Cancer Conditions

Adenocarcinoma

An adenocarcinoma is a type of cancer that develops in the epithelial cells of glandular tissue throughout the body. Though it can originate in any of the body's secretory tissues, adenocarcinoma of the ovary may have a different prognosis and treatment plan than an adenocarcinoma of the lung. Most lung and colon cancers are adenocarcinomas.

Bladder Cancer

Bladder cancer is a term for any number of malignant cell growths in the urinary bladder - typically in the inner lining cells. Blood in the urine, frequent urination, and pain during urination are common symptoms.

Bladder Carcinoma

Bladder carcinoma is a type of bladder cancer originating the cells lining the inside wall of the bladder. The most common type of bladder cancer in the US, a transitional cell carcinoma bladder tumor can originate in similar cells lining the inside of the urethra or ureters.
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Bone Cancer

Bone cancer refers to a malignant cell growth in the bone tissue. Primary bone cancers - such as osteosarcoma - originate in the bone, while the more common secondary bone cancers originate in another part of the body and spread to the bone. Noncancerous (benign) bone tumors are much more common than malignant bone tumors and are often not life-threatening.

Brain Cancer

Tumors that begin in brain tissue are known as primary tumors of the brain. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin.

ci brain

The most common primary brain tumors are gliomas. They begin in glial cells.

There are many types of gliomas:

  • Astrocytoma—The tumor arises from star-shaped glial cells called astrocytes. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum, and the cerebellum. A grade III astrocytoma is sometimes called an anaplastic astrocytoma. A grade IV astrocytoma is usually called a glioblastoma multiforme.
  • Brain stem glioma—The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and middle-aged adults.
  • Ependymoma—The tumor arises from cells that line the ventricles or the central canal of the spinal cord. They are most commonly found in children and young adults.
  • Oligodendroglioma—This rare tumor arises from cells that make the fatty substance that covers and protects nerves. These tumors usually occur in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. They are most common in middle-aged adults.

Some types of brain tumors do not begin in glial cells.

The most common of these are:

  • Medulloblastoma—This tumor usually arises in the cerebellum. It is the most common brain tumor in children. It is sometimes called a primitive neuroectodermal tumor.
  • Meningioma—This tumor arises in the meninges. It usually grows slowly.
  • Schwannoma—A tumor that arises from a Schwann cell. These cells line the nerve that controls balance and hearing. This nerve is in the inner ear. The tumor is also called an acoustic neuroma. It occurs most often in adults.
  • Craniopharyngioma—The tumor grows at the base of the brain, near the pituitary gland. This type of tumor most often occurs in children.
  • Germ cell tumor of the brain—The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger than 30. The most common type of germ cell tumor of the brain is a germinoma.
  • Pineal region tumor—This rare brain tumor arises in or near the pineal gland. The pineal gland is located between the cerebrum and the cerebellum.

Secondary Brain Tumors

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. Cancer that spreads to the brain from another part of the body is different from a primary brain tumor. When cancer cells spread to the brain from another organ (such as the lung or breast), doctors may call the tumor in the brain a secondary tumor or metastatic tumor. Secondary tumors in the brain are far more common than primary brain tumors.

Risk

No one knows the exact causes of brain tumors. Doctors can seldom explain why one person develops a brain tumor and another does not. However, it is clear that brain tumors are not contagious. No one can "catch" the disease from another person.

Research has shown that people with certain risk factors are more likely than others to develop a brain tumor. A risk factor is anything that increases a person's chance of developing a disease.

The following risk factors are associated with an increased chance of developing a primary brain tumor:

  • Being male—In general, brain tumors are more common in males than females. However, meningiomas are more common in females.
  • Race—Brain tumors occur more often among white people than among people of other races.
  • Age—Most brain tumors are detected in people who are 70 years old or older. However, brain tumors are the second most common cancer in children. (Leukemia is the most common childhood cancer.) Brain tumors are more common in children younger than 8 years old than in older children.
  • Family history—People with family members who have gliomas may be more likely to develop this disease.
  • Being exposed to radiation or certain chemicals at work:
    • Radiation—Workers in the nuclear industry have an increased risk of developing a brain tumor.
    • Formaldehyde—Pathologists and embalmers who work with formaldehyde have an increased risk of developing brain cancer. Scientists have not found an increased risk of brain cancer among other types of workers exposed to formaldehyde.
    • Vinyl chloride—Workers who make plastics may be exposed to vinyl chloride. This chemical may increase the risk of brain tumors.
    • Acrylonitrile—People who make textiles and plastics may be exposed to acrylonitrile. This exposure may increase the risk of brain cancer.
    • Scientists are investigating whether cell phones may cause brain tumors. Studies thus far have not found an increased risk of brain tumors among people who use cell phones.

Scientists also continue to study whether head injuries are a risk factor for brain tumors. So far, these studies have not found an increased risk among people who have had head injuries.

Most people who have known risk factors do not get brain cancer. On the other hand, many who do get the disease have none of these risk factors. People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Diagnosis

If a person has symptoms that suggest a brain tumor, the doctor may perform one or more of the following procedures:

  • Physical exam—The doctor checks general signs of health.
  • Neurologic exam—The doctor checks for alertness, muscle strength, coordination, reflexes, and response to pain. The doctor also examines the eyes to look for swelling caused by a tumor pressing on the nerve that connects the eye and brain.
  • CT scan—An x-ray machine linked to a computer takes a series of detailed pictures of the head. The patient may receive an injection of a special dye so the brain shows up clearly in the pictures. The pictures can show tumors in the brain.
  • MRI—A powerful magnet linked to a computer makes detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed. Sometimes a special dye is injected to help show differences in the tissues of the brain. The pictures can show a tumor or other problem in the brain.
  • Angiogram—Dye injected into the bloodstream flows into the blood vessels in the brain to make them show up on an x-ray. If a tumor is present, the doctor may be able to see it on the x-ray.
  • Skull x-ray—Some types of brain tumors cause calcium deposits in the brain or changes in the bones of the skull. With an x-ray, the doctor can check for these changes.
  • Spinal tap—The doctor may remove a sample of cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). This procedure is performed with local anesthesia. The doctor uses a long, thin needle to remove fluid from the spinal column. A spinal tap takes about 30 minutes. The patient must lie flat for several hours afterward to keep from getting a headache. A laboratory checks the fluid for cancer cells or other signs of problems.
  • Myelogram—This is an x-ray of the spine. A spinal tap is performed to inject a special dye into the cerebrospinal fluid. The patient is tilted to allow the dye to mix with the fluid. This test helps the doctor detect a tumor in the spinal cord.
  • Biopsy—The removal of tissue to look for tumor cells is called a biopsy. A pathologist looks at the cells under a microscope to check for abnormal cells. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. A biopsy is the only sure way to diagnose a brain tumor.
  • Surgeons can obtain tissue to look for tumor cells in three ways:
    • Needle biopsy—The surgeon makes a small incision in the scalp and drills a small hole into the skull. This is called a burr hole. The doctor passes a needle through the burr hole and removes a sample of tissue from the brain tumor.
    • Stereotactic biopsy—An imaging device, such as CT or MRI, guides the needle through the burr hole to the location of the tumor. The surgeon withdraws a sample of tissue with the needle.
    • Biopsy at the same time as treatment—Sometimes the surgeon takes a tissue sample when the patient has surgery to remove the tumor. Sometimes a biopsy is not possible. If the tumor is in the brain stem or certain other areas, the surgeon may not be able to remove tissue from the tumor without damaging normal brain tissue. The doctor uses MRI, CT, or other imaging tests instead.

 

Breast Cancer

No one knows the exact causes of breast cancer. Doctors can seldom explain why one woman gets breast cancer and another does not.

Doctors do know that bumping, bruising, or touching the breast does not cause breast cancer. And breast cancer is not contagious. No one can "catch" this disease from another person.

However, research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is anything that increases a person's chance of developing a disease.

