Types of Cancer : Kidney Cancer

Definition

Your kidneys are two bean-shaped organs, each about the size of your fist. They're located behind your abdominal organs, one on each side of your spine. Like other major organs in the body, the kidneys can sometimes develop cancer.

In adults, the most common type of kidney cancer is renal cell carcinoma, which begins in the cells that line the small tubes within your kidneys. Children are more likely to develop a kind of kidney cancer called Wilms' tumor.

The American Cancer Society estimates that almost 51,000 people in the United States are diagnosed with kidney cancer each year. The incidence of kidney cancer seems to be increasing, though it isn't clear why. Many kidney cancers are detected during procedures for other diseases or conditions. Imaging techniques, such as computerized tomography (CT), are being used more often, which may help find more kidney cancers.

Symptoms

Kidney cancer rarely causes signs or symptoms in its early stages. In the later stages, kidney cancer signs and symptoms may include:

• Blood in your urine, which may appear pink, red or cola-colored
• Back pain just below the ribs that doesn't go away
• Weight loss
• Fatigue
• Intermittent fever

Causes

Your kidneys are part of the urinary system, which removes waste and excess fluid and electrolytes from your blood, controls the production of red blood cells, and regulates your blood pressure. Inside each kidney are more than a million small filtering units called nephrons. As blood circulates through your kidneys, the nephrons filter out waste products as well as unneeded minerals and water. This liquid waste — urine — flows through two narrow tubes (ureters) into your bladder, where it's stored until it's eliminated from your body through another tube, the urethra.

Just what causes kidney cells to become cancerous isn't clear. But researchers have identified certain factors that appear to increase the risk of kidney cancer.

Types of kidney cancer
The most common types of kidney cancer include:

• Renal cell carcinoma. This type of kidney cancer usually begins in the cells that line the small tubes of each nephron. In most cases, renal cell tumors grow as a single mass, but you may have more than one tumor in a kidney or develop tumors in both kidneys.
• Transitional cell carcinoma. This type of kidney cancer develops in the tissue that forms the tubes that connect the kidneys to the bladder. Transitional cell carcinomas can also begin in the ureters themselves or in the bladder.
• Wilms' tumor. Wilms' tumor is a type of kidney cancer that occurs in young children.

Risk factors

Renal cell carcinoma risk factors
The majority of kidney cancers are renal cell carcinomas. Risk factors for renal cell carcinoma include:

• Age. Your risk of renal cell carcinoma increases as you age. Renal cell carcinoma occurs most commonly in people 60 and older.
• Sex. Men are more likely to develop renal cell carcinoma than women are.
• Smoking. Smokers have a greater risk of renal cell carcinoma than nonsmokers do. The risk increases the longer you smoke and decreases after you quit.
• Obesity. People who are obese have a higher risk of renal cell carcinoma than do people who are considered average weight.
• High blood pressure (hypertension). High blood pressure increases your risk of renal cell carcinoma, but it isn't clear why. Some research in animals has linked high blood pressure medications to an increased risk of kidney cancer, but studies in people have had conflicting results.
• Chemicals in your workplace. Workers who are exposed to certain chemicals on the job may have a higher risk of renal cell carcinoma. People who work with chemicals such as asbestos, cadmium and trichloroethylene may have an increased risk of kidney cancer.
• Treatment for kidney failure. People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer. People who have a kidney transplant and receive immunosuppressant drugs also are more likely to develop kidney cancer.
• Von Hippel-Lindau disease. People with this inherited disorder are likely to develop several kinds of tumors, including, in some cases, renal cell carcinoma.
• Hereditary papillary renal cell carcinoma. Having this inherited condition makes it more likely you'll develop one or more renal cell carcinomas.

Transitional cell carcinoma risk factors
Risk factors for transitional cell carcinoma include:

• Smoking. Smoking increases your risk of transitional cell carcinomas.
• Chemicals in your workplace. Working with certain chemicals may increase your risk of transitional cell carcinoma.
• A withdrawn medication. Phenacetin, which was removed from the market in the United States in the early 1980s, has been linked to kidney cancer. Phenacetin was used in prescription and over-the-counter pain relievers.

When to seek medical advice

See your doctor right away if you notice blood in your urine. In most cases, this doesn't mean you have kidney cancer. Blood in the urine may be a sign of many other conditions.

Tests and diagnosis

A kidney cancer diagnosis typically begins with a complete medical history and a physical exam. Your doctor may also recommend blood and urine tests. If your doctor suspects a problem or if you're at high risk of kidney cancer, you may also have one or more of the following tests to check your kidneys for growths or tumors:

• Ultrasound. An ultrasound uses high-frequency sound waves to generate images of your internal organs, such as your kidneys and bladder, on a computer screen.
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scan. CT scans use computers to create more-detailed images than those produced by conventional X-rays. MRI scans use magnetic fields and radio waves to generate cross-sectional pictures of your body.

• Tissue sample (biopsy). In selected cases, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. During a biopsy, a surgeon uses ultrasound or CT images to guide a long, thin needle into your kidney to remove the cells. The cells are then examined under a microscope to determine whether they are cancer.

  Biopsy procedures have risks, such as infection, bleeding and a very small chance that cancer could spread to the area where the needle is inserted. Because surgery is usually the first line treatment for kidney cancer, your doctor may forgo biopsy if he or she believes your tumor is very likely to be cancerous. That way you avoid the additional risks of a biopsy. Kidney biopsy is typically reserved for cases that are most likely to be noncancerous or for people who can't undergo an operation.

Additional tests for transitional cell cancer
Tests and procedures used to diagnose transitional cell kidney cancer may include:

• X-ray imaging of your urinary system (excretory urogram). X-rays of your urinary system may show signs of cancer. Your health care team will inject a dye into a vein in your arm. The dye is processed by your kidneys and your urinary system, and the dye makes it possible to see your urinary system on an X-ray.
• Looking inside your bladder (cystoscopy). Your doctor may use a long, narrow tube called a cystoscope to see the inside of your bladder. The cystoscope, which carries a light source and a special lens, is inserted through your urethra into your bladder. A cystoscope can also be used to extract a small tissue sample (biopsy) from any suspicious areas.

Kidney cancer staging
Once your doctor diagnoses kidney cancer, the next step is to determine the extent, or stage, of the cancer. Staging tests for kidney cancer may include additional CT scans, a chest X-ray or other imaging scans your doctor feels are appropriate.

Then your doctor assigns a number, called a stage, to your cancer. Kidney cancer stages include:

• I. Tumor is small and confined to the kidney
• II. Tumor is larger than a stage I tumor, and is confined to the kidney
• III. Tumor extends beyond the kidney to the surrounding tissue or the adrenal glands, and may also spread to a nearby lymph node
• IV. Cancer spreads outside the kidney or to distant parts of the body

Treatments and drugs

Together, you and your treatment team will discuss all of your kidney cancer treatment options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your own preferences for treatment.

