include:

• nausea and vomiting
• hair loss
• mouth sores
• fatigue

Radiation Therapy Side Effects

Like chemotherapy, radiation therapy also affects normal cells. Side effects depend on what part of the body is being treated, and how strong the dose is. Side effects may include:

• nausea and vomiting
• hair loss
• difficulty swallowing
• dry, sore throat
• fatigue
• skin changes at the site of the treatment
• loss of appetite

Patients receiving radiation treatments to the brain may experience:

• headaches
• skin changes
• nausea and vomiting
• fatigue
• hair loss
• problems with thought and memory processes

Photodynamic Therapy Side Effects

Photodynamic therapy makes the person's eyes and skin very sensitive to light for 6 weeks or more after treatment ends. It is recommended that these people not go outside if possible, and to avoid bright indoor light as well. If they must go out, protective clothing and sunglasses are a must. Other side effects of this treatment may include:

• coughing
• difficulty swallowing
• painful breathing, or shortness of breath.

If swelling, redness, or blistering appears on the skin, people should consult with their doctors as to how to treat it.

Types of Treatment

Types of Treatment

What treatment is best for you? Which methods have proven to be most effective? Here you can find answers to your questions, plus learn about what to ask your physician, what's new in research, and what you can expect after treatment is over.

	Surgery Find out when surgery is necessary and what techniques are used.
	Radiation Therapy Principles In-depth guide to see how radiation therapy works and what you can expect before, during, and after treatment.
	Understanding Radiation Therapy: A Guide for Patients and Families Answers to your questions about radiation therapy and managing side effects.
	Chemotherapy: What It Is, How It Helps Basics of how chemotherapy works to treat cancer.
	Chemotherapy Principles In-depth guide to see how chemotherapy works and what you can expect before, during, and after treatment.
	Understanding Chemotherapy: A Guide for Patients and Families Answers to your questions about chemotherapy and managing side effects.
	Oral Chemotherapy: What You Need to Know General information on taking chemotherapy as a liquid, tablet, or capsule.
	Immunotherapy Find out how this treatment uses your body's own defense system to fight cancer.
	Off-Label Drug Use Explains under what circumstances a patient might receive an investigational new drug outside a clinical trial.
	Compassionate Drug Use The term “compassionate use” refers to the treatment of a seriously ill patient using a new, unapproved drug when no other treatments are available. This document explores the topic.

How can patients prepare for treatment?

As a patient, you play an important role in preparing for your cancer treatment. The following are some of the most important things to consider before treatment begins:

• Find an oncologist and treatment center.
  This step is important to everyone with cancer. Ask your general or primary care physician for a referral to an oncologist. You can also contact government and professional medical organizations, such as your state's health department, the National Cancer Institute (NCI), or the American Medical Association (AMA) for information on cancer specialists and treatment centers in your area.
• Get a second opinion.
  It is common for people diagnosed with cancer to ask another cancer specialist for their opinion. A second opinion can help you to be sure your diagnosis and treatment plans are most appropriate for your individual medical history and profile. Asking for a second opinion also provides more information to consider when making choices about your treatment. Often, your oncologist can help you locate another cancer specialist for a second opinion.
• Find out about your cancer treatment.
  Your cancer care team will help you understand your treatment and answer questions. It also helps to learn about the type of cancer you have, as well as your treatment options. Ask your physician where you can find more information about cancer. This Web site contains information on many cancer topics. Also, the National Cancer Institute (NCI), the American Cancer Society (ACS), and other cancer- and health-related organizations provide helpful information.
• Find support when you need it.
  Cancer treatment can be a long and tiring experience. Many people with cancer need help throughout the process. Finding help from others can make your experience more successful. Support groups for people with cancer are available in many communities. Managing your emotional health, your diet, and your finances are all things patients can do to reduce the stress involved in the treatment process. Oncology nurses and social workers are excellent resources for locating appropriate support groups.

How is cancer diagnosed?

There is no single test that can accurately diagnose cancer. The complete evaluation of a patient usually requires a thorough history and physical examination along with diagnostic testing. Many tests are needed to determine whether a person has cancer, or if another condition (such as an infection) is mimicking the symptoms of cancer. Effective diagnostic testing is used to confirm or eliminate the presence of disease, monitor the disease process, and to plan for and evaluate the effectiveness of treatment. In some cases, it is necessary to repeat testing when a person’s condition has changed if a sample collected was not of good quality, or an abnormal test result needs to be confirmed. Diagnostic procedures for cancer may include imaging, laboratory tests (including tests for tumor markers), tumor biopsy, endoscopic examination, surgery, or genetic testing.