Studies have found the following risk factors for breast cancer:

  • ci breastAge: The chance of getting breast cancer goes up as a woman gets older. A woman over age 60 is at greatest risk. This disease is very uncommon before menopause.
  • Personal history of breast cancer: A woman who has had breast cancer in one breast has an increased risk of getting this disease in her other breast.
  • Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer, especially at a young age (before age 40). Having other relatives with breast cancer on either her mother's or her father's side of the family may also increase a woman's risk.
  • Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia or lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
  • Genetic alterations: Changes in certain genes (BRCA1, BRCA2, and others) increase the risk of breast cancer. In families in which many women have had the disease, genetic testing can sometimes show the presence of specific genetic changes. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes.
  • Reproductive and menstrual history:
    • The older a woman is when she has her first child, the greater her chance of breast cancer.
    • Women who began menstruation (had their first menstrual period) at an early age (before age 12), went through menopause late (after age 55), or never had children also are at an increased risk.
    • Women who take menopausal hormone therapy (either estrogen alone or estrogen plus progestin) for 5 or more years after menopause also appear to have an increased chance of developing breast cancer.
    • Much research has been done to learn whether having an abortion or a miscarriage affects a woman's chance of developing breast cancer later on. Large, well-designed studies have consistently shown no link between abortion or miscarriage and the development of breast cancer.
  • Race: Breast cancer occurs more often in white women than Latina, Asian, or African American women.
  • Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
  • Breast density: Older women who have mostly dense (not fatty) tissue on a mammogram (x-ray of the breast) are at increased risk of breast cancer.
  • Taking DES (diethylstilbestrol): DES is a synthetic form of estrogen that was given to some pregnant women in the United States between about 1940 and 1971. (DES is no longer given to pregnant women.) Women who took DES during pregnancy have a slightly increased risk of breast cancer. This does not yet appear to be the case for their daughters who were exposed to DES before birth. However, as these daughters grow older, more studies of their breast cancer risk are needed.
  • Being obese after menopause: After menopause, women who are obese have an increased risk of developing breast cancer. Being obese means that the woman has an abnormally high proportion of body fat. Because the body makes some of its estrogen (a hormone) in fatty tissue, obese women are more likely than thin women to have higher levels of estrogen in their bodies. High levels of estrogen may be the reason that obese women have an increased risk of breast cancer. Also, some studies show that gaining weight after menopause increases the risk of breast cancer.
  • Physical inactivity: Women who are physically inactive throughout life appear to have an increased risk of breast cancer. Being physically active may help to reduce risk by preventing weight gain and obesity.
  • Alcoholic beverages: Some studies suggest that the more alcoholic beverages a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. It is helpful to be aware of risk factors. But it is also important to keep in mind that most women who have these risk factors do not get breast cancer.

Also, most women who develop breast cancer have no history of the disease in their family. In fact, except for growing older, most women with breast cancer have no strong risk factors.

Still, a woman who thinks she may be at risk of breast cancer should discuss this concern with her health care provider. The health care provider may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Detection and Diagnosis

Screening

A woman should talk with her health care provider about her personal risk of getting breast cancer. She should ask questions about when to start and how often to be checked for the disease. These decisions, like many other medical decisions, should fit each woman's needs.

Screening for cancer before there are symptoms can be important. It can help doctors find and treat cancer early. Treatment is more likely to be effective when cancer is found early.

The health care provider may suggest screening tests to check for breast cancer before any symptoms develop:

  • Screening mammogram
  • Clinical breast exam
  • Breast self-exam

Screening Mammogram

To find breast cancer early, the NCI recommends that:

  • Women in their 40s and older should have mammograms (pictures of the breast made with x-rays) every one to two years.
  • Women who are at higher than average risk of breast cancer should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.

Screening mammograms can often show a breast lump before it can be felt. They also can show a cluster of very tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be signs of cancer.

If the doctor sees an abnormal area on the mammogram, the woman may need more pictures taken. Also, the woman may need to have a biopsy. A biopsy is the only way to tell for sure if cancer is present.

Mammograms are the best tool doctors have to find breast cancer early. However, it is good for a woman to keep in mind that:

  • A mammogram may miss some cancers that are present. (This is called a "false negative.")
  • A mammogram may show things that turn out not to be cancer. (This is called a "false positive.")
  • Some fast-growing tumors may already have spread to other parts of the body before a mammogram detects them.

Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. Although the benefits nearly always outweigh the risks, repeated exposure to x-rays could be harmful. It is a good idea for a woman to talk with her health care providers about the need for each x-ray and to ask about the use of shields during the x-ray to protect other parts of the body.

Clinical Breast Exam

During a clinical breast exam, the health care provider feels the breasts while the woman is standing or sitting up and lying down. The woman may be asked to raise her arms over her head, let them hang by her sides, or press her hands against her hips.

The health care provider looks for differences between the breasts, including unusual differences in size or shape. The skin of each breast is checked for a rash, dimpling, or other abnormal signs. The nipples may be squeezed to see if fluid is present.

Using the pads of the fingers to feel for lumps, the health care provider checks the entire breast, the underarm, and the collarbone area, first on one side, then on the other. A lump is generally the size of a pea before anyone can feel it. The lymph nodes near the breast may be checked to see if they are swollen.

A thorough clinical breast exam may take 10 minutes.

Breast Self-Exam

Some women perform monthly breast self-exams to check for any changes in their breasts. When a woman does this exam, it is important for her to remember that each woman's breasts are different, and that changes can occur because of aging, the menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for the breasts to feel a little lumpy and uneven. Also, it is common for a woman's breasts to be swollen and tender right before or during her menstrual period.

Women who notice anything unusual during a breast self-exam or at any other time should contact their health care provider.

Also, it is important to remember that breast self-exams cannot replace regular screening mammograms and clinical breast exams. Although breast self-exams lead to more breast biopsies, studies so far have not shown that breast self-exams reduce the number of deaths from breast cancer.

Symptoms

Breast cancer can cause changes that women should watch for:

  • Change in how the breast or nipple feels
    • A lump or thickening in or near the breast or in the underarm area
    • Nipple tenderness
  • A change in how the breast or nipple looks
    • A change in the size or shape of the breast
    • The nipple is turned inward into the breast
    • The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange.
  • Nipple discharge (fluid)
  • Although early breast cancer usually does not cause pain, a woman should see her health care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not cancer, but it is important to check with the health care provider so that any problems can be diagnosed and treated as early as possible.

Diagnosis

If a woman has a breast change, her doctor must determine whether it is due to breast cancer or some other cause. The woman has a physical exam. The doctor asks about her personal and family medical history. She may have a mammogram or other imaging procedure that makes pictures of tissues inside the breast. After the tests, the doctor may decide that no further tests are needed and no treatment is necessary. Or the woman may need a biopsy to examine the suspicious area for cancer cells.

Clinical Breast Exam

The health care provider feels each breast for lumps and looks for other problems. If a woman has a breast lump, the health care provider can tell a lot about it by feeling it and the tissue around it. Benign lumps often feel different from cancerous ones. The health care provider can check the size, shape, and texture of the lump and feel whether it moves easily. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.


Diagnostic Mammography

Diagnostic mammograms involve x-ray pictures of the breast to get clearer, more detailed pictures of any area that looks abnormal on a screening mammogram. They also are used to help the doctor learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms.

Ultrasonography

Using high-frequency sound waves, ultrasonography (ultrasound) can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). The doctor can view these pictures on a monitor. After the test, the pictures can be stored on video and printed out. This exam may be used along with a mammogram.

Magnetic Resonance Imaging

For magnetic resonance imaging (MRI), a powerful magnet linked to a computer is sometimes used to make detailed pictures of tissue inside the breast. The doctor can view these pictures on a monitor and can print them on film. MRI may be used along with a mammogram.

Biopsy

Often, fluid or tissue must be removed from the breast to help the doctor learn whether cancer is present. This is called a biopsy. For the biopsy, the doctor may refer the woman to a surgeon or breast disease specialist.

Sometimes a suspicious area that can be seen on a mammogram cannot be felt during a clinical breast exam. The doctor can use imaging devices to help see the area to then obtain tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy.

Doctors can remove tissue from the breast in different ways:

  • Fine-needle aspiration: The doctor uses a thin needle to remove fluid and/or cells from a breast lump. If the fluid appears to contain cells, it goes to a lab where a pathologist uses a microscope to check for cancer cells. If the fluid is clear, it may not need to be checked by a lab.
  • Core biopsy: The doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.
  • Surgical biopsy: In an incisional biopsy, the surgeon removes a sample of a lump or abnormal area. In an excisional biopsy, the surgeon removes the entire lump or abnormal area. A pathologist examines the tissue for cancer cells.

If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. It begins in the lining of the ducts. Another type, called lobular carcinoma, begins in the lobules.

Additional Tests

If the diagnosis is cancer, the doctor may order special lab tests on the tissue that was removed. The results of these tests help the doctor learn more about the cancer and plan appropriate treatment.

Many women with breast cancer will have the hormone receptor test. It shows whether the cancer needs hormones (estrogen or progesterone) to grow. The result helps the doctor plan treatment.

Sometimes a sample of breast tissue is checked for the human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. The presence of the HER2 receptor or gene may increase the chance that the breast cancer will come back.

Staging

To plan a woman's treatment, the doctor needs to know the extent (stage) of the disease. The stage is based on the size of the tumor and whether the cancer has spread. Staging may involve x-rays and lab tests to learn whether the cancer has spread and, if so, to what parts of the body. When breast cancer spreads, cancer cells are often found in lymph nodes under the arm (axillary lymph nodes). The extent of the cancer often is not known until after surgery to remove the tumor in the breast and the lymph nodes under the arm.

