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FAQ ON CANCER

Q: What Is Cancer?

A: Cancer is the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are termed cancer cells, malignant cells, or tumor cells. Many cancers and the abnormal cells that compose the cancer tissue are further identified by the name of the tissue that the abnormal cells originated from (for example, breast cancer, lung cancer, colon cancer). Cancer is not confined to humans; animals and other living organisms can get cancer. Below is a schematic that shows normal cell division and how when a cell is damaged or altered without repair to its system, the cell usually dies. Also shown is what occurs when such damaged or unrepaired cells do not die and become cancer cells and show uncontrolled division and growth – a mass of cancer cells develop. Frequently, cancer cells can break away from this original mass of cells, travel through the blood and lymph systems, and lodge in other organs where they can again repeat the uncontrolled growth cycle. This process of cancer cells leaving an area and growing in another body area is termed metastatic spread or metastasis. For example, if breast cancer cells spread to a bone, it means that the individual has metastatic breast cancer to bone. This is not the same as “bone cancer,” which would mean the cancer had started in the bone.

There are over 200 types of cancers; most can fit into the following categories according to the research:

  • Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs.
  • Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
  • Leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.
  • Lymphoma and myeloma: Cancers that begin in the cells of the immune system.
  • Central nervous system cancers: Cancers that begin in the tissues of the brain and spinal cord.
Q: What Are The Causes And Risk Factors For Cancer?

A: Most people don’t realize that cancer is preventable in many cases. Learning what causes cancer and what the risk factors are is the first step in cancer prevention. Many cancer risk factors can be avoided, thus reducing the likelihood of developing cancer.

Tobacco

According to the National Cancer Institute, smoking causes 30% of all cancer deaths in the U.S. and is responsible for 87% of cases of lung cancer. Not only does it affect the lungs, it can cause kidney, pancreatic, cervical, and stomach cancers and acute myeloid leukemia. Quitting smoking immediately decreases your risk factor for cancer.

Physical Activity

Exercising at least 30 minutes a day, 5 days a week greatly reduces your cancer risk. Exercise like yoga, aerobics, walking and running are great activities to lower your cancer risk factor. Not only is physical activity important to preventing other diseases, it reduces the chances of becoming obese. Obesity is a major cause for many cancers. Exercising on a regular basis can prevent prostate, colon, breast, endometrial and lung cancer.

Genetics

Genetics can play a big role in cancer development. If you have a family history of cancer, such as breast cancer, taking extra precautions is vital. When cancer is genetic, a mutated gene has been passed down. Genetic tests are available for many hereditary cancers. Keep in mind that if you have a family history of cancer, it does not mean you will develop it. You only have a greater chance of developing it.

Sun Exposure

Skin cancer is caused by exposure to the UV rays of the sun. A sunburn, or a tan is actually the result of cell damage caused by the sun. Skin cancer can be prevented in most cases. Wearing sunscreen when outdoors and staying out of the sun between the hours of 10 a.m. and 2 p.m., when the sun’s rays are strongest is your best defense.

Environmental Factors

The environment you are in can cause cancer.

Exposure to asbestos, a group of minerals found in housing and industrial building materials can cause a variety of medical problems, such as mesothelioma. Studies have shown that people who are exposed to high amount of benzene are at risk for cancer. Benzene is a chemical found in gasoline, smoking, and pollution.

Unsafe Sex

Practicing unsafe sex can increase your risk of developing a virus called HPV. HPV is a group of over 100 viruses, medically known as human papillioma virus. HPV increases your risk factor for cervical, anal, vulvar and vaginal cancer. Further studies are being conducted in HPV’s role in the development of other cancers.

There is a test available to see if you have contracted HPV. It involves scraping of cervical cells and then the sample is sent to a lab. The lab test can even identify the strain of the virus, also.

Q: What Is The Difference Between A Malignant And A Benign Tumour?

A: Tumours can be benign (not a cancer) or malignant (a cancer). Benign tumours do not invade other tissues or spread to other parts of the body, although they can expand to interfere with other organs. The main features of a malignant tumour (cancer) are its ability to grow in an uncontrolled way and to invade and spread to other parts of the body.

The original site in which a cancerous tumour is formed is referred to as the primary site. The spread of cancerous cells from the primary site to another (i.e. secondary) site is referred to as metastasis.

Q: What Are Cancer Symptoms And Signs?

A: Symptoms and signs of cancer depend on the type of cancer, where it is located, and/or where the cancer cells have spread. For example, breast cancer may present as a lump in the breast or as nipple discharge while metastatic breast cancer may present with symptoms of pain (if spread to bones), extreme fatigue (lungs), or seizures (brain). A few patients show no signs or symptoms until the cancer is far advanced.

The American Cancer Society describes seven warning signs that a cancer may be present, and which should prompt a person to seek medical attention. The word CAUTION can help you remember these.

  • Change in bowel or bladder habits.
  • A sore throat that does not heal.
  • Unusual bleeding or discharge.
  • Thickening or lump in the breast, testicles or elsewhere.
  • Indigestion or difficulty swallowing.
  • Obvious change in the size, color, shape, or thickness of a wart or mole.
  • Nagging cough or hoarseness.

Other signs or symptoms may also alert you or your doctor to the possibility of your having some form of cancer. These include:

  • Unexplained loss of weight or loss of appetite.
  • A new type of pain in the bones or other parts of the body which may be steadily worsening, or come and go, but is unlike previous pains you may have had before.
  • Persistent fatigue, nausea or vomiting.
  • Unexplained low-grade fevers with may be either persistent or come and go.
  • Recurring infections which will not clear with usual treatment.

Anyone with these signs and symptoms should consult their doctor.

Many cancers will present with some of the above general symptoms but often have one or more symptoms that are more specific for the cancer type. For example, lung cancer may present with common symptoms of pain, but usually the pain is located in the chest. The patient may have unusual bleeding, but the bleeding usually occurs when the patient coughs. Lung cancer patients often become short of breath, and then become very fatigued.

Because there are so many cancer types (see next section) with so many nonspecific and sometimes more specific symptoms, the best way to learn about signs and symptoms of specific cancer types is to spend a few moments researching symptoms of a specific body area in question. Conversely, a specific body area can be searched to discover what signs and symptoms a person should look for in that area that is suspected of having cancer.

Q: What Are The Types Of Cancer?

A: Cancer has the potential to affect every organ in the body. The cells within malignant tumors have the ability to invade neighboring tissues and organs, thus spreading the disease. It is also possible for cancerous cells to break free from the tumor and enter the bloodstream, in turn spreading the disease to other organs. This process of spreading is called metastasis.

When cancer has metastasized and has affected other areas of the body, the disease is still referred to the organ of origination. For instance, if cervical cancer spreads to the lungs, it is still called cervical cancer, not lung cancer.

Blood Cancer: The cells in the bone marrow that give rise to red blood cells, white blood cells, and platelets can sometimes become cancerous. These cancers are leukemia or lymphoma.

  • Leukemia
  • Lymphoma
  • Multiple Myeloma
  • Waldenstrom’s Macroglobulinemia
  • Anal Cancer
  • Bile Duct Cancer, Extrahepatic
  • Carcinoid Tumor, Gastrointestinal
  • Colon Cancer
  • Esophageal Cancer
  • Gallbladder Cancer
  • Liver Cancer, Adult Primary
  • Liver Cancer, Childhood
  • Pancreatic Cancer
  • Rectal Cancer
  • Small Intestine Cancer
  • Stomach (Gastric) Cancer

Bone Cancer: Bone cancer is a relatively rare type of cancer that can affect both children and adults, but primarily affects children and teens. There are several types of bone cancer, but the most common types are:

  • Ewing’s Sarcoma
  • Osteosarcoma

Digestive/Gastrointestinal Cancers This is a broad category of cancer that affects everything from the esophagus to the anus. Each type is specific and has its own symptoms, causes, and treatments.

Genitourinary Cancers:These types of cancer affect the male genitalia and urinary tract.

  • Bladder Cancer
  • Kidney (Renal Cell) Cancer
  • Penile Cancer
  • Prostate Cancer
  • Renal Pelvis and Ureter Cancer, Transitional Cell
  • Testicular Cancer
  • Urethral Cancer
  • Wilms’ Tumor and Other Childhood Kidney Tumors

Respiratory Cancers:Cigarette smoking is the primary cause for cancer affecting the respiratory system. Exposure to asbestos is also a factor.

  • Lung Cancer, Non-Small Cell
  • Lung Cancer, Small Cell
  • Malignant Mesothelioma
  • Thymoma and Thymic Carcinoma

Skin Cancers:Non-melanoma skin cancer is the most common type of cancer among men and women. Exposure to the UV rays of the sun is the primary cause for non-melanoma skin cancer and also melanoma.

