Cancer Treatment

Breast cancer is an uncontrolled, potentially deadly division of cells in the breast. In the United States, breast cancer is the most common women's cancer. According to the American Cancer Society and the National Cancer Institute, an average of 1 American woman in 8 will develop breast cancer sometime during her life. Women in Africa and Asia have a lower risk of breast cancer than do women in North America and Europe. A small number of men also develop breast cancer.

The risk of breast cancer increases for all women as they grow older. A woman's risk also increases if a relative, especially her mother or a sister, has also had the disease. Scientists have found two rare abnormal genes, called BRCA1 and BRCA2, that greatly increase risk. Tests to detect these genes are available, but doctors disagree about when such tests should be used. Most women with one or two relatives who have had breast cancer do not have inherited genetic abnormalities.

A painless lump is the most common symptom of breast cancer. Doctors advise women to examine their own breasts for lumps every month. A breast X ray called a mammogram can detect many cancers before they can be felt. Most doctors recommend an annual mammogram for women over 50 years old.

Doctors usually begin treatment of breast cancer by surgically removing the tumor. When the cancer is small, a lumpectomy can preserve the breast. In this operation, a surgeon removes the cancerous lump and a margin of the normal tissue surrounding it. The breast is then treated with radiation to kill stray cancer cells. If the cancer is large, the entire breast must often be removed in a modified radical mastectomy .

In either a lumpectomy or a mastectomy, doctors also remove and examine lymph nodes from the armpit. These nodes are small masses of tissue that help the body fight disease by filtering out bacteria and other harmful particles. Cancer in the lymph nodes indicates a high risk that the tumor will reappear in other parts of the body. A tumor that is especially large or has extremely disorganized cells may also increase risk of renewed cancer even if the lymph nodes are healthy. If the tumor will likely reappear, doctors offer additional treatments.

To determine the best treatment, doctors test some cancer cells to see if female hormones make them grow. If the cells respond, doctors may prescribe the drug tamoxifen to block the action of these hormones. If hormones have no effect, or if the patient still has menstrual periods, doctors may use chemotherapy (drugs that have a toxic effect on a disease). Both tamoxifen and chemotherapy significantly reduce the risk of cancer returning.

Cervical cancer is uncontrolled multiplication of cells in a woman's cervix. The cervix includes the lower portion and opening of the uterus, the hollow, muscular organ in which a baby develops. Throughout the world, cancer of the cervix is an extremely common cancer of the female reproductive system. But it is a cancer that can be diagnosed and cured in its early stages.

Cervical cancer arises in cells of the epithelium, a type of tissue that covers the cervix. The first phase of the disease is called cervical intraepithelial neoplasia and often abbreviated CIN. In CIN, cells of the epithelium look abnormal under a microscope but have not yet become cancerous.

Untreated CIN may progress to a phase known as preinvasive. The progression usually occurs over 5 to 10 years but may take less than a year. Preinvasive neoplasia has not yet spread from the epithelium into deeper tissues of the cervix. The preinvasive phase may then progress to invasive cancer. Invasive cancer extends into layers of cervical tissue beneath the epithelium. In the most advanced cases, it reaches other organs or even distant parts of the body.

A simple, painless office procedure called a Pap test can detect all stages of cervical cell abnormalities. If a Pap test reveals abnormalities, doctors usually examine the cervix with a type of microscope called a colposcope. Tissue samples from suspicious areas provide a definite diagnosis.

Doctors can treat most cases of CIN or preinvasive neoplasia by removing only the affected cervical tissue. Removal methods include surgery, laser vaporization, and cryotherapy (freezing). Women with no future plans to have children may be treated with a hysterectomy (removal of the entire uterus).

In most cases, doctors can cure invasive cervical cancer with either a radical hysterectomy (surgery that removes the uterus and nearby lymph nodes) or with radiation. Radiation combined with chemotherapy (treatment with drugs) can also cure many tumors that extend to nearby organs. Cancer that has spread to distant parts of the body can rarely be cured but may be controlled for some time with chemotherapy.

