Different Kinds of Cancer

Brain Cancer
Glioblastoma multiforme - adults; Ependymoma - adults; Glioma - adults;

Astrocytoma - adults; Medulloblastoma - adults; Neuroglioma - adults;
Oligodendroglioma - adults; Meningioma - adults; Cancer - brain tumor (adults)
Definition
A primary brain tumor is a group (mass) of abnormal cells that start in the brain.
This article focuses on primary brain tumors in adults.
Brain cancer is a disease of the brain where cancer cells (malignant) grow in the
brain tissue. Cancer cells grow to form a mass of cancer tissue (tumor) that
interferes with brain tissue functions such as muscle control, sensation, memory,
and other normal body functions. Tumors composed of cancer cells are called
malignant tumors, and those composed of noncancerous cells are called benign
tumors. Cancer cells that develop from brain tissue are called primary brain
tumors. Statistics suggest that brain cancer is not rare and is likely to develop in
about 20,000 people per year.
What is metastatic brain cancer?
Cancer cells that develop in a body organ such as the lung (primary cancer
tissue type) can go to other body organs such as the brain. Tumors formed by
such cancer cells that spread (metastasize) to other organs are called metastatic
tumors. Metastatic brain cancer is a mass of cells (tumor) that originated in
another body organ and has spread into the brain tissue. Metastatic tumors in the
brain are more common than primary brain tumors.
Causes, incidence, and risk factors
Primary brain tumors arise from many types of brain tissue (for example, glial
cells, astrocytes, and other brain cell types). Metastatic brain cancer is caused by
the spread of cancer cells from a body organ to the brain. However, the causes
for the change from normal cells to cancer cells in both metastatic and primary
brain tumors are not fully understood. Data gathered by research scientists show
that people with certain risk factors (situations or things associated with people
that increase the probability of developing problems) are more likely to develop
brain cancer. Individuals with risk factors such as having a job in an oil refinery,
as a chemist, embalmer, or rubber-industry worker show higher rates of brain
cancer. Some families have several members with brain cancer, but heredity as a
cause for brain tumors has not been proven. Other risk factors such as smoking,
radiation exposure, and viral infection (HIV) have been suggested but not proven
to cause brain cancer. There is no good evidence that brain cancer is contagious,
caused by head trauma, or caused by cell phone use.
Primary brain tumors include any tumor that starts in the brain. Tumors may be
confined to a small area, invasive (spread to nearby areas), benign (not
cancerous), or malignant (cancerous).
Tumors can directly destroy brain cells. They can also indirectly damage cells by
producing inflammation, compressing other parts of the brain as the tumor grows,
causing swelling in the brain, and increasing pressure within the skull.
Brain tumors are classified depending on the exact site of the tumor, the type of
tissue involved, benign or malignant tendencies of the tumor, and other factors.
Primary brain tumors can arise from the brain cells, the meninges (membranes
around the brain), nerves, or glands.
The cause of primary brain tumors is unknown. This is because they are rare,
there are many types, and there are many possible risk factors that could play a
role. Exposure to some types of radiation, head injuries, and hormone
replacement therapy may be risk factors, as well as many others. The risk of
using cell phones is hotly debated.
Some inherited conditions increase the risk of brain tumors, including

neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and
Turcot's syndrome.
Tumors may occur at any age, but many specific tumors have a particular age
group in which they are most common. In adults, gliomas and meningiomas are
most common.
SPECIFIC TUMOR TYPES
Gliomas are thought to be derived from glial cells such as astrocytes,

oligodendrocytes, and ependymal cells. The gliomas are subdivided into 3 types:
• Astrocytic tumors include astrocytomas (less malignant), anaplastic

astrocytomas, and glioblastomas (most malignant). Astrocytomas can
progress over time more malignant forms, including glioblastoma.
• Oligodendroglial tumors also can vary from low grade to very malignant.
Some primary brain tumors are composed of both astrocytic and
oligodendrocytic tumors. These are called mixed gliomas.
• Glioblastomas are the most aggressive type of primary brain tumor.
These may or may not arise from a prior lower grade primary brain tumor.
Meningiomas are another type of brain tumor. These tumors:
• Occur most commonly between the ages of 40-70

• Much more common in women.
• While 90% are benign, they still may cause devastating complications and
death due to their size or location. Some are cancerous and aggressive.
Other primary brain tumors in adults are rare and include ependymomas,
craniopharyngiomas, pituitary tumors, pineal gland tumors, and primary germ cell
tumors of the brain.
Symptoms
The specific symptoms depend on the tumor's size, location, degree of invasion,
and related swelling. Headaches, seizures, weakness in one part of the body,
and changes in the person's mental functions are most common.
Symptoms may include:
• Headache -- a persistent headache that is new for the person, worse on

awakening
• Vomiting -- possibly accompanied by nausea; more severe in the morning
• Personality and behavior changes
• Emotional instability, rapid emotional changes
• Loss of memory, impaired judgment
• Seizures that are new for the person
• Reduced alertness
• Double vision, decreased vision
• Hearing loss
• Decreased sensation of a body area
• Weakness of a body area
• Speech difficulties
• Decreased coordination, clumsiness, falls
• Fever (sometimes)
• Weakness, lethargy
• General ill feeling
• Positive Babinski's reflex
• Decerebrate posture
• Decorticate posture
Additional symptoms that may be associated with primary brain tumors:
• Tongue problems
• Swallowing difficulty
• Impaired sense of smell
• Obesity
• Uncontrollable movement
• Dysfunctional movement
• Absent menstruation
• Hiccups
• Hand tremor
• Facial paralysis
• Eye abnormalities
o pupils different sizes
o uncontrollable movements
o eyelid drooping
• Confusion
• Breathing, absent temporarily
• Unusual or strange behavior
Signs and tests
A doctor can often identify signs and symptoms that are specific to the location of
the tumor. Some tumors may not show symptoms until they are very large and
cause a rapid decline in the person's mental functions. Other tumors have
symptoms that develop slowly.
Most brain tumors increase pressure within the skull and compress brain tissue
because of their size and weight.
The following tests may confirm the presence of a brain tumor and identify its
location:
• CT scan of the head

• MRI of the head
• EEG
• Examination of tissue removed from the tumor during surgery or CT-
guided biopsy (may confirm the exact type of tumor)
• Examination of the cerebral spinal fluid (CSF) may reveal cancerous cells
Treatment
Treatment can involve surgery, radiation therapy, and chemotherapy. Brain

tumors are best treated by a team involving a neurosurgeon, radiation oncologist,
oncologist or neuro-oncologist, and other health care providers, such as
neurologists and social workers.
Early treatment often improves the chance of a good outcome. Treatment,

however, depends on the size and type of tumor and the general health of the
patient. The goals of treatment may be to cure the tumor, relieve symptoms, and
improve brain function or the person's comfort.
Surgery is necessary for most primary brain tumors. Some tumors may be
completely removed. Those that are deep inside the brain or that enter brain
tissue may be debulked instead of entirely removed. Debulking is a procedure to
reduce the tumor's size.
Tumors can be difficult to remove completely by surgery alone, because the

tumor invades surrounding brain tissue much like roots from a plant spread
through soil. In cases where the tumor cannot be removed, surgery may still help
reduce pressure and relieve symptoms.
Radiation therapy and chemotherapy may be used for certain tumors.
Other medications used to treat primary brain tumors in children may include:
• Corticosteroids such as dexamethasone to reduce brain swelling

• Osmotic diuretics such as urea or mannitol to reduce brain swelling and
pressure
• Anti-convulsants such as phenytoin to reduce seizures
• Pain medications
• Antacids or histamine blockers to control stress ulcers
Comfort measures, safety measures, physical therapy, occupational therapy and

other such steps may be required to improve quality of life. Counseling, support
groups, and similar measures may be needed to help in coping with the disorder.
Patients may also consider enrolling in a clinical trial after talking with their
treatment team.
Legal advice may be helpful in creating advanced directives such as a power of

attorney.
A treatment plan is individualized for each brain cancer patient. The treatment
plan is constructed by the doctors who specialize in brain cancer, and treatments
vary widely depending on the cancer type, brain location, tumor size, patient age,
and patient's general health status. A major part of the plan is also determined by
the patient's wishes. Patients should discuss treatment options with their health-
care providers.
Surgery, radiation therapy, and chemotherapy are the major treatment categories
for most brain cancers. Individual treatment plans often include a combination of
these treatments. Surgical therapy attempts to remove the tumor by cutting it
away from normal brain tissue. Radiation therapy attempts to destroy tumor cells
by using high energy radiation focused onto the tumor. Chemotherapy attempts
to destroy tumor cells using chemicals (drugs) that are designed to destroy
specific types of cancer cells. All treatments attempt to spare normal brain cells.
Other treatments that may be part of some treatment plans may include
hyperthermia (heat treatments), immunotherapy (immune cells directed to kill
certain cancer cell types), or steroids to reduce inflammation and brain swelling.
Clinical trials (treatment plans designed by scientists to try new chemicals or
methods on patients) can be another way for patients to obtain treatment
specifically for their cancer cell type.
The best treatment for brain cancer is designed by the team of cancer specialists
in conjunction with the wishes of the patient.
Complications
• Brain herniation (often fatal)

o Uncal herniation
o Foramen magnum herniation
• Permanent, progressive, profound neurologic losses
• Loss of ability to interact or function
• Side effects of medications, including chemotherapy
• Side effects of radiation treatments
• Return of tumor growth
Side effects of brain cancer treatment vary with the treatment plan and the
patient. Most treatment plans try to keep all side effects to a minimum. For some
patients, the side effects of brain cancer treatment can be severe. Treatment
plans should include a discussion of potential side effects and the likelihood of
them developing, so the patient and their caregivers (family, friends) can make
appropriate treatment decisions in conjunction with their medical team. Also, if
side effects develop, the patient has some knowledge of what to do about them
such as when to take certain medicines or when to call their doctor to report
health changes.
Surgical side effects include an increase in current symptoms, damage to normal

brain tissue, brain swelling, and seizures. Other changes in brain functions such
as muscle weakness, mental changes, and decreases in any brain-controlled
function can occur. Combinations of these side effects may happen. The side
effects are most noticeable shortly after surgery but frequently decline with time.
Occasionally, the side effects do not decline.
Chemotherapy usually affects (kills) rapidly growing cancer cells but also can
affect normal tissue. Chemotherapy is usually given intravenously so the drugs
can reach most body organs. Common side effects of chemotherapy are nausea,
vomiting, hair loss, and loss of energy. The immune system is often is depressed
by chemotherapy, which results in a high susceptibility to infections. Other
systems, such as the kidneys and the reproductive organs, may also be
damaged by chemotherapy. Most of the side effects decline over time, but some
may not.
Radiation therapy has most of the same side effects as chemotherapy. Most
radiation therapy is focused onto the brain cancer tissue, so some systems do
not receive direct radiation (immune system, kidneys, and others). The effects on
systems not receiving the direct radiation are usually not as severe as those
seen with chemotherapy. However, hair and skin are usually affected, resulting in
hair loss (sometimes permanently) and reddish and darkened skin that needs
protection from the sun.
What is the prognosis (outcome) of treated brain cancer?
Survival of treated brain cancer varies with the cancer type, location, and overall
age and general health of the patient. In general, most treatment plans seldom
result in a cure. Survival greater that five years, which is considered to be long-
term survival, is less than 10% no matter what treatment plan is used.
So, why use any treatment plan? Without treatment, brain cancers are usually
aggressive and result in death within a short time span. Treatment plans can
prolong survival and can improve the patient's quality of life for some time. Again,
the patient and caregivers should discuss their prognosis when deciding on
treatment plans.
Breast Cancer
Alternative names
Cancer - breast; Carcinoma - ductal; Carcinoma - lobular
Definition
The female breast is composed mainly of fatty tissue interspersed with fibrous or
connective tissue. The circular region around the nipple is often a different color
or pigmented. This region is called the areola.
Breast cancer is a cancer that starts in the tissues of the breast.
There are two main types of breast cancer:
• Ductal carcinoma starts in the tubes (ducts) that move milk from the breast
to the nipple. Most breast cancers are of this type.
• Lobular carcinoma starts in parts of the breast, called lobules, that
produce milk.
In rare cases, breast cancer can start in other areas of the breast.
Many breast cancers are sensitive to the hormone estrogen. This means that
estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen
receptor positive cancer or ER positive cancer.
Some women have what's called HER2-positive breast cancer. HER2 refers to a
gene that helps cells grow, divide, and repair themselves. When cells have too
many copies of this gene, cells -- including cancer cells -- grow faster. Experts
think that women with HER2-positive breast cancer have a more aggressive
disease and a higher risk of recurrence than those who do not have this type.
Over the course of a lifetime, one in eight women will be diagnosed with breast
cancer.
Risk factors you cannot change include:
Age and gender -- Your risk of developing breast cancer increases as you get
older. The majority of advanced breast cancer cases are found in women over
age 50. Women are 100 times more likely to get breast cancer then men.
Family history of breast cancer -- You may also have a higher risk for breast
cancer if you have a close relative has had breast, uterine, ovarian, or colon
cancer. About 20-30% of women with breast cancer have a family history of the
disease.
Genes -- Some people have genes that make them more prone to developing
breast cancer. The most common gene defects are found in the BRCA1 and
BRCA2 genes. These genes normally produce proteins that protect you from
cancer. But if a parent passes you a defective gene, you have an increased risk
for breast cancer. Women with one of these defects have up to an 80% chance
of getting breast cancer sometime during their life.
Other genetic defects have been linked to breast cancer, including those found in
the ATM gene, the CHEK-2 gene, and the p53 tumor suppressor gene, but these
are very rare.
Menstrual cycle -- Women who get their periods early (before age 12) or went
through menopause late (after age 55) have an increased risk for breast cancer.
Other risk factors include:
Alcohol use -- Drinking more than 1-2 glasses of alcohol a day may increase
your risk for breast cancer.
Childbirth -- Women who have never had children or who had them only after
age 30 have an increased risk for breast cancer. Being pregnant more than once
or becoming pregnant at an early age reduces your risk of breast cancer.
DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may

have an increased risk of breast cancer after age 40. This drug was given to the
women in the 1940s-1960s.
Hormone replacement therapy (HRT) -- You have a higher risk for breast
cancer if you have received hormone replacement therapy for several years or
more. Many women take HRT to reduce the symptoms of menopause.
Obesity -- Obesity has been linked to breast cancer, although this link is
controversial. The theory is that obese women produce more estrogen, which
can fuel the development of breast cancer.
Radiation -- If you received radiation therapy as a child or young adult to treat

cancer of the chest area, you have a significantly higher risk for developing
breast cancer. The younger you started such radiation, the higher your risk --
especially if the radiation was given when a female was developing breasts.
Breast implants, using antiperspirants, and wearing underwire bras do not raise
your risk for breast cancer. There is no evidence of a direct link between breast
cancer and induced abortion or pesticides.
The National Cancer Institute provides an online tool to help you figure out your
risk of breast cancer. See: www.cancer.gov/bcrisktool
Symptoms
Early breast cancer usually does not cause symptoms. This is why regular breast
exams are important. As the cancer grows, symptoms may include:
• Breast lump or lump in the armpit that is hard, has uneven edges, and
usually does not hurt
• Change in the size, shape, or feel of the breast or nipple -- for example,
you may have redness, dimpling, or puckering that looks like the skin of an
orange
• Fluid coming from the nipple -- may be bloody, clear-to-yellow, or green,
and look like pus
Men get breast cancer, too. Symptoms include breast lump and breast pain and
tenderness.
Symptoms of advanced breast cancer may include:

• Bone pain
• Breast pain or discomfort
• Skin ulcers
• Swelling of one arm (next to breast with cancer)
• Weight loss
Signs and tests
The doctor will ask you about your symptoms and risk factors, and then perform
a physical exam, which includes both breasts, armpits, and the neck and chest
area. Additional tests may include:
• Mammography to help identify the breast lump

• Breast MRI to help better identify the breast lump
• Breast ultrasound to show whether the lump is solid or fluid-filled
• Breast biopsy, needle aspiration, or breast lump removal to remove all or
part of the breast lump for closer examination by a laboratory specialist
If your doctor learns that you do have breast cancer, additional tests will be done
to see if the cancer has spread. This is called staging. Staging helps guide future
treatment and follow-up and gives you some idea of what to expect in the future.
Breast cancer stages range from 0 to IV. In general, breast cancer that stays
where it has started is called in situ or noninvasive breast cancer. If it spreads, it
is called invasive breast cancer. The higher the number, the more advanced the
cancer.
Treatment
Treatment is based on many factors, including type and stage of the cancer,
whether the cancer is sensitive to certain hormones, and whether or not the
cancer overproduces (overexpresses) a gene called HER2/neu.
In general, cancer treatments may include:
• Chemotherapy medicines to kill cancer cells

• Radiation therapy to destroy cancerous tissue
• Surgery to remove cancerous tissue - a lumpectomy removes the breast
lump; mastectomy removes all or part of the breast and possible nearby
structures
Other treatments:
• Hormonal therapy to block certain hormones that fuel cancer growth

• Targeted therapy to interfere with cancer cell grow and function
An example of hormonal therapy is the drug tamoxifen. This drug blocks the
effects of estrogen, which can help breast cancer cells survive and grow. Most
women with estrogen sensitive breast cancer benefit from this drug. A newer
class of medicines called aromatase inhibitors, such as exemestane (Aromasin),
have been shown to work just as well or even better than tamoxifen in post-
menopausal women with breast cancer.
Targeted therapy, also called biologic therapy, is a newer type of cancer

treatment. This therapy uses special anti-cancer drugs that identify certain
changes in a cell that can lead to cancer. One such drug is trastuzumab
(Herceptin). For women with stage IV HER2-positive breast cancer, Herceptin
plus chemotherapy has been shown to be work better than chemotherapy alone.
Studies have also shown that in women with early stage HER2-positive breast
cancer, this medicine plus chemotherapy cuts the risk of the cancer coming back
by 50%.
Cancer treatment may be local or systemic.
• Local treatments involve only the area of disease. Radiation and surgery
are forms of local treatment.
• Systemic treatments affect the entire body. Chemotherapy is a type of
systemic treatment.
Most women receive a combination of treatments. For women with stage I, II, or
III breast cancer, the main goal is to treat the cancer and prevent it from
returning. For women with stage IV cancer, the goal is to improve symptoms and
help them live longer. In most cases, stage IV breast cancer cannot be cured.
Stage 0 -- Lumpectomy plus radiation or mastectomy is the standard treatment.