  • Cutaneous T-Cell Lymphoma
  • Kaposi’s Sarcoma
  • Melanoma
  • Merkel Cell Carcinoma
  • Non-Melanoma Skin Cancer
  • Brain Cancer: Brain tumors can be malignant (cancerous) or benign (non-cancerous). They affect both children and adults. Malignant brain tumors don’t often spread beyond the brain. However, other types of cancer have the ability to spread to the brain. Types of brain cancer include:

    • Adult Brain Tumor
    • Brain Stem Glioma, Childhood
    • Cerebellar Astrocytoma, Childhood
    • Cerebral Astrocytoma/Malignant Glioma, Childhood
    • Ependymoma, Childhood
    • Medulloblastoma, Childhood
    • Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma, Childhood
    • Visual Pathway and Hypothalamic Glioma, Childhood

    Breast Cancer:Breast cancer is a common type of cancer that affects women and much less commonly, men. Types of breast cancer include, but are not limited to:

    • ductal carcinoma in situ
    • lobular carcinoma in situ
    • inflammatory breast cancer
    • Paget’s disease of the nipple
    • Invasive types of breast cancer

    Endocrine Cancers:The endocrine system is an instrumental part of the body that is responsible for glandular and hormonal activity. Thyroid cancer is the most common of the endocrine cancer types and generally, the least fatal.

    • Adrenocortical Carcinoma
    • Carcinoid Tumor, Gastrointestinal
    • Islet Cell Carcinoma (Endocrine Pancreas)
    • Parathyroid Cancer
    • Pheochromocytoma
    • Pituitary Tumor
    • Thyroid Cancer

    Eye Cancer:Like other organs in the human body, the eyes are vulnerable to cancer as well. Eye cancer can affect both children and adults.

    • Melanoma, Intraocular
    • Retinoblastoma

    Gynecologic Cancers:This group of cancer types affect the organs of the female reproductive system. Specialized oncologists called gynecologic oncologists are recommended for treating gynecologic cancer.

    • Cervical Cancer
    • Endometrial Cancer
    • Gestational Trophoblastic Tumor
    • Ovarian Cancer
    • Uterine Sarcoma
    • Vaginal Cancer
    • Vulvar Cancer

    Head and Neck Cancer:Most head and neck cancers affect moist mucosal surfaces of the head and neck, like the mouth, throat, and nose. Causes of head and neck cancer vary, but cigarette smoking plays a role. Current research suggests a strong HPV link in the development of some head and neck cancer.

    • Hypopharyngeal Cancer
    • Laryngeal Cancer
    • Lip and Oral Cancer
    • Metastatic Squamous Neck Cancer
    • Nasopharyngeal Cancer
    • Oropharyngeal Cancer
    • Paranasal Sinus and Nasal Cavity Cancer
    • Parathyroid Cancer
    • Salivary Gland Cancer
Q: How Is Cancer Diagnosed?

A: A physical exam and medical history, especially the history of symptoms, are the first steps in diagnosing cancer. In many instances, the medical caregiver will order a number of tests, most of which will be determined by the type of cancer and where it is suspected to be located in or on the person’s body. In addition, most caregivers will order a complete blood count, electrolyte levels and, in some cases, other blood studies that may give additional information (for example, a PSA or prostate specific antigen test may guide the caregiver to do additional tests, such as a prostate biopsy).

Imaging studies are commonly used to help physicians detect abnormalities in the body that may be cancer. X-rays, CT and MRI scans, and ultrasound are common tools used to examine the body. Other tests such as endoscopy, which with variations in the equipment used, can allow visualization of tissues in the intestinal tract, throat, and bronchi that may be cancerous. In areas that cannot be well visualized (inside bones or some lymph nodes, for example), radionuclide scanning is often used. The test involves ingestion or IV injection of a weakly radioactive substance that can be concentrated and detected in abnormal tissue.

The biopsy can provide more than the definitive diagnosis of cancer; it can identify the cancer type and thereby help to stage the cancer. The stage, or cancer staging is a way for clinicians and researchers to estimate how extensive the cancer is in the patient’s body.

The preceding tests can be very good at localizing abnormalities in the body; many clinicians consider that some of the tests provide presumptive evidence for the diagnosis of cancer. However, in virtually all patients, the definitive diagnosis of cancer is based on the examination of a tissue sample taken in a procedure called a biopsy from the tissue that may be cancerous, and then analyzed by a doctor called a pathologist. Some biopsy samples are relatively simple to procure (for example, skin biopsy or intestinal tissue biopsy done with a device called an endoscope equipped with a biopsy attachment). Other biopsies may require as little as a carefully guided needle, or as much as a surgery (for example, brain tissue or lymph node biopsy). In some instances, the surgery to diagnose the cancer may result in a cure if all of the cancerous tissue is removed at the time of biopsy.

Q: Is The Cancer That Had Been Found Localized To Its Site Of Origin, Or Is It Spread From That Site To Other Tissues?

A: localized cancer is said to be at an early stage, while one which has spread is at advanced stage. The following section describes the general staging methods for cancers.

Q: How Is Cancer Staging Determined?

There are a number of different staging methods used for cancers and the specific staging criteria varies among cancer types. According to the latest research, the common elements considered in most staging systems are as follows:

  • Site of the primary tumor
  • Tumor size and number of tumors
  • Lymph node involvement (spread of cancer into lymph nodes)
  • Cell type and tumor grade* (how closely the cancer cells resemble normal tissue cells)
  • The presence or absence of metastasis

However, there are two main methods that form the basis for the more specific or individual cancer type staging. The TMN staging is used for most solid tumors while the Roman numeral or stage grouping method is used by some clinicians and researchers on almost all cancer types.

The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent of cancer spread (higher number means bigger tumor or more spread).

The following is how the TNM staging system works:

  • Primary tumor (T)
    • TX – Primary tumor cannot be evaluated
    • T0 – No evidence of primary tumor
    • Tis – Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called pre-invasive cancer)
    • T1, T2, T3, T4 – Size and/or extent of the primary tumor
  • Regional lymph nodes (N)
    • NX – Regional lymph nodes cannot be evaluated
    • N0 – No regional lymph node involvement
    • N1, N2, N3 – Involvement of regional lymph nodes (number of lymph nodes and/or extent of spread)
  • Distant metastasis (M)
    • MX – Distant metastasis cannot be evaluated
    • M0 – No distant metastasis
    • M1 – Distant metastasis is present

Consequently, a person’s cancer could be listed as T1N2M0, meaning it is a small tumor (T1), but has spread to some regional lymph nodes (N2), and has no detected metastasis (M0).

Q: What Are Treatments Available To Cure Cancer?

A: A doctor who specialized in the treatment of cancer is called an oncologist. He or she may be a surgeon, a specialist in radiation therapy, or a medical oncologist. The first uses surgery to treat the cancer; the second, radiation therapy; the third, chemotherapy and related treatments. Each may consult with the others to develop a treatment plan for the particular patient.

The treatment is based on the type of cancer and the stage of the cancer. In some people, diagnosis and treatment may occur at the same time if the cancer is entirely surgically removed when the surgeon removes the tissue for biopsy.

Although patients may receive a unique sequenced treatment, or protocol, for their cancer, most treatments have one or more of the following components: surgery, chemotherapy, radiation therapy, or combination treatments (a combination of two or all three treatments).

Individuals obtain variations of these treatments for cancer. Patients with cancers that cannot be cured (completely removed) by surgery usually will get combination therapy, the composition determined by the cancer type and stage.

Palliative therapy (medical care or treatment used to reduce disease symptoms but unable to cure the patient) utilizes the same treatments described above. It is done with the intent to extend and improve the quality of life of the terminally ill cancer patient. There are many other palliative treatments to reduce symptoms such as pain medications and antinausea medications.

Individuals obtain variations of these treatments for cancer. Patients with cancers that cannot be cured (completely removed) by surgery usually will get combination therapy, the composition determined by the cancer type and stage.

Palliative therapy (medical care or treatment used to reduce disease symptoms but unable to cure the patient) utilizes the same treatments described above. It is done with the intent to extend and improve the quality of life of the terminally ill cancer patient. There are many other palliative treatments to reduce symptoms such as pain medications and antinausea medications.

Q: What Is The Prognosis For Cancer?

A: The prognosis (outcome) for cancer patients may range from excellent to poor. The prognosis is directly related to both the type and stage of the cancer. For example, many skin cancers can be completely cured by removing the skin cancer tissue; similarly, even a patient with a large tumor may be cured after surgery and other treatments like chemotherapy (note that a cure is often defined by many clinicians as a five-year period with no reoccurrence of the cancer). However, as the cancer type either is or becomes aggressive, with spread to lymph nodes or is metastatic to other organs, the prognosis decreases. For example, cancers that have higher numbers in their staging (for example, stage III or T3N2M1; see staging section above) have a worse prognosis than those with low (or 0) numbers. As the staging numbers increase, the prognosis worsens.

There are many complications that may occur with cancer; many are specific to the cancer type and stage and are too numerous to list here. However, some general complications that may occur with both cancer and its treatment protocols are listed below:

  • Fatigue (both due to cancer and its treatments)
  • Anemia (both)
  • Loss of appetite (both)
  • Insomnia (both)
  • Hair loss (during treatments mainly)
  • Nausea (both)
  • Lymphedema (both)
  • Pain (both)
  • Immune system depression (both)
Q: Can Cancer Be Prevented?