Stages of Breast Cancer

Doctors describe breast cancer by the following stages:

  • Stage 0 is called carcinoma in situ.
    • Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lining of a lobule. These abnormal cells are a marker of increased risk. That means a woman with LCIS has an increased risk of developing invasive cancer in either breast sometime in the future. (Both breasts are at risk.)
    • Ductal carcinoma in situ (DCIS) is a precancerous condition in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct to invade the surrounding breast tissue. However, if not treated, DCIS sometimes becomes invasive cancer.
  • Stage I is an early stage of invasive breast cancer. Stage I means that the tumor is no more than 2 centimeters (less than three-quarters of an inch) across, and cancer cells have not spread beyond the breast.
  • Stage II is one of the following:
    • The tumor in the breast is no more than 2 centimeters (less than three-quarters of an inch) across, and the cancer has spread to the lymph nodes under the arm; or
    • The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches), and the cancer may have spread to the lymph nodes under the arm; or
    • The tumor is larger than 5 centimeters (2 inches) but has not spread to the lymph nodes under the arm.
  • Stage III may be a large tumor, but the cancer has not spread beyond the breast and nearby lymph nodes. It is locally advanced cancer.
    • Stage IIIA means the tumor in the breast is smaller than 5 centimeters, the cancer has spread to the underarm lymph nodes, and the lymph nodes are attached to each other or to other structures. Or the tumor is large (more than 5 centimeters across), and the cancer has spread to the underarm lymph nodes.
    • Stage IIIB means the tumor may have grown into the chest wall or the skin of the breast; or the cancer has spread to lymph nodes under the breastbone.
    • Inflammatory breast cancer is a type of Stage IIIB breast cancer. It is rare. The breast looks red and swollen (or inflamed) because cancer cells block the lymph vessels in the skin of the breast.
    • Stage IIIC means the cancer has spread to the lymph nodes under the breastbone and under the arm, or to the lymph nodes under or above the collarbone. The primary breast tumor may be of any size.
  • Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body.

Recurrent cancer is cancer that has come back (recurred) after treatment. It may recur locally (in the breast or chest wall) or in any other part of the body (such as bone, liver, or lungs).

Recurrent Breast Cancer

Recurrent cancer is cancer that has come back after treatment. Treatment for the recurrent disease depends mainly on the location and extent of the cancer and on the type of treatment the woman had before.

If breast cancer comes back in the breast (and not anywhere else) after breast-sparing surgery, the woman may have a mastectomy. Chances are good that the disease will not come back again elsewhere.

If breast cancer recurs in other parts of the body, the treatment may involve chemotherapy, hormonal therapy, or biological therapy. Radiation therapy may help control cancer that recurs in the chest muscles or in certain other areas of the body.

As with Stage IV breast cancer, treatment can seldom cure cancer that recurs outside the breast. Palliative care is often an important part of the treatment plan. Many patients have palliative care to ease their symptoms while they have anticancer treatments to slow the progress of the disease. Some receive only palliative care to improve their quality of life by easing pain, nausea, and other symptoms.

Carcinoma

 Carcinoma refers to a malignant tumor originating in the epithelial cells lining the body's skin, organs, or blood vessels. Most human cancers are carcinomas.

Cervical Cancer

Cervical cancer is a cancer that develops in the tissue of the cervix - the organ connecting the uterus and the vagina. Most cases of cervical cancer are caused by a common sexually transmitted illness called HPV (or human papillomavirus); as the early stages of cervical cancer often do not present with any symptoms, regular pap smears are recommended for sexually active women.

Colorectal Cancer

Cancer of the colon or rectum is also called colorectal cancer. In the United States, colorectal cancer is the fourth most common cancer in men,ci gi after skin, prostate, and lung cancer. It is also the fourth most common cancer in women, after skin, lung, and breast cancer.

No one knows the exact causes of colorectal cancer. Doctors can seldom explain why one person develops the disease and another does not. However, it is clear that colorectal cancer is not contagious. No one can "catch" this disease from another person.

Research has shown that people with certain risk factors are more likely than others to develop colorectal cancer. A risk factor is anything that is linked to an increased chance of developing a disease.

Studies have found the following risk factors for colorectal cancer:

  • Age: Colorectal cancer is more likely to occur as people get older. More than 90 percent of people with this disease are diagnosed after age 50. The average age at diagnosis is in the mid-60s.
  • Colorectal polyps: Polyps are growths on the inner wall of the colon or rectum. They are common in people over age 50. Most polyps are benign (noncancerous), but some polyps (adenomas) can become cancer. Finding and removing polyps may reduce the risk of colorectal cancer.
  • Family history of colorectal cancer: Close relatives (parents, brothers, sisters, or children) of a person with a history of colorectal cancer are somewhat more likely to develop this disease themselves, especially if the relative had the cancer at a young age. If many close relatives have a history of colorectal cancer, the risk is even greater.
  • Genetic alterations: Changes in certain genes increase the risk of colorectal cancer.
    • Hereditary nonpolyposis colon cancer (HNPCC) is the most common type of inherited (genetic) colorectal cancer. It accounts for about 2 percent of all colorectal cancer cases. It is caused by changes in an HNPCC gene. About 3 out of 4 people with an altered HNPCC gene develop colon cancer, and the average age at diagnosis of colon cancer is 44.
    • Familial adenomatous polyposis (FAP) is a rare, inherited condition in which hundreds of polyps form in the colon and rectum. It is caused by a change in a specific gene called APC. Unless familial adenomatous polyposis is treated, it usually leads to colorectal cancer by age 40. FAP accounts for less than 1 percent of all colorectal cancer cases.
    • Family members of people who have HNPCC or FAP can have genetic testing to check for specific genetic changes. For those who have changes in their genes, health care providers may suggest ways to try to reduce the risk of colorectal cancer, or to improve the detection of this disease. For adults with FAP, the doctor may recommend an operation to remove all or part of the colon and rectum.
  • Personal history of colorectal cancer: A person who has already had colorectal cancer may develop colorectal cancer a second time. Also, women with a history of cancer of the ovary, uterus (endometrium), or breast are at a somewhat higher risk of developing colorectal cancer.
  • Ulcerative colitis or Crohn's disease: A person who has had a condition that causes inflammation of the colon (such as ulcerative colitis or Crohn's disease) for many years is at increased risk of developing colorectal cancer.
  • Diet: Studies suggest that diets high in fat (especially animal fat) and low in calcium, folate, and fiber may increase the risk of colorectal cancer. Also, some studies suggest that people who eat a diet very low in fruits and vegetables may have a higher risk of colorectal cancer. More research is needed to better understand how diet affects the risk of colorectal cancer.
  • Cigarette smoking: A person who smokes cigarettes may be at increased risk of developing polyps and colorectal cancer.
  • People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Screening

Screening for cancer before a person has symptoms can help the doctor find polyps or cancer early. Finding and removing polyps may prevent colorectal cancer. Also, treatment for colorectal cancer is more likely to be effective when the disease is found early.

To find polyps or early colorectal cancer:

  • People in their 50s and older should be screened.
  • People who are at higher-than-average risk of colorectal cancer should talk with their doctor about whether to have screening tests before age 50, what tests to have, the benefits and risks of each test, and how often to schedule appointments.

The following screening tests are used to detect polyps, cancer, or other abnormalities in the colon and rectum. The doctor can explain more about each test:

  • Fecal occult blood test (FOBT): Sometimes cancers or polyps bleed, and the FOBT can detect tiny amounts of blood in the stool. If this test detects blood, other tests are needed to find the source of the blood. Benign conditions (such as hemorrhoids) also can cause blood in the stool.
  • Sigmoidoscopy: The doctor checks inside the rectum and lower (sigmoid) colon with a lighted tube called a sigmoidoscope. If polyps are found, the doctor removes them. The procedure to remove polyps is called a polypectomy.
  • Colonoscopy: The doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscope. The doctor removes polyps that may be found.
  • Double-contrast barium enema (DCBE): A DCBE is a series of x-rays of the colon and rectum. The patient is given an enema with a barium solution, and air is pumped into the rectum. The barium and air outline the colon and rectum on the x-rays. Polyps may show up on the x-ray.
  • Digital rectal exam (DRE): A rectal exam is often part of a routine physical examination. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for abnormal areas in the lower part of the rectum.

Symptoms

Common symptoms of colorectal cancer include:

  • A change in bowel habits
  • Diarrhea, constipation, or feeling that the bowel does not empty completely
  • Blood (either bright red or very dark) in the stool
  • Stools that are narrower than usual
  • General abdominal discomfort (frequent gas pains, bloating, fullness, and/or cramps)
  • Weight loss with no known reason
  • Constant tiredness
  • Nausea and vomiting

Most often, these symptoms are not due to cancer. Other health problems can cause the same symptoms. Anyone with these symptoms should see a doctor so that any problem can be diagnosed and treated as early as possible.

Usually, early cancer does not cause pain. It is important not to wait to feel pain before seeing a doctor.

Diagnosis

If a person has any signs or symptoms of colorectal cancer, the doctor must determine whether they are due to cancer or some other cause. The doctor asks about personal and family medical history and may do a physical exam. The person may have one or more of the tests described in the "Screening" section.

If the physical exam and test results do not suggest cancer, the doctor may decide that no further tests are needed and no treatment is necessary. However, the doctor may recommend a schedule for checkups.

If tests show an abnormal area (such as a polyp), a biopsy to check for cancer cells may be necessary. Often, the abnormal tissue can be removed during colonoscopy or sigmoidoscopy. A pathologist checks the tissue for cancer cells using a microscope.