Surgery
Surgery is the initial treatment for the majority of kidney cancers. Surgical procedures used to treat kidney cancer include:

• Removing the affected kidney (nephrectomy). Radical nephrectomy involves the removal of the kidney as well as the adrenal gland that sits atop the kidney, a border of healthy tissue and adjacent lymph nodes. Nephrectomy can be done through an incision, meaning the surgeon makes a large cut in your skin to access your kidney. Or nephrectomy can be done laparoscopically, using small incisions to insert a video camera and tiny surgical tools. The surgeon watches a video monitor in order to perform the nephrectomy.
• Removing the tumor from the kidney (nephron-sparing surgery). During this procedure, the surgeon removes the tumor, rather than the entire kidney. Nephron-sparing surgery may be an option if you have only one kidney or if you have an early-stage kidney cancer.

What type of surgery your doctor recommends will be based on your cancer and its stage, as well as your health and personal preferences. Surgery carries a risk of bleeding and infection.

Treatments when surgery isn't possible
For some people, surgery may be too risky. These people have other options for treating their kidney cancers, including:

• Blocking blood flow to the tumor (embolization). In this procedure, a special material is injected into the main blood vessel leading to the kidney. By clogging this vessel, the tumor is deprived of oxygen and other nutrients. Arterial embolization also may be used before an operation or to relieve pain and bleeding when an operation isn't possible. Side effects may include temporary nausea, vomiting or pain.
• Treatment to freeze cancer cells (cryoablation). Recent studies show cryoablation may be useful for treating kidney tumors that can't be removed through surgery. During cryoablation, one or more special needles (cryoprobes) are inserted through small incisions in your skin and into the tumor. Gas in the needles creates extreme cold that causes the cells around the point of each needle to freeze. Doctors use CT scans to monitor the procedure and to ensure that all of the visible cancer tissue and some of the surrounding healthy tissue is frozen. Another type of gas in the needles creates warmth to thaw the frozen tissue. Then the process is repeated. The cycles of freezing and thawing cause cancer cells to die. You may experience some pain after the procedure. Rare side effects may include bleeding, infection and damage to tissue surrounding the tumor.

Treatments for advanced and recurrent kidney cancer
Kidney cancer that recurs and kidney cancer that spreads to other parts of the body may be curable. In these situations, treatments may include:

• Surgery to remove as much of the kidney tumor as possible. Even when surgery can't remove all of your cancer, in some cases it may be helpful to remove as much of the cancer as possible.
• Drugs that use your immune system to fight cancer (biological therapy). Biological therapy (immunotherapy) uses your body's immune system to fight cancer. Drugs in this category include interferon and interleukin-2, which are synthetic versions of chemicals made in your body. These biological therapy drugs have serious side effects, including chills, fever, nausea, vomiting and loss of appetite. Biological therapy drugs are sometimes used alone, in combination or after surgery.
• Treatment that targets specific aspects of your cancer (targeted therapy). Targeted treatments block specific abnormal signals present in kidney cancer cells that allow them to proliferate. These drugs have shown promise in treating kidney cancer that has spread to other areas of the body. Two targeted drugs, sorafenib (Nexavar) and sunitinib (Sutent), block signals that play a role in the growth of blood vessels that provide nutrients to cancer cells and allow cancer cells to spread. Temsirolimus (Torisel), another targeted drug, blocks a signal that allows cancer cells to grow and survive. Targeted therapy drugs can cause side effects, such as a rash that can be severe, diarrhea and fatigue. Targeted drugs can also be very expensive, sometimes costing over $1,000 a treatment.
• Treatments for distant tumors. Kidney cancer cells that travel to other parts of the body (metastasize) can sometimes be treated. This depends on the number of distant tumors, their locations and your general health. Treatment options vary based on where your cancer has spread. Options might include surgery for brain metastasis or radiation for kidney cancer that has spread to bones.
• Clinical trials. Clinical trials are studies of new treatments and new techniques for treating kidney cancer and other diseases. Participating in a clinical trial may give you a chance to try the latest treatments, but it can't guarantee a cure. Discuss the available clinical trials with your doctor and carefully weigh the benefits and risks. Many kidney cancer clinical trials are studying new and existing targeted therapies to determine the best ways to use this new class of drugs.

Treatment for transitional cell cancer
Treatment for transitional cell cancer typically involves an extensive operation to remove the tumor, ureter, kidney and a portion of the bladder. Surgery to remove only the tumor may be an option in some cases.

Chemotherapy may be useful in treating transitional cell cancer that has spread or that recurs. Chemotherapy is a drug treatment that uses chemicals to kill quickly growing cells, such as cancer cells. Other rapidly growing cells, such as those in your gastrointestinal tract and your hair follicles, also are killed by chemotherapy drugs, which can cause side effects including nausea, vomiting and hair loss.

Prevention

Taking steps to improve your health may help reduce your risk of kidney cancer. To reduce your risk, try to:

• Quit smoking. If you smoke, quit. Many options for quitting exist, including support programs, medications and nicotine replacement products. Tell your doctor you want to quit and discuss your options together.
• Eat more fruits and vegetables. Add more fruits and vegetables to your diet. A variety of fruits and vegetables helps ensure that you're getting all the nutrients that your body needs. Replacing some of your snacks and side dishes with fruits and vegetables may help you lose weight.
• Exercise regularly. Aim for at least 30 minutes of exercise on most days. If you haven't been active before, get your doctor's permission. Start out slowly, and gradually increase the amount of time you exercise. Consider exercises such as walking or riding a bike.
• Maintain a healthy weight. Work to maintain a healthy weight. If you're overweight or obese, reduce the amount of calories you eat each day and try to exercise most days of the week. Ask your doctor about other healthy strategies to help you lose weight.
• Control high blood pressure. Ask your doctor to check your blood pressure at your next appointment. If your blood pressure is high, you can discuss options for lowering your numbers. Lifestyle measures, such as exercise, weight loss and diet changes, can help. Some people may need to add medications to lower their blood pressure. Discuss your options with your doctor.
• Reduce or avoid exposure to environmental toxins. If you work with toxic chemicals, take special precautions such as wearing a mask and heavy gloves. In the United States, your employer is required to tell you what chemicals you may be exposed to on the job. Follow your employer's safety procedures and ask your doctor if there are other ways to protect yourself from chemical exposure.