A: Most clinicians and researchers are convinced that many cancers can either be prevented or the risk of developing cancers can be markedly reduced. Some of the methods are simple; others are relatively extreme, depending on an individual’s view.

Prevention of cancer, by avoiding its potential causes, is the simplest method. First on most clinicians and researchers list is to stop (or better, never start) smoking of tobacco. Avoiding excess sunlight (by decreasing exposure or applying sunscreen) and many of the chemicals and toxins is an excellent way to avoid cancers. Avoiding contact with certain viruses and other pathogens also is likely to prevent some cancers. People who have to work close to cancer-causing agents (chemical workers, X-ray technicians, ionizing radiation researchers) should follow all safety precautions and minimize any exposure to such compounds.

There are also some vaccination available toprevent specific types of cancer. Vaccines against the hepatitis B virus, which is considered a cause of some liver cancers, and vaccines against human papillomavirus types 16 and 18, which, according to the NCI, are responsible for about 70% of cervical cancer. This virus also plays a role in cancers arising in the head and neck, as well as cancers in the anal region, and probably in others. Today, vaccination against HPV is recommended in teenagers and young adults of both sexes. The HPV virus is so common that by the age of 50, half or more people have evidence of being exposed to it.

People with a genetic predisposition to develop certain cancers and others with a history of cancers in their genetically linked relatives currently cannot change their genetic makeup. However, some individuals who have a high possibility of developing genetically linked cancer have taken actions to prevent cancer development. For example, some young women who have had many family members develop breast cancer have elected to have their breast tissue removed even if they have no symptoms or signs of cancer development to reduce or eliminate the possibility they will develop breast cancer. Some doctors consider this as an extreme measure to prevent cancer while others do not. Screening studies for cancer, while they do not prevent cancers, may detect them at an earlier stage when the cancer is more likely to be potentially cured with treatment. Such screening studies are breast exams, testicular exams, colon-rectal exams (colonoscopy), mammography, PSA levels, prostate exams, and others. People who have any suspicion that they may have cancer should discuss their concerns with their doctor as soon as possible. The earlier cancer is disproved or diagnosed and treated, the person will be better served.

Screening recommendations have been the subject of numerous conflicting reports in recent years. Screening may not be cost effective for many groups of patients, but individual patients’ unique circumstances should always be considered by doctors in making recommendations about ordering or not ordering screening tests.

Q: If I Have A Risk Factor Such As Smoking , Does This Mean I Will Develop Cancer?

A: A cancer risk factor is defined as something that can increase the likelihood that one will develop cancer. Keep in mind that not all risk factors can be prevented like genetics, or unintentional exposure to toxins, like asbestos.

However, prevention is key. Many cancers can be prevented by avoiding risk factors, such as smoking.

According to the study, smoking is attributed to 30% of all cancer deaths. Not only does it cause lung cancer, it can cause several other cancers like pancreatic, leukemia, and cervical cancer.

Smoking cigarettes is a high risk factor for cancer, as well as many other dieses. Your best bet for prevention for any cancer, is to quit smoking.

Q: What Causes Lung Cancer?

A: Though we know that smoking causes lung cancer, lung cancer is a multifactorial disease –- that is, many factors work together to either cause or prevent cancer. Between 80 and 90% of lung cancers are due to smoking, yet 10% of men and 20% of women who develop the disease have never smoked. On the other side of the equation, many people who smoke do not develop lung cancer.

Causes of lung cancer may be additive, or in certain cases, more than additive. Individuals who are exposed to asbestos and smoke, or exposed to radon and smoke, have a higher risk of developing lung cancer than can be explained by the risk of these causes added together. On the other hand, certain dietary practices and exercise may reduce the risk of some of these causes. What causes lung cancer?

Smoking

Smoking is responsible for 87% of lung cancers overall.

Secondhand Smoke

Secondhand smoke is also responsible lung cancer deaths all over the world. Living with someone who smokes raises your risk of developing lung cancer by 20-30%.

Environmental Causes

Environmental causes of lung cancer include exposure to chemicals, wood smoke, and radiation.

Occupational Causes

Occupational causes of lung cancer include exposure to chromium, tar, arsenic, and nickel, among other substances.

Genetics

Genetic factors can play a role in lung cancer, and 1.7% of lung cancers are considered “hereditary.” An inherited predisposition to lung cancer is more common in women, non-smokers, and patients under the age of 60 who develop the disease.

Q. My Son Has A Headache. Could He Have A Brain Tumor? My Daughter Has A Swollen Gland. Could She Have Leukemia Or Lymphoma? Does My Child Have Cancer?

A: Unfortunately, they often don’t voice that worry to their Pediatrician, who would usually be able to quickly reassure them that their child likely doesn’t have any type of cancer.

Even though there are many different types of childhood cancer, the risk for any one child to have cancer is fairly low and cancer is considered to be rare in children. Though the % of children affliec with Cancer is very low still, cancer is one of the leading causes of death in children, so it is important to be aware of the signs and symptoms of cancer in children.

Among the types of cancer that children are most likely to get include:

  • leukemia – most common type of childhood cancer
  • brain tumors – second most common form of cancer in children
  • lymphoma – such as Hodgkins and non-Hodgkins lymphoma
  • neuroblastoma – most common solid tumor outside of the brain in children
  • bone tumors – including Ewing’s sarcoma and Osteosarcoma
  • retinoblastoma – an eye tumor that is usually detected by examining for a red reflex in a child’s eye
  • Wilm’s Tumor – a kidney tumor that mostly affects young children between the ages of 2 and 4 years

The symptoms of these cancers are sometimes easy to recognize, such as the large abdominal mass in a child with Wilm’s Tumor. Some other symptoms of cancer in children might include fever, frequent infections, bone pain, night sweats, vomiting, and headaches, all of which children often have when they have more common and less serious viral infections or other common problems of childhood.

Q: What Is Oral Cancer?

A: Oral cancer is part of a group of cancers of the mouth and throat. Oral cancer can develop in any part of the oral cavity (the mouth and lips) or oropharynx (the part of the throat at the back of the mouth). Most oral cancer begins in the flat cells (squamous cells) that cover the surfaces of the mouth, tongue, and lips. These cancers are called squamous cell carcinomas.

Q: Who Gets It?

A: Oral cancer is twice more common in men than women. This may be because of their increased likelihood to use tobacco and alcohol over long periods of time and in large doses. Age is also a risk factor: Two-thirds of all cases are diagnosed in people age 55 and older. In addition, people with diets low in fruits and vegetables tend to be at greater risk, as well as those with outdoor jobs (lip cancer). Finally, the human papillomavirus (HPV) puts people at great risk: Approximately one-quarter of all patients with oral cancer also have HPV.

Q: What Are The Symptoms?

A: The following symptoms and others may be caused by oral cancers, but it’s important to remember that other conditions share these same symptoms, so talk to your doctor if you experience any.

  • White or red patches on the lips, gum, tongue or mouth lining
  • Pain or difficulty chewing, swallowing or speaking
  • Hoarseness, numbness, pain, or swelling in the oral area
  • Bleeding in the mouth
  • A sore on the lips or in the mouth, or an earache, that doesn’t go away
Q. What Are The Warning Signs?
  • change in the size or shape of the breast,
  • discharge from the nipple, or
  • change in the color or feel of the skin of the breast or nipple (dimpled, puckered or scaly; warm, red or swollen).

It’s important to note that there may be no warning signs or symptoms. Breast self-exams, clinical breast exams and regularly scheduled mammograms are vital in the screening and early detection of the disease.

Q. What Are The Warning Signs?
  • A. No one yet knows what causes breast cancer, but medical research has generated a lot of knowledge about the disease. Researchers at the Comprehensive Cancer Center have made some important discoveries in the treatment and prevention of breast cancer, ranging from understanding more about the genetic aspects of cancer to developing a vaccine that may treat and prevent breast cancer.
Q. How Likely Am I To Get Breast Cancer?
A. Statistics show that a woman has a 1 in 8 lifetime chance of developing breast cancer. Breast cancer is the most frequently diagnosed cancer in women in the United States, other than non-melanoma skin cancers. Three-fourths of breast cancer cases are diagnosed in women age 50 and older. And although breast cancer is more common in older women, it does occur in younger women and in men. There are additional factors that may increase a woman’s cancer risk.
Q. What Should I Do If I Find A Lump While Performing A Monthly Breast Self-Exam?
A. Check the other breast. Some lumpiness is normal. However, if the lump is new or unusual, it warrants examination by a physician. A lump found during a breast self-exam, a clinical breast exam or a mammogram does not necessarily mean that a woman has breast cancer. Nearly 80 percent of all breast lumps are noncancerous (benign). However, cancer is a possibility. Early detection and treatment provides the best outcome, so a woman shouldn’t let fear stop her from seeing a physician.
Q. What Are My Risks For Getting Breast Cancer?