The most common cause of cervical cancer is infection with human papilloma virus (HPV). This virus is transmitted during sexual intercourse. Smoking cigarettes or inhaling second-hand smoke increases the risk of infection. Having sex during early adolescence also increases risk, because the cervical epithelium is more easily infected in young women. Having sex with multiple partners raises risk, as does having sex with one partner who has had many other partners. In 2002, scientists announced progress in developing a vaccine that is effective against HPV and which may be used to prevent cervical cancer caused by the virus.

Colon cancer is the common name for an uncontrolled division of cells in the large intestine. Many doctors prefer the term colorectal cancer, because the disease most often affects the main part of the large intestine, called the colon, and the last part, called the rectum.

Colorectal cancer is one of the most common cancers in North America and Europe, but it is relatively rare in Asia and Africa. The difference may be due to regional variations in diet. Studies show that people may help avoid this disease through a diet that is low in fat and rich in fruits and vegetables. Other studies suggest that small doses of aspirin at least every other day may also help prevent colorectal cancer.

Conditions that inflame the intestine, such as ulcerative colitis, increase a person's risk of developing colorectal cancer. People who have family members with that type of cancer also have an increased risk. Scientists have identified abnormalities in particular genes (the hereditary material in cells) that are associated with some rare forms of the disease. Experts believe that many common types of colorectal cancer also involve genetic abnormalities. Cancer often arises in polyps, small noncancerous growths in the intestine. A tendency to develop polyps is probably influenced by genes, as well.

In its early stages, cancer in the right side of the large intestine may not cause noticeable symptoms. Cancer that develops in the left side of the colon or the rectum often affects an individual's bowel habits. People should see a doctor if they experience any change in the frequency of their bowel movements or pain while having a movement. Stools (solid body wastes) that look unusually narrow or appear to contain blood should also be evaluated.

Many doctors recommend that middle-aged people have routine tests for colorectal cancer. Doctors often give such patients special kits to collect tiny samples of stool as part of their regular checkups. Laboratories test these samples for microscopic amounts of blood, which may indicate cancer. Periodic examinations with special instruments that enable doctors to see inside the intestine are also recommended. During these examinations, doctors can obtain samples of suspicious tissue, which can be checked under a microscope for cancer cells.

Most patients whose cancer is confined to the intestine have the growth surgically removed. They may also receive radiation therapy or chemotherapy (treatment with drugs). These patients have an excellent chance of being cured. Patients whose cancer has spread beyond the intestine usually have surgery, supplemented by radiation therapy or chemotherapy.

Hodgkin's disease is a type of cancer in which the lymph nodes become. Other lymphoid tissues, such as the spleen, also may become swollen. Most victims of Hodgkin's disease are 20 to 40 years old. The disease, which strikes more men than women, may be fatal. Its cause is unknown.

Beginning in the 1960's, medical researchers discovered much about Hodgkin's disease and how to control or even conquer it. They learned that the disease (1) spreads in a fairly predictable way from one group of lymph nodes to the next; (2) takes a relatively long time to spread to other areas of the body; (3) can usually be treated successfully with radiation in early stages; and (4) can often be treated successfully with drugs in advanced stages. Hodgkin's disease resembles other diseases that also cause swelling of the lymph nodes. Physicians identify the condition by the presence in the swollen tissue of large cells called Reed-Sternberg cells. Most of these large cells have two nuclei. Hodgkin's disease was first described by Thomas Hodgkin, an English physician, in 1832.

Leukemia is a cancer of the bone marrow, which is the soft, spongy, blood-forming tissue within bones. Bone marrow produces three types of blood cells: (1) white blood cells that fight infections; (2) red blood cells that carry oxygen from the lungs to the rest of the body; and (3) platelets, tiny blood cells that help stop bleeding. In leukemia, large numbers of abnormal white blood cells multiply in an uncontrolled manner in the bone marrow and crowd out normal blood cells. In addition, the abnormal white blood cells do not fight infections.

