Cancer

Cancer

Questions to Ask Your Doctor After a Cancer Diagnosis 1. What type of cancer do I have? How was the diagnosis established? Are there any other diagnostic tests that could provide useful information? 2. What is the extent of spread (stage) of the cancer? To what extent does the stage of the cancer influence treatment? 3. Should I get a second opinion? Can you recommend someone who could provide a second opinion? 4. What are the treatment options? How do you decide among the different options? Are there investigational treatments or clinical trials available for this type of cancer? 5. How much is known about the type of cancer that I have? How common is this cancer and the type of treatment I am to receive? Would I be better off being treated in a more specialized center? 6. What is your experience in treating this type of cancer? What have been the results of this treatment, in your experience? 7. How much time should I take to make a decision about treatment? 8. What is the goal of treatment (for example, to completely eradicate the tumor, to reduce the size of the tumor, to alleviate symptoms)? 9. How often must I receive treatment? How will I feel after treatment? If there will be side effects of treatment, are there any medications that can help prevent or lessen the severity of these? How soon can I return to normal activities after treatment? Learn other questions to ask when facing a cancer diagnosis » Top Searched Cancer Terms:

What is cancer?

Cancer is the uncontrolled growth of abnormal cells anywhere in a body. The 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 can occur when such damaged or unrepaired cells do not die and become cancer cells and proliferate with uncontrolled 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 metastatic disease. For example, if breast cancer cells spread to a bone (or anywhere else), it means that the individual has metastatic breast cancer.

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

• 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

In the U.S., according to the National Cancer Institute in 2010, the most common cancers (excluding non-melanoma skin cancers) are listed below.

Cancer type	Estimated new cases	Estimated deaths
Bladder	70,530	14,680
Breast (female-male)	207,090-1,970	39,840-390
Colon and rectal (combined)	142,570	51,370
Endometrial	43,470	7,950
Kidney (renal cell)	53,581	11,997
Leukemia	43,050	21,840
Lung (including bronchus)	222,520	157,300
Melanoma	68,130	8,700
Non-Hodgkin lymphoma	65,540	20,210
Pancreatic	43,140	36,800
Prostate	217,730	32,050
Thyroid	44,670	1,690

The three most common cancers in men, women and children in the U.S. are as follows:

• Men: Prostate, lung, and colorectal



• Women: Breast, colorectal, and lung



• Children: Leukemia, brain tumors, and lymphoma

The incidence of cancer and cancer types are influenced by many factors such as age, sex, race, local environmental factors, diet, and genetics. Consequently, the incidence of cancer and cancer types vary depending on these variable factors. For example, the World Health Organization (WHO) provides the following general information about cancer worldwide:

• Cancer is a leading cause of death worldwide. It accounted for 7.4 million deaths (around 13% of all deaths) in 2004 (statistics published in 2009).



• Lung, stomach, liver, colon, and breast cancer cause the most cancer deaths each year.



• Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.

Different areas of the world may have cancers that are either more or less predominant then those found in the U.S. One example is that stomach cancer is often found in Japan, while it is rarely found in the U.S.

The objective of this article is to introduce the reader to general aspects of cancers. It is designed to be an overview of cancer and cannot cover every cancer type. This article will also attempt to help guide the reader to more detailed sources about specific cancer types.

What causes cancer?

Anything that may cause a normal body cell to develop abnormally potentially can cause cancer. Many things can cause cell abnormalities and have been linked to cancer development. Some cancer causes remain unknown while other cancers may develop from more than one known cause. Some may be developmentally influenced by a person's genetic makeup. Many patients develop cancer due to a combination of these factors. Although it is often difficult or impossible to determine the initiating event(s) that cause a cancer to develop in a specific person, research has provided clinicians with a number of likely causes that alone or in concert with other causes, are the likely candidates for initiating cancer. The following is a listing of major causes and is not all-inclusive as specific causes are routinely added as research advances:

Chemical or toxic compound exposures: Benzene, asbestos, nickel, cadmium, vinyl chloride, benzidine, N-nitrosamines, tobacco or cigarette smoke (contains at least 66 known potential carcinogenic chemicals and toxins), and aflatoxin

Ionizing radiation: Uranium, radon, ultraviolet rays from sunlight, radiation from alpha, beta, gamma, and X-ray-emitting sources

Pathogens: Human papillomavirus (HPV), EBV or Epstein-Barr virus, hepatitis viruses B and C, Kaposi's sarcoma-associated herpesvirus (KSHV), Merkel cell polyomavirus, Schistosoma spp., and Helicobacter pylori; other bacteria are being researched as possible agents

Genetics: A number of specific cancers have been linked to human genes and are as follows: breast, ovarian, colorectal, prostate, skin and melanoma; the specific genes and other details are beyond the scope of this general article so the reader is referred to http://www.cancer.gov/cancertopics/genetics for more details about genetics and cancer.