A. Being a woman and getting older are the biggest risk factors for developing breast cancer. Other risk factors include:

  • age
  • family history of breast cancer in a close family member on either mother’s or father’s side
  • onset of menstruation before age 12
  • onset of menopause after age 50
  • not having children or having a first child after age 30
Q. How Do I Decide Which Treatment Option Is Best For Me?
A. Speak with your physician about treatment options. Although there are four standard ways to treat breast cancer (surgery, radiation therapy, hormonal therapy and chemotherapy), several treatments may be combined. Your physician can recommend specific treatments depending on the type and location of the cancer, the stage at which it was detected, and your age and general health.
Q. Is A Mammogram Painful?
A. The pressure caused by spreading the breast tissue may be uncomfortable, but it should not be painful. Women who experience pain should tell the technologist.
Q. Is The Radiation Exposure From Getting A Mammogram Harmful?
A. The radiation exposure from modern, low-dose mammography equipment is minimal. Radiation doses usually are so low they’re negligible. Plus, the medical benefits of early detection outweigh any potential risk.
Q. What Is The Difference Between Precancerous Conditions And Cancer Of The Cervix?

A. Cells on the surface of the cervix sometimes appear abnormal but not cancerous. Scientists believe that some abnormal changes in cells on the cervix are the first step in a series of slow changes that can lead to cancer many years later. That is, some abnormal changes are precancerous, and they may become cancerous with time.

Over the years, doctors have used different terms to refer to abnormal changes in the cells on the surface of the cervix. One term now used is squamous intraepithelial lesion (SIL). (The word lesion refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells.) Changes in these cells can be divided into two categories:

Low-grade SIL (LSIL) refers to early changes in the size, shape and number of cells that form the surface of the cervix. Some low-grade lesions go away on their own. However, with time, others may grow larger or become more abnormal, forming a high-grade lesion. Precancerous low-grade lesions also may be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). Such early changes in the cervix most often occur in women between the ages of 25 and 35 but can appear in other age groups as well. High-grade SIL (HSIL) means that the precancerous changes are more severe; they look very different from normal cells. Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. The cells will not become cancerous and invade deeper layers of the cervix for many months, perhaps years. Nevertheless, HSIL on a Pap smear may be associated with malignancy of the cervix. Therefore, a proper diagnostic evaluation (with a microscope to look more closely at the cervix, known as a colposocpe) is necessary. This usually begins with a colposcopic evaluation of the cervix. High-grade lesions also may be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. They develop most often in women between the ages of 30 and 40, but can occur at other ages as well.

If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. The average age of cervical cancer patients is 50.

Q. How Do I Read My Pap Smear Results So That I Can Understand Them?

A. The following table will help you to better understand your Pap smear results:

Results Description Follow-up
Within Normal Limits No abnormal cells detected. Return for pelvic exam and Pap test in one year.
LSIL ,Low Grade Squamous Intraepithelial Lesions,CIN I (mild dysplasia) Some normal cells are changed into abnormal cells. These cells could change into cancer in the future. These changes also are called mild dysplasia. Colposcopy is performed after an LGSIL Pap smear. In specific circumstances, repeat Pap smear in a few months may be warranted depending on the patient’s personal history.
HGSIL,High Grade Squamous Intraepithelial Lesions​,CIN II (moderate dysplasia),CIN III (severe dysplasia),CIS (carcinoma in situ) This also is called moderate to severe dysplasia. Colposcopic evaluation is necessary after an HSIL Pap smear is discovered. A biopsy may be done to determine the amount of abnormality. Treatment involves removal of abnormal cells.
Cervical Cancer Cancer cells are present. Biopsy to confirm Pap tests and determine treatment. The diagnosis of cervical cancer must be made by a biopsy. The Pap smear is only a screening test.
Q. How Can I Detect Cervical Cancer Early?
A. Most precancerous conditions of the cervix could be detected and treated before cancer develops if all women had pelvic exams and Pap tests regularly. This way, most invasive cancers could be prevented. Any invasive cancer that does occur would likely be found at an early, curable stage.
Q. What Is My Doctor Checking When He Or She Does My Pelvic Exam?

A. In a pelvic exam, the doctor checks the uterus, vagina, ovaries, fallopian tubes, bladder and rectum. The doctor feels these organs for any abnormality in their shape or size. A speculum is used to widen the vagina so that the doctor can see the upper part of the vagina and the cervix.

The Pap test is a simple, painless test to detect abnormal cells in and around the cervix. A woman should have this test when she is not menstruating; the best time is between 10 and 20 days after the first day of her menstrual period. For about two days before a Pap test, she should avoid douching or using spermicidal foams, creams, or jellies or vaginal medicines (except as directed by a physician), which may wash away or hide any abnormal cells.

Women should have regular checkups, including a pelvic exam and Pap test, at age 21 and every three years thereafter. Those who are at increased risk of developing cancer of the cervix should be especially careful to follow their doctor’s advice about checkups. Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should not undergo a Pap test (except if the hysterectomy was done for CIN II or CIN III). Hwoever, a yearly pelvic examination is still recommended.

Q. What Are The Symptoms Of Cancer Of The Cervix?

A. Precancerous changes of the cervix usually do not cause pain. In fact, they generally do not cause any symptoms and are not detected unless a woman has a pelvic exam and a Pap test.

Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. Symptoms may include:

  • Abnormal bleeding (bleeding may start and stop between regular menstrual periods)
  • Bleeding after intercourse, douching or pelvic exam
  • Menstrual bleeding that lasts longer or is heavier than usual
  • Bleeding after menopause
  • Increased vaginal discharge

These symptoms may be caused by cancer or by other health problems. Only a provider can tell for sure. It is important for a woman to contact her provider if she is having any of these symptoms.

  • These procedures can be done in the doctor’s office.

    Biopsy – The doctor may remove a small amount of cervical tissue to be evaluated by a pathologist. In one type of biopsy the doctor uses an instrument to pinch off small pieces of cervical tissue.

    Loop Electrosurgical Excision Procedure (LEEP) – Another method used to do a biopsy. In this procedure, the doctor uses an electric wire loop to remove a thin, round piece of the cervix.

    These types of biopsies may be done in the doctor’s office using local anesthesia.

    Endocervical Curettage (ECC) – The doctor may want to check inside the opening of the cervix. The doctor uses a curette (a small, spoon-shaped instrument) to scrape tissue from inside the cervical opening.

    These procedures for removing tissue may cause some bleeding or other discharge. However, healing occurs quickly. Women often experience some pain similar to menstrual cramping, which can be relieved with medicine.

    Cone Biopsy – This procedure requires either local or general anesthesia and may be done in the doctor’s office or in the hospital. This procedure allows for evaluation and treatment of precancerous lesions. The cone biopsy also may provide the diagnosis of an invasive cervical cancer.

    D&C – In a few cases, it may not be clear whether an abnormal Pap Test or a woman’s symptoms are caused by problems in the cervix or in the endometrium (the lining of the uterus). In this situation, the doctor may do a dilatation and curettage (D&C). The doctor stretches the cervical opening and uses a curette to scrape tissue from the lining of the uterus as well as from the cervical canal. Like conization, this procedure requires local or general anesthesia and is done in the hospital.

Q. How Is Cancer Of The Cervix Diagnosed?
A. The pelvic exam and Pap test allow the doctor to detect abnormal changes in the cervix. If these exams show that an infection is present, the doctor treats the infection and then repeats the Pap test at a later time. If the Pap test or exam suggests something other than an infection, the doctor may repeat the Pap test and do other tests to find out what the problem is.The Pap smear is only a screening test and does not give a final diagnosis. A diagnosis and subsequent treatment is based on biopsy results, which are usually obtained after an abnormal Pap smear is discovered.

Colposcopy is the method to check the cervix for abnormal areas. This procedure is most commonly performed after an abnormal Pap smear. The doctor applies a vinegar solution to the cervix and then uses an instrument much like a microscope (called a colposcope) to look closely at the cervix.

Q. How Are Precancerous Conditions Of The Cervix Treated?

A. All treatments directed toward precancerous conditions of the cervix should be based on a biopsy (since a Pap smear alone is not adequate to make the diagnosis). Treatment for a precancerous lesion of the cervix depends on a number of factors. These factors include whether the lesion is low or high grade, whether the woman wants to have children in the future, the woman’s age and general health, and the preference of the woman and her doctor. A woman with a low-grade lesion may not need further treatment, especially if the abnormal area was removed during biopsy, but she should have a Pap test and pelvic exam regularly by a physician with expertise in this area. When a precancerous lesion requires treatment, the doctor may use:

  • Cryosurgery (freezing)
  • Cauterization Burning (also called diathermy)
  • LASER Surgery (to destroy abnormal area without harming nearby healthy tissue
  • LEEP (Loop Electrosurgical Excision Procedure, a larger biopsy to remove the precancerous tissues)
  • Conization (Cone Biopsy, larger biopsy to remove the precancerous tissues)

Treatment for precancerous lesions may cause cramping or other pain, bleeding or a watery discharge. Rarely, a hysterectomy is performed to treat percancerous conditions of the cervix, since removal of the uterus and cervix is considered to be unnecessary in the great majority of cases of precancerous conditions of the cervix unless other gynecologic problems exist. Women are likely to benefit from pretreatment evaluation by a gynecologic oncologist if they have:

  • A suspicious visible growth of the cervix suspicious for cancer
  • A Pap smear report demonstrating invasive carcinoma
  • A biopsy report confirming invasive carcinoma
Q. How Is Cancer Of The Cervix Treated?