Types of Cancer : Anal Cancer

Definition

Anal cancer is an uncommon type of cancer that occurs in the anal canal. The anal canal is a short tube at the end of your rectum through which stool leaves your body.

About 5,000 people in the United States are diagnosed with anal cancer each year, according to the National Cancer Institute. The incidence of anal cancer is increasing, though it isn't clear why.

Most cases of anal cancer are diagnosed at an early stage — when treatment provides the best chance for a cure. Most people with anal cancer are treated with a combination of chemotherapy and radiation.

Symptoms

Anal cancer signs and symptoms include:

• Bleeding from the anus or rectum
• Pain in the area of the anus
• A mass or growth in the anal canal
• Anal itching

Some people with anal cancer don't experience any signs or symptoms.

When to see a doctor
The signs and symptoms of anal cancer aren't specific to this disease. Some people mistake their signs and symptoms for more common conditions, such as hemorrhoids, and don't see their doctors. Talk to your doctor about any signs and symptoms that bother you, especially if you have any factors that increase your risk of anal cancer. Treatment for anal cancer is more likely to succeed if cancer is found at an earlier stage.

Causes

Doctors don't know what causes anal cancer. What's known is that something occurs to create a genetic mutation within a cell that can lead to anal cancer.

In general, cancer begins with a genetic mutation that turns normal, healthy cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can separate from an initial tumor to spread elsewhere in the body (metastasize).

Risk factors

Several factors have been found to increase the risk of anal cancer, including:

• Your age. Most cases of anal cancer occur in people age 50 and older.
• Having many sexual partners. Men and women who have many sexual partners over their lifetimes have a greater risk of anal cancer.
• Anal sex. Men and women who engage in anal sex have an increased risk of anal cancer.
• Smoking. Smoking cigarettes may increase your risk of anal cancer. Former smokers have only a slightly elevated risk of anal cancer.
• Human papillomavirus (HPV). HPV infection increases your risk of several cancers, including anal cancer and cervical cancer. HPV infection is a sexually transmitted disease that can also cause genital warts. HPV may cause cells in the anal canal to appear abnormal — a condition called anal squamous intraepithelial lesions (ASIL). The abnormal cells associated with ASIL aren't cancer, but they may develop into anal cancer. However, some people with ASIL never develop anal cancer.
• Drugs or conditions that suppress your immune system. People who take drugs to suppress their immune systems (immunosuppressive drugs), including people who have received organ transplants, may have an increased risk of anal cancer. Long-term use of corticosteroids, such as those prescribed to control autoimmune disorders, also may increase the risk of anal cancer. HIV — the virus that causes AIDS — suppresses the immune system and increases the risk of anal cancer.

Complications

Anal cancer rarely spreads (metastasizes) to distant parts of the body. Only a small percentage of tumors are found to have spread, but those that do are especially difficult to treat. Anal cancer that metastasizes most commonly spreads to the liver and the lungs.

Preparing for your appointment

f you think you may have anal cancer, you're likely to start by first seeing your family doctor or a general practitioner. If your doctor thinks you could have anal cancer, you may be referred to a surgeon or a specialist who treats digestive diseases (gastroenterologist). Once a cancer diagnosis is made, you may also be referred to a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For anal cancer, some basic questions to ask your doctor include:

• What is the stage of my anal cancer?
• What other tests do I need?
• What are my treatment options?
• Is there one treatment that's best for my type and stage of cancer?
• What are the potential side effects for each treatment?
• Should I seek a second opinion? Can you give me names of specialists you recommend?
• Am I eligible for clinical trials?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Tests and diagnosis

Tests and procedures used to diagnose anal cancer include:

• Examining your anal canal and rectum for abnormalities. During a digital rectal exam (DRE), your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths. DRE isn't used to diagnose anal cancer, but it can give your doctor an indication of what further testing might be appropriate.
• Visually inspecting your anal canal and rectum. Your doctor may use a short, lighted tube (anoscope) to inspect your anal canal and rectum for anything unusual. Your doctor inserts the lubricated tube into your rectum to examine your anal canal and rectum. You may feel pressure during anoscopy, but it shouldn't hurt. You may be required to take laxatives or an enema in order to clean your rectum before the procedure.
• Taking sound wave pictures of your anal canal. In order to create a sonogram picture of your anal canal, your doctor inserts a probe, similar to a thick thermometer, into your anal canal and rectum. The probe emits high-energy sound waves, called ultrasound waves, which bounce off tissues and organs in your body to create a picture. Your doctor evaluates the sonogram picture to look for anything abnormal.
• Removing a sample of tissue for laboratory testing. If your doctor discovers any unusual areas, he or she may take small samples of affected tissue (biopsy) and send the samples to a laboratory for analysis. By looking at the cells under a microscope, doctors can determine if the cells are cancerous. Biopsy samples are typically removed during anoscopy. You may feel a pinch and experience some bleeding during a biopsy procedure.

Staging
Once it's confirmed that you have anal cancer, your doctor works to determine the size of the cancer and whether it has spread — a process called staging. Determining your cancer's stage helps your doctor determine the best approach to treating your cancer. Tests and procedures used in the staging of your cancer may include:

• Images of your pelvis and abdomen. Your doctor may use computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) to make scans of your pelvis and abdomen to assess the extent of your cancer.
• X-ray images of your chest. X-rays of your chest can reveal if cancer has spread to your lungs or the bones in your chest.

Your doctor uses the information from the procedures to assign your cancer a stage. The stages of anal cancer are:

• Stage I. Anal cancer is 2 centimeters (about 3/4 inch) or less — about the size of a peanut or smaller.
• Stage II. Anal cancer is larger than 2 centimeters (about 3/4 inch), but has not spread beyond the anal canal.
• Stage IIIA. Anal cancer is any size and has spread either to lymph nodes near the rectum or to nearby areas, such as the bladder, urethra or vagina.
• Stage IIIB. Anal cancer is any size and has spread to nearby areas and lymph nodes, or it has spread to other lymph nodes in the pelvis.
• Stage IV. Anal cancer has spread to parts of the body away from the pelvis.

Treatments and drugs

What treatment you receive for anal cancer depends on the stage of your cancer, your overall health and your own preferences.

Combined chemotherapy and radiation
Doctors usually treat anal cancer with a combination of chemotherapy and radiation. Combined, these two treatments enhance each other and improve chances for a cure.

• Chemotherapy. Chemotherapy drugs are injected into a vein or taken as pills. The chemicals travel throughout your body, killing rapidly growing cells, such as cancer cells. Unfortunately they also damage healthy cells that grow rapidly, including those in your gastrointestinal tract and in your hair follicles. This causes side effects such as nausea, vomiting and hair loss.
• Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. During radiation therapy, you're positioned on a table and a large machine moves around you, directing radiation beams to specific areas of your body in order to target your cancer. Radiation may damage healthy tissue near where the beams are aimed. Side effects may include skin redness and sores in and around your anus, as well as hardening and shrinking of your anal canal.