Staging

If the biopsy shows that cancer is present, the doctor needs to know the extent (stage) of the disease to plan the best treatment. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Staging may involve some of the following tests and procedures:

  • Blood tests: The doctor checks for carcinoembryonic antigen (CEA) and other substances in the blood. Some people who have colorectal cancer or other conditions have a high CEA level.
  • Colonoscopy: If colonoscopy was not performed for diagnosis, the doctor examines the entire length of the colon and rectum with a colonoscope to check for other abnormal areas.
  • Endorectal ultrasound: An ultrasound probe is inserted into the rectum. The probe sends out sound waves that people cannot hear. The waves bounce off the rectum and nearby tissues, and a computer uses the echoes to create a picture. The picture shows how deep a rectal tumor has grown or whether the cancer has spread to lymph nodes or other nearby tissues.
  • Chest x-ray: X-rays of the chest can show whether cancer has spread to the lungs.

CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of areas inside the body. The patient may receive an injection of dye. Tumors in the liver, lungs, or elsewhere in the body show up on the CT scan.

The doctor also may use other tests (such as MRI) to see whether the cancer has spread. Sometimes staging is not complete until the patient has surgery to remove the tumor.

Doctors describe colorectal cancer by the following stages:

  • Stage 0: The cancer is found only in the innermost lining of the colon or rectum. Carcinoma in situ is another name for Stage 0 colorectal cancer.
  • Stage I: The cancer has grown into the inner wall of the colon or rectum. The tumor has not reached the outer wall of the colon or extended outside the colon. Dukes' A is another name for Stage I colorectal cancer.
  • Stage II: The tumor extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes. Dukes' B is another name for Stage II colorectal cancer.
  • Stage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body. Dukes' C is another name for Stage III colorectal cancer.
  • Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs. Dukes' D is another name for Stage IV colorectal cancer.

Recurrent cancer: This is cancer that has been treated and has returned after a period of time when the cancer could not be detected. The disease may return in the colon or rectum, or in another part of the body.

Esophageal Cancer

Esophageal cancer is a cancer that originates in the esophagus - a tube-like organ that carries food from the throat to the stomach. Tumors in the upper portion of the esophagus are frequently associated with tobacco and alcohol use, and tumors in the lower portion can often be attributed to conditions like Barrett's Esophagus or acid reflux disease.

Head & Neck Cancer

Most head and neck cancers begin in the squamous cells that line the structures found in the head and neck. Because of this, head and neck ci hancancers are often referred to as squamous cell carcinomas. Some head and neck cancers begin in other types of cells. For example, cancers that begin in glandular cells are called adenocarcinomas.

Cancers of the head and neck are further identified by the area in which they begin:

  • Oral cavity-The oral cavity includes the lips, the front two-thirds of the tongue, the gums (gingiva), the lining inside the cheeks and lips (buccal mucosa), the bottom (floor) of the mouth under the tongue, the bony top of the mouth (hard palate), and the small area behind the wisdom teeth.
  • Salivary glands-The salivary glands are in several places: under the tongue, in front of the ears, and under the jawbone, as well as in other parts of the upper digestive tract.
  • Paranasal sinuses and nasal cavity-The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.
  • Pharynx-The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus (the tube that goes to the stomach) and the trachea (the tube that goes to the lungs). The pharynx has three parts:
  • Nasopharynx-The nasopharynx, the upper part of the pharynx, is behind the nose.
  • Oropharynx-The oropharynx is the middle part of the pharynx. The oropharynx includes the soft palate (the back of the mouth), the base of the tongue, and the tonsils.
  • Hypopharynx-The hypopharynx is the lower part of the pharynx.
  • Larynx-The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages.
  • Lymph nodes in the upper part of the neck-Sometimes, squamous cancer cells are found in the lymph nodes of the upper neck when there is no evidence of cancer in other parts of the head and neck. When this happens, the cancer is called metastatic squamous neck cancer with unseen (occult) primary.

Cancers of the brain, eye, and thyroid usually are not included in the category of head and neck cancers. Cancers of the scalp, skin, muscles, and bones of the head and neck are also usually not considered cancers of the head and neck.

Causes

Tobacco (including smokeless tobacco) and alcohol use are the most important risk factors for head and neck cancers, particularly those of the oral cavity, oropharynx, hypopharynx, and larynx. Eighty-five percent of head and neck cancers are linked to tobacco use. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone.

Other risk factors for cancers of the head and neck include the following:

Oral cavity-Sun exposure (lip); human papillomavirus (HPV) infection.
Salivary glands-Radiation to the head and neck. This exposure can come from diagnostic x-rays or from radiation therapy for noncancerous conditions or cancer.
Paranasal sinuses and nasal cavity-Certain industrial exposures, such as wood or nickel dust inhalation. Tobacco and alcohol use may play less of a role in this type of cancer.
Nasopharynx-Asian, particularly Chinese, ancestry; Epstein-Barr virus infection; occupational exposure to wood dust; and consumption of certain preservatives or salted foods.
Oropharynx-Poor oral hygiene, mechanical irritation such as from poorly fitting dentures, and use of mouthwash that has a high alcohol content.
Hypopharynx-Plummer-Vinson (also called Paterson-Kelly) syndrome, a rare disorder that results from nutritional deficiencies. This syndrome is characterized by severe anemia and leads to difficulty swallowing due to webs of tissue that grow across the upper part of the esophagus.
Larynx-Exposure to airborne particles of asbestos, especially in the workplace.

People who are at risk for head and neck cancers should talk with their doctor about ways they can reduce their risk. They should also discuss how often to have checkups.

Symptoms

Symptoms that are common to several head and neck cancer sites include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. Other symptoms may include the following:

  • Oral cavity-A white or red patch on the gums, tongue, or lining of the mouth; a swelling of the jaw that causes dentures to fit poorly or become uncomfortable; and unusual bleeding or pain in the mouth.
  • Nasal cavity and sinuses-Sinuses that are blocked and do not clear, chronic sinus infections that do not respond to treatment with antibiotics, bleeding through the nose, frequent headaches, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures.
  • Salivary glands-Swelling under the chin or around the jawbone; numbness or paralysis of the muscles in the face; or pain that does not go away in the face, chin, or neck.
  • Oropharynx and hypopharynx-Ear pain.
  • Nasopharynx-Trouble breathing or speaking, frequent headaches, pain or ringing in the ears, or trouble hearing.
  • Larynx-Pain when swallowing, or ear pain.
  • Metastatic squamous neck cancer-Pain in the neck or throat that does not go away.

These symptoms may be caused by cancer or by other, less serious conditions. It is important to check with a doctor or dentist about any of these symptoms.

Diagnosis

To find the cause of symptoms, a doctor evaluates a person's medical history, performs a physical examination, and orders diagnostic tests. The exams and tests conducted may vary depending on the symptoms. Some exams and tests that may be useful are described below:

  • Physical examination may include visual inspection of the oral and nasal cavities, neck, throat, and tongue using a small mirror and/or lights. The doctor may also feel for lumps on the neck, lips, gums, and cheeks.
  • Endoscopy is the use of a thin, lighted tube called an endoscope to examine areas inside the body. The type of endoscope the doctor uses depends on the area being examined. For example, a laryngoscope is inserted through the mouth to view the larynx; an esophagoscope is inserted through the mouth to examine the esophagus; and a nasopharyngoscope is inserted through the nose so the doctor can see the nasal cavity and nasopharynx.
  • Laboratory tests examine samples of blood, urine, or other substances from the body.
  • X-rays create images of areas inside the head and neck on film.
  • CT (or CAT) scan is a series of detailed pictures of areas inside the head and neck created by a computer linked to an x-ray machine.
  • Magnetic resonance imaging (or MRI) uses a powerful magnet linked to a computer to create detailed pictures of areas inside the head and neck.
  • Biopsy is the removal of tissue for examination under a microscope. A pathologist studies the tissue to make a diagnosis. A biopsy is the only sure way to tell whether a person has cancer.

If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Staging may involve surgery, x-rays and other imaging procedures, and laboratory tests. Knowing the stage of the disease helps the doctor plan treatment.

Hemangioma

A hemangioma - sometimes called an infantile hemangioma or a strawberry hemangioma - is a spongy, protuberant mass of blood vessels that forms on the skin or organs during gestation and typically disappears within the child's first ten years of life. Typically benign, hemangiomas will typically be monitored by the child's physician but often require no additional treatment.

Hodgkin's Lymphoma

Formerly referred to as Hodgkin's disease, Hodgkin's lymphoma is a cancer of the lymphatic system - the part of the immune system responsible for creating white blood cells. The disease compromises the body's ability to fight infection, and as the lymphatic system carries fluids through the entire body, cancerous cells can spread to other parts of the body easily.
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Kidney Cancer

Kidney cancer - also called renal cancer - is a cancer whose malignant cells originate in the kidneys. The most common type of kidney cancer, renal cell carcinoma, originates in the tubules responsible for filtering the blood. As early kidney cancer frequently presents with no symptoms, tumors are often discovered fortuitously during images or procedures for other conditions.

Leukemia

The types of leukemia are grouped by how quickly the disease develops and gets worse. Leukemia is either chronic (gets worse slowly) or acute (gets worse quickly):

  • Chronic leukemia-Early in the disease, the abnormal blood cells can still do their work, and people with chronic leukemia may not have any symptoms. Slowly, chronic leukemia gets worse. It causes symptoms as the number of leukemia cells in the blood rises.
  • Acute leukemia-The blood cells are very abnormal. They cannot carry out their normal work. The number of abnormal cells increases rapidly. Acute leukemia worsens quickly.