There is some controversy on how best to treat DCIS.
Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of

lymph node removal is standard treatment. Hormone therapy, chemotherapy, and
biologic therapy may also be recommended following surgery.
Stage III -- Treatment involves surgery possibly followed by chemotherapy,

hormone therapy, and biologic therapy.
Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal

therapy, or a combination of such treatments.
Expectations (prognosis)
How well you do after being treated for breast cancer depends on many things.
The more advanced your cancer, the poorer the outcome.
The 5-year survival rate refers to the number of patients who live at least 5 years
after their cancer is found. According to the American Cancer Society (ACS), the
5-year survival rates for persons with breast cancer that is appropriately treated
are as follows:
• 100% for stage 0

• 100% for stage I
• 92% for stage IIA
• 81% for stage IIB
• 67% for stage IIIA
• 54% for stage IIIB
• 20% for stage IV
Complications
New, improved treatments are helping persons with breast cancer live longer
than ever before. However, even with treatment, breast cancer can spread to
other parts of the body. Sometimes, cancer returns even after the entire tumor is
removed and nearby lymph nodes are found to be cancer-free.
You may experience side effects or complications from cancer treatment. For
example, radiation therapy may cause temporary swelling of the breast, and
aches and pains around the area. Ask your doctor about the side effects you may
have during treatment.
Calling your health care provider
Contact your health care provider for an appointment if:
• You have a breast or armpit lump

• You are a woman age 40 or older and have not had a mammogram in the
last year
• You are a woman age 35 or older and have a mother or sister with breast
cancer, or have already had cancer of the breast, uterus, ovary, or colon.
• You do not know how or need help learning how to perform a breast self-
examination
Prevention
Many risk factors -- such as your genes and family history -- cannot be
controlled. However, a healthy diet and a few lifestyle changes may reduce your
overall chance of cancer in general.
Breast cancer is more easily treated and often curable if it is found early.
Early detection involves:

• Breast self-exams (BSE)
• Clinical breast exams by a medical professional
• Screening mammography
Most experts recommend that women age 20 and older examine their breasts
once a month during the week following the menstrual period.
Women between the ages 20 and 39 should have a doctor examine their breasts
at least once every 3 years. After age 40, women should a clinical breast exam
every year.
Mammography is the most effective way of detecting breast cancer early.
Screening recommendations:
• The American Cancer Society recommends mammogram screening every

year for all women age 40 and older. The National Cancer Institute (NCI)
recommends mammogram screening every 1-2 years for women age 40
and older.
• If you are high risk, experts say you should start getting a mammogram at
age 30. Certain women at high risk of breast cancer should also have a
breast MRI along with their yearly mammogram. Ask your doctor if you
need an MRI.
• For those at high risk, including those who have or had a close family
member with the disease, annual mammograms should begin 10 years
earlier than the age at which the relative was diagnosed.
Questions have been raised about the benefit of screening mammography in

women under age 50 and over the age of 69. Annual mammograms in women
between 50 and 69 have been show to save lives. But while screening can also
detect early breast cancer in younger and older women, it has not been shown to
save lives.
This is a topic filled with controversy. A woman needs to have an informed and
balanced discussion with her doctor, along with doing additional reading and
researching on her own, to determine if mammography is right for her.
Women at very high risk for breast cancer may consider preventive (prophylactic)
mastectomy, which is the surgical removal of the breasts. Possible candidates for
this procedure may include those who have already had one breast removed due
to cancer, women with a strong family history of breast cancer, and persons with
genes or genetic mutations that raise their risk of breast cancer.
A needle biopsy is performed under local anesthesia. Simple aspirations are

performed with a small gauge needle to attempt to draw fluid from lumps that are
thought to be cysts. Fine needle biopsy uses a larger needle to make multiple
passes through a lump, drawing out tissue and fluid. Withdrawn fluid and tissue
is further evaluated to determine if there are cancerous cells present.
An open biopsy can be performed under local or general anesthesia and will
leave a small scar. Prior to surgery, a radiologist often first marks the lump with a
wire, making it easier for the surgeon to find.
Monthly breast self-exams should always include: visual inspection (with and
without a mirror) to note any changes in contour or texture; and manual
inspection in standing and reclining positions to note any unusual lumps or
thicknesses.
Breast cancer begins in the breast and spreads first to the lymph nodes of the
armpit (axilla). When a breast lump is found to contain cancer, and if the cancer
has not spread beyond the nodes of the axilla to distant sites, it is often removed
surgically. Radiation therapy may be used in addition to surgery. In certain cases
of malignant lumps, lumpectomy followed by radiation therapy is as effective as a
radical mastectomy. Typically, lumpectomy does not require a breast replacement
(prosthesis).
In many cases of breast cancer, removal of the entire breast is unnecessary. A

procedure such as a segmental mastectomy can be performed. In segmental
mastectomy, the cancer and a larger area of normal breast tissue around it are
removed. Lymph nodes under the arm and the lining over the chest muscles
below the tumor also may be removed.
In some cases, the cancer is too large to be removed by lumpectomy. In these

situations, removal of the breast along with the lymph nodes in the armpit (axilla)
that drain the breast, is required. This procedure is called modified radical
mastectomy (MRM). The results of mastectomy for breast cancer depend on the
stage of the cancer, the tumor size, and whether there is cancer in the lymph
nodes.
Chemotherapy is often administered after surgery for patients with cancer

involving the lymph nodes.
Early detection of a breast lump is very important to a patient's prognosis

(probable outcome). Most breast lumps are not diagnosed at the doctor's office,
they are detected by women who give themselves breast self-examinations at
home. Any breast lump that persists beyond a few days must be reported to a
physician.
In some cases, a needle aspiration of a breast lump can be performed. If the

tissue obtained is clearly not cancerous, if no blood was seen on the aspirate,
and if the lump disappears after aspiration and does not recur, physicians will
often simply observe patients.
Otherwise, the breast lump must be removed surgically to determine if cancer is
present.
A breast lump may either be a cyst filled with fluid or a solid mass of tissue. A
sample of the breast tissue (biopsy) must be made to determine whether
malignant (cancerous) cells are present. Almost two-thirds of all breast lumps are
benign but the chance of a malignant lump is greatly increased if the woman is
past menopause.
While the patient is awake and pain-free (using local anesthesia) or asleep and
pain-free (using general anesthesia), an incision is made over the lump.
The incision for a lumpectomy is usually around 3 to 4 centimeters long. The

incision will also depend on the size of the lump that needs to be removed. After
the lump is removed in one piece, it is sent to the laboratory for immediate
examination. If the lump is found to be cancerous nearby lymph nodes will be
removed to check for the extent of the cancer spreading.
The outcome of the lumpectomy depends on the type of lump found. If the lump
is benign (whether it is needle aspirated or excised), no further treatment is
required.
If the lump is malignant, the outcome depends on the degree to which the tumor
has spread. Radiation therapy may be used in addition to surgery. In certain
cases of malignant lumps, lumpectomy followed by radiation therapy is as
effective as a radical mastectomy. Typically, lumpectomy does not require a
breast replacement (prosthesis).
Colon Cancer
Colon cancer is cancer that starts in the large intestine (colon) or the rectum (end
of the colon). Such cancer is sometimes referred to as "colorectal cancer."
Other types of colon cancer such as lymphoma, carcinoid tumors, melanoma,

and sarcomas are rare. In this article, use of the term "colon cancer" refers to
colon carcinoma and not these rare types of colon cancer.
Causes, incidence, and risk factor
According to the American Cancer Society, colorectal cancer is one of the

leading causes of cancer-related deaths in the United States. (However, in
almost all cases, early diagnosis can lead to a complete cure.)
There is no single cause for colon cancer. Nearly all colon cancers begin as
benign polyps, which slowly develop into cancer.
You have a higher risk for colon cancer if you have:
• Colorectal polyps
• Cancer elsewhere in the body
• A family history of colon cancer
• Ulcerative colitis
• Crohn's disease
• Personal history of breast cancer
Certain genetic syndromes also increase the risk of developing colon cancer.
What you eat may play a role in your risk of colon cancer. Colon cancer may be
associated with a high-fat, low-fiber diet and red meat. However, some studies
found that the risk does not drop if you switch to a high-fiber diet, so the cause of
the link is not yet clear.
Symptoms
Many cases of colon cancer have no symptoms. The following symptoms,

however, may indicate colon cancer:
• Diarrhea, constipation, or other change in bowel habits

• Blood in the stool
• Unexplained anemia
• Abdominal pain and tenderness in the lower abdomen
• Intestinal obstruction
• Weight loss with no known reason
• Narrow stools
With proper screening, colon cancer can be detected BEFORE the development
of symptoms, when it is most curable.
Signs and tests
Your doctor will perform a physical exam and press on your belly area. The
physical exam rarely shows any problems, although an abdominal mass may be
felt. A rectal exam may reveal a mass in patients with rectal cancer, but not colon
cancer.
Imaging tests to diagnose colorectal cancer include:
• Colonoscopy
• Sigmoidoscopy
Note: Only colonoscopy can see the entire colon.

A fecal occult blood test (FOBT) may detect small amounts of blood in the stool,
which could suggest colon cancer. However, this test is often negative in patients
with colon cancer. For this reason, a FOBT must be done along with colonoscopy
or sigmoidoscopy. It is also important to note that a positive FOBT doesn't
necessarily mean you have cancer.
A complete blood count may reveal show signs of anemia with low iron levels.
If your doctor learns that you do have colorectal cancer, additional tests will be
done to see if the cancer has spread. This is called staging.
• Stage 0: Very early cancer on the innermost layer of the intestine

• Stage I: Cancer is in the inner layers of the colon
• Stage II: Cancer has spread through the muscle wall of the colon
• Stage III: Cancer has spread to the lymph nodes
• Stage IV: Cancer that has spread to other organs
Treatment
Treatment depends partly on the stage of the cancer. In general, treatments may
include:
• Chemotherapy medicines to kill cancer cells

• Surgery to remove cancer cells
• Radiation therapy to destroy cancerous tissue
Stage 0 colon cancer may be treated by removing the cancer cells, often during a
colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to
remove the part of the colon that is cancerous. (See: Colon resection.)
There is some debate as to whether patients with stage II colon cancer should
receive chemotherapy after surgery. You should discuss this with your oncologist.
Almost all patients with stage III colon cancer should receive chemotherapy after
surgery for approximately 6 - 8 months. The chemotherapy drug 5-fluorouracil
given has been shown to increase the chance of a cure in certain patients.
Chemotherapy is also used to treat patients with stage IV colon cancer.

Irinotecan, oxaliplatin, and 5-fluorouracil are the three most commonly used
drugs. You may receive just one type, or a combination of the drugs.
Capecitabine is a chemotherapy drug taken by mouth, and is similar to 5-
fluroruracil.
For patients with stage IV disease that has spread to the liver, various treatments
directed specifically at the liver can be used. This may include cutting out the
cancer, burning it (ablation), or freezing it (cryotherapy). Chemotherapy or
radiation can sometimes be delivered directly into the liver.
While radiation therapy is occasionally used in patients with colon cancer, it is

usually used in combination with chemotherapy for patients with stage III rectal
cancer.
How well a patient does depends on many things, including the stage of the
cancer. In general, when treated at an early stage, more than 90% of patients
survive at least 5 years after their diagnosis. (This is called the 5-year survival
rate.) However, only about 39% of colorectal cancer is found at an early stage.
The 5-year survival rate drops considerably once the cancer has spread.
If the patient's colon cancer does not come back (recur) within 5 years, it is
considered cured. Stage I, II, and III cancers are considered potentially curable.
In most cases, stage IV cancer is not curable.
Complications
• Cancer spreading to other organs or tissues (metastasis)

• Recurrence of carcinoma within the colon
• Development of a second primary colorectal cancer
Colon cancer is, in almost all cases, a treatable disease if caught early. Removal
of pre-cancerous polyps by colonoscopy essentially prevents colon cancer. If you
are age 50 or older and have not yet had a colonoscopy, you should ask your
health care provider about scheduling one. Early colon cancer usually has no
symptoms, so screening by colonoscopy is important.
You should also call your health care provider if you have blood during a bowel
movement, black, tar-like stools, or a change in bowel habits.
Prevention
The death rate for colon cancer has dropped in the last 15 years. This may be
due to increased awareness and screening by colonoscopy. Colon cancer can
almost always be caught in its earliest and most curable stages by colonoscopy.
Almost all men and women age 50 and older should have a colonoscopy.
Colonoscopy is almost always painless and most patients are asleep for the
entire procedure.
For information on this procedure, see colonoscopy.

Dietary and lifestyle modifications are important. Some evidence suggests that
low-fat and high-fiber diets may reduce your risk of colon cancer.
The U.S. Preventive Services Task Force recommends against taking aspirin or
other anti-inflammatory medicines to prevent colon cancer if you have an
average risk of the disease -- even if someone in your family has had the
condition. Taking more than 300 mg a day of aspirin and similar drugs may cause
dangerous gastrointestinal bleeding and heart problems in some people.
Although low-dose aspirin may help reduce your risk of other conditions, such as
heart disease, it does not lower the rate of colon cancer.
The barium enema is a valuable diagnostic tool that helps detect abnormalities
in the large intestine (colon). The barium enema, along with colonoscopy, remain
standards in the diagnosis of colon cancer, ulcerative colitis, and other diseases
of the colon.
There are 4 basic tests for colon cancer: a stool test (to check for blood);
sigmoidoscopy (inspection of the lower colon; colonoscopy (inspection of the
entire colon); and double contrast barium enema. All 4 are effective in catching
cancers in the early stages, when treatment is most beneficial.
The esophagus, stomach, large and small intestine, aided by the liver,
gallbladder and pancreas convert the nutritive components of food into energy
and break down the non-nutritive components into waste to be
excreted.(Digestive System)
The large intestine is the portion of the digestive system most responsible for
absorption of water from the indigestible residue of food. The ileocecal valve of
the ileum (small intestine) passes material into the large intestine at the cecum.
Material passes through the ascending, transverse, descending and sigmoid
portions of the colon, and finally into the rectum. From the rectum, the waste is
expelled from the body.
The staging of a carcinoma has to do with the size of the tumor, and the degree
to which it has penetrated. When the tumor is small and has not penetrated the
mucosal layer, it is said to be stage I cancer. Stage II tumors are into the muscle
wall, and stage III involves nearby lymph nodes. The rare stage IV cancer has
spread (metastasized) to remote organs.
The large intestine (or colon, or large bowel) is the last structure to process
food, taking the undigestible matter from the small intestine, absorbing water
from it and leaving the waste product called feces. Feces are expelled from the
body through the rectum and the anus.
When polyps are discovered in a sigmoidoscopy (an inspection of the lower third
of the large intestine), they are retrieved to be tested for cancer. If a large amount
of polyps are found, a more thorough examination of the entire length of the large
intestine (a colonoscopy) may be recommended. Colon Culture
The colon, or large intestine, is a muscular tube that begins at the end of the
small intestine and ends at the rectum. The colon absorbs water from liquid stool
that is delivered to it from the small intestine.
Colon cancer is the third most common cancer in the United States. Risk factors
include a diet low in fiber and high in fat, certain types of colonic polyps,
inflammatory bowel disease (such as Crohn's disease or ulcerative colitis), and
certain hereditary disorders.
The treatment of colon cancer depends on the stage of the disease. Stage I
cancer is limited to the inner lining of the colon; stage II cancer involves the entire
wall of the colon; stage III cancer has spread to the lymph nodes; stage IV
cancer has spread to other organs (metastasized).
Surgery is the main treatment for colon cancer and removal of the involved colon
is required. If the cancer is located near the rectum, a colostomy may be
necessary. For stage I and II colon cancer, surgery is usually the only treatment.
For stage III or IV colon cancer, chemotherapy is necessary after surgery. There
is also some suggestion that chemotherapy may also be helpful in some selected
stage II patients. Chemotherapy involves a course of drugs which are toxic to
cancer cells.
Stage I and II colon cancer have very high cure rates (60% to 90%); lower cure
rates are seen with stage III and IV colon cancer. To detect colon cancer early,
when it is most curable, everyone over the age of 55 should have bi-annual
endoscopic examinations of the colon.
A colostomy is done when the lower large intestine, rectum, or anus is unable to
function normally or needs rest from normal functions. Intestinal obstruction with
associated inflammation, as in diverticulitis, is a common indication for
colostomy.
A colostomy creates an opening on the abdomen (stoma) for the drainage of

stool (feces) from the large intestine (colon). Colostomies are usually performed
after the diseased colon has been removed.
Colostomies may be temporary or permanent. While the patient is deep asleep

and pain-free (general anesthesia), an incision is made in the abdomen. The
diseased colon is removed.
The proximal end of the healthy colon is then brought out to the skin of the
abdominal wall, where it is sutured in place. An adhesive drainage bag (stoma
appliance) is placed around the opening. The abdominal incision is then closed.
In more than 90% of the cases, the surgery is successful.
The patient may experience considerable pain after surgery as the anus tightens
and relaxes. Medications to relieve pain may be used. To avoid straining, stool
softeners will be used. Avoid any straining during bowel movement or urination.
Soaking in a warm bath can bring additional comfort. Depending on the disease
process being treated, colostomies can be "taken down" and the colon
reconnected in a second operation within weeks to months after the first
operation.
The large bowel [large intestine or the colon] is part of the digestive system. It
runs from the small intestine to the rectum. It is made up of three portions; the
ascending, transverse and descending colon. The ascending colon is sometimes
referred to as the right colon; the descending colon is sometimes referred to as
the left, or sigmoid colon.
Bowel resection may be indicated for:
• blockage of the intestine (intestinal obstruction) due to scar tissue or

tumors
• bleeding, due to diverticulosis or arteriovenous malformations
• injuries
• cancer
• precancerous polyps
• familial polyposis
• infection, due to diverticulitis
The patient is deep asleep and pain-free (general anesthesia). A lower midline
incision is made in the abdomen. Sometimes, the surgeon will use a lateral lower
transverse incision instead."
The diseased part of the large intestine (colon) is removed. The two healthy ends
are then sewn or stapled back together and the incision is closed. A stapling
procedure is shown here.
If it is necessary to spare the intestine from its normal digestive work while it
heals, a temporary opening of the intestine onto the abdomen (colostomy) may
be done. A temporary colostomy will be closed and repaired later. If a large
portion of the bowel is removed, the colostomy may be permanent. The large
intestine (colon) absorbs most of the fluid from foods. When the colon is
bypassed by a colostomy in the right colon, the colostomy output is generally
liquid stool (feces). If the colon is bypassed in the left colon, the colostomy output
is generally more solid stool. The constant or frequent drainage of liquid stool can
cause the skin around the colostomy to become inflamed. Careful skin care and
a well-fitting colostomy bag can reduce this irritation.
Most patients will stay in the hospital for 5 to 7 days. Complete recovery from
surgery may take 2 months. During the first few days after surgery, eating is
restricted.
Anal Cancer
Anal cancer is a disease in which malignant (cancer) cells form in the

tissues of the anus.
The anus is the end of the large intestine, below the rectum, through which stool
(solid waste) leaves the body. The anus is formed partly from the outer skin
layers of the body and partly from the intestine. Two ring-like muscles, called
sphincter muscles, open and close the anal opening to let stool pass out of the
body. The anal canal, the part of the anus between the rectum and the anal
opening, is about 1½ inches long.
The skin around the outside of the anus is called the perianal area. Tumors in
this area are skin tumors, not anal cancer.
Being infected with the human papillomavirus (HPV) can affect the risk of
developing anal cancer.
Risk factors include the following:
• Being over 50 years old.