You typically undergo radiation therapy for anal cancer for five or six weeks. Chemotherapy is typically administered during the first week and the fifth week. Your doctor tailors your treatment schedule based on characteristics of your cancer and your overall health. Though combining chemotherapy and radiation increases the effectiveness of the two treatments, it also makes side effects more likely. Discuss with your doctor what side effects to expect.

People with HIV are more likely to experience side effects when undergoing chemotherapy and radiation, since treatments can weaken their already-vulnerable immune systems. Side effects make it more difficult to endure and complete treatment. For this reason, your doctor may recommend lower doses of chemotherapy and radiation if you have HIV.

Surgery
Doctors typically use different procedures to remove anal cancer based on the stage of the cancer:

• Surgery to remove early-stage anal cancers. Very small anal cancers that haven't spread beyond the anal canal may be removed through surgery. During this procedure, the surgeon removes the tumor and a small amount of healthy tissue that surrounds it. Because the tumors are small, early-stage cancers can sometimes be removed without damaging the anal sphincter muscles that surround the anal canal. Anal sphincter muscles control bowel movements, so doctors work to keep the muscles intact. Depending on your cancer, your doctor may also recommend chemotherapy and radiation after surgery.

  If your cancer can't be removed without damaging the anal sphincters, your doctor may recommend trying combined chemotherapy and radiation first. Combined treatment may shrink your cancer to a size that allows your surgeon to perform sphincter-sparing surgery.

• Surgery for late-stage anal cancers or anal cancers that haven't responded to other treatments. If your cancer hasn't responded to chemotherapy and radiation, or if your cancer is advanced, your doctor may recommend a more extensive operation called abdominoperineal resection, which is sometimes referred to as an AP resection. During this procedure the surgeon removes the anal canal, rectum and a portion of the colon. The surgeon then attaches the remaining portion of your colon to an opening in your abdomen (stoma) through which waste will leave your body and collect in a colostomy bag.

Alternative medicine

Alternative medicine treatments can't cure anal cancer. But some alternative medicine treatments may help you cope with the side effects of cancer treatment. Your doctor can treat many side effects, but sometimes medications aren't enough. Alternative treatments can complement your doctor's treatments and may offer additional comfort.

Options for common side effects include:

• Fatigue — gentle exercises, tai chi or yoga
• Nausea — acupuncture or aromatherapy
• Pain — acupuncture, massage or meditation

While these options are generally safe, talk it over with your doctor first to be sure that alternative medicine options won't interfere with your cancer treatment.

Types of Cancer : Male Breast Cancer

Definition

Breast cancer isn't just a woman's disease. Men also have breast tissue that can undergo cancerous changes. While women are about 100 times more likely to get breast cancer, any man can develop breast cancer. Male breast cancer is most common between the ages of 60 and 70.

The prognosis for male breast cancer is the same as for breast cancer in women. In the past, male breast cancer was often diagnosed at a more advanced stage, which may have led people to believe it had a worse prognosis. Although male breast cancer and breast cancer in women are similar, important distinctions such as breast size and awareness affect early diagnosis and survival in cases of male breast cancer.

Symptoms

Knowing the signs and symptoms of breast cancer may help save your life. The earlier the disease is discovered, the more treatment options and the better chance of recovery you have.

The most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often the lump is painless. Other male breast cancer symptoms include:

• Skin dimpling or puckering
• Development of a new retraction or indentation of the nipple
• Changes in the nipple or breast skin, such as scaling or redness
• Nipple discharge

Causes

Cancer is a group of abnormal cells that grow more rapidly than do normal cells. Cancer cells also have the ability to invade and destroy normal tissues, either by growing directly into surrounding structures or after traveling to another part of your body through your bloodstream or lymphatic system. Microscopic cancer cells form small clusters that continue to grow, becoming more densely packed and hard.

In most cases it isn't clear what triggers abnormal cell growth in breast tissue in men. But doctors do know that about one in six cases of breast cancers in men are inherited, compared with about 5 percent to 10 percent of breast cancers in women. Defects in breast cancer gene 1 or 2 (BRCA 1 or BCRA 2) put you at greater risk of developing breast cancer. Other inherited genes also may increase your risk of developing breast cancer. Knowing your family history is important to determine your chance of inheriting an abnormal gene.

Most genetic mutations related to breast cancer aren't inherited, but instead develop during your lifetime. These acquired mutations may result from radiation exposure, such as receiving chest radiation therapy in childhood, or from other, as yet unknown, factors.

Risk factors

A risk factor is anything that makes it more likely you'll get a particular disease. But not all risk factors are created equal. Some, such as your age, sex and family history, can't be changed. Others, including smoking and a poor diet, are personal choices over which you have some control.

Having one or even several risk factors doesn't necessarily mean you'll become sick — some men with more than one risk factor never get breast cancer, whereas others with no identifiable risk factors do.

Factors that may make you more susceptible to breast cancer include:

• Age. Breast cancer is most commonly diagnosed in men between the ages of 60 and 70, with an average age range of 65 to 67.
• Family history. If you have a close relative, such as a mother or sister, with breast cancer, you have a greater chance of also developing the disease. About one in five men with breast cancer have a relative who's had it, too. Just because you have a family history of breast cancer doesn't mean it's hereditary, though.

• Genetic predisposition. In men, nearly 20 percent of breast cancers are inherited. Defects in one of several genes, especially BRCA1 or BRCA2 put you at greater risk of developing breast and prostate cancers. Usually these genes help prevent cancer by making proteins that keep cells from growing abnormally. But if they have a mutation, the genes aren't as effective at protecting you from cancer.

  Men with a BRCA2 mutation have a 6 percent lifetime risk of breast cancer — about 100 times more than other men's risk. Inherited mutations in the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene also make it more likely that you'll develop breast cancer.

• Radiation exposure. If you received radiation treatments to your chest as a child or young adult, you're more likely to develop breast cancer later in life.

• Klinefelter's syndrome. This condition results from an abnormality of the sex chromosomes, X and Y, present at birth (congenital). A male normally has only one X and one Y chromosome. In Klinefelter's syndrome, two or more X chromosomes are present in addition to one Y chromosome. The Y chromosome contains the genetic material that determines the sex of a child and related development.

  The extra X chromosome that occurs in Klinefelter's syndrome causes abnormal development of the testicles. As a result, men with this syndrome produce lower levels of certain male hormones — androgens — and more female hormones — estrogens, which can cause noncancerous breast growth (gynecomastia). Men with this condition may be at greater risk of breast cancer, though this connection is still unclear.