The types of leukemia are also grouped by the type of white blood cell that is affected. Leukemia can arise in lymphoid cells or myeloid cells. Leukemia that affects lymphoid cells is called lymphocytic leukemia. Leukemia that affects myeloid cells is called myeloid leukemia or myelogenous leukemia.

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There are four common types of leukemia:

  • Chronic lymphocytic leukemia (chronic lymphoblastic leukemia, CLL) accounts for about 7,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.
  • Chronic myeloid leukemia (chronic myelogenous leukemia, CML) accounts for about 4,400 new cases of leukemia each year. It affects mainly adults.
  • Acute lymphocytic leukemia (acute lymphoblastic leukemia, ALL) accounts for about 3,800 new cases of leukemia each year. It is the most common type of leukemia in young children. It also affects adults.
  • Acute myeloid leukemia (acute myelogenous leukemia, AML) accounts for about 10,600 new cases of leukemia each year. It occurs in both adults and children.
  • Hairy cell leukemia is a rare type of chronic leukemia.

No one knows the exact causes of leukemia. Doctors can seldom explain why one person gets this disease and another does not. However, research has shown that people with certain risk factors are more likely than others to develop leukemia. A risk factor is anything that increases a person's chance of developing a disease.

Studies have found the following risk factors for leukemia:

  • Very high levels of radiation-People exposed to very high levels of radiation are much more likely than others to develop leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) and nuclear power plant accidents (such as the Chernobyl [also called Chornobyl] accident in 1986).
  • Medical treatment that uses radiation can be another source of high-level exposure. Radiation used for diagnosis, however, exposes people to much lower levels of radiation and is not linked to leukemia.
  • Working with certain chemicals-Exposure to high levels of benzene in the workplace can cause leukemia. Benzene is used widely in the chemical industry. Formaldehyde is also used by the chemical industry. Workers exposed to formaldehyde also may be at greater risk of leukemia.
  • Chemotherapy-Cancer patients treated with certain cancer-fighting drugs sometimes later develop leukemia. For example, drugs known as alkylating agents are associated with the development of leukemia many years later.
  • Down syndrome and certain other genetic diseases-Some diseases caused by abnormal chromosomes may increase the risk of leukemia.
  • Human T-cell leukemia virus-I (HTLV-I)-This virus causes a rare type of chronic lymphocytic leukemia known as human T-cell leukemia. However, leukemia does not appear to be contagious.
  • Myelodysplastic syndrome-People with this blood disease are at increased risk of developing acute myeloid leukemia.

In the past, some studies suggested exposure to electromagnetic fields as another possible risk factor for leukemia. Electromagnetic fields are a type of low-energy radiation that comes from power lines and electric appliances. However, results from recent studies show that the evidence is weak for electromagnetic fields as a risk factor.

Most people who have known risk factors do not get leukemia. On the other hand, many who do get the disease have none of these risk factors. People who think they may be at risk of leukemia should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Symptoms

Like all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms.

Common symptoms of leukemia may include:

  • Fevers or night sweats
  • Frequent infections
  • Feeling weak or tired
  • Headache
  • Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
  • Pain in the bones or joints
  • Swelling or discomfort in the abdomen (from an enlarged spleen)
  • Swollen lymph nodes, especially in the neck or armpit
  • Weight loss

Such symptoms are not sure signs of leukemia. An infection or another problem also could cause these symptoms. Anyone with these symptoms should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.

In the early stages of chronic leukemia, the leukemia cells function almost normally. Symptoms may not appear for a long time. Doctors often find chronic leukemia during a routine checkup-before there are any symptoms. When symptoms do appear, they generally are mild at first and get worse gradually.

In acute leukemia, symptoms appear and get worse quickly. People with this disease go to their doctor because they feel sick. Other symptoms of acute leukemia are vomiting, confusion, loss of muscle control, and seizures. Leukemia cells also can collect in the testicles and cause swelling. Also, some patients develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.

Diagnosis

If a person has symptoms that suggest leukemia, the doctor may do a physical exam and ask about the patient's personal and family medical history. The doctor also may order laboratory tests, especially blood tests.

The exams and tests may include the following:

  • Physical exam-The doctor checks for swelling of the lymph nodes, spleen, and liver.
  • Blood tests-The lab checks the level of blood cells. Leukemia causes a very high level of white blood cells. It also causes low levels of platelets and hemoglobin, which is found inside red blood cells. The lab also may check the blood for signs that leukemia has affected the liver and kidneys.
  • Biopsy-The doctor removes some bone marrow from the hipbone or another large bone. A pathologist examines the sample under a microscope. The removal of tissue to look for cancer cells is called a biopsy. A biopsy is the only sure way to know whether leukemia cells are in the bone marrow.
  • There are two ways the doctor can obtain bone marrow. Some patients will have both procedures:
    • Bone marrow aspiration: The doctor uses a needle to remove samples of bone marrow.
    • Bone marrow biopsy: The doctor uses a very thick needle to remove a small piece of bone and bone marrow.
  • Local anesthesia helps to make the patient more comfortable.
  • Cytogenetics-The lab looks at the chromosomes of cells from samples of peripheral blood, bone marrow, or lymph nodes.
  • Spinal tap-The doctor removes some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the spinal column. The procedure takes about 30 minutes and is performed with local anesthesia. The patient must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
  • Chest x-ray-The x-ray can reveal signs of disease in the chest.

Liver Cancer

Liver cancer, also called hepatoma or primary liver cancer, is a cancer arising from the liver's hepatocytic cells. The term "liver cancer" can also refer to secondary liver cancers that originated in cancerous tissue and have metastasized to the liver from other parts of the body.
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Lung Cancer

Cancers that begin in the lungs are divided into two major types, non-small cell lung cancer and small cell lung cancer, depending on how the cells look under a microscope. Each type of lung cancer grows and spreads in different ways and is treated differently.

 ci lung

  • Nonsmall cell lung cancer is more common than small cell lung cancer, and it generally grows and spreads more slowly. There are three main types of non-small cell lung cancer. They are named for the type of cells in which the cancer develops: squamous cell carcinoma (also called epidermoid carcinoma), adenocarcinoma, and large cell carcinoma.
  • Small cell lung cancer, sometimes called oat cell cancer, is less common than non-small cell lung cancer. This type of lung cancer grows more quickly and is more likely to spread to other organs in the body.

Researchers have discovered several causes of lung cancer -- most are related to the use of tobacco.

  • Cigarettes. Smoking cigarettes causes lung cancer. Harmful substances, called carcinogens, in tobacco damage the cells in the lungs. Over time, the damaged cells may become cancerous. The likelihood that a smoker will develop lung cancer is affected by the age at which smoking began, how long the person has smoked, the number of cigarettes smoked per day, and how deeply the smoker inhales. Stopping smoking greatly reduces a person's risk for developing lung cancer.
  • Cigars and Pipes. Cigar and pipe smokers have a higher risk of lung cancer than nonsmokers. The number of years a person smokes, the number of pipes or cigars smoked per day, and how deeply the person inhales all affect the risk of developing lung cancer. Even cigar and pipe smokers who do not inhale are at increased risk for lung, mouth, and other types of cancer.
  • Environmental Tobacco Smoke. The chance of developing lung cancer is increased by exposure to environmental tobacco smoke (ETS) -- the smoke in the air when someone else smokes. Exposure to ETS, or secondhand smoke, is called involuntary or passive smoking.
  • Radon. Radon is an invisible, odorless, and tasteless radioactive gas that occurs naturally in soil and rocks. It can cause damage to the lungs that may lead to lung cancer. People who work in mines may be exposed to radon and, in some parts of the country, radon is found in houses. Smoking increases the risk of lung cancer even more for those already at risk because of exposure to radon. A kit available at most hardware stores allows homeowners to measure radon levels in their homes. The home radon test is relatively easy to use and inexpensive. Once a radon problem is corrected, the hazard is gone for good.
  • Asbestos. Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air and stick to clothes. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk for lung cancer. Studies have shown that workers who have been exposed to large amounts of asbestos have a risk of developing lung cancer that is 3 to 4 times greater than that for workers who have not been exposed to asbestos. This exposure has been observed in such industries as shipbuilding, asbestos mining and manufacturing, insulation work, and brake repair. The risk of lung cancer is even higher among asbestos workers who also smoke. Asbestos workers should use the protective equipment provided by their employers and follow recommended work practices and safety procedures.
  • Pollution. Researchers have found a link between lung cancer and exposure to certain air pollutants, such as by-products of the combustion of diesel and other fossil fuels. However, this relationship has not been clearly defined, and more research is being done.
  • Lung Diseases. Certain lung diseases, such as tuberculosis (TB), increase a person's chance of developing lung cancer. Lung cancer tends to develop in areas of the lung that are scarred from TB.
  • Personal History. A person who has had lung cancer once is more likely to develop a second lung cancer compared with a person who has never had lung cancer. Quitting smoking after lung cancer is diagnosed may prevent the development of a second lung cancer.

