Types of Cancer : Pancreatic Cancer

Definition

Pancreatic cancer begins in the tissues of your pancreas — a large organ that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars.

Pancreatic cancer often has a poor prognosis, even when diagnosed early. Pancreatic cancer typically spreads rapidly and is seldom detected in its early stages, which is a major reason why it's a leading cause of cancer death. Signs and symptoms may not appear until pancreatic cancer is quite advanced and surgical removal isn't possible.

Symptoms

Signs and symptoms of pancreatic cancer often don't occur until the disease is advanced. When signs and symptoms do appear, they may include:

• Upper abdominal pain that may radiate to your back
• Yellowing of your skin and the whites of your eyes (jaundice)
• Loss of appetite
• Weight loss
• Depression

Causes

Pancreatic cancer occurs when cells in your pancreas develop genetic mutations. These mutations cause the cells to grow uncontrollably and to continue living after normal cells would die. These accumulating cells can form a tumor.

Understanding your pancreas
Your pancreas is about 6 inches (15 centimeters) long and looks something like a pear lying on its side. The pancreas is a crucial part of your digestive system. It secretes hormones, including insulin, to help your body process sugar. And it produces digestive juices to help your body digest food.

Types of pancreatic cancer
The types of cells involved in a pancreatic cancer help determine the best treatment. Types of pancreatic cancer include:

• Cancer that forms in the pancreas ducts (adenocarcinoma). Cells that line the ducts of the pancreas help produce digestive juices. The majority of pancreatic cancers are adenocarcinomas. Sometimes these cancers are called exocrine tumors.
• Cancer that forms in the hormone-producing cells. Cancer that forms in the hormone-producing cells of the pancreas is called endocrine cancer. Endocrine cancers of the pancreas are very rare.

Risk factors

Factors that may increase your risk of pancreatic cancer include:

• Smoking.
• Being overweight or obese.
• Personal or family history of chronic inflammation of the pancreas (pancreatitis).
• Personal or family history of pancreatic cancer.
• Family history of genetic syndromes that can increase cancer risk, including a BRCA2 gene mutation, Peutz-Jeghers syndrome, Lynch syndrome and familial atypical mole-malignant melanoma (FAMMM).
• Older age. Pancreatic cancer occurs most often in older adults. Most people diagnosed with pancreatic cancer are in their 70s and 80s.
• Being black. Pancreatic cancer occurs more frequently in blacks than in whites.

When to seek medical advice

See your doctor if you experience an unexplained weight loss, abdominal pain, jaundice, or other signs and symptoms that bother you. Many diseases and conditions other than cancer may cause similar signs and symptoms, so your doctor will check for these conditions as well as for pancreatic cancer.

Tests and diagnosis

Researchers are studying ways to detect pancreatic cancer early. However, it isn't clear who should undergo screening and which screening tests may most reliably find pancreatic cancer in its earliest stages. Currently no standard screening exists for pancreatic cancer.

Diagnosing pancreatic cancer
If your doctor suspects pancreatic cancer, you may have one or more of the following tests to diagnose the cancer:

• Ultrasound. Ultrasound uses high-frequency sound waves to create moving images of your internal organs, including your pancreas. The ultrasound sensor (transducer) is placed on your upper abdomen to obtain images.
• Computerized tomography (CT) scan. CT scan uses X-ray images to help your doctor visualize your internal organs. In some cases you may receive an injection of dye into a vein in your arm to help highlight the areas your doctor wants to see.
• Magnetic resonance imaging (MRI). MRI uses a powerful magnetic field and radio waves to create images of your pancreas.
• Endoscopic retrograde cholangiopancreatography (ERCP). This procedure uses a dye to highlight the bile ducts in your pancreas. During ERCP, a thin, flexible tube (endoscope) is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so that your doctor can more easily see the openings of your pancreatic and bile ducts. A dye is then injected into the ducts through a small hollow tube (catheter) that's passed through the endoscope. Finally, X-rays are taken of the ducts. A tissue or cell sample (biopsy) can be collected during ERCP.
• Endoscopic ultrasound (EUS). EUS uses an ultrasound device to make images of your pancreas from inside your abdomen. The ultrasound device is passed through an endoscope into your stomach in order to obtain the images. Your doctor may also collect a sample of cells (biopsy) during EUS.
• Percutaneous transhepatic cholangiography (PTC). PTC involves injecting a dye into your liver to highlight your bile ducts. Your doctor carefully inserts a thin needle into your liver and injects the dye into the bile ducts in your liver. A special X-ray machine (fluoroscope) tracks the dye as it moves through the ducts.
• Biopsy. During a biopsy, your doctor obtains a small sample of tissue from the pancreas for examination under a microscope. A biopsy sample can be obtained by inserting a needle through your skin and into your pancreas (fine-needle aspiration). Or it can be done using endoscopic ultrasound to guide special tools into your pancreas where a sample of cells can be obtained for testing.