• Being infected with human papillomavirus (HPV).
• Having many sexual partners.
• Having receptive anal intercourse (anal sex).
• Frequent anal redness, swelling, and soreness.
• Having anal fistulas (abnormal openings).
• Smoking cigarettes.
Possible signs of anal cancer include bleeding from the anus or rectum or
a lump near the anus.
These and other symptoms may be caused by anal cancer. Other conditions may
cause the same symptoms. A doctor should be consulted if any of the following
problems occur:
• Bleeding from the anus or rectum.

• Pain or pressure in the area around the anus.
• Itching or discharge from the anus.
• A lump near the anus.
• A change in bowel habits.
Tests that examine the rectum and anus are used to detect (find) and
diagnose anal cancer.
The following tests and procedures may be used:
• Physical exam and history: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or anything
else that seems unusual. A history of the patient’s health habits and past
illnesses and treatments will also be taken.
• Digital rectal examination (DRE): An exam of the anus and rectum. The
doctor or nurse inserts a lubricated, gloved finger into the lower part of the
rectum to feel for lumps or anything else that seems unusual.
• Anoscopy: An exam of the anus and lower rectum using a short, lighted
tube called an anoscope.
• Proctoscopy: An exam of the rectum using a short, lighted tube called a
proctoscope.
• Endo-anal or endorectal ultrasound: A procedure in which an ultrasound
transducer (probe) is inserted into the anus or rectum and used to bounce
high-energy sound waves (ultrasound) off internal tissues or organs and
make echoes. The echoes form a picture of body tissues called a
sonogram.
• Biopsy: The removal of cells or tissues so they can be viewed under a
microscope by a pathologist to check for signs of cancer. If an abnormal
area is seen during the anoscopy, a biopsy may be done at that time.
Certain factors affect the prognosis (chance of recovery) and treatment

options.
The prognosis (chance of recovery) depends on the following:
• The size of the tumor.

• Where the tumor is in the anus.
• Whether the cancer has spread to the lymph nodes.
The treatment options depend of the following:
• The stage of the cancer.

• Where the tumor is in the anus.
• Whether the patient has human immunodeficiency virus (HIV).
• Whether cancer remains after initial treatment or has recurred.
Stages of Anal Cancer
After anal cancer has been diagnosed, tests are done to find out if cancer
cells have spread within the anus or to other parts of the body.
The process used to find out if cancer has spread within the anus or to other
parts of the body is called staging. The information gathered from the staging
process determines the stage of the disease. It is important to know the stage in
order to plan treatment. The following tests may be used in the staging process:
• CT scan (CAT scan): A procedure that makes a series of detailed pictures

of areas inside the body, taken from different angles. The pictures are
made by a computer linked to an x-ray machine. A dye may be injected
into a vein or swallowed to help the organs or tissues show up more
clearly. This procedure is also called computed tomography, computerized
tomography, or computerized axial tomography. For anal cancer, a CT
scan of the pelvis and abdomen may be done.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is
a type of energy beam that can go through the body and onto film, making
a picture of areas inside the body.
• Endo-anal or endorectal ultrasound: A procedure in which an ultrasound
transducer (probe) is inserted into the anus or rectum and used to bounce
high-energy sound waves (ultrasound) off internal tissues or organs and
make echoes. The echoes form a picture of body tissues called a
sonogram.
The following stages are used for anal cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, cancer is found only in the innermost lining of the anus. Stage 0
cancer is also called carcinoma in situ.
Stage I
In stage I, the tumor is 2 centimeters or smaller.
Stage II
In stage II, the tumor is larger than 2 centimeters.
Stage IIIA
In stage IIIA, the tumor may be any size and has spread to either:
• lymph nodes near the rectum; or

• nearby organs, such as the vagina, urethra, and bladder.
Stage IIIB
In stage IIIB, the tumor may be any size and has spread:
• to nearby organs and to lymph nodes near the rectum; or
• to lymph nodes on one side of the pelvis and/or groin, and may have
spread to nearby organs; or
• to lymph nodes near the rectum and in the groin, and/or to lymph nodes
on both sides of the pelvis and/or groin, and may have spread to nearby
organs.
Stage IV
In stage IV, the tumor may be any size and cancer may have spread to lymph
nodes or nearby organs and has spread to distant parts of the body.
Recurrent Anal Cancer
Recurrent anal cancer is cancer that has recurred (come back) after it has been
treated. The cancer may come back in the anus or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with anal cancer.
Different types of treatments are available for patients with anal cancer. Some
treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before starting treatment, patients may want to think about
taking part in a clinical trial. A treatment clinical trial is a research study meant to
help improve current treatments or obtain information on new treatments for
patients with cancer. When clinical trials show that a new treatment is better than
the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about
ongoing clinical trials is available from the NCI Web site. Choosing the most
appropriate cancer treatment is a decision that ideally involves the patient, family,
and health care team.
Three types of standard treatment are used:
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other

types of radiation to kill cancer cells. There are two types of radiation therapy.
External radiation therapy uses a machine outside the body to send radiation
toward the cancer. Internal radiation therapy uses a radioactive substance sealed
in needles, seeds, wires, or catheters that are placed directly into or near the
cancer. The way the radiation therapy is given depends on the type and stage of
the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer
cells, either by killing the cells or by stopping the cells from dividing. When
chemotherapy is taken by mouth or injected into a vein or muscle, the drugs
enter the bloodstream and can reach cancer cells throughout the body (systemic
chemotherapy). When chemotherapy is placed directly into the spinal column, an
organ, or a body cavity such as the abdomen, the drugs mainly affect cancer
cells in those areas (regional chemotherapy). The way the chemotherapy is given
depends on the type and stage of the cancer being treated.
Surgery
• Local resection: A surgical procedure in which the tumor is cut from the
anus along with some of the healthy tissue around it. Local resection may
be used if the cancer is small and has not spread. This procedure may
save the sphincter muscles so the patient can still control bowel
movements. Tumors that develop in the lower part of the anus can often
be removed with local resection.
• Abdominoperineal resection: A surgical procedure in which the anus, the
rectum, and part of the sigmoid colon are removed through an incision
made in the abdomen. The doctor sews the end of the intestine to an
opening, called a stoma, made in the surface of the abdomen so body
waste can be collected in a disposable bag outside of the body. This is
called a colostomy. Lymph nodes that contain cancer may also be
removed during this operation.
Having the human immunodeficiency virus can affect treatment of anal

cancer.
Cancer therapy can further damage the already weakened immune systems of
patients who have the human immunodeficiency virus (HIV). For this reason,
patients who have anal cancer and HIV are usually treated with lower doses of
anticancer drugs and radiation than patients who do not have HIV.
Other types of treatment are being tested in clinical trials. These include
the following:
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation
therapy. Combining radiation therapy with radiosensitizers may kill more tumor
cells.
This summary section refers to specific treatments under study in clinical trials,
but it may not mention every new treatment being studied. Information about
ongoing clinical trials is available from the NCI Web site.
Treatment Options by Stage
Stage 0 Anal Cancer (Carcinoma in Situ)
Treatment of stage 0 anal cancer is usually local resection.
Stage I Anal Cancer
Treatment of stage I anal cancer may include the following:
• Local resection.
• External-beam radiation therapy with or without chemotherapy. If cancer
remains after treatment, additional chemotherapy and radiation therapy
may be given to avoid the need for a permanent colostomy.
• Internal radiation therapy.
• Abdominoperineal resection, if cancer remains or comes back after
treatment with radiation therapy and chemotherapy.
• Internal radiation therapy for cancer that remains after treatment with
external-beam radiation therapy.
Patients who have had treatment that saves the sphincter muscles may receive
follow-up exams every 3 months for the first 2 years, including rectal exams with
endoscopy and biopsy, as needed.
Stage II Anal Cancer
Treatment of stage II anal cancer may include the following:
• Local resection.
• External-beam radiation therapy with chemotherapy. If cancer remains
after treatment, additional chemotherapy and radiation therapy may be
given to avoid the need for a permanent colostomy.
• Internal radiation therapy.
treatment with radiation therapy and chemotherapy.
• A clinical trial of new treatment options.
Patients who have had treatment that saves the sphincter muscles may receive
follow-up exams every 3 months for the first 2 years, including rectal exams with
endoscopy and biopsy, as needed.
Stage IIIA Anal Cancer

Treatment of stage IIIA anal cancer may include the following:
• External-beam radiation therapy with chemotherapy. If cancer remains

after treatment, additional chemotherapy and radiation therapy may be
given to avoid the need for a permanent colostomy.
• Internal beam radiation.
treatment with chemotherapy and radiation therapy.
Information about ongoing clinical trials is available from the NCI Web site.
Stage IIIB Anal Cancer
Treatment of stage IIIB anal cancer may include the following:
• External-beam radiation therapy with chemotherapy.

• Local resection or abdominoperineal resection, if cancer remains or
comes back after treatment with chemotherapy and radiation therapy.
Lymph nodes may also be removed.
Stage IV Anal Cancer
Treatment of stage IV anal cancer may include the following:
• Surgery as palliative therapy to relieve symptoms and improve the quality

of life.
• Radiation therapy as palliative therapy.
• Chemotherapy with radiation therapy as palliative therapy.
Information about ongoing clinical trials is available from the NCI Web site.
Treatment Options for Recurrent Anal Cancer
Treatment of recurrent anal cancer may include the following:
• Radiation therapy and chemotherapy, for recurrence after surgery.

• Surgery, for recurrence after radiation therapy and/or chemotherapy.
• A clinical trial of radiation therapy with chemotherapy and/or
radiosensitizers.
This summary section refers to specific treatments under study in clinical trials,
but it may not mention every new treatment being studied. Information about
ongoing clinical trials is available from the NCI Web site.
Bladder Cancer
The bladder is a hollow organ in the lower abdomen. It stores urine, the liquid
waste produced by the kidneys. Urine passes from each kidney into the bladder
through a tube called a ureter.
An outer layer of muscle surrounds the inner lining of the bladder. When the
bladder is full, the muscles in the bladder wall can tighten to allow urination.
Urine leaves the bladder through another tube, the urethra.
Understanding bladder cancer
Cancer is a group of many related diseases. All cancers begin in cells, the body's
basic unit of life. Cells make up tissues, and tissues make up the organs of the
body.
Normally, cells grow and divide to form new cells as the body needs them. When
cells grow old and die, new cells take their place.
Sometimes this orderly process goes wrong. New cells form when the body does
not need them, and old cells do not die when they should. These extra cells can
form a mass of tissue called a growth or tumor.
Tumors can be benign or malignant:
• Benign tumors are not cancer. Usually, doctors can remove them. Cells
from benign tumors do not spread to other parts of the body. In most
cases, benign tumors do not come back after they are removed. Most
important, benign tumors are rarely a threat to life.
• Malignant tumors are cancer. They are generally more serious. Cancer
cells can invade and damage nearby tissues and organs. Also, cancer
cells can break away from a malignant tumor and enter the bloodstream or
the lymphatic system. That is how cancer cells spread from the original
(primary) tumor to form new tumors in other organs. The spread of cancer
is called metastasis.
The wall of the bladder is lined with cells called transitional cells and squamous
cells. More than 90 percent of bladder cancers begin in the transitional cells. This
type of bladder cancer is called transitional cell carcinoma. About 8 percent of
bladder cancer patients have squamous cell carcinomas.
Cancer that is only in cells in the lining of the bladder is called superficial bladder
cancer. The doctor might call it carcinoma in situ. This type of bladder cancer
often comes back after treatment. If this happens, the disease most often recurs
as another superficial cancer in the bladder.
Cancer that begins as a superficial tumor may grow through the lining and into
the muscular wall of the bladder. This is known as invasive cancer. Invasive
cancer may extend through the bladder wall. It may grow into a nearby organ
such as the uterus or vagina (in women) or the prostate gland (in men). It also
may invade the wall of the abdomen.
When bladder cancer spreads outside the bladder, cancer cells are often found in
nearby lymph nodes. If the cancer has reached these nodes, cancer cells may
have spread to other lymph nodes or other organs, such as the lungs, liver, or
bones.
When cancer spreads (metastasizes) 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. For example, if bladder cancer spreads to the lungs, the
cancer cells in the lungs are actually bladder cancer cells. The disease is
metastatic bladder cancer, not lung cancer. It is treated as bladder cancer, not as
lung cancer. Doctors sometimes call the new tumor "distant" disease.
Bladder cancer: Who's at risk?

No one knows the exact causes of bladder cancer. However, it is clear that this
disease is not contagious. No one can "catch" cancer from another person.
People who get bladder cancer are more likely than other people to have certain
risk factors. A risk factor is something that increases a person's chance of
developing the disease.
Still, most people with known risk factors do not get bladder cancer, and many
who do get this disease have none of these factors. Doctors can seldom explain
why one person gets this cancer and another does not.
Studies have found the following risk factors for bladder cancer:
• Age. The chance of getting bladder cancer goes up as people get older.
People under 40 rarely get this disease.
• Tobacco. The use of tobacco is a major risk factor. Cigarette smokers are
two to three times more likely than nonsmokers to get bladder cancer.
Pipe and cigar smokers are also at increased risk.
• Occupation. Some workers have a higher risk of getting bladder cancer
because of carcinogens in the workplace. Workers in the rubber, chemical,
and leather industries are at risk. So are hairdressers, machinists, metal
workers, printers, painters, textile workers, and truck drivers.
• Infections. Being infected with certain parasites increases the risk of
bladder cancer. These parasites are common in tropical areas but not in
the United States.
• Treatment with cyclophosphamide or arsenic. These drugs are used to
treat cancer and some other conditions. They raise the risk of bladder
cancer.
• Race. Whites get bladder cancer twice as often as African Americans and
Hispanics. The lowest rates are among Asians.
• Being a man. Men are two to three times more likely than women to get
bladder cancer.
• Family history. People with family members who have bladder cancer are
more likely to get the disease. Researchers are studying changes in
certain genes that may increase the risk of bladder cancer.
• Personal history of bladder cancer. People who have had bladder
cancer have an increased chance of getting the disease again.
Chlorine is added to water to make it safe to drink. It kills deadly bacteria.

However, chlorine by-products sometimes can form in chlorinated water.
Researchers have been studying chlorine by-products for more than 25 years.
So far, there is no proof that chlorinated water causes bladder cancer in people.
Studies continue to look at this question.
Some studies have found that saccharin, an artificial sweetener, causes bladder
cancer in animals. However, research does not show that saccharin causes
cancer in people.
People who think they may be at risk for bladder cancer 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 of bladder cancer
Common symptoms of bladder cancer include:
• Blood in the urine (making the urine slightly rusty to deep red),
• Pain during urination, and
• Frequent urination, or feeling the need to urinate without results.
These symptoms are not sure signs of bladder cancer. Infections, benign tumors,
bladder stones, or other problems also can cause these symptoms. Anyone with
these symptoms should see a doctor so that the doctor can diagnose and treat
any problem as early as possible. People with symptoms like these may see their
family doctor or a urologist, a doctor who specializes in diseases of the urinary
system.
Diagnosis of bladder cancer
If a patient has symptoms that suggest bladder cancer, the doctor may check
general signs of health and may order lab tests. The person may have one or
more of the following procedures:
• Physical exam -- The doctor feels the abdomen and pelvis for tumors.
The physical exam may include a rectal or vaginal exam.
• Urine tests -- The laboratory checks the urine for blood, cancer cells, and
other signs of disease.
• Intravenous pyelogram -- The doctor injects dye into a blood vessel. The
dye collects in the urine, making the bladder show up on x-rays.
• Cystoscopy -- The doctor uses a thin, lighted tube (cystoscope) to look
directly into the bladder. The doctor inserts the cystoscope into the bladder
through the urethra to examine the lining of the bladder. The patient may
need anesthesia for this procedure.
The doctor can remove samples of tissue with the cystoscope. A pathologist then
examines the tissue under a microscope. The removal of tissue to look for cancer
cells is called a biopsy. In many cases, a biopsy is the only sure way to tell
whether cancer is present. For a small number of patients, the doctor removes
the entire cancerous area during the biopsy. For these patients, bladder cancer is
diagnosed and treated in a single procedure.
A patient who needs a biopsy may want to ask the doctor some of the following
questions:
• Why do I need to have a biopsy?

• How long will it take? Will I be awake? Will it hurt?
• How soon will I know the results?
• Are there any risks? What are the chances of infection or bleeding after the
biopsy?
• If I do have cancer, who will talk with me about treatment? When?
Treatment for bladder cancer
Staging
If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of
the disease to plan the best treatment. Staging is a careful attempt to find out
whether the cancer has invaded the bladder wall, whether the disease has
spread, and if so, to what parts of the body.
The doctor may determine the stage of bladder cancer at the time of diagnosis,
or may need to give the patient more tests. Such tests may include imaging tests
-- CT scan, magnetic resonance imaging (MRI), sonogram, intravenous
pyelogram, bone scan, or chest x-ray. Sometimes staging is not complete until
the patient has surgery.
These are the main features of each stage of the disease:
• Stage 0 -- The cancer cells are found only on the surface of the inner
lining of the bladder. The doctor may call this superficial cancer or
carcinoma in situ.
• Stage I -- The cancer cells are found deep in the inner lining of the
bladder. They have not spread to the muscle of the bladder.
• Stage II -- The cancer cells have spread to the muscle of the bladder.
• Stage III -- The cancer cells have spread through the muscular wall of the
bladder to the layer of tissue surrounding the bladder. The cancer cells
may have spread to the prostate (in men) or to the uterus or vagina (in
women).
• Stage IV -- The cancer extends to the wall of the abdomen or to the wall of
the pelvis. The cancer cells may have spread to lymph nodes and other
parts of the body far away from the bladder, such as the lungs.
Treatment
Many people with bladder cancer want to take an active part in decisions about
their medical care. They want to learn all they can about their disease and their
treatment choices. However, the shock and stress that people often feel after a
diagnosis of cancer can make it hard for them to think of everything they want to
ask the doctor. Often it helps to make a list of questions before an appointment.
To help remember what the doctor says, patients may take notes or ask whether
they may use a tape recorder. Some patients also want to have a family member
or friend with them when they talk to the doctor -- to take part in the discussion,
to take notes, or just to listen.
The doctor may refer patients to doctors who specialize in treating cancer, or
patients may ask for a referral. Treatment generally begins within a few weeks
after the diagnosis. There will be time for patients to talk with the doctor about
treatment choices, get a second opinion, and learn more about bladder cancer.
Getting a second opinion
Before starting treatment, a patient may want to get a second opinion about the
diagnosis, the stage of cancer, and the treatment plan. Some insurance
companies require a second opinion; others may cover a second opinion if the
patient requests it. Gathering medical records and arranging to see another
doctor may take a little time. In most cases, a brief delay does not make
treatment less effective.
There are a number of ways to find a doctor for a second opinion:
• The doctor may refer patients to one or more specialists. Specialists who
treat bladder cancer include surgeons, urologists, medical oncologists,
radiation oncologists, and urologic oncologists. At cancer centers, these
doctors often work together as a team.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about treatment facilities, including cancer centers and other programs
supported by the National Cancer Institute.
• People can get the names of specialists from their local medical society, a
nearby hospital, or a medical school.
• The American Board of Medical Specialties (ABMS) has a list of doctors
who have met certain education and training requirements and have
passed specialty examinations. The Official ABMS Directory of Board
Certified Medical Specialists lists doctors' names along with their specialty
and their educational background. The directory is available in most public
libraries. Also, ABMS offers this information on the Internet at
http://www.abms.org. (Click on "Who's Certified.")
Preparing for treatment
The doctor develops a treatment plan to fit each patient's needs. Treatment
depends on the type of bladder cancer, the stage of the disease, and the grade
of the tumor. (The grade tells how closely the cancer cells resemble normal cells.
It suggests how fast the cancer is likely to grow. Low-grade cancers usually grow
and spread more slowly than high-grade cancers.) The doctor also considers
other factors, including the patient's age and general health.
These are some questions a patient may want to ask the doctor before treatment
begins:
• What kind of bladder cancer do I have?