A. The choice of treatment for cervical cancer depends on the location and the size of the tumor, the stage (extent) of the disease, the woman’s age and general health, and other factors.

Gynecologic oncologists have expertise in the diagnostic evaluation and treatment of patients with cervical carcinoma. They also have surgical expertise in the procedures of radical hysterectomy, lymphnode removal, pretreatment surgical staging procedures, and exenterations for patients with recurrent cervical cancer. Gynecologic oncologists work closely with oncologists when this is the primary treatment modality. During that time, they function as the patient’s primary care oncologist and continue to direct their care after the radiation therapy is finished.

Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. Blood and urine tests are usually done. The doctor also may do a thorough pelvic exam in the operating room with the patient under anesthesia to better define the location of the cancer.

As part of the examination under anesthesia, the doctor may perform a cystoscopy, where the doctor looks inside the bladder with a thin, lighted instrument. Also may be performed is proctosigmoidoscopy where a lighted instrument is used to check the rectum and the lower part of the large intestine. Because cervical cancer may spread to the bladder, rectum, lymph nodes or lungs, the doctor also may order x-rays or tests to check these areas. For example, the woman may have a series of x-rays of the kidneys and bladder, called a computed tomography (CT) or an intravenous pyelogram (IVP). The doctor also may check the intestines and rectum using a barium enema. To look for lymph nodes that may be enlarged because they contain cancer cells, the doctor may order a CT scan, a series of x-rays put together by a computer to make detailed pictures of areas inside the body. Other procedures that may be used to check organs inside the body are ultrasonography and MRI.

Q. Is A Second Opinion Important?

A. Before starting treatment, you may want a second pathologist to review the diagnosis and another specialist to review the treatment plan. Some insurance companies require a second opinion; others may cover second opinion if the patient requests it. It may take a week or two to arrange for a second opinion. This short delay will not reduce the chance that treatment will be successful.

A gynecologic oncologist is usually in the best position to offer a patient an expert opinion on the diagnosis and management of cervical cancer. At The James, patients also have their case presented at the gynecologic oncology multidisciplinary tumor board. This is a meeting where gynecologic oncologists, radiation oncologists and gynecologic pathologists meet to discuss the diagnostic and treatment options for a patient with or suspected to have a gynecologic cancer.

Q. What Can I Do To Prepare For Treatment?

A. Here are some questions you may want to ask your doctor before treatment begins:

  • What is the stage (extent) of my disease?
  • What are my treatment choices? Which do you recommend? Why?
  • What are the chances that the treatment will be successful?
  • Would a clinical trial be appropriate for me?
  • What are the risks and possible side effects of each treatment?
  • How long will treatment last?
  • Will it affect my normal activities?
  • What is the treatment likely to cost?
  • What is likely to happen without treatment?
  • How often will I need to have checkups?

When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor. Often it helps to make a list of questions. Taking notes will help you remember what the doctor says. You may also want to have a family member/friend with you when you talk to the doctor to assist you in taking notes, asking questions or just to listen. You do not need to ask all your questions or remember all the answers at one time. There will be other opportunities to ask the doctor to explain things and to get more information.

Q. What Is Ovarian Cancer?

A. There are several types of ovarian cancer. Ovarian tumors are the most histologically diverse group of tumors. At least 80 percent of malignant ovarian tumors arise from the lining of the ovary and are called epithelial carcinomas. The most common type is ovarian adenocarcinomas, which accounts for 75 percent of cases of ovarian cancer. The remaining 25 percent of malignant ovarian tumors are germ cell and sex cord-stromal cell tumors, which are non-epithelial in origin, and metastatic carcinoma to the ovary. Germ cell tumors, which arise from the primary germ cells of the ovary, occur in young women and are uncommon in women more than 30 years old.

Q. What Are The Causes And Risk Factors For Ovarian Cancer?

A. It is difficult to discover what actually causes cancer from one person to another, but researchers have discovered several factors that increase a woman’s likelihood of developing ovarian cancer. Some risk factors for ovarian cancer include:

  • Most ovarian cancers develop around 60 years old
  • Women who started menstruating before age 12, had no children, or had their first child after age 30, and/or experienced menopause after age 50
  • Not eating enough fruits, vegetables, whole grain products and eating more high-fat foods, especially those from animal sources, leading to obesity
  • Women whose mother, sister or daughter have, or have had, ovarian or breast cancer, especially if they developed these cancers at a young age
  • Having breast cancer
  • Talcum powder applied to the genital area or on sanitary napkins may be carcinogenic to the ovaries
Q. What Are The Symptoms For Ovarian Cancer?

A. As a tumor grows, a woman may notice these symptoms:

  • Swelling, bloating or general discomfort in the lower abdomen
  • Loss of appetite or a feeling of fullness, even after a light meal
  • Gas
  • Indigestion
  • Nausea
  • Weight loss
  • Diarrhea, constipation or frequent urination caused by a large tumor pressing on nearby organs, such as the bowel or bladder
  • Less often, bleeding from the vagina is a symptom of ovarian cancer

Most of these may also be caused by benign (noncancerous) diseases of the ovaries and by cancers of other organs. It is important to see your doctor.

Q. How Will My Doctor Know If I Have Ovarian Cancer?

A. Women who have regular pelvic exams increase the chance that, if ovarian cancer occurs, it will be found before the disease causes symptoms. However, pelvic exams often cannot find ovarian cancer at an early stage. Often, the doctor orders a blood test to measure a substance in the blood called CA-125. This substance, called a tumor marker, can be produced by ovarian cancer. However, CA-125 is not always present in women with ovarian cancer, and it may be present in women who have benign ovarian conditions. Thus, this blood test cannot be used alone to diagnose cancer.

A diagnosis can be made only by surgical removal of the mass and/or ovary. Once the mass is removed, a pathologist must examine a sample of the tissue under the microscope to determine the diagnosis. To obtain the tissue, the surgeon does an operation by making an incision. This is called laparotomy. An alternative procedure is laparoscopy, which is surgery performed through small tubes where a camera is used to view the pelvis and abdomen. If cancer is suspected, the surgeon removes the entire ovary. The surgeon should be prepared to perform complete surgical staging if the malignancy appears to be confined to the ovary. A large portion of these patients will have spread that is recognized only by obtaining multiple tissue samples and removing lymph nodes.

Q. What About Treatment? What Should I Ask?
A. Ovarian cancer is usually treated with a combination of surgery and chemotherapy. Sometimes surgery alone is sufficient treatment. Here are some questions a woman may want to ask her doctor before treatment begins:

  • What is the stage of the disease?
  • What are my treatment choices? Which do you recommend for me? Why?
  • Do I need comprehensive surgical staging?
  • Is it likely that aggressive debulking surgery will be required?
  • Am I an individual who may require chemotherapy prior to my definitive surgery (this is called neoadjuvant chemotherapy)?
  • Would a clinical trial be appropriate for me?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment?
Q. What Are The Side Effects Of Treatment?
A. It is hard to limit the effects of therapy so that only cancer cells are destroyed. Because treatment often damages healthy cells and tissues, it can cause unpleasant side effects.The side effects of cancer treatment vary, depending on the type of treatment. Also, each woman reacts differently. Doctors try to keep side effects to a minimum, but problems may occur.

Surgery for ovarian cancer is a major operation. For several days after surgery, a woman may have difficulty emptying her bladder or having normal bowel movements. Doctors or nurses can administer medicine to relieve pain and/or prevent infection associated with ovarian cancer surgery. For a period of time after surgery, some normal activities are limited to encourage healing. Young women whose ovaries are removed begin experiencing the side effects of menopause because their body’s natural source of estrogen has been removed. Hormone-replacement therapy is commonly used to lessen these side effects.

With chemotherapy, side effects depend on which drugs the patient receives, as well as personal variance from patient to patient. In general, chemotherapy drugs affect rapidly dividing cells. The drugs kill cancer cells, but also affect other cells in the body, like cells in hair roots and cells that line the digestive tract. As a result, chemotherapy can cause hair loss, nausea, vomiting or mouth sores. Doctors can suggest diet changes or medication to ease these problems, and most side effects of chemotherapy gradually disappear during the recovery period or after treatment stops.

Radiation therapy mainly causes fatigue, especially in the later weeks of treatment. Though resting is important, doctors usually advise patients to stay as active as possible. Skin in the treated area may become red, dry, tender and itchy, and there may be permanent darkening or “bronzing” in the treated area. Radiation therapy in the lower abdomen may cause nausea, vomiting, diarrhea or urinary discomfort. Doctors can usually suggest diet changes or medicines to ease these problems. Radiation therapy for ovarian cancer can also cause vaginal dryness and interfere with intercourse. Women may be advised not to have intercourse during treatment. However, most women are able to resume sexual activity a few weeks after radiation therapy ends.