Staging pancreatic cancer
Once a diagnosis of pancreatic cancer is confirmed, your doctor will work to determine the extent, or stage, of the cancer. Your cancer's stage helps determine what treatments are available to you. In order to determine the stage of your pancreatic cancer, your doctor may recommend:

• Laparoscopy. Laparoscopy uses a lighted tube with a video camera to explore your pancreas and surrounding tissue. The surgeon passes the laparoscope through an incision in your abdomen. The camera on the end of the scope transmits video to a screen in the operating room. This allows your doctor to look for signs cancer has spread within your abdomen.
• Chest X-ray. A chest X-ray helps your doctor look for signs that cancer has spread to your lungs.
• CT scan. CT scans allow your doctor to see your pancreas and assess whether the cancer has spread to nearby tissues, lymph nodes or other organs.
• MRI. MRI images may show if the cancer has spread beyond the pancreas.
• Positron emission tomography (PET) scan. PET scans use a radioactive tracer injected into a vein in order to help your doctor look for areas where cancer has spread beyond the pancreas. PET scans aren't typically used for pancreatic cancer, but they may offer another way to examine unusual areas found with a CT scan or MRI.
• Bone scan. Bone scans use radioactive tracers to look for evidence that cancer cells have spread to your bones.
• Blood test. Your doctor may test your blood for specific proteins (tumor markers) shed by pancreatic cancer cells. One tumor marker test used in pancreatic cancer is called CA19-9. Some research indicates that the more elevated your level of CA19-9 is, the more advanced the cancer. But the test isn't always reliable, and it isn't clear how best to use the CA19-9 test results. Some doctors measure your levels before, during and after treatment. Others use it to gauge your prognosis.

Stages of pancreatic cancer
The stages of pancreatic cancer can be expressed in different ways. One description of the stages uses three broad categories:

• Resectable. All the tumor nodules can be removed.
• Locally advanced. The tumor can no longer be removed with surgery because the cancer has spread to tissues around the pancreas or into the blood vessels.
• Metastatic. At this stage, the cancer has spread to distant organs, such as the lungs and liver.

Another description of the stages uses numerals:

• Stage I. Cancer is confined to the pancreas.
• Stage II. Cancer has spread beyond the pancreas to nearby tissues and organs and may have spread to the lymph nodes.
• Stage III. Cancer has spread beyond the pancreas to the major blood vessels around the pancreas and may have spread to the lymph nodes.
• Stage IV. Cancer has spread to distant sites beyond the pancreas, such as the liver, lungs and the lining that surrounds your abdominal organs (peritoneum).

Complications

As pancreatic cancer progresses, it can cause complications such as:

• Jaundice. Pancreatic cancer that blocks the liver's bile duct can cause jaundice. Signs include yellow skin and eyes, dark-colored urine and very pale stools.

  Your doctor may recommend that a plastic or metal tube (stent) be placed inside the bile duct to hold it open. In some cases a bypass may be needed to create a new way for bile to flow from the liver to the intestines.

• Pain. A growing tumor may press on nerves in your abdomen, causing pain that can become severe. Pain medications can help you feel more comfortable. Radiation therapy may help stop tumor growth temporarily to give you some relief.

  In severe cases, your doctor may recommend a procedure to inject alcohol into the nerves that control pain in your abdomen (celiac plexus block). This procedure stops the nerves from sending pain signals to your brain.