It is important to point out that most everyone is exposed to cancer-causing substances (for example, sunlight, cigarette smoke, and X-rays) during their lifetime but many individuals do not develop cancer. In addition, many people have the genes that are linked to cancer but do not develop it. Why? Although researchers may not be able give a satisfactory answer for every individual, it is clear that the higher the amount or level of cancer-causing materials a person is exposed to, the higher the chance the person will develop cancer. In addition, the people with genetic links to cancer may not develop it for similar reasons (lack of enough stimulus to make the genes function). In addition, some people may have a heightened immune response that controls or eliminates cells that are or potentially may become cancer cells. There is evidence that even certain dietary lifestyles may play a significant role in conjunction with the immune system to allow or prevent cancer cell survival. For these reasons, it is difficult to assign a specific cause of cancer to many individuals.

Proving that a substance does not cause or is not related to increased cancer risk is difficult. For example, antiperspirants are considered to possibly be related to breast cancer by some investigators and not by others. The official stance by the NCI is "additional research is needed to investigate this relationship and other factors that may be involved." This unsatisfying conclusion is presented because the data collected so far is contradictive. Other claims that are similar require intense and expensive research which may never be done. Reasonable advice might be to avoid large amounts of any compounds even remotely linked to cancer, although it may be difficult to do in complex, technologically advanced modern societies.

What are cancer symptoms and signs?

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. However, there are some signs and symptoms, although not specific, which usually occur in most cancer patients that are fairly easy for the person to detect. They are as follows:

• Fever (no clear infectious source, recurrent or constant)



• Fatigue (not relived by rest)



• Weight loss (without trying to lose weight)



• Pain (usually persistent)



• Skin changes (coloration, sores that do not heal, white spots in mouth or on tongue, wart changes)



• Change in bowel or bladder functions (including trouble swallowing or constipation)



• Unusual bleeding (mouth, vaginal, and bladder) or discharge



• Persistent cough or change in voice



• Lumps or tissue masses

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. The following examples are two ways to proceed to get information on symptoms:

• Use a search engine (Google, Bing) to find links to cancer by listing the symptom followed by the term "cancer." For example, listing "blood in urine and cancer" will bring a person to web sites that list possible organs and body systems where cancer may produce the listed symptoms.



• Use a search engine as above and list the suspected body area and cancer (for example, bladder and cancer), and the person will see sites that list the signs and symptoms of cancer in that area (blood in urine being one of several symptoms listed).

In addition, if the cancer type is known (diagnosed), then even more specific searches can be done listing the diagnosed cancer type and whatever may be questioned about the cancer (symptoms, tumor grades, treatments, prognosis, and many other items).

Your own research should not replace consulting a health-care provider if you are concerned about cancer.

What are the different types of cancer?

There are over 200 types of cancer; far too numerous to include in this introductory article. However, the NCI lists several general categories (see list in first section of this article). This list is expanded below to list more specific types of cancers found in each general category; it is not all inclusive and the cancers listed in quotes are the general names of some cancers:

• Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs -- "skin, lung, colon, pancreatic, ovarian cancers," epithelial, squamous and basal cell carcinomas, melanomas, papillomas, and adenomas



• Sarcoma: Cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue -- "bone, soft tissue cancers," osteosarcoma, synovialsarcoma, liposarcoma, angiosarcoma, rhabdosarcoma, and fibrosarcoma



• 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 -- "leukemia," lymphoblastic leukemias (ALL and CLL), myelogenous leukemias (AML and CML), T-cell leukemia, and hairy-cell leukemia



• Lymphoma and myeloma: Cancers that begin in the cells of the immune system -- "lymphoma," T-cell lymphomas, B-cell lymphomas, Hodgkin lymphomas, non-Hodgkin lymphoma, and lymphoproliferative lymphomas



• Central nervous system cancers: Cancers that begin in the tissues of the brain and spinal cord -- "brain and spinal cord tumors," gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, primary CNS lymphomas, and primitive neuroectodermal tumors

Not included in the above types listed are metastatic cancers; this is because metastatic cancer cells usually arise from a cell type listed above and the major difference from the above types is that these cells are now present in a tissue from which the cancer cells did not originally develop. Consequently, if the terms "metastatic cancer" is used, for accuracy, the tissue from which the cancer cells arose should be included. For example, a patient may say they have or are diagnosed with "metastatic cancer" but the more accurate statement is "metastatic (breast, lung, colon, or other type) cancer."

How is cancer diagnosed?