Researchers continue to study the causes of lung cancer and to search for ways to prevent it. We already know that the best way to prevent lung cancer is to quit (or never start) smoking. The sooner a person quits smoking the better. Even if you have been smoking for many years, it's never too late to benefit from quitting. The best way to prevent lung cancer is to quit, or never start, smoking.

Recognizing Symptoms

Common signs and symptoms of lung cancer include:

  • A cough that doesn't go away and gets worse over time
  • Constant chest pain
  • Coughing up blood
  • Shortness of breath, wheezing, or hoarseness
  • Repeated problems with pneumonia or bronchitis
  • Swelling of the neck and face
  • Loss of appetite or weight loss
  • Fatigue

These symptoms may be caused by lung cancer or by other conditions. It is important to check with a doctor.

Diagnosing Lung Cancer

To help find the cause of symptoms, the doctor evaluates a person's medical history, smoking history, exposure to environmental and occupational substances, and family history of cancer. The doctor also performs a physical exam and may order a chest x-ray and other tests. If lung cancer is suspected, sputum cytology (the microscopic examination of cells obtained from a deep-cough sample of mucus in the lungs) is a simple test that may be useful in detecting lung cancer. To confirm the presence of lung cancer, the doctor must examine tissue from the lung. A biopsy -- the removal of a small sample of tissue for examination under a microscope by a pathologist -- can show whether a person has cancer. A number of procedures may be used to obtain this tissue:

  • Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.
  • Needle aspiration. A needle is inserted through the chest into the tumor to remove a sample of tissue.
  • Thoracentesis. Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells.
  • Thoracotomy. Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital.

Staging the Disease

If the diagnosis is cancer, the doctor will want to learn the stage (or extent) of the disease. Staging is done to find out whether the cancer has spread and, if so, to what parts of the body. Lung cancer often spreads to the brain or bones. Knowing the stage of the disease helps the doctor plan treatment. Some tests used to determine whether the cancer has spread include:

  • CAT (or CT) scan (computed tomography). A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.
  • MRI (magnetic resonance imaging). A powerful magnet linked to a computer makes detailed pictures of areas inside the body.
  • Radionuclide scanning. Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.
  • Bone scan. A bone scan, one type of radionuclide scanning, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein. It travels through the bloodstream and collects in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas and records them on x-ray film.
  • Mediastinoscopy/Mediastinotomy. A mediastinoscopy can help show whether the cancer has spread to the lymph nodes in the chest. Using a lighted viewing instrument, called a scope, the doctor examines the center of the chest (mediastinum) and nearby lymph nodes. In mediastinoscopy, the scope is inserted through a small incision in the neck; in mediastinotomy, the incision is made in the chest. In either procedure, the scope is also used to remove a tissue sample. The patient receives a general anesthetic.

Lymphoma

The term "lymphoma" refers to a number of cancers of the lymphatic system in which white blood cells undergo a malignant transformation and gather in the lymph nodes - forming a tumor. Lymphomas can be categorized as Hodgkin's lymphoma (which develops from a specific line of white blood cells) or non-Hodgkin's lymphoma (which comprises all other lymphomas).

Melanoma

Melanoma occurs when melanocytes (pigment cells) become malignant. Most pigment cells are in the skin; when melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma may also occur in the eye (ocular melanoma or intraocular melanoma). Rarely, melanoma may arise in the meninges, the digestive tract, lymph nodes, or other areas where melanocytes are found.

Melanoma is one of the most common cancers. The chance of developing it increases with age, but this disease affects people of all ages. It can occur on any skin surface. In men, melanoma is often found on the trunk (the area between the shoulders and the hips) or the head and neck. In women, it often develops on the lower legs. Melanoma is rare in black people and others with dark skin. When it does develop in dark-skinned people, it tends to occur under the fingernails or toenails, or on the palms or soles.

When melanoma spreads, cancer cells may show up in nearby lymph nodes. Groups of lymph nodes are found throughout the body. Lymph nodes trap bacteria, cancer cells, or other harmful substances that may be in the lymphatic system. If the cancer has reached the lymph nodes, it may mean that cancer cells have spread to other parts of the body such as the liver, lungs, or brain. In such cases, the cancer cells in the new tumor are still melanoma cells, and the disease is called metastatic melanoma, not liver, lung, or brain cancer.

No one knows the exact causes of melanoma. Doctors can seldom explain why one person gets melanoma and another does not.

However, research has shown that people with certain risk factors are more likely than others to develop melanoma. A risk factor is anything that increases a person's chance of developing a disease. Still, many who do get this disease have no known risk factors.

Studies have found the following risk factors for melanoma:

  • Dysplastic nevi: Dysplastic nevi are more likely than ordinary moles to become cancerous. Dysplastic nevi are common, and many people have a few of these abnormal moles. The risk of melanoma is greatest for people who have a large number of dysplastic nevi. The risk is especially high for people with a family history of both dysplastic nevi and melanoma.
  • Many (more than 50) ordinary moles: Having many moles increases the risk of developing melanoma.
  • Fair skin: Melanoma occurs more frequently in people who have fair skin that burns or freckles easily (these people also usually have red or blond hair and blue eyes) than in people with dark skin. White people get melanoma far more often than do black people, probably because light skin is more easily damaged by the sun.
  • Personal history of melanoma or skin cancer: People who have been treated for melanoma have a high risk of a second melanoma. Some people develop more than two melanomas. People who had one or more of the common skin cancers (basal cell carcinoma or squamous cell carcinoma) are at increased risk of melanoma.
  • Family history of melanoma: Melanoma sometimes runs in families. Having two or more close relatives who have had this disease is a risk factor. About 10 percent of all patients with melanoma have a family member with this disease. When melanoma runs in a family, all family members should be checked regularly by a doctor.
  • Weakened immune system: People whose immune system is weakened by certain cancers, by drugs given following organ transplantation, or by HIV are at increased risk of developing melanoma.
  • Severe, blistering sunburns: People who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma. Because of this, doctors advise that parents protect children's skin from the sun. Such protection may reduce the risk of melanoma later in life. Sunburns in adulthood are also a risk factor for melanoma.
  • Ultraviolet (UV) radiation: Experts believe that much of the worldwide increase in melanoma is related to an increase in the amount of time people spend in the sun. This disease is also more common in people who live in areas that get large amounts of UV radiation from the sun. In the United States, for example, melanoma is more common in Texas than in Minnesota, where the sun is not as strong. UV radiation from the sun causes premature aging of the skin and skin damage that can lead to melanoma. Artificial sources of UV radiation, such as sunlamps and tanning booths, also can cause skin damage and increase the risk of melanoma. Doctors encourage people to limit their exposure to natural UV radiation and to avoid artificial sources.

Doctors recommend that people take steps to help prevent and reduce the risk of melanoma caused by UV radiation:

  • Avoid exposure to the midday sun (from 10 a.m. to 4 p.m.) whenever possible. When your shadow is shorter than you are, remember to protect yourself from the sun.
  • If you must be outside, wear long sleeves, long pants, and a hat with a wide brim.
  • Protect yourself from UV radiation that can penetrate light clothing, windshields, and windows.
  • Protect yourself from UV radiation reflected by sand, water, snow, and ice.
  • Help protect your skin by using a lotion, cream, or gel that contains sunscreen. Many doctors believe sunscreens may help prevent melanoma, especially sunscreens that reflect, absorb, and/or scatter both types of ultraviolet radiation. These sunscreen products will be labeled with "broad-spectrum coverage." Sunscreens are rated in strength according to a sun protection factor (SPF). The higher the SPF, the more sunburn protection is provided. Sunscreens with an SPF value of 2 to 11 provide minimal protection against sunburns. Sunscreens with an SPF of 12 to 29 provide moderate protection. Those with an SPF of 30 or higher provide the most protection against sunburn.
  • Wear sunglasses that have UV-absorbing lenses. The label should specify that the lenses block at least 99 percent of UVA and UVB radiation. Sunglasses can protect both the eyes and the skin around the eyes.

People who are concerned about developing melanoma should talk with their doctor about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the person's personal and family history, medical history, and other risk factors.

Signs and Symptoms

Often, the first sign of melanoma is a change in the size, shape, color, or feel of an existing mole. Most melanomas have a black or blue-black area. Melanoma also may appear as a new mole. It may be black, abnormal, or "ugly looking."

If you have a question or concern about something on your skin, see your doctor. Do not use the following pictures to try to diagnose it yourself. Pictures are useful examples, but they cannot take the place of a doctor's examination.

Thinking of "ABCD" can help you remember what to watch for:

  • Asymmetry-The shape of one half does not match the other.
  • Border-The edges are often ragged, notched, blurred, or irregular in outline; the pigment may spread into the surrounding skin.
  • Color-The color is uneven. Shades of black, brown, and tan may be present. Areas of white, grey, red, pink, or blue also may be seen.
  • Diameter-There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (1/4 inch or 5 millimeters).

Melanomas can vary greatly in how they look. Many show all of the ABCD features. However, some may show changes or abnormalities in only one or two of the ABCD features.