• Exposure to estrogen. If you take estrogen-related drugs, such as those used as part of a sex change procedure, you have a much higher risk of breast cancer. Estrogen drugs may also be used in hormone therapy for prostate cancer. Such drugs may slightly increase your risk of breast cancer, though not enough to outweigh the benefit of treating prostate cancer.
• Liver disease. If you have liver disease, such as cirrhosis of the liver, your body's androgen activity may be reduced and its estrogen activity greater. This can increase your risk of gynecomastia and breast cancer.
• Excess weight. Obesity may be a risk factor for breast cancer in men, because it increases the number of fat cells in the body. Fat cells convert androgens into estrogen, increasing the amount of estrogen in your body and, therefore, your risk of breast cancer.
• Excessive use of alcohol. If you drink heavy amounts of alcohol, you have a greater risk of breast cancer.

When to seek medical advice

Most breast lumps in men are a result of enlarged breasts (gynecomastia), not breast cancer. However, it's important to have lumps evaluated promptly. If a problem exists, you can have it identified and treated as soon as possible. See your doctor if you discover a lump or any of the other warning signs of breast cancer.

Tests and diagnosis

Because male breast cancer is rare, routine screening mammograms (mammography) generally aren't recommended for men. If, however, you have a strong family history of breast cancer, consider talking to your doctor about developing a breast-screening program.

If your doctor suspects breast cancer, to diagnose your condition he or she may conduct a number of tests including breast examination (clinical breast exam), mammograms (mammography) or other tests:

• Clinical breast exam. During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you missed and will assess how large the lumps are, how they feel, and how close they are to your skin and muscles. Your doctor will also examine the rest of your body for signs that the cancer has spread, such as an enlarged liver or lymph nodes.
• Mammogram. A mammogram uses a series of X-rays to show images of your breast tissue. This test may be even more accurate in men than in women, because men don't have dense breast tissue that can make it difficult to distinguish abnormal from normal tissue or breast cysts. During a mammogram, your breasts are compressed between plastic plates while a radiology technician takes the X-rays. If you find the compression too uncomfortable, tell the technician.
• Breast ultrasound (ultrasonography). Your doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to form images of structures within the body.
• Nipple discharge examination. Your doctor may collect nipple discharge if you're experiencing it. The discharge is then examined for cancerous cells.

• Biopsy. A biopsy is the only way for your doctor to know whether a lump or abnormality is cancer. Biopsies can provide important information about an unusual breast change and help determine whether treatment is needed and, if so, the type of treatment required. To obtain a tissue sample, your doctor may use one of several procedures.

  Fine-needle aspiration biopsy is used for lumps you or your doctor can feel. During the procedure your doctor uses a thin, hollow needle to withdraw cells from the lump. He or she then sends the cells to a lab for analysis.

  In core needle biopsy, a radiologist or surgeon uses a hollow needle to remove tissue samples from a breast lump. A number of samples, each about the size of a grain of rice, may be taken, and a pathologist then analyzes them for malignant cells. The advantage of a core needle biopsy is that it removes tissue, rather than just cells, for analysis.

  In surgical biopsy, your surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is larger, only a sample will be taken (incisional biopsy). The biopsy is generally performed on an outpatient basis in a clinic or hospital.

• Estrogen and progesterone receptor tests. If a biopsy reveals malignant cells, your doctor will recommend additional tests — such as estrogen and progesterone receptor tests — on the malignant cells. These tests help determine whether female hormones affect the way the cancer grows. About 90 percent of male breast cancers have estrogen receptors, and more than 80 percent have progesterone receptors. If the cancer cells have receptors for estrogen or progesterone or both, your doctor may recommend treatment with a drug such as tamoxifen, which prevents estrogen from binding to these cells and stimulating growth.
• HER2 testing. If the biopsy shows malignant cells, your doctor may also test the sample for the presence of a protein called human epidermal growth factor receptor-2 (HER2), which promotes the growth of cancer cells. About 30 percent of male breast cancers have too much of this protein. Such cancers are usually more aggressive, growing and spreading more quickly than do other breast cancers. Once identified, this type of cancer is treated with a drug called trastuzumab (Herceptin). This medication keeps the protein from stimulating the growth of breast cancer cells.

Staging tests
If your doctor finds cancer, he or she will examine you further to determine if and how far the cancer has spread. Staging tests help determine the size and location of your cancer and whether it has spread. They also help your doctor determine the best treatment for you. Cancer is staged using the numbers 0 through IV:

• Stage 0 cancers are also called noninvasive or in situ (in one place) cancers. Although they haven't spread to other parts of your body or invaded normal breast tissue, it's important to have them removed, because they eventually can become invasive cancers. Finding and treating a cancerous lump at this stage offers the best chance for a full recovery.
• Stage I to IV cancers are invasive tumors that have the ability to spread to other areas. A stage I cancer is small and well localized and has a very successful treatment rate. But the higher the stage number, the lower the chances of cure. By stage IV, the cancer has spread beyond your breast to other organs, such as your bones, lungs or liver. Although it may not be possible to eliminate the cancer at this stage, its spread and some symptoms may be controlled with radiation, hormonal therapy, chemotherapy or all three.

Tests to determine a cancer's spread may include:

• Chest X-ray. Your doctor may take a chest X-ray to see whether the cancer has spread to your lungs.
• Computerized tomography. A CT scan is an X-ray technique that produces more-detailed images of your internal organs than do conventional X-ray exams. Conventional X-ray exams produce 2-D images. But CT uses an X-ray-sensing unit that rotates around your body and a large computer to create cross-sectional images (like slices) of the inside of your body. A CT scan can help your doctor see if cancer has spread to your liver or other organs. Some CT scans require you to ingest a contrast medium before the scan. A contrast medium blocks X-rays and appears white on images, which can help emphasize some structures in your body.
• Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images. Most MRI machines are large, cylindrical-shaped magnets. The strong magnetic field is produced by passing an electric current through wire loops or coils, which are located inside a protective housing. Other coils in the housing send and receive radio waves. When you're in the machine, your body produces very faint signals in response to the radio waves. These signals are detected by coils within the machine, or by additional coils designed to surround a specific body part needing examination. A computer then processes the signals and generates an image. The collected signals create a composite, 3-D representation of your body.
• Positron emission tomography (PET) scan. Unlike other scanning techniques, a PET scan doesn't produce clear structural images of organs. Instead, it shows images containing areas of more or less intense color to provide information about chemical activity within certain organs and tissues. Tumors often use more energy than healthy tissues do and may absorb more of a radioactive tracer, which allows the tumors to appear on the scan.