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 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 most patients, the definitive diagnosis of cancer is based on the examination of a tissue sample from the tissue that may be cancerous by a qualified pathologist. Some biopsy samples are relatively simple to procure (for example, skin biopsy or intestinal tissue biopsy done with an endoscope equipped with a biopsy attachment). Other biopsies may require 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.

The biopsy can provide more than the definitive diagnosis of cancer; it can identify the cancer type (for example, a primary or metastatic type of brain cancer) and the "stage" of the cancerous cells. The stage or cancer staging is a way for clinicians and researchers to estimate how advanced or how severe the disease is. The following section describes the general staging methods for cancers.

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 NCI, 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 following is how the NCI describes the TNM staging system:

1. 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).


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

2.


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)

3.


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).

The Roman numeral or stage grouping method is described by the NCI as follows:

Stage	Definition
Stage 0	Carcinoma in situ.
Stage I, Stage II, and Stage III	Higher numbers indicate more extensive disease: Larger tumor size and/or spread of the cancer beyond the organ in which it first developed to nearby lymph nodes and/or organs adjacent to the location of the primary tumor
Stage IV	The cancer has spread to another organ(s).

As mentioned above, variations of these staging methods exist. For example, some cancer registries use surveillance, epidemiology, and end results program (SEER) termed summary staging. SEER groups cancer cases into five main categories:

• In situ: Abnormal cells are present only in the layer of cells in which they developed.



• Localized: Cancer is limited to the organ in which it began, without evidence of spread.



• Regional: Cancer has spread beyond the primary site to nearby lymph nodes or organs and tissues.



• Distant: Cancer has spread from the primary site to distant organs or distant lymph nodes.



• Unknown: There is not enough information to determine the stage.

Staging of cancer is important; it helps the physician to decide on the most effective therapeutic protocols, provides a basis for estimating the prognosis (outcome) for the patient, and provides a system to communicate the patient's condition to other health professionals that become involved with the patients' care.

What is the treatment for cancer?

The treatment for cancer is usually designed by a team of doctors or by the patient's oncologist and is based on the type of cancer and the stage of the cancer. Most treatments are designed specifically for each individual. 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 obtain a unique treatment 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.

What is the prognosis for cancer?

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 cancer and treatments)



• Anemia (both)



• Loss of appetite (both)



• Insomnia (both)



• Hair loss (treatments mainly)



• Nausea (both)



• Lymphedema (both)



• Pain (both)



• Immune system depression (both)

Can cancer be prevented?

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 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 two vaccines currently approved by the U.S. Food and Drug Administration (FDA) to prevent 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. Some clinicians and researchers recommend that all people, especially young teens, be vaccinated against the human papillomavirus, but this approach is still controversial.

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.

Where can people find more information about cancer?

There are many ways a person can find more information about cancer, but if they have any immediate concerns about having cancer, their first source of information should be their doctor. In addition to the references listed at the end of this article, the following is a list of information sources that are well recognized as authorities for cancer information by most clinicians:

• National Cancer Institute (http://www.cancer.gov/)



• American Cancer Society (http://www.cancer.org/Cancer/index)

Cancer At A Glance

• Cancer is the uncontrolled growth of abnormal cells anywhere in a body.
• There are over 200 types of cancer.
• Anything that may cause a normal body cell to develop abnormally potentially can cause cancer; general categories of cancer-related or causative agents are as follows: chemical or toxic compound exposures, ionizing radiation, some pathogens, and human genetics.
• Cancer symptoms and signs depend on the specific type and grade of cancer; general signs and symptoms are not very specific but are as follows: fever, fatigue, weight loss, pain, skin changes, change in bowel or bladder function, unusual bleeding, persistent cough or voice change, lumps, or tissue masses
• Although there are many tests to presumptively find or presumptively diagnose cancer, the definite diagnosis is made by examination of a biopsy sample of suspected cancer tissue.
• Cancer staging is often determined by biopsy results and helps determine the aggressiveness of the cancer type and the extent of cancer spread; staging also helps caregivers determine treatment protocols. In general, most staging methods show that the higher the number assigned (usually between 0-4), the more aggressive the cancer type or more widespread is the cancer in the body.
• Treatment protocols vary according to the type and stage of the cancer. Most treatment protocols are designed to fit the individual patient's disease. However, most treatments include at least one of the following and may include all: surgery, chemotherapy, and radiation therapy.
• The prognosis of cancer can range from excellent to poor. The prognosis depends on the cancer type and its staging with those cancers known to be aggressive and those staged with higher numbers (3-4) often have a prognosis that ranges more toward poor.
• Some cancers can be prevented by taking simple precautions, other cancers may have the risk of contracting them reduced by several methods, and a few may be difficult to avoid for some individuals.

http://www.medicinenet.com/cancer/article.htm