Melanomas in an early stage may be found when an existing mole changes slightly, for example, when a new black area forms. Newly formed fine scales and itching in a mole also are common symptoms of early melanoma. In more advanced melanoma, the texture of the mole may change. For example, it may become hard or lumpy. Melanomas may feel different from regular moles. More advanced tumors may itch, ooze, or bleed. But melanomas usually do not cause pain.

A skin examination is often part of a routine checkup by a health care provider. People also can check their own skin for new growths or other changes. (The "How To Do a Skin Self-Exam" section has a simple guide on how to do this skin self-exam.) Changes in the skin, such as a change in a mole, should be reported to the health care provider right away. The person may be referred to a dermatologist, a doctor who specializes in diseases of the skin.

Melanoma can be cured if it is diagnosed and treated when the tumor is thin and has not deeply invaded the skin. However, if a melanoma is not removed at its early stages, cancer cells may grow downward from the skin surface and invade healthy tissue. When a melanoma becomes thick and deep, the disease often spreads to other parts of the body and is difficult to control.

People who have had melanoma have a high risk of developing a new melanoma. People at risk for any reason should check their skin regularly and have regular skin exams by a health care provider.

Dysplastic Nevi

Some people have certain abnormal-looking moles (called dysplastic nevi or atypical moles) that are more likely than normal moles to develop into melanoma. Most people with dysplastic nevi have just a few of these abnormal moles; some people have many. People with dysplastic nevi and their health care provider should examine these moles regularly to watch for changes.

Dysplastic nevi often look very much like melanoma. Doctors with special training in skin diseases are in the best position to decide whether an abnormal-looking mole should be closely watched or removed and checked for cancer.

In some families, many members have a large number of dysplastic nevi, and some have had melanoma. Members of these families have a very high risk of melanoma. Doctors often recommend that they have frequent checkups (every 3 to 6 months) so that any problems can be detected early. The doctor may take pictures of a person's skin to help show when changes occur.

Diagnosis

If the doctor suspects that a spot on the skin is melanoma, the patient will need to have a biopsy. A biopsy is the only way to make a definite diagnosis. In this procedure, the doctor tries to remove all of the suspicious-looking growth. This is an excisional biopsy. If the growth is too large to be removed entirely, the doctor removes a sample of the tissue. The doctor will never "shave off" or cauterize a growth that might be melanoma.

A biopsy can usually be done in the doctor's office using local anesthesia. A pathologist then examines the tissue under a microscope to check for cancer cells. Sometimes it is helpful for more than one pathologist to check the tissue for cancer cells.

Staging

If the diagnosis is melanoma, the doctor needs to learn the extent, or stage, of the disease before planning treatment. Staging is a careful attempt to learn how thick the tumor is, how deeply the melanoma has invaded the skin, and whether melanoma cells have spread to nearby lymph nodes or other parts of the body. The doctor may remove nearby lymph nodes to check for cancer cells. (Such surgery may be considered part of the treatment because removing cancerous lymph nodes may help control the disease.) The doctor also does a careful physical exam and, if the tumor is thick, may order chest x-rays, blood tests, and scans of the liver, bones, and brain.

Stages of Melanoma

The following stages are used for melanoma:

  • Stage 0: In stage 0, the melanoma cells are found only in the outer layer of skin cells and have not invaded deeper tissues.
  • Stage I: Melanoma in stage I is thin:
    • The tumor is no more than 1 millimeter (1/25 inch) thick. The outer layer (epidermis) of skin may appear scraped. (This is called an ulceration).
    • Or, the tumor is between 1 and 2 millimeters (1/12 inch) thick. There is no ulceration.
  • The melanoma cells have not spread to nearby lymph nodes.
  • Stage II: The tumor is at least 1 millimeter thick:
    • The tumor is between 1 and 2 millimeters thick. There is ulceration.
    • Or, the thickness of the tumor is more than 2 millimeters. There may be ulceration.
  • The melanoma cells have not spread to nearby lymph nodes.
  • Stage III: The melanoma cells have spread to nearby tissues:
    • The melanoma cells have spread to one or more nearby lymph nodes.
    • Or, the melanoma cells have spread to tissues just outside the original tumor but not to any lymph nodes.
  • Stage IV: The melanoma cells have spread to other organs, to lymph nodes, or to skin areas far away from the original tumor.
  • Recurrent: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may have come back in the original site or in another part of the body.

How To Do a Skin Self-Exam

Your doctor or nurse may recommend that you do a regular skin self-exam. If your doctor has taken photos of your skin, comparing your skin to the photos can help you check for changes.

The best time to do a skin self-exam is after a shower or bath. You should check your skin in a well-lighted room using a full-length mirror and a hand-held mirror. It's best to begin by learning where your birthmarks, moles, and blemishes are and what they usually look and feel like.

Check for anything new:

  • A new mole (that looks abnormal)
  • A change in the size, shape, color, or texture of a mole
  • A sore that does not heal

Check yourself from head to toe. Don't forget to check all areas of the skin, including the back, the scalp, between the buttocks, and the genital area.

  • Look at your face, neck, ears, and scalp. You may want to use a comb or a blow dryer to move your hair so that you can see better. You also may want to have a relative or friend check through your hair because this is difficult to do yourself.
  • Look at the front and back of your body in the mirror, then raise your arms and look at your left and right sides.
  • Bend your elbows and look carefully at your fingernails, palms, forearms (including the undersides), and upper arms.
  • Examine the back, front, and sides of your legs. Also look between your buttocks and around your genital area.
  • Sit and closely examine your feet, including the toenails, the soles, and the spaces between the toes.

By checking your skin regularly, you will become familiar with what is normal for you. It may be helpful to record the dates of your skin exams and to write notes about the way your skin looks. If you find anything unusual, see your doctor right away.

Mesothelioma

Mesothelioma is a rare cancer originating in the mesothelium - the thin, protective layer of cells lining the body's internal organs. The vast majority of cases are related to asbestos exposure, though symptoms may not appear until decades after contact with asbestos.

Metastasis

Metastasis is the process by which cancer cells break away from their host tumor, invade either the circulatory or lymphatic system, and travel to other parts of the body. This allows the cancer to spread by establishing new tumors - metastasis indicates a later-stage cancer and makes treatment more complicated.

Myeloma

Multiple myeloma is a type of cancer. It affects certain white blood cells called plasma cells. To understand multiple myeloma, it is helpful to know about normal cells, especially plasma cells, and what happens when they become cancerous.

Normal Cells

The body is made up of many kinds of cells. Each type of cell has special functions. Normal cells are produced in an orderly, controlled way as the body needs them. This process keeps us healthy.

Plasma cells and other white blood cells are part of the immune system, which helps protect the body from infection and disease. All white blood cells begin their development in the bone marrow, the soft, spongy tissue that fills the center of most bones. Certain white blood cells leave the bone marrow and mature in other parts of the body. Some of these develop into plasma cells when the immune system needs them to fight substances that cause infection and disease.

Plasma cells produce antibodies, proteins that move through the bloodstream to help the body get rid of harmful substances. Each type of plasma cell responds to only one specific substance by making a large amount of one kind of antibody. These antibodies find and act against that one substance. Because the body has many types of plasma cells, it can respond to many substances.

Cancer

Cancer is a group of diseases with one thing in common: Cells become abnormal and are produced in large amounts. Cancerous cells interfere with the growth and functions of normal cells. In addition, they can spread from one part of the body to another.

Myeloma Cells

When cancer involves plasma cells, the body keeps producing more and more of these cells. The unneeded plasma cells -- all abnormal and all exactly alike -- are called myeloma cells.

Myeloma cells tend to collect in the bone marrow and in the hard, outer part of bones. Sometimes they collect in only one bone and form a single mass, or tumor, called a plasmacytoma. In most cases, however, the myeloma cells collect in many bones, often forming many tumors and causing other problems. When this happens, the disease is called multiple myeloma. This booklet deals mainly with multiple myeloma.

(It is important to keep in mind that cancer is classified by the type of cell or the part of the body in which the disease begins. Although plasmacytoma and multiple myeloma affect the bones, they begin in cells of the immune system. These cancers are different from bone cancer, which actually begins in cells that form the hard, outer part of the bone. This fact is important because the diagnosis and treatment of plasmacytoma and multiple myeloma are different from the diagnosis and treatment of bone cancer.)

Because people with multiple myeloma have an abnormally large number of identical plasma cells, they also have too much of one type of antibody. These myeloma cells and antibodies can cause a number of serious medical problems:

  • As myeloma cells increase in number, they damage and weaken bones, causing pain and sometimes fractures. Bone pain can make it difficult for patients to move.
  • When bones are damaged, calcium is released into the blood. This may lead to hypercalcemia -- too much calcium in the blood. Hypercalcemia can cause loss of appetite, nausea, thirst, fatigue, muscle weakness, restlessness, and confusion.
  • Myeloma cells prevent the bone marrow from forming normal plasma cells and other white blood cells that are important to the immune system. Patients may not be able to fight infection and disease.
  • The cancer cells also may prevent the growth of new red blood cells, causing anemia. Patients with anemia may feel unusually tired or weak.
  • Multiple myeloma patients may have serious problems with their kidneys. Excess antibody proteins and calcium can prevent the kidneys from filtering and cleaning the blood properly.