What are the different types of diagnostic imaging?

Imaging is the process of producing valuable pictures of body structures and organs. It is used to detect tumors and other abnormalities, to determine the extent of disease, and to evaluate the effectiveness of treatment. Imaging may also be used when performing biopsies and other surgical procedures. There are three types of imaging used for diagnosing cancer: transmission imaging, reflection imaging, and emission imaging. Each uses a different process.

• transmission imaging
  X-rays, computed tomography scans (CT scans), and fluoroscopy are radiological examinations whose images are produced by transmission. In transmission imaging, a beam of high-energy photons is produced and passed through the body structure being examined. The beam passes very quickly through less dense types of tissue such as watery secretions, blood, and fat, leaving a darkened area on the x-ray film. Muscle and connective tissues (ligaments, tendons, and cartilage) appear gray. Bones will appear white.
  • x-ray
    X-rays are diagnostic tests that use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays may be taken of any part of the body to detect a tumor (or cancer).
  • computed tomography scan (Also called a CT scan or computed axial tomography or CAT scan.)
    A CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • bone scan
    Bone scans are pictures or x-rays taken of the bone after a radioactive material has been injected that is absorbed by bone tissue. These scans are used to detect tumors and bone abnormalities.
  • lymphangiogram (LAG)
    Lymphangiogram is an imaging study that can detect cancer cells or abnormalities in the lymphatic system and structures. It involves a dye being injected into the lymph system.
  • mammogram
    A mammogram is an x-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints. Mammography cannot prove that an abnormal area is cancerous, but if it raises a significant suspicion of cancer, a biopsy may be performed. Tissue may be removed by needle or open surgical biopsy and examined under a microscope to determine if it is cancer. Mammography has been used for about 30 years, and in the past 15 years technical advancements have greatly improved both the technique and results. Today, dedicated equipment, used only for breast x-rays, produces studies that are high in quality but low in radiation dose. Radiation risks are considered to be negligible.
• reflection imaging
  Reflection imaging refers to the type of imaging produced by sending high-frequency sounds to the body part or organ being studied. These sound waves "bounce" off of the various types of body tissues and structures at varying speeds, depending on the density of the tissues present. The bounced sound waves are sent to a computer that analyzes the sound waves and produces a visual image of the body part or structure.
  • ultrasound
    Ultrasound, or sonography, is the most commonly used type of reflection imaging. This technique uses high-frequency sound waves and a computer to create images, called sonograms, of blood vessels, tissues, and organs. Sonograms are used to view internal organs as they function and to assess blood flow through various vessels. Tumors in the abdomen, liver, and kidneys can often be seen with an ultrasound.
• emission imaging
  Emission imaging occurs when tiny nuclear particles or magnetic energy are detected by a scanner and analyzed by computer to produce an image of the body structure or organ being examined. Nuclear medicine uses emission of nuclear particles from nuclear substances introduced into the body specifically for the examination.
  • magnetic resonance imaging (MRI)
    MRI is a diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRI is often used to examine the heart, brain, liver, pancreas, male and female reproductive organs, and other soft tissues. It can assess blood flow, detect tumors and diagnose many forms of cancer, evaluate infections, and assess injuries to bones and joints.
  • positron emission tomography (PET)
    PET is a specialized radiology procedure used to examine various body tissues to identify certain conditions. PET may also be used to follow the progress of the treatment of certain conditions. PET is a type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is used during the procedure to assist in the examination of the tissue under study. Specifically, PET studies evaluate the metabolism of a particular organ or tissue, so that information about the physiology (functionality) and anatomy (structure) of the organ or tissue is evaluated, as well as its biochemical properties. Thus, PET may detect biochemical changes in an organ or tissue that can identify the onset of a disease process before anatomical changes related to the disease can be seen with other imaging processes such as computed tomography (CT) or magnetic resonance imaging (MRI).

Cancer Overview

What do the terms benign and malignant mean?