• What is the stage of the disease? Has the cancer spread?
• What is the grade of the tumor?
• What are my treatment choices? Which do you recommend for me? Why?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment?
• What is the treatment likely to cost? Is this treatment covered by my
insurance plan?
• How will treatment affect my normal activities?
People do not need to ask all of their questions or understand all of the answers
at once. They will have other chances to ask the doctor to explain things that are
not clear and to ask for more information.
Methods of treatment
People with bladder cancer have many treatment options. They may have
surgery, radiation therapy, chemotherapy, or biological therapy. Some patients
get a combination of therapies.
The doctor is the best person to describe treatment choices and discuss the
expected results of treatment.
A patient may want to talk to the doctor about taking part in a clinical trial, a
research study of new treatment methods. Clinical trials are an important option
for people with all stages of bladder cancer. The section on "The Promise of
Cancer Research" has more information about clinical trials.
Surgery is a common treatment for bladder cancer. The type of surgery depends
largely on the stage and grade of the tumor. The doctor can explain each type of
surgery and discuss which is most suitable for the patient:
• Transurethral resection: The doctor may treat early (superficial) bladder

cancer with transurethral resection (TUR). During TUR, the doctor inserts
a cystoscope into the bladder through the urethra. The doctor then uses a
tool with a small wire loop on the end to remove the cancer and to burn
away any remaining cancer cells with an electric current. (This is called
fulguration.) The patient may need to be in the hospital and may need
anesthesia. After TUR, patients may also have chemotherapy or biological
therapy.
• Radical cystectomy: For invasive bladder cancer, the most common type
of surgery is radical cystectomy. The doctor also chooses this type of
surgery when superficial cancer involves a large part of the bladder.
Radical cystectomy is the removal of the entire bladder, the nearby lymph
nodes, part of the urethra, and the nearby organs that may contain cancer
cells. In men, the nearby organs that are removed are the prostate,
seminal vesicles, and part of the vas deferens. In women, the uterus,
ovaries, fallopian tubes, and part of the vagina are removed.
• Segmental cystectomy: In some cases, the doctor may remove only part
of the bladder in a procedure called segmental cystectomy. The doctor
chooses this type of surgery when a patient has a low-grade cancer that
has invaded the bladder wall in just one area.
Sometimes, when the cancer has spread outside the bladder and cannot be
completely removed, the surgeon removes the bladder but does not try to get rid
of all the cancer. Or, the surgeon does not remove the bladder but makes
another way for urine to leave the body. The goal of the surgery may be to relieve
urinary blockage or other symptoms caused by the cancer.
When the entire bladder is removed, the surgeon makes another way to collect
urine. The patient may wear a bag outside the body, or the surgeon may create a
pouch inside the body with part of the intestine.
These are some questions a patient may want to ask the doctor about surgery:
• What kind of operation will it be?

• How will I feel afterward?
• What will you do for me if I have pain?
• How long will I have to stay in the hospital?
• Will I have any long-term effects?
• When can I get back to my normal activities?
• Will I urinate in a normal way?
• Will the surgery affect my sex life?
• How often will I need checkups?
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer
cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in
the treated area.
A small number of patients may have radiation therapy before surgery to shrink
the tumor. Others may have it after surgery to kill cancer cells that may remain in
the area. Sometimes, patients who cannot have surgery have radiation therapy
instead.
Doctors use two types of radiation therapy to treat bladder cancer:
• External radiation: A large machine outside the body aims radiation at

the tumor area. Most people receiving external radiation are treated 5
days a week for 5 to 7 weeks as an outpatient. This schedule helps protect
healthy cells and tissues by spreading out the total dose of radiation.
Treatment may be shorter when external radiation is given along with
radiation implants.
• Internal radiation: The doctor places a small container of a radioactive
substance into the bladder through the urethra or through an incision in
the abdomen. The patient stays in the hospital for several days during this
treatment. To protect others from radiation exposure, patients may not be
able to have visitors or may have visitors for only a short period of time
while the implant is in place. Once the implant is removed, no radioactivity
is left in the body.
Some patients with bladder cancer receive both kinds of radiation therapy.
These are some questions a patient may want to ask the doctor about radiation
therapy:
• Why do I need this therapy?

• How will the radiation be given?
• Will I need to stay in the hospital? For how long?
• When will the treatments begin? When will they end?
• How will I feel during therapy? Are there side effects?
• What can I do to take care of myself during treatment?
• How will we know if the radiation is working?
• Will I be able to continue my normal activities during treatment?
Chemotherapy uses drugs to kill cancer cells. The doctor may use one drug or a
combination of drugs.
For patients with superficial bladder cancer, the doctor may use intravesical
chemotherapy after removing the cancer with TUR. This is local therapy. The
doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the
bladder through the catheter. The drugs remain in the bladder for several hours.
They mainly affect the cells in the bladder. Usually, the patient has this treatment
once a week for several weeks. Sometimes, the treatments continue once or
several times a month for up to a year.
If the cancer has deeply invaded the bladder or spread to lymph nodes or other
organs, the doctor may give drugs through a vein. This treatment is called
intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow
through the bloodstream to nearly every part of the body. The drugs are usually
given in cycles so that a recovery period follows every treatment period.
The patient may have chemotherapy alone or combined with surgery, radiation
therapy, or both. Usually chemotherapy is an outpatient treatment given at the
hospital, clinic, or at the doctor's office. However, depending on which drugs are
given and the patient's general health, the patient may need a short hospital stay.
Biological therapy (also called immunotherapy) uses the body's natural ability
(immune system) to fight cancer. Biological therapy is most often used after TUR
for superficial bladder cancer. This helps prevent the cancer from coming back.
The doctor may use intravesical biological therapy with BCG solution. BCG
solution contains live, weakened bacteria. The bacteria stimulate the immune
system to kill cancer cells in the bladder. The doctor uses a catheter to put the
solution in the bladder. The patient must hold the solution in the bladder for about
2 hours. BCG treatment is usually done once a week for 6 weeks.
Patients may want to ask these questions about chemotherapy or biological

therapy:
• Why do I need this treatment?

• What drug will I get? How will it be given? What will it do?
• Will I have side effects? What can I do about them?
• How long will I be on this treatment?
Side effects of bladder cancer treatment
Because cancer treatment may damage healthy cells and tissues, unwanted side
effects sometimes occur. These side effects depend on many factors, including
the type and extent of the treatment. Side effects may not be the same for each
person, and they may even change from one treatment session to the next.
Doctors and nurses will explain the possible side effects of treatment and how
they will help the patient manage them.
The NCI provides helpful booklets about cancer treatments and coping with side
effects, such as Radiation Therapy and You, Chemotherapy and You, and Eating
Hints for Cancer Patients. See the "National Cancer Institute Information
Resources" and "National Cancer Institute Booklets" sections for other sources of
information about side effects.
Surgery
For a few days after TUR, patients may have some blood in their urine and
difficulty or pain when urinating. Otherwise, TUR generally causes few problems.
After cystectomy, most patients are uncomfortable during the first few days.
However, medicine can control the pain. Patients should feel free to discuss pain
relief with the doctor or nurse. Also, it is common to feel tired or weak for a while.
The length of time it takes to recover from an operation varies for each person.
After segmental cystectomy, patients may not be able to hold as much urine in
their bladder as they used to, and they may need to urinate more often. In most
cases, this problem is temporary, but some patients may have long-lasting
changes in how much urine they can hold.
If the surgeon removes the bladder, the patient needs a new way to store and
pass urine. In one common method, the surgeon uses a piece of the person's
small intestine to form a new tube through which urine can pass. The surgeon
attaches one end of the tube to the ureters and connects the other end to a new
opening in the wall of the abdomen. This opening is called a stoma. A flat bag fits
over the stoma to collect urine, and a special adhesive holds it in place. The
operation to create the stoma is called a urostomy or an ostomy.
For some patients, the doctor is able to use a part of the small intestine to make
a storage pouch (called a continent reservoir) inside the body. Urine collects in
the pouch instead of going into a bag. The surgeon connects the pouch to the
urethra or to a stoma. If the surgeon connects the pouch to a stoma, the patient
uses a catheter to drain the urine.
Bladder cancer surgery may affect a person's sexual function. Because the
surgeon removes the uterus and ovaries in a radical cystectomy, women are not
able to get pregnant. Also, menopause occurs at once. Hot flashes and other
symptoms of menopause caused by surgery may be more severe than those
caused by natural menopause. Many women take hormone replacement therapy
(HRT) to relieve these problems. If the surgeon removes part of the vagina
during a radical cystectomy, sexual intercourse may be difficult.
In the past, nearly all men were impotent after radical cystectomy, but
improvements in surgery have made it possible for some men to avoid this
problem. Men who have had their prostate gland and seminal vesicles removed
no longer produce semen, so they have dry orgasms. Men who wish to father
children may consider sperm banking before surgery or sperm retrieval later on.
It is natural for a patient to worry about the effects of bladder cancer surgery on
sexuality. Patients may want to talk with the doctor about possible side effects
and how long these side effects are likely to last. Whatever the outlook, it may be
helpful for patients and their partners to talk about their feelings and help one
another find ways to share intimacy during and after treatment.
Radiation therapy
The side effects of radiation therapy depend mainly on the treatment dose and
the part of the body that is treated. Patients are likely to become very tired during
radiation therapy, especially in the later weeks of treatment. Resting is important,
but doctors usually advise patients to try to stay as active as they can.
External radiation may permanently darken or "bronze" the skin in the treated
area. Patients commonly lose hair in the treated area and their skin may become
red, dry, tender, and itchy. These problems are temporary, and the doctor can
suggest ways to relieve them.
Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or

urinary discomfort. The doctor can suggest medicines to ease these problems.
Radiation therapy also may cause a decrease in the number of white blood cells,
cells that help protect the body against infection. If the blood counts are low, the
doctor or nurse may suggest ways to avoid getting an infection. Also, the patient
may not get more radiation therapy until blood counts improve. The doctor will
check the patient's blood counts regularly and change the treatment schedule if it
is necessary.
For both men and women, radiation treatment for bladder cancer can affect
sexuality. Women may experience vaginal dryness, and men may have difficulty
with erections.
Although the side effects of radiation therapy can be distressing, the doctor can
usually treat or control them. It also helps to know that, in most cases, side
effects are not permanent.
Chemotherapy
The side effects of chemotherapy depend mainly on the drugs and the doses the
patient receives as well as how the drugs are given. In addition, as with other
types of treatment, side effects vary from patient to patient.
Anticancer drugs that are placed in the bladder cause irritation, with some
discomfort or bleeding that lasts for a few days after treatment. Some drugs may
cause a rash when they come into contact with the skin or genitals.
Systemic chemotherapy affects rapidly dividing cells throughout the body,

including blood cells. Blood cells fight infection, help the blood to clot, and carry
oxygen to all parts of the body. When anticancer drugs damage blood cells,
patients are more likely to get infections, may bruise or bleed easily, and may
have less energy. Cells in hair roots and cells that line the digestive tract also
divide rapidly. As a result, patients may lose their hair and may have other side
effects such as poor appetite, nausea and vomiting, or mouth sores. Usually,
these side effects go away gradually during the recovery periods between
treatments or after treatment is over.
Certain drugs used in the treatment of bladder cancer also may cause kidney
damage. To protect the kidneys, patients need a lot of fluid. The nurse may give
the patient fluids by vein before and after treatment. Also, the patient may need
to drink a lot of fluids during treatment with these drugs.
Certain anticancer drugs can also cause tingling in the fingers, ringing in the
ears, or hearing loss. These problems may go away after treatment stops.
Biological therapy
BCG therapy can irritate the bladder. Patients may feel an urgent need to urinate,
and may need to urinate frequently. Patients also may have pain, especially
when urinating. They may feel tired. Some patients may have blood in their urine,
nausea, a low-grade fever, or chills.
Nutrition
Patients need to eat well during cancer therapy. They need enough calories to
maintain a good weight and protein to keep up strength. Good nutrition often
helps people with cancer feel better and have more energy.
But eating well can be difficult. Patients may not feel like eating if they are
uncomfortable or tired. Also, the side effects of treatment, such as poor appetite,
nausea, or vomiting, can be a problem. Foods may taste different.
The doctor, dietitian, or other health care provider can suggest ways to maintain
a healthy diet. Patients and their families may want to read the National Cancer
Institute booklet Eating Hints for Cancer Patients, which contains many useful
ideas and recipes. The "National Cancer Institute Booklets" section tells how to
get this publication.
Rehabilitation
Rehabilitation is an important part of cancer care. The health care team makes
every effort to help the patient return to normal activities as soon as possible.
Patients who have a stoma need to learn to care for it. Enterostomal therapists or
nurses can help. These health care specialists often visit patients before surgery
to discuss what to expect. They teach patients how to care for themselves and
their stomas after surgery. They talk with patients about lifestyle issues, including
emotional, physical, and sexual concerns. Often they can provide information
about resources and support groups.
Followup care
Followup care after treatment for bladder cancer is important. Bladder cancer can
return in the bladder or elsewhere in the body. Therefore, people who have had
bladder cancer may wish to discuss the chance of recurrence with the doctor.
If the bladder was not removed, the doctor will perform cystoscopy and remove
any new superficial tumors that are found. Patients also may have urine tests to
check for signs of cancer. Followup care may also include blood tests, x-rays, or
other tests.
People should not hesitate to discuss followup care with the doctor. Regular
followup ensures that the doctor will notice changes so that any problems can be
treated as soon as possible. Between checkups, people who have had bladder
cancer should report any health problems as soon as they appear.
The promise of cancer research
Doctors all over the country are conducting many types of clinical trials. These
are research studies in which people take part voluntarily. Doctors are studying
ways to treat bladder cancer and prevent it from coming back. Research already
has led to advances in these areas, and researchers continue to search for more
effective approaches.
Patients who join clinical trials have the first chance to benefit from new
treatments that have shown promise in earlier research. They also make an
important contribution to medical science by helping doctors learn more about
the disease. Although clinical trials may pose some risks, researchers take many
steps to protect their patients.
Patients who are interested in joining a clinical study should talk with their doctor.
They may want to read Taking Part in Clinical Trials: What Cancer Patients Need
To Know. This NCI booklet describes how treatment studies are carried out and
explains their possible benefits and risks. NCI's Web site at http://cancer.gov
provides general information about clinical trials. It also offers detailed
information about specific ongoing studies of bladder cancer by linking to PDQ®,
NCI's cancer information database. The Cancer Information Service at 1-800-4-
CANCER can answer questions and provide information from the PDQ database.
Doctors are studying surgery, radiation therapy, chemotherapy, biological

therapy, and combinations of these types of treatment. Another approach under
study is photodynamic therapy, which uses drugs that start to work when
exposed to light. After the cancer cells absorb the drug, the doctor shines a
special light inside the bladder through a cystoscope. The drug becomes active
and kills the cancer cells.
Doctors also are studying whether large doses of vitamins or certain drugs may
prevent bladder cancer from coming back after treatment.
Bladder Cancer At A Glance
• While the exact cause(s) of bladder cancer is not known, risk factors have
been identified.
• The most common warning sign of bladder cancer is blood in the urine.
• The diagnosis of bladder cancer is supported by findings of the medical

history and examination, blood, urine, and x-ray tests, and confirmed with
a biopsy (usually during a cystoscope exam).
• Treatment of bladder cancer depends on the growth, size, and location of

the tumor as well as the age and health of the patient.
Bone Cancer
What are bones for?
The 206 bones in the body serve several purposes. They support and protect
internal organs (for example, the skull protects the brain and the ribs protect the
lungs). Muscles pull against bones to make the body move. Bone marrow, the
soft, spongy tissue in the center of many bones, makes and stores blood cells.
What is cancer?
Cancer is a group of diseases. More than 100 different types of cancer are
known. They all have one thing in common: cells become abnormal. These
abnormal cells grow and destroy body tissue and can spread to other parts of the
body.
Healthy cells that make up the body's tissues grow, divide, and replace
themselves in an orderly way. This process keeps the body in good repair. If cells
lose the ability to control their growth, they grow too rapidly and without any
order. They form too much tissue. The mass of extra tissue is called a tumor.
Tumors can be benign or malignant.
Benign tumors are not cancer. They do not spread to other parts of the body and
are seldom a threat to life. Benign tumors can usually be removed. Although
benign bone tumors sometimes return, they usually can be removed with
additional surgery.
Malignant tumors are cancer. They can invade and destroy nearby healthy
tissues and organs. Cancer cells also can break away from the tumor and enter
the bloodstream. That is how bone cancer can spread to other parts of the body.
This spread is called metastasis.
Cancer that begins in the bone is called primary bone cancer. Each year, more
than 2000 people in the United States learn that they have bone cancer. It is
found most often in the arms and legs, but it can occur in any bone in the body.
Children and young people are more likely than adults to have bone cancers.
Primary bone cancers are called sarcomas. There are several types of sarcoma.
Each type begins in a different kind of bone tissue. The most common are
osteosarcoma, Ewing's sarcoma, and chondrosarcoma.
Osteosarcoma is the most common type of bone cancer in young people. It

usually occurs between ages 10 and 25. Males are affected more often than
females. Osteosarcoma often starts in the ends of bones, where new bone tissue
forms as a young person grows. It usually affects the long bones of the arms or
legs.
Ewing's sarcoma usually is found in people between 10 and 25 years old;

teenagers are most often affected. This cancer forms in the middle part (shaft) of
large bones. It most often affects the hip bones and the long bones in the thigh
and upper arm. It also occurs in the ribs.
Chondrosarcoma is found mainly in adults. This type of tumor forms in cartilage,