Q. Will I Be Able To Adjust To This Disease Well?
A. Each cancer survivor’s recovery is different, and a person’s adjustment after cancer treatment depends on a number of factors. Ovarian cancer can cause major life changes in its survivors. If a woman undergoes removal of the ovaries and/or uterus, she will be unable to become pregnant. Women will also begin menopause if they have not already if they receive this treatment. Chemotherapy may also cause premature menopause or infertility. It is important for women to seek support during and after cancer treatment. In fact, behavioral scientists have found that women who take advantage of a social support system, such as a cancer support group, survive with a better quality of life. Maintain an open dialogue with your cancer care team to address any concerns you have.
Q. What Is Vulvar Cancer?
A. Cancer of the vulva, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the vulva. The vulva is the outer part of a woman’s vagina. The vagina is the passage between the uterus (the hollow, pear-shaped organ where a baby grows) and the outside of the body. It is also called the birth canal. Vulvar malignancies are rare and account for 3 percent to 5 percent of all female genital cancers.

  • Vulvar intraepithelial neoplasia (VIN) – Women with VIN have an increased risk of progression to invasive vulvar cancer. Although most cases of VIN never progress to cancer, it is not possible to tell which will, so treatment and/or close medical follow-up are needed.
  • Immunosuppression – Also a risk factor for vulvar cancer.
Q. What Are The Causes And Risk Factors For Vulvar Cancer?
A. It is difficult to discover what causes cancer from one person to another, but researchers have found several factors that increase a woman’s likelihood of developing vulvar cancer. Some risk factors for vulvar cancer include:

  • Age – Of women who develop vulvar cancer, three-fourths are over 50 and two-thirds are over 70.The average age at diagnosis is 65 years; however, vulvar carcinoma is becoming more common in women under 40.
  • Human papillomavirus (HPV) infection – Human papillomavirus infection is thought to be responsible for up to 90 percent of vulvar cancers.
  • Tobacco use – Smoking exposes the body to many cancer-causing chemicals that affect more than just the lungs. These harmful substances can be absorbed into the lining of the lungs and spread throughout the body. Among women who have a history of genital warts, smoking further increases the risk of developing vulvar cancer.
Q. What Are The Symptoms For Vulvar Cancer?
A. A doctor should be seen if a woman observes any of the following:

  • Vulvar mass or lump
  • Pruritus (itching)
  • Pain
  • Burning
  • Bleeding
  • Dysuria
  • Discharge
Q. What Are The Causes And Risk Factors For Vulvar Cancer?
A. If there are symptoms, a doctor may do certain tests to see if there is cancer, usually beginning by looking at the vulva and feeling for lumps. The doctor may then cut out a small piece of tissue (called a biopsy) from the vulva and look at it under a microscope. A patient will be given some medicine to numb the area when the biopsy is done. Some pressure may be felt, but usually with no pain. This test is often done in a doctor’s office.
Q. What About Treatment? What Should I Ask?
A. There are treatments for all patients with cancer of the vulva. Three kinds of treatment are used:

  • Surgery (taking out the cancer in an operation)
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
  • Chemotherapy (using drugs to kill cancer cells)

A doctor may use just one method or combine methods to treat the cancer most effectively; however, surgery is the most common treatment of cancer of the vulva. The standard therapy for cancer localized to the vulva includes radical surgery resection of the primary lesion and inguinal lymphadenectomy. Inadequate local surgical excision results in a high local recurrence rate. Radical excision with bilateral groin node dissection has been the recommended treatment for larger vulvar lesions. When vulvar cancers are diagnosed earlier, smaller localized, less traumatic surgeries with unilateral lymph node dissection can be performed.

Here are some questions a woman may want to ask her doctor before treatment begins:

  • What is my diagnosis?
  • What is the stage of the disease?
  • What are my treatment choices? Which do you recommend for me? Why?
  • What are the chances that the treatment will be successful?
  • Would a clinical trial be appropriate for me?
  • What are the risks and possible side effects of each treatment?
  • How long will my treatment last?
  • Will I have to change my normal activities?
  • What is the treatment likely to cost?
Q. What Are The Side Effects Of Treatment?
A. It is hard to limit the effects of therapy so that only cancer cells are destroyed. Because treatment often damages healthy cells and tissues, it can cause unpleasant side effects.The side effects of cancer treatment vary, depending on the type of treatment. Also, each woman reacts differently. Doctors try to keep side effects to a minimum, but problems may occur.

The consequences of curative surgery can be psychologically devastating, as vulvar surgery can result in lifelong anatomic alterations. Sexual dysfunction is common because of loss of clitoris in some clinical situations and in general because of alteration in body image. Lower extremity lymphedema (leg swelling) can occur, causing difficulty walking, pain, recurrent infections and disfigurement. Therefore, all therapy includes pretreatment counseling about sexual and physical function.

If the cancer has spread outside the vulva and the other female organs, the doctor may take out the lower colon, rectum or bladder (depending on where the cancer has spread), along with the cervix, uterus and vagina (pelvic exenteration). Physicians have developed ways for patients to store and eliminate wastes after these procedures, and it is sometimes possible to reconstruct or reattach these organs so no external appliances are needed. A patient may need to have skin from another part of the body added (grafted) and plastic surgery to make an artificial vulva or vagina after these operations.

Radiation therapy is delivered by exposing cancer cells to high-energy rays or particles to destroy them. The most common method of radiation therapy is known as external beam radiation or teletherapy. With this method, a beam from a machine outside the body is focused in the area of the cancer. Treatment usually involves receiving teletherapy for five days a week for about six weeks. The side effects for this method of radiation therapy include a skin reaction like a sunburn on the outside of the skin, fatigue, nausea and diarrhea. When delivered to the pelvis, premature menopause and problems with urination may also occur.

Q: How Does Prostate Cancer Compare With Other Cancers?
A: A non-smoking man is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined. In fact, a man is 35% more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
Q: Are Some Men More Likely To Be Diagnosed With Prostate Cancer?
A: As men increase in age, their risk of developing prostate cancer increases exponentially. Although only 1 in 10,000 under age 40 will be diagnosed, the rate shoots up to 1 in 38 for ages 40 to 59, and 1 in 14 for ages 60 to 69. About 60% of all prostate cancers are diagnosed in men over the age of 65 and 97% occur in men 50 years of age and older.Men with a single first-degree relative—father, brother or son—with a history of prostate cancer are twice as likely to develop the disease, while those with two or more relatives are nearly four times as likely to be diagnosed. The risk is highest in men whose family members were diagnosed before age 65.

Q: How Curable Is Prostate Cancer?
A: As with all cancers, “cure” rates for prostate cancer describe the percentage of patients likely remaining disease-free for a specific time. In general, the earlier the cancer is caught, the more likely it is for the patient to remain disease-free.Because approximately 90% of all prostate cancers are detected in the local and regional stages, the cure rate for prostate cancer is very high—nearly 100% of men diagnosed at this stage will be disease-free after five years.

Q: What Are The Symptoms Of Prostate Cancer?
A: If the cancer is caught at its earliest stages, most men will not experience any symptoms. Some men, however, will experience symptoms such as frequent, hesitant, or burning urination, difficulty in having an erection, or pain or stiffness in the lower back, hips or upper thighs.Because these symptoms can also indicate the presence of other diseases or disorders, men who experience any of these symptoms will undergo a thorough work-up to determine the underlying cause of the symptoms. You can read more about prostate cancer symptoms here.

Q: If There Are No Symptoms, How Is Prostate Cancer Detected?
Screening for prostate cancer can be performed in a physician’s office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE).
Q: How Is Prostate Cancer Treated?
There are a wide variety of treatment options available for men with prostate cancer, including surgery, radiation therapy, hormone therapy and chemotherapy, any or all of which might be used at different times depending on the stage of disease and the need for treatment.Consultation with all three types of prostate cancer specialists—an urologist, a radiation oncologist and a medical oncologist—will offer the most comprehensive assessment of the available treatments and expected outcomes. More information regarding treatments for prostate cancer can be found on our website here.

Q. How Do I Prevent Colon-Rectal (Colorectal) Cancer?
A. Although colorectal cancer is one of the most common types of cancer in the United States, scientists are trying to learn more about what causes the disease and how it can be prevented.Doctors do not yet know why one person gets colorectal cancer and another does not, but they do know that no one can catch colorectal cancer from another person. Cancer is not contagious.

People can lower their risk of getting colorectal cancer. For example, those who have colorectal polyps (nodular growths of tissue developing in the lining of a cavity, which may be benign or malignant), should talk with the doctor about having them removed. People can also change their eating habits to cut down on fat and increase the amount of fiber (roughage) in their diet.