Tumors can be benign (noncancerous) or malignant (cancerous). Benign tumors tend to grow slowly and do not spread. Malignant tumors can grow rapidly, invade and destroy nearby normal tissues, and spread throughout the body.

What do the terms "locally invasive" and "metastatic" mean?

Cancer is malignant because it can be "locally invasive" and "metastatic":

• locally invasive - the tumor can invade the tissues surrounding it by sending out "fingers" of cancerous cells into the normal tissue.
• metastatic - the tumor can send cells into other tissues in the body, which may be distant from the original tumor.

How is each cancer type named?

Cancer is named after the part of the body where it originated. When cancer spreads, it keeps this same name. For example, if kidney cancer spreads to the lungs, it is still kidney cancer, not lung cancer. (The lung cancer would be an example of a secondary tumor.) Staging is the process of determining whether cancer has spread and, if so, how far. There is more than one system used for staging cancer, and the definition of each stage will depend on the type of cancer.

What are the different types of cancer?

Cancer is not just one disease but rather a group of diseases, all of which cause cells in the body to change and grow out of control. Cancers are classified either according to the kind of fluid or tissue from which they originate, or according to the location in the body where they first developed. In addition, some cancers are of mixed types. The following five broad categories indicate the tissue and blood classifications of cancer:

• carcinoma
  A carcinoma is a cancer found in body tissue known as epithelial tissue that covers or lines surfaces of organs, glands, or body structures. For example, a cancer of the lining of the stomach is called a carcinoma. Many carcinomas affect organs or glands that are involved with secretion, such as breasts that produce milk. Carcinomas account for 80 percent to 90 percent of all cancer cases.
• sarcoma
  A sarcoma is a malignant tumor growing from connective tissues, such as cartilage, fat, muscle, tendons, and bones. The most common sarcoma, a tumor on the bone, usually occurs in young adults. Examples of sarcoma include osteosarcoma (bone) and chondrosarcoma (cartilage).
• lymphoma
  Lymphoma refers to a cancer that originates in the nodes or glands of the lymphatic system, whose job it is to produce white blood cells and clean body fluids, or in organs such as the brain and breast. Lymphomas are classified into two categories: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
• leukemia
  Leukemia, also known as blood cancer, is a cancer of the bone marrow that keeps the marrow from producing normal red and white blood cells and platelets. White blood cells are needed to resist infection. Red blood cells are needed to prevent anemia. Platelets keep the body from easily bruising and bleeding. Examples of leukemia include acute myelogenous leukemia, chronic myelogenous leukemia, acute lymphocytic leukemia, and chronic lymphocytic leukemia. The terms myelogenous and lymphocytic indicate the type of cells that are involved.
• myeloma
  Myeloma grows in the plasma cells of bone marrow. In some cases, the myeloma cells collect in one bone and form a single tumor, called a plasmacytoma. However, in other cases, the myeloma cells collect in many bones, forming many bone tumors. This is called multiple myeloma.

What causes cancer?

There is no one single cause for cancer. Scientists believe that it is the interaction of many factors together that produces cancer. The factors involved may be genetic, environmental, or constitutional characteristics of the individual.

Diagnosis, treatment, and prognosis for childhood cancers are different than for adult cancers. The main differences are the survival rate and the cause of the cancer. The survival rate for childhood cancer is about 79 percent, while in adult cancers the survival rate is 64 percent. This difference is thought to be because childhood cancer is more responsive to therapy, and a child can tolerate more aggressive therapy.

Childhood cancers often occur or begin in the stem cells, which are simple cells capable of producing other types of specialized cells that the body needs. A sporadic (occurs by chance) cell change or mutation is usually what causes childhood cancer. In adults, the type of cell that becomes cancerous is usually an "epithelial" cell, which is one of the cells that line the body cavity, including the surfaces of organs, glands, or body structures, and cover the body surface. Cancer in adults usually occurs from environmental exposures to these cells over time. Adult cancers are sometimes referred to as "acquired" for this reason.

What are the risk factors for cancer?