Genetic testing
The discovery of BRCA2 and other genes that may increase breast cancer risk has raised a number of emotional and legal questions about genetic testing. A simple blood test can help identify defective BRCA genes, but it's not 100 percent accurate. And it's important to know that having a defective BRCA gene doesn't mean you'll get breast cancer. In addition, test results can't determine at what age you might develop cancer, how aggressively the cancer might progress or what your risk of death might be.

In general, testing is most beneficial if the results will help you make a decision about how you might best reduce your chance of developing breast cancer, such as modifying your lifestyle or closer screening. It may also help family members decide if they should be tested or evaluated for the presence of an abnormal gene. Be sure to thoroughly discuss all your options with a genetic counselor before any testing is done, so that you can understand the risks and the benefits of such testing.

Treatments and drugs

Breast cancer in men is generally treated the same as it is in women. In most cases no one right treatment exists. Instead, you'll want to find the approach that's best for you. To do that, you'll need to consider many different factors, including the stage of your cancer and your age.

Before making any decisions, learn as much as you can about the many treatment options. Talk extensively with your health care team. Consider a second opinion. Don't be afraid to ask questions. In addition, look for breast cancer books, Web sites, and information from organizations such as the American Cancer Society and Susan G. Komen for the Cure. Talking to others who have faced the same decision also may help. This may be the most important decision you ever make.

Treatments exist for every type and stage of breast cancer. Some men may need only surgery. Others will need surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy.

Surgery
Breast-sparing procedures are often an option for women, but are not typically feasible for men. This is because a man's breast doesn't contain much tissue, so removing the cancer usually means removing all of the breast. Breast cancer operations include the following:

• Simple mastectomy. During a simple mastectomy, your surgeon removes all of your breast tissue — the lobules, ducts, fatty tissue, and a strip of skin with the nipple and areola. Depending on the results of the operation and follow-up tests, you may also need treatment with radiation to the chest wall, chemotherapy or hormone therapy.
• Modified radical mastectomy. Most men with breast cancer require a modified radical mastectomy. In this procedure, a surgeon removes your entire breast and some underarm (axillary) lymph nodes, but leaves your chest muscles intact. If the cancer has spread into the chest wall, your doctor may need to do a radical mastectomy that removes the chest wall muscles. Serious arm swelling (lymphedema) is more likely to occur in modified radical mastectomy than in simple mastectomy with sentinel node biopsy. Your lymph nodes will be tested to see if the cancer has spread. Depending on those results, you may need further treatment.
• Sentinel lymph node biopsy. Breast cancer first spreads to the lymph nodes under the arm. That's why you need to have these nodes examined. If your surgeon doesn't plan to do this, be sure you understand the reason. Until recently surgeons would remove as many lymph nodes as possible. But this greatly increased the risk of numbness, recurrent infections and serious swelling of the arm. That's why a procedure has been developed that focuses on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to develop cancer. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small, and no other nodes need to be removed. This spares the need for a more extensive operation and decreases the risk of complications. It's important that the procedure be performed by an experienced team.

Radiation therapy
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It's administered by a radiation oncologist at a radiation center. It may be used to shrink the tumor before surgery or to eliminate any remaining cancer cells in the breast, chest muscles or armpit after surgery.

Most men who undergo radiation therapy for breast cancer receive external beam radiation. In this procedure you receive radiation directed at the cancerous area from a machine outside your body. Radiation is usually started three to four weeks after surgery, to allow some time for your body to heal.

If your doctor recommends chemotherapy, the radiation will be delayed until all of the chemotherapy treatments are completed. You'll typically receive treatment five days a week for about six consecutive weeks. The treatments are painless, and each treatment takes just a few minutes. The effects are cumulative, however, and you may become quite tired toward the end of the series. Your breast may be pink, puffy and somewhat tender, as if it had been sunburned.

Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. Your doctor may recommend chemotherapy after surgery to kill any cancer cells that may have spread outside your breast. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both. You may have treatments every two or three weeks for three to six months.

For many people, chemotherapy can feel like another illness. The side effects may include hair loss, nausea, vomiting and fatigue. These effects occur because chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow — as well as cancerous ones. Not everyone has side effects, however, and there are now better ways to control some of them.

New drugs can help prevent or reduce nausea. Relaxation techniques, including guided imagery, meditation and deep breathing, also may help. In addition, exercise has been shown to be effective in reducing fatigue caused by chemotherapy.

One side effect of chemotherapy that has only recently been described is called "chemobrain." This refers to the difficulties some patients have with thinking or concentrating while receiving chemotherapy or after. It's uncertain how commonly this occurs, or if this is even due to the chemotherapy. Many people who receive chemotherapy don't experience this side effect. Those who do may have difficulty with word finding, memory, multitasking and learning new things. Studies suggest it may effect between 20 percent and 30 percent of people undergoing chemotherapy. There's no way to predict who will experience this mild cognitive impairment, and it's not clear whether the treatment or the cancer is the actual cause of chemobrain.

In rare cases, certain chemotherapy medications may lead to cancer of the white blood cells (acute myeloid leukemia) — usually within one to two years after treatment ends. Some chemotherapy medications have the potential to damage the heart.

Hormone therapy
Estrogen receptor positive cancer means that estrogen might encourage the growth of breast cancer cells in your body. Estrogen is present in men, though in smaller amounts than in women. But 90 percent of breast cancers in men have estrogen receptors. Normally estrogen binds to certain cells in your breast and in other parts of your body. Hormone-blocking agents such as tamoxifen block this binding of estrogen to those receptors. This may help destroy cancer cells that have spread or reduce the chances that your cancer will recur.

The primary medication used to reduce the effect of estrogen in your body is tamoxifen (Nolvadex). This synthetic hormone belongs to a class of drugs known as selective estrogen receptor modulators (SERMs). It's used as a treatment for men with hormone-sensitive metastatic breast cancer and as an adjuvant therapy for men with early-stage estrogen receptor positive breast cancer. You take tamoxifen daily, in pill form, for five years.

The male hormones — androgens — also play a role in the growth of breast cancer in men, although the role is unclear. Limiting androgens through the use of certain drugs does appear to effectively reduce the spread of the cancer. These drugs include:

• Luteinizing hormone-releasing hormone analogues. These drugs cause the testicles to reduce their androgen production.
• Anti-androgen drugs. Anti-androgens block the effect of male hormones on breast cancer cells.

Side effects of hormonal therapies may include hot flashes, decreased sexual desire, loss of erection, weight gain and mood swings.

A new group of hormonal therapy medications called aromatase inhibitors (anastrozole, exemestane and letrozole) are used to treat hormone-sensitive breast cancer in postmenopausal women. At this time, no data exist as to the usefulness of these medications in the treatment of male breast cancer.