Symptoms

Symptoms of multiple myeloma depend on how advanced the disease is. In the earliest stage of the disease, there may be no symptoms. When symptoms do occur, patients commonly have bone pain, often in the back or ribs. Patients also may have broken bones, weakness, fatigue, weight loss, or repeated infections. When the disease is advanced, symptoms may include nausea, vomiting, constipation, problems with urination, and weakness or numbness in the legs. These are not sure signs of multiple myeloma; they can be symptoms of other types of medical problems. A person should see a doctor if these symptoms occur. Only a doctor can determine what is causing a patient's symptoms.

Diagnosis

Multiple myeloma may be found as part of a routine physical exam before patients have symptoms of the disease. When patients do have symptoms, the doctor asks about their personal and family medical history and does a complete physical exam. In addition to checking general signs of health, the doctor may order a number of tests to determine the cause of the symptoms. If a patient has bone pain, x-rays can show whether any bones are damaged or broken. Samples of the patient's blood and urine are checked to see whether they contain high levels of antibody proteins called M proteins. The doctor also may do a bone marrow aspiration and/or a bone marrow biopsy to check for myeloma cells. In an aspiration, the doctor inserts a needle into the hip bone or breast bone to withdraw a sample of fluid and cells from the bone marrow. To do a biopsy, the doctor uses a larger needle to remove a sample of solid tissue from the marrow. A pathologist examines the samples under a microscope to see whether myeloma cells are present.

To plan a patient's treatment, the doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out what parts of the body are affected by the cancer. Treatment decisions depend on these findings. Results of the patient's exam, blood tests, and bone marrow tests can help doctors determine the stage of the disease. In addition, staging usually involves a series of x-rays to determine the number and size of tumors in the bones. In some cases, a patient will have MRI if closeup views of the bones are needed.

Ovarian Carcinoma

Ovarian carcinoma is a cancer arising from the ovaries - either from the cells of the epithelial lining or from the egg cells. The disease is difficult to detect early, often presents with a range of non-specific symptoms (such as back or abdominal pain, bloating, and weight loss), and its cause is unknown.

Pancreatic Cancer

Pancreatic cancer is a malignant cancer of the pancreas - an enzyme-producing organ located behind the stomach that secretes insulin and other digestive enzymes. One of the most aggressive types of cancer, the disease spreads rapidly, is often resistant to treatment, and is usually not discovered until after it has spread to other parts of the body.

Prostate Cancer

The causes of prostate cancer are not well understood. Doctors cannot explain why one man gets prostate cancer and another does not.

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Researchers are studying factors that may increase the risk of this disease.

Studies have found that the following risk factors are associated with prostate cancer:

  • Age. In the United States, prostate cancer is found mainly in men over age 55. The average age of patients at the time of diagnosis is 70.
  • Family history of prostate cancer. A man's risk for developing prostate cancer is higher if his father or brother has had the disease.
  • Race. This disease is much more common in African American men than in white men. It is less common in Asian and American Indian men.
  • Diet and dietary factors. Some evidence suggests that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk. Studies are in progress to learn whether men can reduce their risk of prostate cancer by taking certain dietary supplements.

Although a few studies suggested that having a vasectomy might increase a man's risk for prostate cancer, most studies do not support this finding. Scientists have studied whether benign prostatic hyperplasia, obesity, lack of exercise, smoking, radiation exposure, or a sexually transmitted virus might increase the risk for prostate cancer. At this time, there is little evidence that these factors contribute to an increased risk.

Detecting Prostate Cancer

A man who has any of the risk factors may want to ask a doctor whether to begin screening for prostate cancer (even though he does not have any symptoms), what tests to have, and how often to have them. The doctor may suggest either of the tests described below. These tests are used to detect prostate abnormalities, but they cannot show whether abnormalities are cancer or another, less serious condition. The doctor will take the results into account in deciding whether to check the patient further for signs of cancer. The doctor can explain more about each test.

  • Digital rectal exam -- the doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas.
  • Blood test for prostate-specific antigen (PSA) -- a lab measures the levels of PSA in a blood sample. The level of PSA may rise in men who have prostate cancer, BPH, or infection in the prostate.

Recognizing Symptoms

Early prostate cancer often does not cause symptoms. But prostate cancer can cause any of these problems:

  • A need to urinate frequently, especially at night;
  • Difficulty starting urination or holding back urine;
  • Inability to urinate;
  • Weak or interrupted flow of urine;
  • Painful or burning urination;
  • Difficulty in having an erection;
  • Painful ejaculation;
  • Blood in urine or semen; or
  • Frequent pain or stiffness in the lower back, hips, or upper thighs.

Any of these symptoms may be caused by cancer or by other, less serious health problems, such as BPH or an infection. A man who has symptoms like these should see his doctor or a urologist (a doctor who specializes in treating diseases of the genitourinary system).

Diagnosing Prostate Cancer

If a man has symptoms or test results that suggest prostate cancer, his doctor asks about his personal and family medical history, performs a physical exam, and may order laboratory tests. The exams and tests may include a digital rectal exam, a urine test to check for blood or infection, and a blood test to measure PSA. In some cases, the doctor also may check the level of prostatic acid phosphatase (PAP) in the blood, especially if the results of the PSA indicate there might be a problem.

The doctor may order exams to learn more about the cause of the symptoms. These may include:

  • Transrectal ultrasonography -- sound waves that cannot be heard by humans (ultrasound) are sent out by a probe inserted into the rectum. The waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.
  • Intravenous pyelogram -- a series of x-rays of the organs of the urinary tract.
  • Cystoscopy -- a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube.

Biopsy

If test results suggest that cancer may be present, the man will need to have a biopsy. During a biopsy, the doctor removes tissue samples from the prostate, usually with a needle. A pathologist looks at the tissue under a microscope to check for cancer cells. If cancer is present, the pathologist usually reports the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue and suggests how fast the tumor is likely to grow. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. Tumors with higher scores or grades are more likely to grow and spread than tumors with lower scores.

If the physical exam and test results do not suggest cancer, the doctor may recommend medicine to reduce the symptoms caused by an enlarged prostate. Surgery is another way to relieve these symptoms. The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. (Patients may want to ask whether other procedures might be appropriate.)

Stages of Prostate Cancer

If cancer is found in the prostate, the doctor needs to know the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The doctor may use various blood and imaging tests to learn the stage of the disease. Treatment decisions depend on these findings.

Prostate cancer staging is a complex process. The doctor may describe the stage using a Roman number (I-IV) or a capital letter (A-D). These are the main features of each stage:

  • Stage I or Stage A -- The cancer cannot be felt during a rectal exam. It may be found by accident when surgery is done for another reason, usually for BPH. There is no evidence that the cancer has spread outside the prostate.
  • Stage II or Stage B -- The tumor involves more tissue within the prostate, it can be felt during a rectal exam, or it is found with a biopsy that is done because of a high PSA level. There is no evidence that the cancer has spread outside the prostate.
  • Stage III or Stage C -- The cancer has spread outside the prostate to nearby tissues.
  • Stage IV or Stage D -- The cancer has spread to lymph nodes or to other parts of the body.

Skin Cancer

Also called skin neoplasm, skin cancer is a broad term encompassing three different types of cancer - basal cell cancer, squamous cell cancer, and melanoma. Basal cell cancer and squamous cell cancer are much more common and have a significantly lower mortality rate than melanoma. Skin cancers are frequently linked with sun exposure and are the most commonly diagnosed form of cancer in the United States.

Stomach Cancer

Stomach cancer - also called gastric cancer - forms in the tissue of the stomach and spreads easily to the esophagus and lungs. Associated with prolonged consumption of carcinogens through food, stomach cancer has become increasingly less common in the United States and is more frequently diagnosed in developing countries.

Testicular Cancer

Testicular cancer is a cancer of the testicles - it mostly affects younger men (between the ages of 20 and 39) who have a family history of testicular cancer or otherwise abnormal testicular development. Early signs include pain and swelling in the groin area, and most cases are very treatable when caught early.
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Throat Cancer

Throat cancer is a cancer that develops in the tissues of the throat, voice box, and tonsils - most cases are squamous cell cancers arising from the mucosal tissue lining these parts. Often categorized with head and neck cancers, throat cancer is strongly linked to smoking, use of chewing tobacco, and alcohol.

Thyroid Cancer

Thyroid cancer arises from the tissue of the thyroid gland - a butterfly-shaped gland in the throat that secretes hormones responsible for regulating metabolism. Thyroid cancer mostly affects women between the ages of 25 and 65 and is typically quite curable.

Tumor

A tumor is an abnormal growth of cells within the body that swells and protrudes from the surrounding tissue. Tumors can be benign (non-cancerous), malignant (cancerous), or pre-malignant. Growths are be caused by a number of factors, including genetics, family history, viruses, alcohol or tobacco use, and environmental exposure - symptoms will depend on the type and location of the mass.

Uterine Cancer

Uterine cancer originates in the endometrial lining or in the muscle of the uterus - though the vast majority of uterine cancers are endometrial cancer. The most commonly diagnosed gynecological cancer in the United States, uterine cancer can be linked to obesity and diet as well as genetics and is treatable when caught in its early stages.
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