the rubbery tissue around joints.
Other types of bone cancer include fibrosarcoma, malignant giant cell tumor, and
chordoma. These rare cancers most often affect people over 30.
Cancers that begin in the bone are quite rare. On the other hand, it is not unusual
for cancer to spread to the bone from other parts of the body. When this
happens, the disease is not called bone cancer. Each type of cancer is named for
the organ or the tissue in which it begins. Cancer that spreads is the same
disease and has the same name as the original, or primary, cancer. Treatment for
cancer that has spread to the bones depends on where the cancer started and
the extent of the spread.
Cancers that begin in the muscles, fat, nerves, blood vessels, and other types of
connective or supporting tissues in the body are called soft tissue sarcomas.
They can affect both children and adults. They are not discussed in this article.
Leukemia, multiple myeloma, and lymphoma are cancers that arise in cells
produced in the bone marrow. These are different diseases and are not types of
bone cancer.
What are symptoms of bone cancer?
Symptoms of bone cancer tend to develop slowly. They depend on the type,
location, and size of the tumor.
Pain is the most frequent symptom of bone cancer. Sometimes a firm, slightly
tender lump on the bone can be felt through the skin. In some cases, bone
cancer interferes with normal movements. Bone cancer can also cause bones to
break.
These symptoms are not sure signs of cancer. They may also be caused by
other, less serious problems. Individuals who are experiencing symptoms should
consult a doctor.
How is bone cancer diagnosed?
To diagnose bone cancer, the doctor asks about the patient's personal and family
medical history and does a complete physical exam. In addition to checking the
general signs of health, the doctor usually orders blood tests and x-rays. X-rays
can show the location, size, and shape of a bone tumor. On x-rays, benign
tumors usually look round and smooth, with distinct edges. Bone cancers
generally have odd shapes and irregular edges.
If x-rays show that the tumor is possible cancer, some of the following special
tests may be done. These tests can also show whether the cancer has begun to
spread.
Bone scans outline the size, shape, and location of abnormal areas in the bone.
A small amount of radioactive material is injected into the bloodstream. This
material collects in the bones and is detected by a special instrument called a
scanner.
CT or CAT scan is an x-ray procedure that gives detailed pictures of cross-

sections of the body. The pictures are created by a computer.
MRI (magnetic resonance imaging) also creates detailed pictures of cross-

sections of the body. MRI uses a very strong magnet linked to a computer.
Angiograms are special x-rays of the blood vessels. A dye that shows up on x-
rays is injected into the bloodstream so that the vessels can be seen in detail.
This test is also done to help plan surgery.
A biopsy is the only sure way to tell whether cancer is present. Biopsies are best
done at a hospital where doctors are experienced in the diagnosis of bone
cancers. The doctor removes a sample of tissue from the bone tumor. A
pathologist looks at the tissue under a microscope. If cancer is found, the
pathologist can tell the type of sarcoma and whether it is likely to grow slowly or
quickly.
If a diagnosis of bone cancer is made, it is important for the doctor to know

exactly where the cancer is located and whether it has spread from its original
location. This information is very important for planning treatment. The results of
exams, tests, x-rays, scans, and the biopsy are all used in staging the cancer.
The stage indicates whether the disease has spread and how much tissue is
affected.
How is bone cancer treated?
A number of factors are considered to decide on the best treatment for bone
cancer. Among these are the type, location, size, and extent of the tumor as well
as the patient's age and general health. A treatment plan is tailored to fit each
patient's needs.
Treatment Methods
Bone cancer is treated with surgery, radiation therapy, and/or chemotherapy. The
doctor often uses a combination of treatment methods, depending on the
patient's needs. Patients may be referred to doctors who specialize in different
kinds of cancer treatment. Often, the specialists work together as a team. The
team may include a surgeon, a pediatric oncologist, and a radiation oncologist.
Surgery is part of the treatment for most bone cancers. Because the disease may
recur near the original site, the surgeon removes the tumor and some healthy
bone and other tissue around the tumor.
When bone cancer occurs in an arm or leg, the surgeon tries, whenever possible,
to remove just the tumor and an area of healthy tissue around it. Sometimes, the
surgeon can use a metal device to replace the bone that is removed. In some
children, the surgeon may replace the bone with a metal device that can be
lengthened as the child grows. This limb-sparing procedure will require additional
operations to keep expanding the artificial bone.
Sometimes, however, when the tumor is large, amputation may be necessary. If

the limb is removed, a prosthesis (artificial part) can be made. The artificial part
takes the place of a leg, arm, hand, or foot.
Chemotherapy uses drugs to kill cancer cells. Often, a combination of three or
more drugs is used. Chemotherapy can be given by mouth or by injection into a
muscle or blood vessel. The drugs travel through the body in the bloodstream.
Chemotherapy is given in cycles: a treatment period followed by a recovery
period, then another treatment and recovery period, and so on.
Some patients have chemotherapy as an outpatient at the hospital, clinic, or

doctor's office or at home. Depending on which drugs are given, however, the
patient may need to stay in the hospital for a short while.
Chemotherapy is almost always used in combination with surgery for cancers of

the bone. Sometimes, chemotherapy is used to shrink a tumor before surgery. It
is also used as an adjuvant therapy after surgery to kill cancer cells that may
remain in the body and to prevent the disease from recurring. In some cases, a
patient may have chemotherapy both before and after surgery. For some bone
cancer, chemotherapy is combined with radiation therapy. Chemotherapy can
also be used to control bone cancer that has spread.
Radiation therapy (also called radiotherapy) uses high-energy rays to damage

cancer cells and stop them from growing. In some cases, radiation therapy is
used instead of surgery to destroy the tumor. This form of treatment can also be
used to destroy cancer cells that remain in the area after surgery.
The patient goes to the hospital or clinic each day for radiation treatments.
Usually, treatments are given 5 days a week for 5 to 8 weeks.
What are the side effects of treatment for bone cancer?
The methods used to treat bone cancer are very powerful. It is hard to limit the
effects of treatment so that only cancer cells are destroyed; healthy tissue may
also be damaged. That is why treatment often causes side effects. Side effects
depend on the type of treatment and on the part of the body being treated.
Surgery for cancer of the bone is a major operation. The area must be carefully
watched for infection. Rehabilitation is an important part of post-surgery
treatment.
The side effects of chemotherapy depend on the drugs that are given. In
addition, each person reacts differently. Chemotherapy affects rapidly growing
cells, such as blood-forming cells and those that line the digestive tract. As a
result, patients may have side effects, such as a lowered resistance to infection,
loss of appetite, nausea, vomiting, or mouth sores. They may also have less
energy and may lose their hair. These are short-term side effects which usually
end after treatment stops.
During radiation therapy, patients can become very tired as treatment continues.
Resting as much as possible is important. Skin reactions such as redness or
dryness in the area being treated are common, and the skin should be protected
from the sun. Good skin care is important at this time, but the patient should not
use any lotion or cream on the skin without checking with the doctor.
For some patients, it may be important to have a complete dental exam before
treatment begins. Because cancer treatment can make the mouth sensitive and
easily infected, doctors often advise patients to see a dentist so that their mouths
are as healthy as possible.
Loss of appetite can be a problem for patients during their treatment for cancer.
Patients who eat well may be better able to withstand the side effects of their
treatment, so good nutrition is important. Eating well means getting enough
calories to prevent weight loss and having enough protein to regain strength and
rebuild normal tissues. Many patients find that eating several small meals and
snacks during the day works better than trying to have three large meals.
The side effects that patients have during cancer treatment vary for each person.
They may even be different from one treatment to the next. Attempts are made to
plan treatment to keep problems to a minimum. Fortunately, most side effects are
temporary. Doctors, nurses, and dietitians can explain the side effects of cancer
treatment and can suggest ways to deal with them.
Researchers are concerned about the possibility of long-term effects in young

people who are treated with chemotherapy and radiation therapy. These depend
on the location of the tumor and the way it is treated. Some types of
chemotherapy can affect a patient's fertility. When this side effect is permanent, it
is not possible for the person to have children. This can be true for both men and
women. Radiation therapy can increase the possibility that a second tumor will
later develop in the area that was treated. The doctor can tell patients and their
families more about these possible effects.
What happens after treatment for bone cancer?
Regular follow-up is very important after treatment for bone cancer. The doctor
will want to continue to check the patient closely for several years. This is
important to be sure that cancer has not come back or to find and treat it
promptly if it does. Checkups may include a physical exam, x-rays, scans, blood
tests, and other laboratory tests.
Cancer treatment can cause side effects many years later. For this reason,
patients should continue to have check-ups and should report any problem as
soon as it appears.
Patients who have had part or all of a limb removed will need physical therapy.
Physical therapists and doctors who specialize in rehabilitation help patients
learn to do their regular activities in new ways. Physical therapists also help
patients learn to use their prostheses.
The diagnosis of cancer can change the lives of patients and the people close to
them. These changes can be difficult to handle. It is natural for patients and their
families and friends to have many different and sometimes confusing emotions.
At times, patients and their loved ones may feel frightened, angry, or depressed.
These are normal reactions when people face a serious health problem. Patients,
including children and teenagers, usually are better able to cope with their
emotions if they can talk openly about their illness and their feelings with family
members and friends. Sharing feelings with others can help everyone feel more
at ease, opening the way for others to show their concern and offer their support.
Concern about what the future holds, as well as worries about tests, treatments,
hospital stays, and medical bills, are common. Talking with doctors, nurses, or
other members of the health care team may help calm fears and ease confusion.
Patients can take an active part in decisions about their medical care by asking
questions about bone cancer and their treatment choices. Patients, family, or
friends often find it helpful to write down questions to ask the doctor as they think
of them. Taking notes during visits to the doctor can help them remember what
was said. Patients should ask the doctor to explain anything that is not clear.
Patients and families have many important questions, and the doctor is the best
person to answer them.
Sometimes, patients use statistics to try to figure out their chance of being cured.
It is important to remember, however, that statistics are averages. They are
based on the experience of large numbers of people, and no two cancer patients
are alike. Only the doctor who takes care of a patient knows enough about his or
her case to discuss the chance of recovery (prognosis). Doctors often talk about
"surviving" bone cancer, or they may use the term "remission" rather than "cure."
Even though many bone cancer patients recover completely, doctors use these
terms because the disease can recur.
People who have had bone cancer may worry that removal of a limb or other
surgery will affect not only how they look but how other people feel about them.
Parents may worry about whether their children will be able to take part in normal
school and social activities. Adults who have had extensive surgery can be
concerned about working, taking part in social activities, and caring for their
families.
The doctor can give advice about treatment, working, going to school, or other
activities. Patients may also want to discuss concerns about the future, family
relationships, and finances. If it is hard to talk with the doctor about feelings or
other personal matters, it may be helpful to speak with a nurse, social worker,
counselor, or a member of the clergy.
A physical or vocational therapist can help patients get used to new ways of
doing things. This is especially important for those who have lost all or part of a
limb and are learning to use a prosthesis. Therapists also understand and can
help patients deal with the feelings that come with these changes.
Learning to live with the changes that are brought about by bone cancer is easier
for patients and those who care about them when they have helpful information
and support services. Many patients feel that it helps to talk with others who are
facing problems like theirs. They can meet other cancer patients through self-
help and support groups. Some hospitals have special support groups for
youngsters with cancer and their families. Often, a social worker at the hospital or
clinic can suggest local and national groups that will help with rehabilitation,
emotional support, financial aid, transportation, or home care.
The American Cancer Society (ACS), for example, is a nonprofit organization that
has many services for patients and their families. Local ACS offices are listed in
the telephone book.
What does the future hold for patients with bone cancer?
At this time, little is know about the causes of bone cancer. Doctors can seldom
explain why one person gets this rare type of cancer and another doesn't. We do
know, however, that bone cancer is not contagious; no one can "catch" cancer
from another person.
Scientists at hospitals and medical centers all across the country are studying
bone cancer. They are trying to learn more about what causes this disease and
how to prevent it. They are also looking for better ways to diagnose and treat it.
The National Cancer Institute (NCI) is supporting many studies of new treatments
for bone cancer. When laboratory research shows that a new treatment method
has promise, it is used to treat cancer patients in clinical trials. These trials are
designed to answer scientific questions and to find out whether a new treatment
is safe and effective. Patients who take part in clinical trials make an important
contribution to medical science and may have the first chance to benefit from
improved treatment methods. Researchers are exploring new drugs and drug
combinations and new ways of giving radiation therapy and chemotherapy. They
are also looking for ways to use surgery more effectively in combination with
other forms of treatment.
One way to learn about clinical trials is through PDQ, a computerized resource of
cancer treatment information. Developed by NCI, PDQ contains an up-to-date list
of trials all over the country. The Cancer Information Service, at 1-800-4-
CANCER, can provide PDQ information to doctors, patients, and the public.
Bone Cancer At A Glance
• Cancers that begin in bone are rare.

• It is not unusual for cancers to spread to bone from other parts of the
body. This is not called bone cancer, but is named for the organ or tissue
in which the cancer begins.
• Pain is the most frequent symptom of cancer of the bone.
• Diagnosis of cancer of the bone is supported by findings of the medical
history and examination, blood and x-ray tests and confirmed with a
biopsy.
• Treatment of cancer of the bone depends on the type, location, size, and
extent of the tumor as well as the age and health of the patient.
Cervical Cancer
Definition
Cervical cancer is cancer that starts in the cervix, the lower part of the uterus
(womb) that opens at the top of the vagina.
The development of cervical cancer is gradual and begins as a pre-cancerous

condition called dysplasia. It is usually a slow-growing cancer and if caught early
can be successfully treated. Routine Pap smears can detect early changes in the
cells of the cervix allowing cervical cancer to be caught early.
Cervical cancer is the third most common type of cancer in women.

Approximately 2-3% of all women over age 40 years will develop some form of
cervical cancer.
Worldwide, cervical cancer is the third most common type of cancer in women. It
is much less common in the United States because of routine use of Pap
smears.
Cervical cancers start in the cells on the surface of the cervix. There are two
types of cells on the cervix's surface: squamous and columnar. The majority of
cervical cancers are from squamous cells.
The development of cervical cancer is very slow. It starts as a pre-cancerous

condition called dysplasia. This pre-cancerous condition can be detected by a
Pap smear and is 100% treatable. That is why it is so important for women to get
regular Pap smears. Most women that are diagnosed with cervical cancer today
have not had regular Pap smears or they have not followed up on abnormal
results.
Undetected, pre-cancerous changes can develop into cervical cancer and spread
to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous
changes to turn into cervical cancer. Patients with cervical cancer do not usually
have problems until the cancer is advanced and has spread.
Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a
common virus that is spread through sexual intercourse. There are many
different types of HPV, and many do not cause problems. However, only certain
strains of HPV actually lead to cervical cancer. (Other strains may cause genital
warts.)
Other risk factors for cervical cancer include:
• Having sex at an early age

• Multiple sexual partners
• Sexual partners who have multiple partners or who participate in high-risk
sexual activities
• Women whose mothers took the drug DES (diethylstilbestrol) during
pregnancy in the early 1970s to prevent miscarriage
• Long-term use of birth control pills (more than 5 years)
• Weakened immune system
• Infections with genital herpes or chronic chlamydia infections
• Poor economic status (may not be able to afford regular Pap smears)
Symptoms
Most of the time, early cervical cancer has no symptoms. Symptoms that may
occur can include:
• Continuous vaginal discharge, which may be pale, watery, pink, brown,

bloody, or foul-smelling
• Abnormal vaginal bleeding between periods, after intercourse, or after
menopause
• Periods become heavier and last longer than usual
Symptoms of advanced cervical cancer may include:
• Loss of appetite
• Weight loss
• Fatigue
• Pelvic pain
• Back pain
• Leg pain
• Single swollen leg
• Heavy bleeding from the vagina
• Leaking of urine or feces from the vagina
• Bone fractures
Signs and tests
Pre-cancerous changes of the cervix and cervical cancer can not be seen with
the naked eye. Special tests and tools are needed to spot such conditions.
Pap smears screen for pre-cancers and cancer, but do not offer the final
diagnosis. If abnormal changes are found, the cervix is usually examined under
magnification. This is called colposcopy. Pieces of tissue are surgically removed
(biopsied) during this procedure and sent to a laboratory for examination.
Other tests may include:
• Endocervical curettage (ECC) to examine the opening of the cervix

• Cone biopsy
If the woman is diagnosed with cervical cancer, the health care provider will order
more tests to determine how far the cancer has spread. This is called staging.
Tests may include:
• CT scan
• Cystoscopy
• MRI
• Chest x-ray
• Intravenous pyelogram (IVP)
Treatment
Treatment of cervical cancer depends on the stage of the cancer, the size and
shape of the tumor, the age and general health of the woman, and her desire to
have children in the future.
Early cervical cancer can be cured by removing or destroying the pre-cancerous

or cancerous tissue. There are various surgical ways to do this without removing
the uterus or damaging the cervix, so that a woman can still have children in the
future.
Types of surgery for early cervical cancer include:
• LEEP (Loop Electrosurgical Excision Procedure) - uses electricity to

remove abnormal tissue
• Cryotherapy - freezes abnormal cells
• Laser therapy - uses light to burn abnormal tissue
A hysterectomy (removal of the uterus but not the ovaries) is not often performed
for cervical cancer that has not spread. It may be done in women who have
repeated LEEP procedures. However, in more advanced disease, a radical
hysterectomy may be performed. This type of hysterectomy removes the uterus
and much of the surrounding tissues, including internal lymph nodes and upper
part of the vagina. In the most extreme surgery, called a pelvic exenteration, all of
the organs of the pelvis, including the bladder and rectum, are removed.
Radiation may be used to treat cancer that has spread beyond the pelvis, or
cancer that has returned. Radiation therapy is either external or internal. Internal
radiation therapy uses a device filled with radioactive material, which is placed
inside the woman's vagina next to the cervical cancer. The device is removed
when she goes home. External radiation therapy beams radiation from a large
machine onto the body where the cancer is located. It is similar to an x-ray.
Chemotherapy uses drugs to kill cancer. Some of the drugs used for
chemotherapy for cervical cancer include 5-FU, Cisplatin, Carboplatin,
Ifosfamide, Paclitaxel, and Cyclophosphamide. Sometimes radiation and
chemotherapy are used before or after surgery.
Many factors influence the outcome of cervical cancer. These include:
• The type of cancer

• The stage of the disease
• The age and general physical condition of the woman
Pre-cancer conditions are completely curable when followed up and treated

properly. The chance of being alive in 5 years (5-year survival rate) for cancer
that has spread to the inside of the cervix walls but not outside the cervix area is
92%.
However, the 5-year survival rate falls steadily as the cancer spreads into other
areas.
Complications
• Some types of cervical cancer do not respond well to treatment.