As mentioned, some cancers, particularly in adults, have been associated with certain risk factors. A risk factor is anything that may increase a person's chance of developing a disease. A risk factor does not necessarily cause the disease, but it may make the body less resistant to it. Persons who have an increased risk of developing cancer can help to protect themselves by scheduling regular screenings and check-ups with their physician and avoiding certain risk factors. Cancer treatment has been proven to be more effective when the cancer is detected early. The following risk factors and mechanisms have been proposed as contributing to the development of cancer:

• lifestyle factors
  Lifestyle and environmental factors such as smoking, high-fat diet, exposure to ultraviolet light (UV radiation from the sun), or exposure to chemicals (cancer-causing substances) in the work place over long periods of time may be risk factors for some adult cancers. Most children with cancer, however, are too young to have been exposed to these lifestyle factors for any extended time.
• genetic factors
  Family history, inheritance, and genetics may play an important role in some adult and childhood cancers. It is possible for cancer of varying forms to be present more than once in a family. Some gene alterations are inherited. However, this does not necessary mean that the person will develop cancer. It indicates that the chance of developing cancer increases. It is unknown in these circumstances if the disease is caused by a genetic mutation, other factors, or simply coincidence.
• virus exposure
  Exposures to certain viruses, such as the human papillomavirus (HPV) and human immunodeficiency virus (HIV; the virus that causes acquired immune deficiency, or AIDS), and the herpes virus have been linked to an increased risk of developing certain types of cancers. Possibly, the virus alters a cell in some way. That cell then reproduces an altered cell and, eventually, these alterations become a cancer cell that reproduces more cancer cells. Cancer is not contagious and a person cannot contract cancer from another person who has the disease.
• environmental exposures
  Environmental exposures such as pesticides, fertilizers, and power lines have been researched for a direct link to childhood cancers. There has been evidence of cancer occurring among non-related children in certain neighborhoods and/or cities. Whether prenatal or infant exposure to these agents causes cancer, or whether it is a coincidence, is unknown.

How do genes affect cancer growth?

The discovery of certain types of genes that contribute to cancer has been an extremely important development for cancer research. Over 90 percent of cancers are observed to have some type of genetic alteration. A small percentage (5 percent to 10 percent) of these alterations are inherited, while the rest are sporadic, which means they occur by chance or occur from environmental exposures (usually over many years). There are three main types of genes that can affect cell growth, and are altered (mutated) in certain types of cancers, including the following:

• oncogenes
  These genes regulate the normal growth of cells. Scientists commonly describe oncogenes as similar to a cancer "switch" that most people have in their bodies. What "flips the switch" to make these oncogenes suddenly become unable to control the normal growth of cells and allowing abnormal cancer cells to begin to grow, is unknown.
• tumor suppressor genes
  These genes are able to recognize abnormal growth and reproduction of damaged cells, or cancer cells, and can interrupt their reproduction until the defect is corrected. If the tumor suppressor genes are mutated, however, and they do not function properly, tumor growth may occur.
• mismatch-repair genes
  These genes help recognize errors when DNA is copied to make a new cell. If the DNA does not "match" perfectly, these genes repair the mismatch and correct the error. If these genes are not working properly, however, errors in DNA can be transmitted to new cells, causing them to be damaged.

Usually the number of cells in any of our body tissues is tightly controlled so that new cells are made for normal growth and development, as well as to replace dying cells. Ultimately, cancer is a loss of this balance due to genetic alterations that "tip the balance" in favor of excessive cell growth.

Cancer-research-center

Welcome to All About Cancer

your resource for everything related to cancer. Here, you can find comprehensive information cancer diagnosis, treatment, genetics, nutrition, complementary therapies and more. You can also find detailed information about specific types of cancer.

What Is Cancer?

Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells.

Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries.

Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells.

Cancer cells develop because of damage to DNA. This substance is in every cell and directs all activities. Most of the time when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. More often, though, a person's DNA becomes damaged by exposure to something in the environment, like smoking.

Cancer usually forms as a tumor. Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow.

Often, cancer cells travel to other parts of the body where they begin to grow and replace normal tissue. This process is called metastasis. Regardless of where a cancer may spread, however, it is always named for the place it began. For instance, breast cancer that spreads to the liver is still called breast cancer, not liver cancer.

Not all tumors are cancerous. Benign (noncancerous) tumors do not spread (metastasize) to other parts of the body and, with very rare exceptions, are not life threatening.

Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer.

Cancer is the second leading cause of death in the United States. Half of all men and one third of all women in the United States will develop cancer during their lifetimes. Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. The sooner a cancer is found and treatment begins, the better are the chances for living for many years.