Symptoms of leukemia include fevers and infections. Fatigue, anemia (a lack of functioning red blood cells), and bleeding or bruising due to low platelet count are also among the symptoms of the disease.

Leukemia is classified as acute or chronic, depending on how quickly it develops. The disease is also classified by the type of white blood cells affected. The most common types of white blood cells are lymphoid and myeloid, and each kind fights certain infections. When leukemia affects lymphoid cells, it is called lymphocytic leukemia. Leukemia that affects myeloid cells is called myeloid or myelogenous leukemia. Both lymphocytic and myeloid leukemia may be acute or chronic.

Acute leukemias develop extremely quickly. Abnormal, immature white blood cells multiply rapidly, and the number of normal cells decreases sharply. Acute lymphocytic leukemia is the most common leukemia in children. About 70 percent of children with this leukemia can be cured with current treatments.

The most common treatment for acute lymphocytic leukemia is chemotherapy, the use of chemicals to kill the cancer cells. Radiation therapy may be combined with chemotherapy to treat this leukemia. Radiation therapy uses high-energy X-rays to kill cancer cells. Another treatment is bone marrow transplant, in which the diseased bone marrow is destroyed and replaced with healthy bone marrow from a donor.

All treatments for acute leukemias are intensive and may endanger the patient's life. The use of powerful antibiotics and of blood transfusions has increased the chances of surviving the intensive therapy.

Acute myeloid leukemia usually strikes adults. Chemotherapy is the preferred treatment for this leukemia. Seventy percent of patients receiving chemotherapy enter remission. During remission, the blood cells and bone marrow return to normal. Patients are considered cured if they remain in remission for at least two years. However, only 25 percent of patients with acute myeloid leukemia remain in remission and are cured.

Chronic leukemias develop more slowly than acute leukemias. In chronic leukemias, the abnormal white blood cells appear mature and resemble normal white blood cells. In the early stages of the disease, the abnormal cells even function normally. Chronic lymphocytic leukemia is the most common leukemia among adults. The disease may take as long as 10 years to develop. This leukemia typically changes within several years into an acute leukemia that is resistant to most treatments. Chronic myeloid leukemia also occurs primarily in adults.

The cause of most leukemia is unknown. Possible causes include genetic abnormalities and exposure to radiation or certain chemicals. In patients with chronic myeloid leukemia, sections of two chromosomes have switched places. This switch leads to the production of an enzyme that triggers cell growth. Scientists have created a drug that blocks the action of the enzyme. The drug, marketed as Gleevec, is highly effective for treating chronic myeloid leukemia. By targeting the abnormality that causes the growth of the leukemia cells, Gleevec kills only leukemia cells. As a result, side effects of the treatment are minimal. Scientists are working to identify all the molecular abnormalities of each type of leukemia so that similar treatments can be developed.

Lung cancer is an uncontrolled, extremely deadly division of cells in the lung. In most developed countries, it kills more men and women than any other form of cancer. The death rate is high because many lung cancers have spread through the body by the time symptoms appear. Once lung cancer has spread, it is extremely difficult to cure.

Smoking causes most cases of lung cancer. The risk of developing lung cancer increases according to the length of time and the amount a person smokes. Exposure to secondhand smoke also increases risk. Other causes include long-term exposure to a radioactive gas called radon or to airborne asbestos fibers .

Symptoms of lung cancer include persistent cough, weight loss, shortness of breath, coughing up blood, chest pain, or a hoarse voice. If lung cancer is suspected, doctors may begin their examination by examining a patient's sputum (coughed-up material) for cancer cells. Patients may also have a chest X ray to reveal suspicious masses or other signs of lung disease.