• The cancer may come back (recur) after treatment.
• Women who have treatment to save the uterus have a high risk of the
cancer coming back (recurrence).
• Surgery and radiation can cause problems with sexual, bowel, and
bladder function.
In a cervical punch biopsy, the cervix may be stained with iodine solution in order to see
abnormalities better. These areas of tissue are then sampled and examined. (Cervical
Biopsy)
Cervical intraepithelial neoplasia (CIN) is the presence of abnormal cells on the

surface of the cervix. A Pap smear and colposcopy are two of the procedures
performed to monitor the cells and appearance of the cervix.
A Pap test is a simple, relatively inexpensive procedure that can easily detect
cancerous or precancerous conditions.
Endometrial Cancer
The uterus is a hollow muscular organ located in the female pelvis between the
bladder and rectum. The ovaries produce the eggs that travel through the
fallopian tubes. Once the egg has left the ovary it can be fertilized and implant
itself in the lining of the uterus. The main function of the uterus is to nourish the
developing fetus prior to birth.
Alternative names
Endometrial/uterine adenocarcinoma; Uterine cancer; Adenocarcinoma of the

endometrium/uterus; Cancer - uterine; Cancer - endometrial; Uterine corpus
cancer
Definition
Endometrial cancer is cancer that starts in the endometrium, the lining of the
uterus (womb).Endometrial cancer is a cancerous growth of the endometrium
(lining of the uterus). It is the most common uterine cancer.
Endometrial cancer is the most common type of uterine cancer. Although the
exact cause of endometrial cancer is unknown, increased levels of estrogen
appear to have a role. Estrogen helps stimulate the buildup of the epithelial lining
of the uterus. Studies have shown that high levels of estrogen in animals results
in endometrial hyperplasia and cancer.
Most cases of endometrial cancer occur between the ages of 60 and 70 years,
but a few cases may occur before age 40.
The following increase your risk of endometrial cancer:
• History of endometrial polyps or other benign growths of the uterine lining

• Estrogen replacement therapy
• Tamoxifen, a drug for breast cancer treatment
• Diabetes
• Never being pregnant (nulliparity)
• Starting menstruation at an early age (before age 12)
• Infertility (inability to become pregnant)
• Starting menopause after age 50
Associated conditions include the following:
• Obesity
• Hypertension
• Polycystic ovarian disease
Symptoms
• Abnormal uterine bleeding, abnormal menstrual periods

o Bleeding between normal periods before menopause
o Vaginal bleeding or spotting after menopause
• Extremely long, heavy, or frequent episodes of vaginal bleeding after age
40
• Lower abdominal pain or pelvic cramping
• Thin white or clear vaginal discharge after menopause
Signs and tests
A pelvic examination is frequently normal, especially in the early stages of

disease. Changes in the size, shape, or consistency of the uterus or its
surrounding, supporting structures may be seen when the disease is more
advanced.
Tests used to diagnose endometrial cancer include:
• Pap smear
• Endometrial aspiration or biopsy
• Dilation and curettage (D and C)
If cancer is found, other tests may be done to determine how widespread the
cancer is and whether it has spread to other parts of the body. This is called
staging.
Stages of endometrial cancer:
1. The cancer is only in the uterus.

2. The cancer is in the uterus and cervix.
3. The cancer has spread outside of the uterus but not beyond the true pelvis
area. Cancer may involve the lymph nodes in the pelvis or near the aorta
(the major artery in the abdomen).
4. The cancer has spread to the inner surface of the bowel, bladder,
abdomen, or other organs.
Treatment
Treatment options involve surgery, radiation therapy, and chemotherapy.
A hysterectomy may be performed in women with the early stage 1 disease.

Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also
usually recommended.
Abdominal hysterectomy is recommended over vaginal hysterectomy. This type

of hysterectomy allows the surgeon to look inside the abdominal area and
remove tissue for a biopsy.
Surgery combined with radiation therapy is often used to treat women with stage
1 disease that could return and stage 2 disease. Chemotherapy may be
considered in some cases, especially for those with stage 3 and 4 disease.
Endometrial cancer is usually diagnosed at an early stage. The 1-year survival

rate is about 94%.
The 5-year survival rate for endometrial cancer that has not spread is 96%. If the
cancer has spread to distant organs, the 5-year survival rate drops to 25%.
Complications
Complications may include anemia due to blood loss. A perforation (hole) of the
uterus may occur during a D and C or endometrial biopsy.
Call for an appointment with your health care provider if you have abnormal
vaginal bleeding or any other symptoms of endometrial cancer. This is
particularly important if you have any associated risk factors or if you have not
had routine pelvic exams.
Any of the following symptoms should be reported immediately to the doctor:
• Bleeding or spotting after intercourse or douching

• Bleeding lasting longer than 7 days
• Periods that occur every 21 days or less
• Bleeding or spotting after 6 months or more of no bleeding at all
Prevention
All women should have regular pelvic exams and Pap smears beginning at the
onset of sexual activity (or at the age of 20 if not sexually active) to help detect
signs of any abnormal development.
Women with any risk factors for endometrial cancer should be followed more
closely by their doctors. Frequent pelvic examinations and screening tests,
including a Pap smear and endometrial biopsy, should be done.
Women who are taking estrogen replacement therapy should also take these
precautions.
Laparoscopy is performed when less-invasive surgery is desired. It is also

called "band-aid" surgery because only small incisions need to be made to
accomodate the small surgical instruments that are used to view the abdominal
contents and perform the surgery.
D and C (dilatation and curettage) is a procedure in which the vaginal canal is

held open with a speculum and the cervix is dilated with a metal rod. A curette is
then passed through the cervical canal into the uterine cavity where endometrial
tissue is scraped away and collected for examination.
The mucosal lining of the cavity of the uterus is called the endometrium. It is this
lining which undergoes changes over the course of the monthly menstrual cycle,
sloughs off and becomes part of the menses. A biopsy of the endometrium is
used to check for disease or problems of fertility.
Hysterectomy is surgical removal of the uterus, resulting in inability to become

pregnant. This surgery may be done for a variety of reasons including, but not
restricted to, chronic pelvic inflammatory disease, uterine fibroids and cancer. A
hysterectomy may be done through an abdominal or a vaginal incision.
Liver Cancer
Alternative names
Primary liver cell carcinoma; Tumor - liver; Liver cancer; Cancer - liver
Definition
Hepatocellular carcinoma is cancer of the liver.

The esophagus, stomach, large and small intestine, aided by the liver,
gallbladder and pancreas convert the nutritive components of food into
energy and break down the non-nutritive components into waste to be
excreted.
Hepatocellular carcinoma accounts for 80 - 90% of all liver cancers. This type of
cancer occurs more often in men than women, usually in people 50 to 60 years
old. The disease is more common in parts of Africa and Asia than in North or
South America and Europe.
The cause of liver cancer is usually cirrhosis (scarring of the liver). Cirrhosis may
be caused by viral hepatitis, primarily hepatitis B and C, alcohol abuse,
hemochromatosis, certain autoimmune diseases of the liver, and other diseases
that result in chronic inflammation of the liver. The most common cause for
cirrhosis in the United States is alcohol abuse.
Symptoms
• Abdominal pain or tenderness, particularly in the right-upper quadrant

• Enlarged abdomen
• Easy bruising or bleeding
• Jaundice (a yellow discoloration of the skin and eyes)
Signs and tests
• Physical examination shows an enlarged, tender liver.

• A liver biopsy shows hepatocellular carcinoma.
• Serum alpha fetoprotein may be elevated.
• There may be a mass shown on abdominal CT scan.
• A liver scan may indicate an abnormality.
• Liver enzymes (liver function tests) are elevated.
Treatment
Aggressive surgery or liver transplantation may be successful in treating small or

slow-growing tumors if they are diagnosed early.
Chemotherapy and radiation treatments are not usually effective but may be
used to shrink large tumors so that surgery has a greater chance of success.
Support Groups
The stress of illness can often be eased by joining a support group with members
who share common experiences and problems. See liver disease - support group
and cancer - support group.
The usual outcome is poor, because only 10 - 20% of hepatocellular carcinomas

can be removed completely using surgery. If the cancer cannot be completely
removed, the disease is usually deadly within 3 to 6 months, although this varies
greatly. Survival much longer than this occasionally occurs.
Complications
• Gastrointestinal bleeding
• Liver failure
• Spread (metastasis) of the carcinoma
Call your health care provider if persistent abdominal pain develops, particularly if
there has been a history of any liver disease.
Prevention
Preventing and treating viral hepatitis may help reduce risk. Avoid excessive
alcohol consumption. Certain patients may benefit from hemochromatosis
screening.
A liver biopsy is not a routine procedure, but is performed when it is necessary

to determine the presence of liver disease and to look for malignancy, cysts,
parasites, or other pathology. The actual procedure is only slightly uncomfortable.
Most of the discomfort arises from being required to lie still for several hours
afterwards to prevent bleeding from the biopsy site.
A CT scan of the upper abdomen showing a widespread (disseminated)

carcinoma of the liver (hepato cellular carcinoma). The liver is the large organ on
the left side of the picture. Note the moth-eaten appearance.
Gastric Cancer
Alternative names
Cancer - stomach; Stomach cancer; Gastric carcinoma
Definition
The stomach is the portion of the digestive system most responsible for breaking
down food. The lower esophageal sphincter at the top of the stomach regulates
food passing from the esophagus into the stomach, and prevents the contents of
the stomach from reentering the esophagus. The pyloric sphincter at the bottom
of the stomach governs the passage of food out of the stomach into the small
intestine.
The stomach connects the esophagus to the small intestine, and functions to
break up food into small particles that can be absorbed by the small intestine.
Gastric cancers are malignancies of the stomach.
Several different types of cancer can occur in the stomach. The most common
type is called adenocarcinoma, which refers to the way the cancer looks under
the microscope. There are several types of adenocarcinoma. Because other
types of gastric cancer occur much less frequently, this article focuses on
adenocarcinoma.
Adenocarcinoma of the stomach is a common cancer of the digestive tract

worldwide, although it is relatively uncommon in the US. It occurs most frequently
in men over 40 years old. The incidence of this form of gastric cancer is
extremely high in Japan, Chile, and Iceland. The incidence of most types of
gastric adenocarcinoma in the US has declined over the years. Experts think the
decrease may be related to reduced intake of salted, cured, and smoked foods,
and increased vitamin C consumption.
However, the incidence of adenocarcinoma in the high part of the stomach where
it connects with the esophagus has increased markedly, along with an increase
in cancers of the lower esophagus. The reason for this increase is unknown.
Diagnosis is often delayed by the absence of symptoms in early disease or by

self-treatment of symptoms that may be common to other, less serious
gastrointestinal disorders (bloating, gas, and a sense of fullness).
Risk factors for gastric cancer are a family history of gastric cancer, Helicobacter
pylori infection, blood type A, a history of pernicious anemia, a history of chronic
atrophic gastritis, a condition of decreased gastric acid, and a prior history of
adenomatous gastric polyp.
Symptoms
• Loss of appetite
• Difficulty swallowing, particularly difficulty that increases over time
• Vague abdominal fullness
• Nausea and vomiting
• Vomiting blood
• Abdominal pain
• Excessive belching
• Breath odor
• Excessive gas (flatus)
• Unintentional weight loss
• A general decline in health
• Premature abdominal fullness after meals
Signs and tests
• An upper GI series showing gastric cancer

• An EGD (esophagogastroduodenoscopy) and biopsy showing gastric
cancer
• A CBC showing anemia (although there are many other reasons for
anemia)
• A stool test that is positive for blood
Treatment
Surgical removal of the stomach (gastrectomy) is the only curative treatment.

Radiation therapy and chemotherapy may be beneficial. A recent study showed
that for many patients, chemotherapy and radiation therapy given after surgery
improve the chance of a cure.
For patients in whom surgery is not an option, chemotherapy or radiation can

improve symptoms. For some patients, a surgical bypass procedure may provide
relief of symptoms.
There is a wide variation in prognosis of gastric tumors. Tumors in the lower

stomach are more often cured than those in the higher area -- gastric cardia or
gastroesophageal junction. The depth to which the tumor invades the stomach
wall and whether lymph nodes are involved influence the chances of cure.
In circumstances in which the tumor has spread outside of the stomach, cure is
not possible and treatment is directed toward improvement of symptoms.
Complications
• Cancer spreading (metastasizing) to other organs or tissues

• Weight loss
• Fluid accumulation in the belly (ascites)
Prevention
In Japan, where the risk of gastric cancer is very high, mass screening programs have
been successful in detecting disease in the early stages. The value of screening in the
United States and other countries with lower rates of gastric cancer is not clear. Avoiding
smoking may reduce risk.
The patient will be on nasogastric tube suction to keep the stomach empty and at
rest after surgery. After several days and when the stomach starts to function
normally again the tube will be removed and the patient will begin ingesting clear
liquids and gradually progress to a full and normal diet. (Post Gastrectomy)
Renal Cancer
Alternative names
Renal cancer; Kidney cancer; Hypernephroma; Adenocarcinoma of renal cells;

Cancer - kidney
Definition
The kidneys are paired organs that lie posterior to the abdomen, in the area of
the lower back. The kidneys make urine, which is transported from the kidneys to
the bladder by the ureters.
The kidneys are located in the posterior abdomen and are responsible for filtering
urine from the blood.
The kidneys are responsible for removing wastes from the body, regulating
electrolyte balance and blood pressure, and stimulating red blood cell production.
Renal cell carcinoma is a type of kidney cancer. The cancerous cells are found in
the lining of very small tubes (tubules) in the kidney. It is the most common type
of kidney cancer in adults.
Renal cell carcinoma affects about 3 in 10,000 people, resulting in about 32,000
new cases in the US per year. Every year, about 12,000 people in the US die
from renal cell carcinoma. It occurs is most common in people between 50 and
70 years of age, and typically affects men.
The exact cause is unknown.
Risk factors include:

• Smoking
• Genetics
• Family history of the disease
• Dialysis treatment
• von Hippel-Lindau disease, a hereditary disease that affects the capillaries
of the brain
The first symptom is usually blood in the urine. Sometimes both kidneys are
involved. The cancer spreads easily, most often to the lungs and other organs.
About one-third of patients have spreading (metastasis) at the time of diagnosis.
Symptoms
• Blood in the urine

• Abnormal urine color (dark, rusty, or brown)
• Flank pain
• Back pain
• Abdominal pain
• Unintentional weight loss of more than 5% of body weight
• Emaciated, thin, malnourished appearance
• Enlargement of one testicle
• Swelling or enlargement of the abdomen
Additional symptoms that may be associated with this disease:
• Vision abnormalities
• Paleness
• Excessive hair grown in females
• Constipation
• Cold intolerance
Signs and tests
Palpation of the abdomen may show a mass or organ enlargement, particularly

of the kidney or liver. There may be a testicular varicocele in men.
• Complete blood count (CBC)

• Urine test may show red blood cells
• Serum calcium levels may be high
• SGPT and alkaline phosphatase may be high
• A urine cytology
• Liver function tests
• An ultrasound of the abdomen and kidney
• Kidney x-ray
• IVP
• Renal arteriography
The following tests may be performed to see if the cancer has spread:
• An abdominal CT scan may show a liver mass.

• Abdominal MRI can determine if the cancer has spread to any surrounding
blood vessels and whether it can be surgically removed.
• A chest x-ray may show mass in the chest.
• A bone scan may show involvement of the bones.
Treatment
Surgical removal of all or part of the kidney (nephrectomy) is recommended. This

may include removal of the bladder or surrounding tissues or lymph nodes.
Radiation therapy does not usually work for renal cell carcinoma and, therefore,
is not often used. Hormone treatments may reduce the growth of the tumor in
some cases.
Medications such as alpha-interferon and interleukin have been successful in

reducing the growth of some renal cell carcinomas, including some that have
spread. In December 2005, the US Food and Drug Administration approved a
new type of drug called Nexavar for adults with advanced renal cell carcinoma.
The drug works by blocking a tumor's blood supply.
Chemotherapy may be used in some cases, but cure is unlikely unless all the
cancer is removed with surgery.
Support Groups
The stress of illness may be eased by joining a support group whose members
share common experiences and problems. See cancer - support group and
kidney disease - support group.
The outcome varies depending on the degree of metastasis. The 5-year survival
rate is around 60 - 75% if the tumor is in the early stages and has not spread
outside the kidney. If it has metastasized to the lymph nodes, the 5-year survival
is around 5 - 15%. If it has spread to other organs, the 5-year survival at less
than 5%.
Complications
• Hypertension
• Metastasis of the cancer

Call your health care provider any time blood in the urine develops. Also call if
any other symptoms of this disorder occur.
Prevention
Stop smoking. Follow your health care provider's recommendations in the

treatment of kidney disorders, especially those that may require dialysis.
Nephrectomy
Kidney removal, also called nephrectomy, is a surgical procedure to remove a

kidney.
Description
This surgery is done under general anesthesia (asleep and pain-free). The
surgeon makes a cut in the abdomen or in the side of the abdomen (flank area).
A rib may need to be removed to perform the procedure.
The ureter (the tube that carries urine from the kidney to the bladder) and the
blood vessels are cut away from the kidney and the kidney is removed. The cut is
then closed.
Kidney removal may be done as open surgery, which involves a large cut in the
side of the abdomen. Some patients may have laparoscopic surgery, which is
less invasive and involves three or four small cuts, usually no more than an inch
each, in the abdominal and flank areas.
Indication
Kidney removal may be recommended for:
• Birth defects (congenital abnormalities)