Herceptin therapy
One new medication, trastuzumab (Herceptin), is a monoclonal antibody that attacks and blocks the activity of a certain protein made by some breast cancers. Only about one-third of breast cancers make too much of this protein called HER-2-neu. This protein stimulates the cancer cells to grow. Trastuzumab binds onto this protein and blocks its effect and kills the cancer cells. This treatment only works in those breast cancers that make too much HER-2-neu. Side effects of trastuzumab are uncommon, but may include heart problems, fever, chills, nausea and vomiting, weakness, diarrhea and headache.

Biological therapy
Sometimes called biological response modifier or immunotherapy, this treatment tries to stimulate your body's immune system to fight cancer. Using substances produced by the body or similar substances made in a laboratory, biological therapy seeks to enhance your body's natural defenses against specific diseases. Many of these therapies are experimental and available only in clinical trials.

Prevention

To help reduce your risk of breast cancer, maintain a healthy body weight and avoid heavy alcohol use. Early detection also increases your chances of surviving the disease. So if you develop a breast lump or other abnormality, seek prompt care.

Types of Cancer : Liver Cancer

Definition

Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

Liver cancer is one of the most common forms of cancer in the world, but liver cancer is uncommon in the United States. Rates of liver cancer diagnosis are increasing in the United States.

In the United States, most cancer that occurs in the liver begins in another area of the body, such as the colon, lung or breast. Doctors call this metastatic cancer, rather than liver cancer. And this type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.

Symptoms

Most people don't have signs and symptoms in the early stages of primary liver cancer. When symptoms do appear, they may include:

• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• An enlarged liver
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)

When to see a doctor
Make an appointment with your doctor if you experience any signs or symptoms that worry you.

Causes

It's not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.

Liver cancer occurs when liver cells develop changes (mutations) in their DNA — the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of malignant cells.

Types of liver cancer
Primary liver cancer, which begins in the cells of the liver, is divided into different types based on the kind of cells that become cancerous. Types include:

• Hepatocellular carcinoma (HCC). This is the most common form of primary liver cancer in both children and adults. It starts in the hepatocytes, the main type of liver cell.
• Cholangiocarcinoma. This type of cancer begins in the small tube-like bile ducts within the liver. This type of cancer is sometimes called bile duct cancer.
• Hepatoblastoma. This rare type of liver cancer affects children younger than 4 years of age. Most children with hepatoblastoma can be successfully treated.
• Angiosarcoma or hemangiosarcoma. These rare cancers begin in the blood vessels of the liver and grow very quickly.

Risk factors

Factors that increase the risk of primary liver cancer include:

• Your sex. Men are more likely to develop liver cancer than are women.
• Your age. In North America, Europe and Australia, liver cancer most commonly affects older adults. In developing countries of Asia and Africa, liver cancer diagnosis tends to occur at a younger age — between 20 and 50.
• Chronic infection with HBV or HCV. Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
• Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
• Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis, autoimmune hepatitis and Wilson's disease.
• Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than do people who don't have diabetes.
• Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
• Exposure to aflatoxins. Consuming foods contaminated with fungi that produce aflatoxins greatly increases the risk of liver cancer. Crops such as corn and peanuts can become contaminated with aflatoxins.
• Excessive alcohol consumption. Consuming more than a moderate amount of alcohol can lead to irreversible liver damage and increase your risk of liver cancer.
• Obesity. Having an unhealthy body mass index increases the risk of liver cancer.

Preparing for your appointment

If you think you may have liver cancer, you're likely to start by first seeing your family doctor or a general practitioner. If your doctor suspects you may have liver cancer, you may be referred to a doctor who specializes in diseases of the liver (hepatologist) or to a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For liver cancer, some basic questions to ask your doctor include:

• What type of liver cancer do I have?
• What is the stage of my liver cancer?
• What does my pathology report say? Can I have a copy of the pathology report?
• Will I need more tests?
• What are my treatment options?
• What are the potential side effects of each treatment option?
• Is there one treatment you recommend over the others?
• What advice would you give a loved one in my same situation?
• How will my treatment affect my daily life?
• How much time can I take to make my decision about liver cancer treatment?
• Should I seek a second opinion?
• Should I see a liver cancer specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Tests and diagnosis

Diagnosing liver cancer
Tests and procedures used to diagnose liver cancer include:

• Blood tests. Blood tests may reveal liver function abnormalities.
• Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
• Removing a sample of liver tissue for testing. During a liver biopsy, a sample of tissue is removed from your liver and examined under a microscope. Your doctor may insert a thin needle through your skin and into your liver to obtain a tissue sample. Liver biopsy carries a risk of bleeding, bruising and infection.

Determining the extent of the liver cancer
Once cancer is diagnosed, your doctor will work to determine the extent (stage) of the liver cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CT, MRI, chest X-ray and bone scan.

The stages of liver cancer are:

• Stage I. At this stage, liver cancer is a single tumor confined to the liver that hasn't grown to invade any blood vessels.
• Stage II. Liver cancer at this stage can be a single tumor that has grown to invade nearby blood vessels, or it can be multiple small tumors in the liver.
• Stage III. This stage may indicate that the cancer is composed of several larger tumors. Or cancer may be one large tumor that has grown to invade the liver's main veins or to invade nearby structures, such as the gallbladder.
• Stage IV. At this stage, liver cancer has spread beyond the liver to other areas of the body.

Treatments and drugs

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.

The goal of any treatment is to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or spreading. In some cases only comfort care is appropriate. In this situation, the goal of treatment is not to remove or slow the disease but to help relieve symptoms, making you as comfortable as possible.

Liver cancer treatment options may include:

• Surgery to remove a portion of the liver. Your doctor may recommend partial hepatectomy to remove the liver cancer and a small portion of healthy tissue that surrounds it if your tumor is small and your liver function is good.
• Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery may be an option for people with early-stage liver cancer who also have cirrhosis.
• Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. Cryoablation can be the only liver cancer treatment, or it can be used along with surgery, chemotherapy or other standard treatments.
• Heating cancer cells. In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. Using an ultrasound or CT scan as a guide, your surgeon inserts several thin needles into small incisions in your abdomen. When the needles reach the tumor, they're heated with an electric current, destroying the cancer cells.
• Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die.
• Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. During the procedure, the hepatic artery — the artery from which liver cancers derive their blood supply — is blocked, and chemotherapy drugs are injected between the blockage and the liver.
• Radiation therapy. This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors. During radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body. Radiation side effects may include fatigue, nausea and vomiting.
• Targeted drug therapy. Sorafenib (Nexavar) is a targeted drug designed to interfere with a tumor's ability to generate new blood vessels. Sorafenib has been shown to slow or stop advanced liver cancer from progressing for a few months longer than with no treatment. More studies are needed to understand how this and other targeted therapies may be used to control advanced liver cancer.