Q. What Are The Risk Factors For Developing Colorectal Cancer?
A. Some people are more likely to develop colorectal cancer than others. Studies have found that certain factors increase a person’s risk. The following are risk factors for this disease:

  • Polyps – Most (perhaps all) colorectal cancers develop in polyps. Polyps are benign, but they may become cancerous over time. Removing polyps is an important way to prevent colorectal cancer.
  • Age – Colorectal cancers occur most often in people who are over the age of 50, and the risk increases as people get older.
  • Family history – Close relatives of a person who has had colorectal cancer have a higher than average risk of developing the disease. The risk for colon cancer is even higher among members of a family in which many relatives have had it. (In such cases, the disease is called familial colon cancer.)
  • Familial polyposis – This is an inherited condition in which hundreds of polyps develop in the colon and rectum. Over time, these polyps can become cancerous. Unless the condition is treated, a person who has familial polyposis is almost sure to develop colorectal cancer.
  • Diet – The risk of developing colon cancer seems to be higher in people whose diet is high in fat, low in fruits and vegetables, and low in high-fiber foods such as whole-grain breads and cereals.
  • Ulcerative colitis – This disease causes inflammation of the lining of the colon. The risk of colon cancer is much greater than average for people who have this disease, and the risk increases with the length of time they have had it.
Q. What Can I Do To Detect It?

A. Most health problems respond best to treatment when they are diagnosed and treated as early as possible. This is especially true of colorectal cancer. Treatment is most effective before the disease spreads.

People can take an active role in the early detection of colorectal cancer by following these guidelines:

  • During regular checkups, have a digital rectal exam. For this exam, the doctor inserts a lubricated, gloved finger into the rectum and feels for abnormal areas.
  • Beginning at age 40, have an annual fecal occult blood test. This test is a check for hidden (occult) blood in the stool. The test is done because colorectal cancer may cause bleeding that cannot be seen. However, other conditions also may cause bleeding, so having blood in the stool does not necessarily mean a person has cancer.
  • Beginning at age 50, have a sigmoidoscopy/colonoscopy every 3 to 5 years. (Speak with your doctor.) This is an exam of the rectum and lower colon using a sigmoidoscope. The doctor looks through a thin, lighted tube to check for polyps, tumors or other abnormalities.
  • People who may be at a greater than average risk for colon cancer should discuss a schedule for these or other tests with their doctor.
Q. What Are The Risk Factors For Developing Colorectal Cancer?
A. Some people are more likely to develop colorectal cancer than others. Studies have found that certain factors increase a person’s risk. The following are risk factors for this disease:

  • Polyps – Most (perhaps all) colorectal cancers develop in polyps. Polyps are benign, but they may become cancerous over time. Removing polyps is an important way to prevent colorectal cancer.
  • Age – Colorectal cancers occur most often in people who are over the age of 50, and the risk increases as people get older.
  • Family history – Close relatives of a person who has had colorectal cancer have a higher than average risk of developing the disease. The risk for colon cancer is even higher among members of a family in which many relatives have had it. (In such cases, the disease is called familial colon cancer.)
  • Familial polyposis – This is an inherited condition in which hundreds of polyps develop in the colon and rectum. Over time, these polyps can become cancerous. Unless the condition is treated, a person who has familial polyposis is almost sure to develop colorectal cancer.
  • Diet – The risk of developing colon cancer seems to be higher in people whose diet is high in fat, low in fruits and vegetables, and low in high-fiber foods such as whole-grain breads and cereals.
  • Ulcerative colitis – This disease causes inflammation of the lining of the colon. The risk of colon cancer is much greater than average for people who have this disease, and the risk increases with the length of time they have had it.
Q. What Are The Symptoms Of Colorectal Cancer?
A. Colorectal cancer can cause many symptoms. Warning signs to watch for include:

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

These symptoms also can be caused by other problems such as ulcers, an inflamed colon or hemorrhoids. Only a doctor can determine the cause. People who have any of these symptoms should see their doctor. The doctor may refer them to a doctor who specializes in diagnosing and treating digestive problems (a gastroenterologist).

Q. What Can I Do To Detect It?

A. Most health problems respond best to treatment when they are diagnosed and treated as early as possible. This is especially true of colorectal cancer. Treatment is most effective before the disease spreads.

People can take an active role in the early detection of colorectal cancer by following these guidelines:

  • During regular checkups, have a digital rectal exam. For this exam, the doctor inserts a lubricated, gloved finger into the rectum and feels for abnormal areas.
  • Beginning at age 40, have an annual fecal occult blood test. This test is a check for hidden (occult) blood in the stool. The test is done because colorectal cancer may cause bleeding that cannot be seen. However, other conditions also may cause bleeding, so having blood in the stool does not necessarily mean a person has cancer.
  • Beginning at age 50, have a sigmoidoscopy/colonoscopy every 3 to 5 years. (Speak with your doctor.) This is an exam of the rectum and lower colon using a sigmoidoscope. The doctor looks through a thin, lighted tube to check for polyps, tumors or other abnormalities.
  • People who may be at a greater than average risk for colon cancer should discuss a schedule for these or other tests with their doctor.
Q. How Will I Be Diagnosed For Colorectal Cancer?

A: To find the cause of symptoms, the doctor will ask about your personal and family medical history. He will do a physical exam, and may order laboratory tests. In addition to the exams discussed above, the doctor may also order the following tests:

  • Lower GI series – X-rays of the colon and rectum (the lower gastrointestinal tract). The x-rays are taken after the patient is given an enema with a white, chalky solution containing barium. (This test is sometimes called a barium enema.) The barium outlines the colon and rectum on the x-rays, helping the doctor find tumors or other abnormal areas. To make small tumors easier to see, the doctor may expand the colon by carefully pumping in air during the test. This is called an air contrast or double-contrast barium enema.
  • Colonoscopy – An examination of the inside of the entire colon using a colonoscope, an instrument similar to a flexible sigmoidoscope, but longer.

If a polyp or other abnormal growth is found, the doctor can remove part or all of it through a sigmoidoscope or colonoscope. A pathologist examines the tissue under a microscope to check for cancer cells. This procedure is called a biopsy. Most polyps are benign, but a biopsy is the only way to know for sure.

If the pathologist finds cancer, the patient’s doctor needs to learn the stage, or extent of the disease. Staging exams and tests help the doctor find out whether the cancer has spread and, if so, what parts of the body are affected. Treatment decisions depend on these findings.

Staging may include x-rays, ultrasonography or CT (or CAT) scans of the lungs and liver, because colorectal cancer tends to spread to these organs. The doctor may order blood tests to measure how well the liver is functioning. The doctor also may do a blood test called a CEA assay. This test measures the blood level of carcinoembryonic antigen (CEA), a substance that is sometimes found in higher-than-normal amounts in people who have colorectal cancer, especially when the disease has spread.

Q. What Do I Need To Know About The Treatment For Colorectal Cancer?

A. The doctor develops a treatment plan to fit each patient’s needs. Treatment for colorectal cancer depends on the size and location of the tumor, the stage of the disease, the patient’s general health, and other factors.

Most people who have cancer want to learn all they can about the disease and their treatment choices so they can take an active part in decisions about their medical care. It helps to make a list of questions before seeing the doctor. Here are some questions you may want to ask before treatment begins:

  • What is the stage of the disease?
  • What are my treatment choices? Which do you suggest for me? Why?
  • Would a clinical trial be appropriate for me?
  • What are the expected benefits of each treatment?
  • What are the risks and possible side effects of each treatment?
  • What can be done about side effects?
  • What can I do to take care of myself during therapy?
  • What is the treatment likely to cost?

Patients and their loved ones are naturally concerned about the effectiveness of the treatment. Sometimes they use statistics to try to figure out whether the patient will be cured, or how long her or she will live. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a particular person because no two cancer patients are alike.

People should feel free to ask the doctor about the chance of recovery (prognosis), but even the doctor does not know for sure what will happen. When doctors talk about surviving cancer, they may use the term remission rather than cure. Even though many patients recover completely, doctors use this term because the disease can come back.

Q. What About A Second Opinion?

A. Treatment decisions are complex. Sometimes it is helpful for patients to have a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others provide coverage for a second opinion at the patient’s request. There are several ways to find another doctor to consult:

  • Your doctor may be able to suggest a doctor who specializes in treating colorectal cancer. Specialists who treat this disease include surgeons, medical oncologists, gastroenterologists and radiation oncologists.
  • Patients can get the names of doctors from their local medical society, a nearby hospital or a medical school.
  • Cancer information lines can tell callers about treatment facilities, including cancer centers and other National Cancer Institute-supported programs.
Q. What Methods Of Treatment Are Available For Colorectal Cancer?

A. Colorectal cancer is generally treated with surgery, chemotherapy and/or radiation therapy. New treatment approaches such as biological therapy and improved ways of using current methods are being studied in clinical trials. A patient may have one form of treatment or a combination.

Surgery is the most common treatment for colorectal cancer and may be the only treatment needed. The type of operation depends on the location and size of the tumor. Most patients have a partial colectomy. In this operation, the surgeon takes out the part of the colon or rectum that contains the cancer and a small amount of surrounding healthy tissue.

Usually, lymph nodes near the tumor are removed during surgery to help the doctor be more accurate about the stage of the cancer. In most cases, the surgeon reconnects the healthy sections of the colon or rectum. This part of the surgery is called anastomosis. If the healthy sections of the colon or rectum cannot be reconnected, the doctor performs a colostomy, creating an opening (stoma) in the abdomen through which solid waste leaves the body. The patient uses a special bag to cover the stoma and collect waste. A colostomy may be temporary or permanent.