• Injury (trauma)
• Infection
• Hypertension
• Tumor
• Chronic bleeding
• kidney deformities (birth defects: congenital abnormalities)
• removal of kidney from donor for kidney transplant
Kidney removal is also performed on someone who donates a kidney for a

kidney transplant.
Risks
Risks for any anesthesia include the following:
• Reactions to medications
• Problems breathing
Risks for any surgery include the following:
• Bleeding
• Infection
Procedure
The tube that carries urine from the kidney to the bladder (ureter) and the blood
vessels are cut away from the kidney and the kidney is removed. The incision is
then closed. This opoeration is called a nephrectomy.
Expectations after surgery
Outcome is usually good in the case of the removal of a single kidney. If both
kidneys are removed or if the remaining kidney does not function well enough,
hemodialysis or kidney transplantation will be necessary to maintain life.
Patients are generally in the hospital after surgery for 3-5 days. The removal of
one kidney generally has no health consequences as long as the remaining
kidney is functioning well. Some centers are now performing nephrectomies
using laparoscopic surgical techniques.
Convalescence
You will be given fluids through an IV and pain medication. Kidney removal
surgery is often very painful because of the location.
The health care team will carefully watch your blood pressure and electrolytes
and fluid balance. These body functions are controlled in part by the kidneys. You
will most likely have a urinary catheter (tube to drain urine) in place for a short
time during your recovery.
You will probably remain in the hospital for 2 to 7 days, depending on the method
of surgery used. You will be encouraged to return to light activities as soon as
you feel up to it. Strenuous activity should be avoided for 6 weeks following the
procedure.
Ovarian Cancer
Alternative names
Cancer - ovaries
Definition
Cancer of the ovaries is considered very dangerous because the ovaries are in
close proximity to many other abdominal organs and the risk of metastasis is
high.
Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female
reproductive organs that produce eggs.
Ovarian cancer is particularly dangerous because its presence is difficult to detect until it
has spread beyond the ovaries.
Prior to menopause, a mass on the ovary that is smaller than 2 centimeters is

probably a follicle cyst that will go away on its own. However, if the growth is
larger and doesn't go away over the course of a few menstrual cycles, then it
may need to be removed.
A woman has a 1 in 67 chance of developing ovarian cancer. Ovarian cancer is

the fifth most common cancer among women, and it causes more deaths than
any other type of female reproductive cancer.
The cause is unknown.
The risk for developing ovarian cancer appears to be affected by several factors.
The more children a woman has and the earlier in life she gives birth, the lower
her risk of ovarian cancer. Certain genes (BRCA1 and BRCA2) are responsible
for a small number of ovarian cancer cases. Women with a personal history of
breast cancer or a family history of breast or ovarian cancer have an increased
risk for ovarian cancer.
The use of fertility drugs may be associated with an increased chance of

developing ovarian cancer, although this is a subject of ongoing debate.
The links between ovarian cancer and talc use, asbestos exposure, a high-fat
diet, and childhood mumps infection are controversial and have not been
definitively proven.
Older women are at highest risk. About two-thirds of the deaths from ovarian
cancer occur in women age 55 and older. About 25% of ovarian cancer deaths
occur in women between 35 and 54 years of age.
Ovarian cancer symptoms are often vague and non-specific, so women and
doctors often blame the symptoms on other, more common conditions. By the
time the cancer is diagnosed, the tumor has often spread beyond the ovaries.
Symptoms
• Sense of pelvic heaviness

• Vague lower abdominal discomfort
• Vaginal bleeding
Common Causes of Vaginal Bleeding
> Uterine fibroids or polyps
> Injury or disease of the vaginal opening (caused by intercourse, infection,

polyp, genital warts, ulcer, or varicose veins)
> Vaginal injury from insertion of foreign objects, from malignancy, or from
infection
> Dry vaginal walls resulting from lack of estrogen after menopause
> Pregnancy complicated by abortion (spontaneous or induced)
> Ectopic pregnancy
> Fluctuation in hormone levels
> Stopping and starting birth control pills or estrogens
> Low thyroid function
> IUD use (may cause occasional spotting)
> Drugs such as anticoagulants
> Cervical conization or cauterization procedures
> Stress
• Weight gain or loss

• Abnormal menstrual cycles
• Unexplained back pain that worsens over time
• Increased abdominal girth
• Non-specific gastrointestinal symptoms:
o Increased gas
o Indigestion
o Lack of appetite
o Nausea and vomiting
o Inability to ingest usual volumes of food
o Bloating
Additional symptoms that may be associated with this disease:
• Increased urinary frequency or urgency
Urgent urination; Urinary frequency or urgency
Definition
Frequent urination means needing to urinate more often than usual. Urgent
urination is a sudden, compelling urge to urinate, along with discomfort in your
bladder.
A frequent need to urinate at night is called nocturia. Most people can sleep for 6
to 8 hours without having to urinate. Middle aged and older men often wake to
urinate once in the early morning hours.
Common Causes
Together, frequent and urgent urination are classic signs of a urinary tract
infection. Since inflammation reduces the bladder's capacity to hold urine, even
small amounts of urine cause discomfort.
Diabetes, pregnancy, and prostate problems are other common causes of these
symptoms.
Other causes include:
• Interstitial cystitis (an ongoing inflammation of the bladder that is much

more common in women than men; often difficult to diagnose and treat)
• Diuretics and many other medications
And, less commonly:
• Radiation therapy
• Bladder dysfunction
• Bladder cancer
Common causes of nighttime urination:
• Drinking too much before bedtime, especially caffeine or alcohol

• Enlarged prostate
Home Care
Follow the therapy recommended by your doctor to treat the underlying cause of
your urinary frequency or urgency. It may help to keep a diary of times and
amounts of urine voided to bring with you to the doctor.
In some cases, you may experience some urinary incontinence for a period of
time. You may need to take steps to protect your clothing and bedding.
• Excessive hair growth
The normal amount of body hair varies widely among women. When coarse, dark
hairs grow where women typically do not grow dark hair, such as the lip, chin,
chest, abdomen, or back, the condition is called hirsutism.
Common Causes
Excessive hair growth in women is usually from too much male hormone
(androgen). A common cause is polycystic ovarian syndrome (PCOS). In most
cases, however, the specific cause is never identified. It tends to run in families.
In general, hirsutism is a harmless condition. But many women find it
bothersome, even embarrassing.
If hirsutism develops suddenly and is accompanied by other typical male

features, such as deepening voice, acne, or increased muscle mass, it may be
caused by a more serious disorder. These causes, such as hormone-secreting
tumors or cancer, are rare.
Rare causes include:
• Tumor or cancer of the adrenal gland.

• Tumor or cancer of the ovary
• Cushing's syndrome
• Congenital adrenal hyperplasia
• Hyperthecosis
• Medications (testosterone, danazol, anabolic steroids, glucocorticoids,
cyclosporine, minoxidil, phenytoin)
Home Care
There are a variety of ways to remove unwanted hair:
• Bleaching -- lightening hair to make it less noticeable.

• Hair removal -- shaving, plucking, waxing, or chemical depilation.
• Electrolysis -- using electrical current to damage individual hair follicles so
they do not grow back. This is expensive and requires multiple treatments.
• Laser hair removal -- using laser to damage individual hair follicles so they
do not grow back. This is expensive and requires multiple treatments.
• Weight loss -- in overweight women, weight loss can decrease male
hormone levels and reduce hair growth.
Birth control pills and anti-androgen medications can also help reduce hair
growth. A doctor must prescribe these medications.
There may be no symptoms until late in the disease.
Signs and test
A physical examination may reveal increased abdominal girth and ascites (fluid
within the abdominal cavity). A pelvic examination may reveal an ovarian or
abdominal mass.
Tests include:
• CBC
• Blood chemistry
• CA125
• Quantitative serum HCG (blood pregnancy test)
• Alpha fetoprotein
• Urinalysis
• GI series
• Exploratory laparotomy
• Ultrasound
• Abdominal CT scan or MRI of abdomen
Treatment
Surgery is the preferred treatment and is often needed to diagnose ovarian

cancer.
Studies have shown that surgery performed by a specialist in gynecologic

oncology results in a higher cure rate.
Chemotherapy is used as after surgery to treat any remaining disease.

Chemotherapy can also be used if the cancer comes back.
Radiation therapy is rarely used in ovarian cancer in the United States.
.Expectations (prognosis)
Ovarian cancer is rarely diagnosed in its early stages. It is usually quite
advanced by the time diagnosis is made. The outcome is often poor.
• About 76% of women with ovarian cancer survive 1 year after diagnosis.
• About 45% live longer than 5 years after diagnosis.
• If diagnosis is made early in the disease and treatment is received before
the cancer spreads outside the ovary, the 5-year survival rate is about
94%.
Complications
• Spread of the cancer to other organs

• Loss of organ function
• Fluid in the abdomen (ascites)
• Blockage of the intestines
Call for an appointment with your health care provider if you are a woman over
40 years old who has not recently had a Pap smear and pelvic examination.
Routine Pap smears and pelvic examinations are recommended for all women
over 20 years old.
Call for an appointment with your provider if you have symptoms of ovarian
cancer.
Prevention
Having regular pelvic examinations may decrease the overall risk. Screening
tests for ovarian cancer remains a very active research area. To date, there is no
cost-effective screening test for ovarian cancer, so more than 50% of women with
ovarian cancer are diagnosed in the late stages of the disease.
Recent research has shown that surgery to remove the ovaries in women with
mutation in the BRCA1 and BRCA2 genes can dramatically reduce their risk of
developing ovarian cancer.
Skin Cancer
Definition
The skin is the largest organ of the body. The skin and its derivatives (hair, nails,
sweat and oil glands) make up the integumentary system. One of the main
functions of the skin is protection. It protects the body from external factors such
as bacteria, chemicals, and temperature.
Skin cancer is the uncontrolled growth of skin cells. If left unchecked, these
cancer cells can spread from the skin into other tissues and organs.
There are different types of skin cancer. Basal cell carcinoma is the most
common. Melanoma is less common, but more dangerous.
The outer layer of skin, the epidermis, is made up of different types of cells. Skin
cancers are classified by the types of epidermal cells involved:
• Basal cell carcinoma develops from abnormal growth of the cells in the
lowest layer of the epidermis and is the most common type of skin cancer.
• Squamous cell carcinoma involves changes in the squamous cells, found
in the middle layer of the epidermis.
• Melanoma occurs in the melanocytes (cells that produce pigment) and is
less common than squamous or basal cell carcinoma -- but more
dangerous. It is the leading cause of death from skin disease.
Melanoma is a malignant skin tumor that involves the skin cells that produce
pigment (melanin). The risk of melanoma increases with age, but frequently
affects young, otherwise healthy people. Melanoma is the number one cause of
cancer death in women aged 25 to 30.
Skin cancers are sometimes classified as either melanoma or nonmelanoma.

Basal cell carcinoma and squamous cell carcinoma are the most common
nonmelanoma skin cancers. Other nonmelanoma skin cancers are Kaposi's
sarcoma, Merkel cell carcinoma, and cutaneous lymphoma.
Skin cancer is the most common form of cancer in the Unites States. Known risk
factors for skin cancer include the following:
• Complexion - Skin cancers are more common in people with light-colored

skin, hair, and eyes.
• Genetics - Having a family history of melanoma increases the risk of
developing this cancer.
• Age - Nonmelanoma skin cancers are more common after age 40.
• Sun exposure and sunburn - Most skin cancers occur on areas of the skin
that are regularly exposed to sunlight or other ultraviolet radiation. This is
considered the primary cause of all skin cancers.
Skin cancer can develop in anyone, not only people with these risk factors.
Young, healthy people -- even those with with dark skin, hair, and eyes -- can
develop skin cancer.
Symptoms
Skin cancers may have many different appearances. They can be small, shiny, or
waxy, scaly and rough, firm and red, crusty or bleeding, or have other features.
Therefore, anything suspicious should be looked at by a physician. See the
individual articles on specific skin cancers for more information.
Here are some features to look for:
• Asymmetry: one half of the abnormal skin area is different than the other
half
• Borders: irregular borders
• Color: varies from one area to another with shades of tan, brown, or black
(sometimes white, red, blue)
• Diameter: usually (but not always) larger than 6 mm in size (diameter of a
pencil eraser)
Use a mirror or have someone help you look on your back, shoulders, and other
hard-to-see areas.
Treatment
Different types of skin cancer require different treatment approaches. See the
specific type of skin cancer for information:
• Basal cell carcinoma

• Squamous cell carcinoma
• Melanoma
.Expectations (prognosis)
The outlook depends on a number of factors, including the type of cancer and
how quickly it was diagnosed. See the specific skin cancer articles for additional
information.
Any suspicious mole, sore, or skin growth should be looked at by a physician

immediately. Take any changes in a mole or sudden growth of a skin lesion
seriously.
Prevention
Minimizing sun exposure is the best way to prevent skin damage, including many
types of skin cancer:
• Protect your skin from the sun when you can -- wear protective clothing
such as hats, long-sleeved shirts, long skirts, or pants.
• Try to avoid exposure during midday, when the sun is most intense.
• Use sunscreen with an SPF of at least 15. Apply sunscreen at least one-
half hour before sun exposure, and reapply frequently.
• Apply sunscreen during winter months as well.
Sentinel node biopsy is a technique which helps determine if a cancer has

spread (metastasized), or is contained locally. When a cancer has been
detected, often the next step is to find the lymph node closest to the tumor site
and retrieve it for analysis. The concept of the "sentinel" node, or the first node to
drain the area of the cancer, allows a more accurate staging of the cancer, and
leaves unaffected nodes behind to continue the important job of draining fluids.
The procedure involves the injection of a dye (sometimes mildly radioactive) to
pinpoint the lymph node which is closest to the cancer site. Sentinel node biopsy
is used to stage many kinds of cancer, including lung and skin (melanoma).
Testicular Cancer
Alternative names
Cancer - testes; Germ cell tumor; Seminoma
Definition
The male reproductive structures include the penis, the scrotum, the seminal
vesicles and the prostate.
Testicular cancer is an abnormal, rapid, and invasive growth of cancerous

(malignant) cells in the testicles (male sex glands adjacent to the penis).
Although the exact cause of testicular cancer is unknown, several factors seem
to increase risk. These include a past medical history of undescended testicle(s),
abnormal testicular development, Klinefelter's syndrome (a sex chromosome
disorder that may be characterized by low levels of male hormones, sterility,
development of breasts, and small testes), or previous testicular cancer.
Other factors are under investigation as possible causes. They include exposure
to certain chemicals and infection with the human immunodeficiency virus (HIV).
A family history of testicular cancer may increase risk. There is no link between
vasectomy (an operation to cause sterility) and elevated risk of testicular cancer.
Between 6,000 and 8,000 men will be diagnosed with testicular cancers each
year. Although testicular cancer accounts for 1% of all cancers in men, it is the
most common form of cancer in young men 15 to 40 years old. It may also occur
in young boys, but only about 3% of all testicular cancer is found in this group.
White American men have about five times the risk of African-American men and
more than twice the risk of Asian-American men. The risk for testicular cancer
has doubled among white Americans in the past 40 years but has remained the
same for African-Americans. The reasons for these differences are not known.
Testicular cancers may be classified as follows:
• Seminomas account for about 30-40% of all testicular tumors. These are
usually is found in men in their 30s and 40s. The condition is usually
localized to the testes, although in about 25% of cases it has spread to
lymph nodes.
• Non-seminomas account for 60% of all testicular tumors; subcategories of
these tumors are listed below. Non-seminoma tumors often contain more
than one of the following cell types:
o Embryonal carcinoma (about 20% of testicular cancers) occurs in
20-30 year olds and is highly malignant. It grows rapidly and
spreads to the lung and liver.
o Yolk sac tumor (about 60% of all testicular cancers in young boys).
o Teratomata (about 7% of testicular cancers in adult men and 40%
in young boys).
o Choriocarcinoma (rare).
Stromal cell tumors are a kind of tumor that is made of Leydig cells (testosterone-
secreting cells), Sertoli cells (cells where sperm matures), and granulose cells.
These tumors account for only 3-4% of all testicular tumors. However, they do
make up nearly 20% of all childhood testicular tumors. These tumors may
secrete a hormone -- estradiol -- that can cause one of the symptoms of
testicular cancer, gynecomastia (excessive development of breast tissue).
Symptoms
• Enlargement of a testicle or a change in the way it feels

• Lump or swelling in either testicle
• Dull ache in the back or lower abdomen
• Gynecomastia (excessive development of male breast tissue), this can
also occur normally in adolescent males, in whom it is not a symptom of
testicular cancer
• Testicular discomfort/pain or a feeling of heaviness in the scrotum
• Occasionally, the initial symptoms are related to the spread of the cancer
to other parts of the body, such as the lungs, abdomen, pelvis, or brain
Note: There may be no symptoms.
Signs and tests

A physical examination typically reveals a firm, non-tender testicular mass that
does not "trans-illuminate" (light from a flashlight held to the scrotum does not
pass through the mass).
Other tests include:
• Scrotal ultrasound is used to confirm solid mass.

• Blood tests for tumor markers: alpha-fetoprotein (AFP), human chorionic
gonadotrophin (beta HCG), and lactic dehydrogenase (LDH).
Approximately 85% of non-seminomas will have elevations of either AFP
or beta HCG. Seminomas will have elevations only in beta HCG or LDH.
These tests can also be used to monitor the response to treatment.
• A chest X-ray is done to look for potential metastasis (spreading of cancer)
to the lungs.
• An abdominal CT scan may be done to look for potential metastasis.
Tissue biopsy is usually by surgical removal of the testicle. After the testicle is
removed, the tissue is examined.
Treatment
Treatment depends on the type of tumor, the stage of the tumor, and the extent of
the disease. Most patients can be cured.
Once cancer is found, the first step is to determine the type of cancer cell. This
determination is done by a microscopic exam. The cells can be seminoma or
non-seminoma. If both types of seminoma and non-seminoma cells are found in
a single tumor, the tumor is treated as a non-seminoma.
The next step is to determine how far it has spread to other parts of the body.
This is called "staging."
• In Stage I, the cancer has not spread beyond the testicle.