Doctors further investigate abnormal lung areas by obtaining a biopsy (sample of tissue) and examining it under a microscope. In one biopsy procedure, doctors pass a thin, lighted tube called a bronchoscope into the bronchi. The bronchi are the lung's breathing tubes, where most cancers form. Doctors can test other lung parts with a technique called video thoracoscopy. In this technique, tiny cameras inserted into the chest send detailed pictures to a big screen, enabling doctors to find and sample abnormalities.

If diagnostic tests show cancer, doctors identify the type of lung cell from which the cancer developed. The various types of cells respond differently to treatments. Treatment also depends on whether the cancer has spread beyond the lung. Many lung cancers spread first to lymph nodes in the chest. These nodes are small masses of tissue that help fight disease by filtering out bacteria and other harmful particles. Other sites invaded by lung cancer include bones, the brain, and the liver.

Doctors can sometimes cure patients whose cancer has not spread. If cancer appears confined to the lung and the patient is otherwise healthy, surgeons usually remove all or part of the lung. During surgery, doctors also remove lymph nodes and test them for cancer cells.

Few patients whose cancer has spread can be cured. Treatment of these patients aims at extending life and reducing pain. Doctors may prescribe drug treatments-called chemotherapy-or radiation therapy to try to shrink tumors and relieve symptoms.

Prostate cancer is an uncontrolled division of cells in the prostate gland, a walnut-sized internal organ of the male reproductive system. In the United States, prostate cancer kills more men than any other cancer except lung cancer. African American men have the highest rate of prostate cancer in the world. Individuals have an increased risk of prostate cancer if other men in their families have also had the disease.

A cancerous prostate gland may become enlarged and press on the urethra, the tube through which urine leaves the body. The expanding gland may also put pressure on the bladder. Many prostate cancer patients consult a doctor because this pressure causes frequent urination or difficulty passing urine.

Doctors must perform tests to determine if these symptoms are due to cancer or to noncancerous enlargement of the prostate, another common condition. The first such test is often a digital rectal examination. In this procedure, a doctor feels the prostate gland directly by inserting a finger, covered with a lubricated glove, into the patient's rectum. A lump or an area of hardness may indicate cancer. Another means of diagnosing prostate cancer is a blood test that measures a protein called prostate-specific antigen (PSA). Elevated levels of PSA, which is produced only in the prostate gland, may indicate cancer.

A suspicious digital exam or PSA test is often followed by an ultrasound examination, which uses sound waves to create a detailed image of the prostate. This image aids a doctor in obtaining small surgical samples of tissue from the gland. If the tissue is cancerous, more tests are needed to determine if the cancer is confined to the prostate or has spread elsewhere in the body.

Doctors can often cure cancer that remains confined to the prostate by radiation therapy or by surgical removal of the gland. Both treatments may interfere with a man's ability to have sexual relations or may cause urinary incontinence (inability to hold back urine). Surgeons have developed an operation that may avoid sexual problems by preserving nerves important in sexual functioning. Doctors extend the lives of patients whose cancer has spread beyond the prostate gland with treatments that reduce levels of male hormones. Prostate cancer cells need male hormones to survive and grow.

Doctors recommend that middle-aged men have an annual digital rectal examination to detect any prostate cancer before it causes symptoms. Many doctors also recommend an annual PSA test, which can detect small tumors before they can be felt. Some doctors fear that this use of the PSA test will find some slow-growing cancers that would never become life-threatening. Treating such cancers may subject patients to the risks of unnecessary surgery or other procedures. But doctors cannot yet predict which tumors will become life-threatening.

Skin cancer is the world's most common form of cancer. Like nearly all living tissue, the skin constantly forms new cells to replace worn ones. But some harmful factors-especially the sun's rays-can damage the genes (hereditary material) in skin cells. When certain genes are damaged, cells can multiply wildly instead of dividing in their normal, orderly way. Cancer arises from this uncontrolled multiplication.