A temporary colostomy is sometimes needed to allow the lower colon or the rectum to heal after surgery. Later in a second operation, the surgeon reconnects the healthy sections of the colon or rectum and closes the colostomy. The patient’s bowel functions soon return to normal.

Although it may take some time to adjust to a colostomy, most patients return to their normal lifestyle. A nurse or an enterostomal therapist teaches the patient how to care for a colostomy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is sometimes given after surgery for colorectal cancer to try to prevent the disease from recurring, or coming back. This additional treatment is called adjuvant therapy. The doctor may use one drug or a combination of drugs.

Chemotherapy and radiation therapy are sometimes given to shrink the tumor prior to surgery.

Q. What Is The Difference Between Primary Bone Cancer And Secondary Bone Cancer?

A: Primary bone cancer refers to cancers that start in the bone. Secondary bone cancer is cancer that spreads to the bone from another part of the body. Primary bone cancer is rare, with approximately 2,400 new cases diagnosed each year in the United States. More commonly, bones are the site of tumors that result from the spread (metastasis) of cancer from other parts of the body such as the breasts, lungs or prostate. Bone metastases can cause pain and can lead to other symptoms such as hypercalcemia (abnormally high levels of calcium in the blood).

Q. Are There Different Types Of Primary Bone Cancer?

A. There are several types of cancer that start in the bones. The most common isosteosarcoma, which often develops in new tissue in growing bones. Evidence suggests that Ewing’s sarcoma (see Ewing’s family of tumors), another form of bone cancer, begins in immature nerve tissue in bone marrow. Osteosarcoma and Ewing’s sarcoma tend to occur more frequently in children and adolescents, while chondrosarcoma, which starts in cartilage, occurs more often in adults.

Q. What Are The Risk Factors For Bone Cancer?

A. There are a number of factors that may put a person at increased risk for bone cancer. Children and adolescents, particularly those who have had radiation or chemotherapy treatments for other conditions, develop bone cancer more frequently than adults. Adults with Paget’s disease, a noncancerous condition characterized by abnormal development of new bone cells, may be at increased risk for osteosarcoma. A very small number of bone cancers are due to heredity. For example, children with hereditary retinoblastoma (an uncommon cancer of the eye) are at a higher risk of developing osteosarcoma.

Q. What Are The Symptoms Of Bone Cancer?

A. The symptoms of bone cancer vary from person to person, depending on the location and size of the cancer. Pain is the most common symptom. Tumors that occur in or near joints may cause swelling or tenderness in the affected area. Bone cancer can also interfere with normal movements and can weaken the bones, occasionally leading to a fracture. Other symptoms may include fatigue, fever, weight loss, and anemia. None of these symptoms is a sure sign of cancer. They may also be caused by other, less serious conditions. If you have these symptoms, you should consult a doctor.

Q. How Is Bone Cancer Diagnosed?

A. To diagnose bone cancer, the doctor asks about the patient’s personal and family medical history and does a complete medical exam. The doctor may suggest a blood test, since some bone tumors can be associated with increased levels of certain proteins in the blood.

X-rays can show the location, size, and shape of a bone tumor. If x-rays suggest that a tumor may be cancer, the doctor may recommend special imaging tests such as a bone scan, a CT (or CAT) scan, an MRI, or an angiogram. However, a biopsy—the removal of a sample of tissue from the bone tumor—is needed to determine whether cancer is present.

The surgeon may perform a needle biopsy or an incisional biopsy. During a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue. Biopsies are best done by orthopedic oncologists – doctors experienced in the diagnosis of bone cancer. A pathologist – a doctor who identifies disease by studying cells and tissues under a microscope – examines the tissue to determine whether it is cancerous.

Q. Are There Bone Tumors That Are Not Cancerous?

A. Bone tumors may be benign (noncancerous) or malignant (cancerous). Benign bone tumors are more common than malignant ones. Both types may grow and compress healthy bone tissue and absorb or replace it with abnormal tissue. However, benign tumors do not spread and are rarely life-threatening.

Q. What Are The Treatment Options For Bone Cancer?

A. Treatment options depend on the type, size, location and stage of the cancer, as well as the person’s age and general health. The three main types of treatment for bone cancer are surgery, chemotherapy and radiation therapy.

Surgery is often the primary treatment. Although amputation of a limb is sometimes necessary, pre- or post-operative chemotherapy has made limb-sparing surgery possible in most cases. When appropriate, surgeons avoid amputation by removing only the cancerous section of the bone and replacing it with an artificial device called an endoprosthesis.

Chemotherapy and radiation may also be used alone or in combination. Because Ewing’s sarcoma tends to metastasize rapidly, multidrug chemotherapy is often used in addition to radiation therapy or surgery on the primary tumor.

Q. What Is Skin Cancer?

A. Skin cancer is the most common of all cancers. It is a disease in which malignant cells are found in the outer layers of your skin. Several types of cancer can start in the skin. The most common are basal cell carcinoma and squamous cell carcinoma. These types are called non-melanoma skin cancer.

Q. What Are The Symptoms Of Skin Cancer?

A. The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore that doesn’t heal. Skin cancers do not all look the same. The cancer may start as a small, smooth, shiny, pale or waxy lump. Or it can appear as a firm red lump. Sometimes, the lump bleeds or develops a crust. It can also start as a flat red spot that is rough, dry or scaly.

Both basal and squamous cell cancers are found mainly on areas of the skin that are exposed to the sun – the head, face, neck, hands and arms. However, skin cancer can occur anywhere.

Q. What Causes Skin Cancer?

A. Several risk factors increase the chance of getting skin cancer. Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. There are two types of ultraviolet radiation – UVA and UVB. UVB rays are more likely to cause sunburn, but UVA rays pass farther into the skin. Scientists have long thought that UVB radiation can cause skin cancer. They now think UVA radiation also may add to skin damage that can lead to cancer. For this reason, skin specialists recommend that people use sunscreens that block both kinds of UV radiation.

Artificial sources of UV radiation, such as sunlamps and tanning booths, can also cause skin cancer. Although anyone can get skin cancer, the risk is greatest for people who have fair skin that freckles easily – often those with red or blond hair and blue or light colored eyes.

The risk of developing skin cancer is also affected by where are person lives. People who live in areas that get high levels of UV radiation from the sun are more likely to get skin cancer.

In addition, skin cancer is related to lifetime exposure to UV radiation. Most skin cancers appear after age 50, but the sun’s damaging effects begin at an early age. Therefore, protection should start in childhood to prevent skin cancer later in life.

Q. How Can I Prevent Skin Cancer?
A. Whenever possible, people should avoid exposure to the midday sun (from 10 a.m. to 2 p.m. standard time, or from 11 a.m. to 3 p.m. daylight saving time). Keep in mind that protective clothing, such as sun hats and long sleeves, can block out the sun’s harmful rays. Also, lotions that contain sunscreens can protect the skin. Sunscreens are rated in strength according to a sun protection factor (SPF), which ranges from 2 to 30 or higher. Those rated 15 to 30 block most of the sun’s harmful rays.
Q. How Can I Detect Skin Cancer?
A. Check yourself regularly for new growths or changes in the skin. Skin cancer is almost totally curable when caught in the early stages. Performing a self-examination requires a full length mirror, a hand mirror and a well-lighted room.

  • Examine your body front and back in the mirror
  • Bend elbows and look at your arms and the palms of your hands
  • Look at your legs and feet, spaces between toes and bottom of soles
  • your back and buttocks with a hand mirror
  • Examine your neck and scalp with a hand mirror

Any suspicious spots should be reported to your doctor. The doctor should also look at your skin during routine physical exams.

Q. How Is Skin Cancer Diagnosed?
A. When an area of skin does not look normal, the doctor will perform a biopsy (removal of all or part of growth). The tissue is examined under the microscope to determine if it is cancerous.Doctors generally divide skin cancer into two stages: local (affecting only the skin) or metastatic (spreading beyond the skin). Because skin cancer rarely spreads, a biopsy often is the only test needed to determine the stage. In cases where the growth is very large or has been present for a long time, the doctor will carefully check the lymph nodes in the area. In addition, you may have to have additional tests, such as special x-rays, to find out whether the cancer has spread to other parts of the body. Knowing the stage of a skin cancer helps the doctor plan the best treatment.

Q. What Will My Doctor Do If I Have Skin Cancer?
A. In treating skin cancer, the doctor’s main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment, the doctor considers the location and size of the cancer, the risk of scarring, and the person’s age, general health, and medical history.It is sometimes helpful to have the advice of more than one doctor before starting treatment. It may take a week or two to arrange for a second opinion, but this short delay will not reduce the chance that treatment will be successful.

Q. How Will My Skin Cancer Be Treated?
A. Treatment for skin cancer usually involves some type of surgery. In some cases, doctors suggest radiation therapy or chemotherapy. Sometimes a combination of these methods is used.
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