Alternative medicine

Alternative treatments may help control pain in people with advanced liver cancer. Your doctor will work to control pain with treatments and medications. But sometimes your pain may persist or you may want to avoid the side effects of pain medications.

Ask your doctor about alternative treatments that may help you cope with pain, such as:

• Acupressure
• Acupuncture
• Deep breathing
• Listening to music (music therapy)
• Massage

Types of Cancer : Gallbladder Cancer

Definition

Gallbladder cancer is cancer that begins in the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder stores bile, a digestive fluid produced by your liver.

Gallbladder cancer is uncommon. When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, when the prognosis is often very poor.

Gallbladder cancer is difficult to diagnose because it often causes no signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.

Symptoms

Gallbladder cancer signs and symptoms may include:

• Abdominal pain, particularly in the upper right portion of the abdomen
• Abdominal bloating
• Itchiness
• Fever
• Loss of appetite
• Losing weight without trying
• Nausea
• Yellowing of the skin and whites of the eyes (jaundice)

When to see a doctor
Make an appointment with your doctor if you experience any signs or symptoms that worry you.

Causes

It's not clear what causes gallbladder cancer. Doctors know that gallbladder cancer forms when healthy gallbladder cells develop changes (mutations) in their DNA. These mutations cause cells to grow out of control and to continue living when other cells would normally die. The accumulating cells form a tumor that can grow beyond the gallbladder and spread to other areas of the body.

Most gallbladder cancer begins in the cells that line the inner surface of the gallbladder. Gallbladder cancer that begins in this type of cell is most commonly called adenocarcinoma. This term refers to the way the cancer cells appear when examined under a microscope.

Risk factors

Factors that can increase the risk of gallbladder cancer include:

• Your sex. Gallbladder cancer is more common in women than it is in men.
• Your age. Your risk of gallbladder cancer increases as you age.
• A history of gallstones. Gallbladder cancer is most common in people who have had gallstones in the past. Still, gallbladder cancer is very rare in these people.
• Other gallbladder diseases and conditions. Other gallbladder conditions that can increase the risk of gallbladder cancer include porcelain gallbladder, choledochal cyst and chronic gallbladder infection.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. If your doctor suspects you may have gallbladder cancer, you may be referred to a doctor who specializes in treating digestive conditions (gastroenterologist), a surgeon who operates on the liver or gallbladder, or a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For gallbladder cancer, some basic questions to ask your doctor include:

• What is my stage of gallbladder cancer?
• Can you explain the pathology report to me? Can I have a copy of my pathology report?
• Will I need more tests?
• What are the treatment options for my gallbladder cancer?
• What are the benefits and risks of each option?
• Is there one treatment option you recommend over the others?
• What would you recommend to a loved one in my same situation?
• Should I get a second opinion from a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment if you don't understand something.

Tests and diagnosis

Diagnosing gallbladder cancer
Tests and procedures used to diagnose gallbladder cancer include:

• Blood tests. Blood tests to evaluate your liver function may help your doctor determine what's causing your signs and symptoms.
• Procedures to create images of the gallbladder. Imaging tests that can create pictures of the gallbladder include ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI).

Determining the extent of gallbladder cancer
Once your doctor diagnoses your gallbladder cancer, he or she works to find the extent (stage) of your cancer. Your gallbladder cancer's stage helps determine your prognosis and your treatment options. Tests and procedures used to stage gallbladder cancer include:

• Exploratory surgery. Your doctor may recommend surgery to look inside your abdomen for signs that gallbladder cancer has spread. In a procedure called laparoscopy, the surgeon makes a small incision in your abdomen and inserts a tiny camera. The camera allows the surgeon to examine organs surrounding your gallbladder for signs that the cancer has spread.
• Tests to examine the bile ducts. Your doctor may recommend procedures to inject dye into the bile ducts. This is followed by an imaging test that records where the dye goes. These tests can show blockages in the bile ducts. These tests may include endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiography and percutaneous transhepatic cholangiography.

Stages of gallbladder cancer
The stages of gallbladder cancer are:

• Stage I. At this stage, gallbladder cancer is confined to the inner layers of the gallbladder.
• Stage II. This stage of gallbladder cancer has grown to invade the outer layer of the gallbladder and may protrude into nearby organs, such as the liver, stomach, intestines or pancreas. This stage of cancer may also include less extensive tumors that have spread to nearby lymph nodes.
• Stage III. At this stage, gallbladder cancer has grown to invade more than one of the nearby organs, or it may invade the portal vein or hepatic artery.
• Stage IV. The latest stage of gallbladder cancer includes tumors of any size that have spread to distant areas of the body.

Treatments and drugs

What gallbladder cancer treatment options are available to you depend on the stage of your cancer, your overall health and your preferences. The initial goal of treatment is to remove the gallbladder cancer, but when that isn't possible, other therapies may help control the spread of the disease and keep you as comfortable as possible.

Surgery for early-stage gallbladder cancers
Surgery may be an option if you have an early-stage gallbladder cancer. Options include:

• Surgery to remove the gallbladder. Early gallbladder cancer that is confined to the gallbladder is most often treated with an operation to remove the gallbladder (cholecystectomy).
• Surgery to remove the gallbladder and a portion of the liver. Gallbladder cancer that extends beyond the gallbladder and into the liver is sometimes treated with surgery to remove the gallbladder, as well as a portion of the liver and bile ducts that surround the gallbladder.

It's not clear whether additional treatments after successful surgery can increase the chances that your gallbladder cancer won't return. Some studies have found this to be the case, so in some instances, your doctor may recommend chemotherapy, radiation therapy or a combination of both after surgery. Still, this is controversial because few studies have tested these additional treatments.

Treatments for late-stage gallbladder cancer
Surgery can't cure gallbladder cancer that has spread beyond the gallbladder. Instead, doctors use treatments that may relieve signs and symptoms of cancer and make you as comfortable as possible. Options may include:

• Chemotherapy. Chemotherapy is a drug treatment that uses chemicals to kill cancer cells.
• Radiation therapy. Radiation uses high-powered beams of energy, such as X-rays, to kill cancer cells.
• Procedures to relieve blocked bile ducts. Advanced gallbladder cancer can cause blockages in the bile ducts, causing further complications. Procedures to relieve the blockage may help. For instance, surgeons can place a hollow metal tube (stent) in a duct to hold it open or surgically reroute bile ducts around the blockage (biliary bypass).