The best way to prevent skin cancer is to protect the skin from excess sun. Doctors believe that people could avoid many skin cancers with such measures as using sunscreen regularly and wearing protective clothing.

Doctors group skin cancer in two broad categories that reflect different levels of seriousness of the disease. The more serious category is a dangerous skin cancer called melanoma. The other category-nonmelanoma skin cancer-is much easier to treat.

Melanoma arises in melanocytes, the cells that make the pigment that gives skin its natural color. Some melanomas form in moles that change into cancer. Others begin to grow in skin with no previous markings. Melanoma is an extremely aggressive cancer that tends to spread to other parts of the body. But most melanomas that are detected early can be cured by removing the growth and a margin of healthy tissue.

Because early detection is so vital, doctors recommend that people learn the warning signs of melanoma and examine their skin regularly. Skin examination is especially important for people who have an increased risk of melanoma. Factors for increased risk include having light skin and green or blue eyes; having a large number of moles; and having already had a melanoma.

Doctors have developed a memory aid called ABCD to help people remember how to evaluate a pigmented area for danger signs of melanoma. In ABCD, A stands for asymmetry--that is, the shape of one side is unlike the other side; B stands for an irregular border; C stands for variations in color; and D stands for diameter greater than 6 millimeters (about the size of a pencil eraser). People should see a doctor immediately about an area that has any of these characteristics.

Nonmelanoma skin cancer occurs in two principal forms-basal cell cancer and squamous cell cancer. Both of these cancers can have a wide variety of appearances, including small red or pearly bumps; flat, scaly, red areas; or sores that do not heal. Experts recommend that people consult a medical professional about any change in their skin that lasts longer than about three weeks.

Basal cell cancer is the most common nonmelanoma skin cancer. It rarely spreads beyond the skin. Squamous cell cancer is slightly more likely to spread than basal cell. Because they usually do not spread, most nonmelanoma cancers can be cured by removing the affected skin. Cancer that has spread is more difficult to cure. People who have had one nonmelanoma skin cancer have an increased risk of forming additional cancers in their skin and in their other organs. Anyone who has had skin cancer should have regular medical checkups.

Testicular cancer is an uncontrolled division of cells in the testicles, a pair of oval glands of the male reproductive system. The testicles, also called testes, hang behind the penis in a sack called the scrotum. Testicular cancer is a relatively rare type of cancer. But unlike many other cancers, it occurs primarily in men under 35 years of age. Research shows that the incidence of this type of cancer may be slowly rising.

A painless lump or area of hardness in one testicle is the most common symptom of testicular cancer. Other signs may sometimes include back pain or tenderness of the breasts. Doctors advise young men to conduct a testicular self-examination every month to detect lumps or abnormal growths. A doctor may examine a lump using ultrasound (high frequency sound waves). Physicians also perform blood tests to detect certain chemicals that testicular cancer cells release. These chemicals, which include human chorionic gonadotropin (hCG) and alpha fetoprotein (AFP), can be measured in tiny amounts.

Doctors usually begin treatment of testicular cancer by surgically removing the affected testicle. A pathologist (expert on tissue changes) examines the tissue under a microscope to confirm that cancer is present and to determine certain properties that affect treatment choices. Surgery may also include removal of lymph nodes to check if cancer has spread. Testicular cancer rarely spreads to other parts of the body, and surgery usually results in a complete cure. A patient is considered completely cured if blood tests after surgery find no trace of hCG or AFP. The removal of one testicle does not usually interfere with a man's ability to have sexual relations, and many patients can still have children.

If the cancer has spread beyond the testicle, surgery may be followed with radiation or chemotherapy (drugs that kill cancer cells). One type of testicular cancer, called seminoma, is treatable with radiation. Another type, called nonseminoma, is best treated with chemotherapy. Even patients whose cancer has spread have an excellent chance of being cured.