• In Stage II, the cancer has spread to lymph nodes in the abdomen.
• In Stage III, the cancer has spread beyond the lymph nodes; it could be as
far as the liver or lungs.
There are three types of treatment that can be used.
1. Surgical treatment includes removing the testicle (orchiectomy) and

removal of associated lymph nodes (lymphadenectomy). This is usually
performed in the case of both seminoma and non-seminoma testicular
cancers
2. Radiation therapy using high-dose X-rays or other high-energy rays may
be used after surgery for patients with seminomas to prevent the tumor
from returning. The use of radiation therapy is usually limited to the
treatment of seminomas.
3. Chemotherapy -- using drugs such as cisplatin, bleomycin, and etoposide
to kill cancer cells -- has greatly enhanced the survival rate of both
seminomas and non-seminomatous testicular tumors.
The cure rate for Stage I seminoma tumor is over 95%. The treatment is usually
surgery to remove the testis and radiation to the lymph nodes in the abdomen.
Stage II seminoma tumors are divided into bulky and non-bulky disease. Bulky
disease is generally defined as tumors greater than 5 centimeters.
The treatment of Stage II seminomas includes surgery to remove the testis

followed by either radiation to the lymph nodes in the case of non-bulky disease
or chemotherapy with cisplatin for patients with bulky disease. The cure rate is
between 85-95%.
Stage III seminoma tumors have a 90% cure rate. The treatment is surgery to
remove the testis and multi-drug chemotherapy.
The cure rate for a Stage I nonseminoma tumor is over 95%. The treatment is
removal of the testis and, possibly, removal of lymph nodes in the abdomen.
Stage II nonseminoma tumors have a cure rate of over 95%. The treatment is
usually surgery to remove the testis and lymph nodes in the abdomen, possibly
followed by chemotherapy.
Stage III nonseminoma has a 70% cure rate. The treatment will probably be
chemotherapy and surgical removal of the testis.
If the cancer is a recurrence of a previous testicular cancer, the treatment usually

consists of chemotherapy using combinations of different medications, such as
ifosfamide, cisplatin, etoposide, or vinblastine, sometimes followed by an
autologous bone marrow or peripheral stem-cell transplant.
The survival rate for men with early stage seminoma (the least aggressive type of
testicular cancer) is greater than 95%. The disease-free survival rate for Stage I
non-seminomatous cancer is nearly 95%; for Stage II seminomas it is 70-90%,
depending on the size of the tumor when treatment is begun; for Stage II non-
seminomas it is greater than 95%; and for Stage III for both is usually about 70%
curable.
This response to treatment means that testicular cancer is one of the most
treatable cancers.
Complications
Metastasis (spreading) to other parts of the body may occur with testicular
cancer. The most common sites include the retroperitoneal area, the abdomen,
the spine, and the lungs.
If both testicles are removed, the man becomes infertile (unable to have children)
because no sperm cells will be produced. If surgery is done to remove lymph
nodes, there can be damage to nerves that control ejaculation. This can also
cause infertility as well as impotence. There is a newer type of surgery that has a
better chance of preserving the nerves that maintain erection while still removing
the lymph nodes.
Since testicular cancer affects men at the ages they may want to father children,
nerve-sparing surgery and sperm banking (to save sperm and freeze it for use in
artificial insemination) before any treatment should be discussed with the doctor.
Call your health care provider if symptoms of testicular cancer occur.
Also call if you are a male over 15 years old who has not been taught testicular
self-examination (TSE), or who has not had testicular screenings performed by
your health care provider during routine physical examinations.
Prevention
There is no prevention for testicular cancer, but finding it early is important to

successful treatment and survival. Young men should learn to perform testicular
self-examination (TSE) shortly after puberty. A TSE performed on a monthly basis
may play a major role in detecting tumors at earlier stages -- before they spread.
Thyroid Cancer
Alternative names
Tumor - thyroid; Cancer - thyroid
Definition
Endocrine glands release hormones (chemical messengers) into the

bloodstream to be transported to various organs and tissues throughout the
body. For instance, the pancreas secretes insulin, which allows the body to
regulate levels of sugar in the blood. The thyroid gets instructions from the
pituitary to secrete hormones which determine the pace of chemical activity in the
body (the more hormone in the bloodstream, the faster the chemical activity; the
less hormone, the slower the activity).
The pituitary secretes thyroid stimulating hormone (TSH), which stimulates the
thyroid gland to secrete hormones that affect body metabolism.
Thyroid cancer is a malignancy (cancerous growth) of the thyroid gland.
Thyroid cancer can occur in all age groups. People who have had radiation
therapy to the neck are at higher risk. This therapy was commonly used in the
1950s to treat enlarged thymus glands, adenoids and tonsils, and skin disorders.
People who received radiation therapy as children have a higher incidence of
thyroid cancer.
Other risk factors are a family history of thyroid cancer and chronic goiter. The
disease affects 1 in 1,000 people.
There are several types of thyroid cancer:
• Papillary carcinoma is the most common and usually affects women of

child-bearing age. It metastasizes (spreads from the original site) slowly
and is the least malignant type of thyroid cancer.
• Follicular carcinoma accounts for about 30% of all cases and has a
greater rate of recurrence and metastasis.
• Medullary carcinoma is a cancer of non-thyroid cells in the thyroid gland
and tends to occur in families. It requires different treatment from other
types of thyroid cancer.
• Anaplastic carcinoma (also called giant and spindle cell cancer) is the
most malignant form of thyroid cancer. It is rare, but does not respond to
radioiodine therapy. Anaplastic carcinoma metastasizes quickly and
invades nearby structures such as the trachea, causing compression and
breathing difficulties.
Symptoms
• Enlargement of the thyroid gland

• Neck swelling
• A thyroid nodule
• Hoarseness or changing voice
• Cough or cough with bleeding
• Difficulty swallowing
Note: Symptoms may vary depending on the type of thyroid cancer

Signs and tests
A physical examination can reveal a thyroid mass or nodule (usually in the lower
part of the front of the neck), or enlarged lymph nodes in the neck.
Tests that indicate thyroid cancer:
• Thyroid biopsy showing anaplastic, follicular, medullary or papillary cancer

cells
• Ultrasound of the thyroid showing a nodule
• Thyroid scan showing cold nodule (a nodule that does not light up on
scan)
• Laryngoscopy showing paralyzed vocal cords
• Elevated serum calcitonin (for medullary cancer) or serum thyroglobulin
(for papillary or follicular cancer)
This disease may also alter the results of the following tests:
• T4
Thyroxine test
Definition
A T4 test measures the amount of the T4 hormone in the blood. T4 is produced

by the thyroid gland.
How the test is performed
Blood is drawn from a vein on the inside of the elbow or the back of the hand.
The puncture site is cleaned with antiseptic, and an elastic band is placed around
the upper arm to apply pressure and restrict blood flow through the vein. This
causes veins below the band to swell with blood.
A needle is inserted into the vein, and the blood is collected in an air-tight vial or
a syringe. During the procedure, the band is removed to restore circulation. Once
the blood has been collected, the needle is removed, and the puncture site is
covered to stop any bleeding.
For an infant or young child, the area is cleansed with antiseptic and punctured
with a sharp needle or a lancet. The blood may be collected in a pipette (small
glass tube), on a slide, onto a test strip, or into a small container. Cotton or a
bandage may be applied to the puncture site if there is any continued bleeding.
How to prepare for the test

The health care provider may advise you to stop taking drugs that may affect the
test (see "special considerations").
For infants and children:
The preparation you can provide for this test depends on your child's age and
experience. For specific information regarding how you can prepare your child,
see the following topics:
• infant test or procedure preparation (birth to 1 year)

• toddler test or procedure preparation (1 to 3 years)
• preschooler test or procedure preparation (3 to 6 years)
• schoolage test or procedure preparation (6 to 12 years)
• adolescent test or procedure preparation (12 to 18 years)
How the test will feel
When the needle is inserted to draw blood, some people feel moderate pain,
while others feel only a prick or stinging sensation. Afterward, there may be some
throbbing.
Why the test is performed
This test may be performed as part of an evaluation of thyroid function. Thyroid

function is complex and depends on the action of many different hormones:
1. Thyroid-stimulating hormone (TSH) is a secreted by the pituitary gland.

2. TSH causes the thyroid gland to produce two more hormones, T4
(thyroxine) and T3 (triiodothyronine).
3. Finally, TSH itself is stimulated by another hormone, thyroid-releasing
hormone (TRH), which is made by the hypothalamus.
In people with normal thyroid function, having enough T3 and T4 inhibits both
TSH and TRH, which prevents the body from making too much T3 and T4.
T4 levels are important, because T4 increases numerous enzymes that produce

energy for the body.
Most T3 and T4 is transported by a protein called TBG (thyroxine binding

globulin), but smaller amounts are found on prealbumin and albumin. When not
bound to proteins, they are called "free" T3 or T4.
Normal Values
Normal values vary among different laboratories. A typical normal range is: 4.5 to
11.2 mcg/dL (micrograms per deciliter).
What abnormal results mean
Greater-than-normal levels of T4 along with low levels of TSH may indicate

hyperthyroid conditions, such as:
• Graves' disease
• Toxic multinodular goiter
• Subacute or chronic thyroiditis
• Early Hashimoto's disease
• Iodine-induced hyperthyroidism
• Germ cell tumors
• Trophoblastic disease
Lower-than-normal levels of T4 may indicate:
• Hypothyroidism (including Hashimoto's disease, cretinism, myxedema,

goitrous diseases, scleroderma, amyloid goiter, or hemochromatosis
following neck irradiation for head and neck cancer)
• Malnutrition or fasting
• Illness throughout the body
• Use of certain prescribed medication, including dexamethasone,
propranolol, lithium, iodine, methimazole, propylthiouracil, interferon alfa,
interleukin-2, and amiodarone
Additional conditions under which the test may be performed:
• Hypopituitarism
• Hypothyroidism - primary
• Hypothyroidism - secondary
• Thyrotoxic periodic paralysis
What the risks are
Risks associated with having blood drawn are slight:
• excessive bleeding
• fainting or feeling lightheaded
• hematoma (blood accumulating under the skin)
• infection (a slight risk any time the skin is broken)
• multiple punctures to locate veins
Special considerations
Drugs that can increase T4 measurements include clofibrate, estrogens,

methadone, amiodarone, and birth control pills.
Drugs that can decrease T4 measurements include anabolic steroids,
androgens, antithyroid drugs (for example, propylthiouracil and methimazole),
lithium, phenytoin, propranolol, amiodarone, interferon alpha, and interleukin-2.
Veins and arteries vary in size from one patient to another and from one side of
the body to the other. Obtaining a blood sample from some people may be more
difficult than from others.
• T3
Triiodothyronine; T3 radioimmunoassay
Definition Return to top
The T3 test measures the amount of T3 hormone in the blood.
Blood is drawn from a vein on the inside of the elbow or the back of the hand.
The puncture site is cleaned with antiseptic, and an elastic band is placed around
the upper arm to apply pressure and restrict blood flow through the vein. This
causes veins below the band to swell with blood.
A needle is inserted into the vein, and the blood is collected in an air-tight vial or
a syringe. During the procedure, the band is removed to restore circulation. Once
the blood has been collected, the needle is removed, and the puncture site is
covered to stop any bleeding.
For an infant or young child, the area is cleansed with antiseptic and punctured
with a sharp needle or a lancet. The blood may be collected in a pipette (small
glass tube), on a slide, onto a test strip, or into a small container. Cotton or a
bandage may be applied to the puncture site if there is any continued bleeding.
The health care provider may advise you to stop taking drugs that may affect the
test (see "special considerations").
For infants and children:
The preparation you can provide for this test depends on your child's age and
experience. For specific information regarding how you can prepare your child,
see the following topics:
• infant test or procedure preparation (birth to 1 year)

• toddler test or procedure preparation (1 to 3 years)
• preschooler test or procedure preparation (3 to 6 years)
• schoolage test or procedure preparation (6 to 12 years)
• adolescent test or procedure preparation (12 to 18 years)
throbbing.
T3 is measured as part of a thyroid function evaluation. Most of the thyroid

hormone made in the thyroid is in the form of T4. The body's cells convert the T4
to T3, which is the more active hormone.
Sometimes it can be useful to measure both T4 and T3 when looking at thyroid

function. For example, in some cases of hyperthyroidism, T4 may be normal but
T3 will be elevated.
Most of the T4 and T3 in the body is attached to proteins in the blood. These
proteins serve as carriers. The T3 test measures both the T3 that is bound to the
proteins and the T3 that is "free" floating in the blood. The free fraction is the
hormone that is active.
Conditions that increase the levels of the carrier proteins -- such as pregnancy
and liver disease -- will falsely raise the T3 level. In these cases, it is useful to
measure either the free T3 level or to perform the RT3U test, which gives a
measure of the amount of carrier protein.
T4 and T3 are important hormones in the regulation of metabolism. The exact

mechanisms are not understood, but it is known that T4 increases the
concentrations of numerous enzymes involved in the production of energy in the
body.
Normal Values
100 to 200 ng/dL (nanograms per deciliter)
What abnormal results mean Return to top
Greater-than-normal levels may indicate:
• hyperthyroidism (for example, Graves' disease)

• T3 thyrotoxicosis (rare)
• thyroid cancer (rare)
Lower-than-normal levels may indicate:
• chronic illness
• hypothyroidism (for example, Hashimoto's disease)
• starvation
Additional conditions under which the test may be performed:
• painless (silent) thyroiditis

• thyrotoxic periodic paralysis
• toxic nodular goiter
What the risks are
The only risks of the test is those minor risks associated with having blood
drawn.
Drugs that can increase T3 measurements include clofibrate, estrogens,

methadone, and oral contraceptives.
Drugs that can decrease T3 measurements include anabolic steroids,

androgens, antithyroid drugs (for example, propylthiouracil), lithium, phenytoin,
and propranolol.
• TSH
TSH is a test that measures the amount of the hormone TSH in the blood.
Adult or child:
Blood is drawn from a vein, usually from the inside of the elbow or the back of the
hand. The puncture site is cleaned with antiseptic, and a tourniquet is placed
around the upper arm to apply pressure and restrict blood flow through the vein.
This causes veins below the tourniquet to fill with blood. A needle is inserted into
the vein, and the blood is collected in an air-tight vial or a syringe. The tourniquet
is then removed to restore circulation. After blood has been collected the needle
is removed, and the puncture site is covered to stop any bleeding.
Infant or young child:
The area is cleansed with antiseptic and punctured with a sharp needle or a
lancet. The blood may be collected in a pipette (small glass tube), on a slide,
onto a test strip, or into a small container. A bandage may be applied to the
puncture site if there is any bleeding.
No special preparation is usually necessary.
throbbing.
TSH is measured as a screening test for abnormal thyroid function (either

hyperthyrodism or hypothyrodism). It is also measured to monitor treatment of
these conditions. The test is also done in infertile females, to check if thyroid
disease is the cause of infertility.
TRH, a hormone produced in the hypothalamus, stimulates the pituitary gland to

release TSH. TSH subsequently stimulates the thyroid to produce thyroid
hormones, T3 and T4. These hormones feedback to the hypothalamus and
pituitary to regulate the release of both TSH and TRH.
In certain diseases, this regulation pathway is altered, leading to under- or over-

production of thyroid hormone. When a thyroid disorder is suspected clinically, a
TSH level is obtained as an initial test.
Normal Values
Normal values are from 0.4 to 4.0 mIU/L for those with no symptoms of an under-
or over-active thyroid.
If you are being treated for a thyroid disorder, your TSH should be between 0.5
and 2.0 mIU/L. This means that you are being treated appropriately.
Some people with a TSH value over 2.0 mIU/L, who have no signs or symptoms
suggestive of an under-active thyroid, may develop hypothyroidism sometime in
the future. Anyone with a TSH above 2.0 mIU/L, therefore, should be followed
very closely by a doctor.
Normal value ranges may vary slightly among different laboratories.
What abnormal results mean

Greater-than-normal levels may indicate:
• Congenital hypothyroidism (cretinism)

• Primary hypothyroidism
• TSH-dependent hyperthyroidism
• Thyroid hormone resistance
• Exposure to mice (lab workers or veterinarians)
Lower-than-normal levels may indicate:
• Hyperthyroidism
• TSH deficiency
• Medications (dopamine agonists, glucocorticoids, somatostatin analogues,
bexarotene)
What the risks are
• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)
• Multiple punctures to locate veins
Drugs that can affect TSH measurements include: antithyroid medications,

lithium, potassium iodide, amiodarone, dopamine and prednisone.
Veins and arteries vary in size from one patient to another and from one side of
the body to the other. Obtaining a blood sample from some people may be more
difficult than from others.
Treatment
Treatment varies depending on the type of tumor.
Surgery is usually the treatment of choice, and the entire thyroid gland is usually
removed. If the physician suspects that the cancer has spread to lymph nodes in
the neck, these will also be removed during surgery.
Radiation therapy with radioactive iodine is often used with or without surgery.
Radiation therapy with beam radiation can also be used.
After treatment, patients need to take thyroid hormone to replace what their
glands used to make. The dose is usually a little higher than what the body
needs, which helps keep the cancer from coming back.
If the cancer does not respond to surgery or radiation and has spread to other
parts of the body, chemotherapy may be used, but this is only effective for a third
of the patients.
Anaplastic carcinoma has the worst prognosis (probable outcome) of all the
types of thyroid cancer, and has an expected life span of less than 6 months after
diagnosis. Follicular carcinomas are often fast growing and may invade other
tissues, but the probable outcome is still good -- over 90% of patients are cured.
The outcome with medullary carcinoma varies. Women under 40 years old have
a better chance of a good outcome. The cure rate is 40-50%.
Papillary carcinomas are usually slower growing. Most people are cured (over
95%) and have a normal life expectancy.
Complications
• Low calcium levels from inadvertent removal of the parathyroid glands

during surgery
• Injury to the voice box or nerve and hoarseness after surgery
• Spread of the cancer to the lung or other parts of the body
Prevention
There is no known prevention. Awareness of risk (such as previous radiation

therapy) can allow earlier diagnosis and treatment.

Different Kinds of Cancer

Загружено:

Сведения о документе

Исходное описание:

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Different Kinds of Cancer

Загружено:

Авторское право:

Доступные форматы

Brain Cancer

Glioblastoma multiforme - adults; Ependymoma - adults; Glioma - adults;

What is metastatic brain cancer?

Causes, incidence, and risk factors

Some inherited conditions increase the risk of brain tumors, including

SPECIFIC TUMOR TYPES

Gliomas are thought to be derived from glial cells such as astrocytes,

• Astrocytic tumors include astrocytomas (less malignant), anaplastic

Meningiomas are another type of brain tumor. These tumors:

• Occur most commonly between the ages of 40-70

Symptoms may include:

• Headache -- a persistent headache that is new for the person, worse on

Additional symptoms that may be associated with primary brain tumors:

Signs and tests

• CT scan of the head

Treatment can involve surgery, radiation therapy, and chemotherapy. Brain

Early treatment often improves the chance of a good outcome. Treatment,

Tumors can be difficult to remove completely by surgery alone, because the

Radiation therapy and chemotherapy may be used for certain tumors.

• Corticosteroids such as dexamethasone to reduce brain swelling

Comfort measures, safety measures, physical therapy, occupational therapy and

Legal advice may be helpful in creating advanced directives such as a power of

• Brain herniation (often fatal)

Surgical side effects include an increase in current symptoms, damage to normal

What is the prognosis (outcome) of treated brain cancer?

Cancer - breast; Carcinoma - ductal; Carcinoma - lobular

Breast cancer is a cancer that starts in the tissues of the breast.

There are two main types of breast cancer:

Causes, incidence, and risk factors

Risk factors you cannot change include:

Other risk factors include:

DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may

Radiation -- If you received radiation therapy as a child or young adult to treat

Symptoms of advanced breast cancer may include:

Signs and tests

• Mammography to help identify the breast lump

In general, cancer treatments may include:

• Chemotherapy medicines to kill cancer cells

• Hormonal therapy to block certain hormones that fuel cancer growth

Targeted therapy, also called biologic therapy, is a newer type of cancer

Cancer treatment may be local or systemic.

Stage 0 -- Lumpectomy plus radiation or mastectomy is the standard treatment.

Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of

Stage III -- Treatment involves surgery possibly followed by chemotherapy,

Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal

• 100% for stage 0

Calling your health care provider

Contact your health care provider for an appointment if:

• You have a breast or armpit lump

Early detection involves:

Mammography is the most effective way of detecting breast cancer early.

• The American Cancer Society recommends mammogram screening every

Questions have been raised about the benefit of screening mammography in

A needle biopsy is performed under local anesthesia. Simple aspirations are

In many cases of breast cancer, removal of the entire breast is unnecessary. A

In some cases, the cancer is too large to be removed by lumpectomy. In these

Chemotherapy is often administered after surgery for patients with cancer

Early detection of a breast lump is very important to a patient's prognosis

In some cases, a needle aspiration of a breast lump can be performed. If the

The incision for a lumpectomy is usually around 3 to 4 centimeters long. The

Other types of colon cancer such as lymphoma, carcinoid tumors, melanoma,

Causes, incidence, and risk factor