• Bowel obstruction. Pancreatic cancer that grows into or presses on the small intestine (duodenum) can block the flow of digested food from your stomach into your intestines.

  Your doctor may recommend a tube (stent) be placed in your small intestine to hold it open. Or bypass surgery may be necessary to attach your stomach to a lower point in your intestines that isn't blocked by cancer.

• Weight loss. A number of factors may cause weight loss in people with pancreatic cancer. Nausea and vomiting caused by cancer treatments or a tumor pressing on your stomach may make it difficult to eat. Or your body may have difficulty properly processing nutrients from food because your pancreas isn't making enough digestive juices.

  Your doctor will work to correct the factors contributing to your weight loss. Pancreatic enzyme supplements may be recommended to aid in digestion. Try to maintain your weight by adding extra calories where you can and making mealtime as pleasant and relaxed as possible.

• Death. Pancreatic cancer leads to death for most people diagnosed with the disease. Even people diagnosed when their cancer is at an early stage face a high risk of recurrence and death.

Treatments and drugs

Treatment for pancreatic cancer depends on the stage and location of the cancer as well as on your age, overall health and personal preferences. The first goal of pancreatic cancer treatment is to eliminate the cancer, when possible. When that isn't an option, the focus may be on preventing the pancreatic cancer from growing or causing more harm. When pancreatic cancer is advanced and treatments aren't likely to offer a benefit, your doctor may suggest ways to relieve symptoms and make you as comfortable as possible.

Surgery
Only a small portion of pancreatic cancers are considered resectable — that is, they have a good chance of being removed completely with surgery. Once the cancer has spread beyond the pancreas to other organs, lymph nodes or blood vessels, surgery is usually no longer an option. When surgery is possible, your surgeon may recommend:

• Surgery for tumors in the pancreatic head. If your pancreatic cancer is located in the head of the pancreas, you may consider an operation called a Whipple procedure (pancreatoduodenectomy). The Whipple procedure involves removing the head of your pancreas, as well as a portion of your small intestine (duodenum), your gallbladder and part of your bile duct. Part of your stomach may be removed as well. Your surgeon reconnects the remaining parts of your pancreas, stomach and intestines to allow you to digest food.

  Whipple surgery carries a risk of infection and bleeding. It can cause temporary diabetes until your pancreas recovers from surgery. And some people experience nausea and vomiting that can occur if the stomach has difficulty emptying after surgery (delayed gastric emptying). Expect a long recovery after a Whipple procedure. You'll spend 10 days or more in the hospital and then recover for several more weeks at home.

• Surgery for tumors in the pancreatic tail and body. Surgery to remove the tail of the pancreas or the tail and a small portion of the body is called distal pancreatectomy. Your surgeon may also remove your spleen. Surgery carries a risk of bleeding and infection.

Research shows pancreatic cancer surgery tends to cause fewer complications when done by experienced surgeons. Don't hesitate to ask about your surgeon's experience with pancreatic cancer surgery. If you have any doubts, get a second opinion.

Radiation therapy
Radiation therapy uses high-energy beams to destroy cancer cells. You may receive radiation treatments before or after cancer surgery, often in combination with chemotherapy. Or, your doctor may recommend a combination of radiation and chemotherapy treatments when your cancer can't be treated surgically.

Radiation therapy can come from a machine outside your body (external beam radiation), or it can be placed inside your body near your cancer (brachytherapy). Radiation therapy can also be used during surgery (intraoperative radiation).

Chemotherapy
Chemotherapy uses drugs to help kill cancer cells. Chemotherapy can be injected into a vein or taken orally. You may receive only one chemotherapy drug, or you may receive a combination of chemotherapy drugs.

Chemotherapy can also be combined with radiation therapy (chemoradiation). Chemoradiation is typically used to treat cancer that has spread beyond the pancreas, but only to nearby organs and not to distant regions of the body. This combination may also be used after surgery to reduce the risk that pancreatic cancer may recur.

In people with advanced pancreatic cancer, chemotherapy may be combined with targeted drug therapy.

Targeted drug therapy
Targeted drug therapy is an emerging area of cancer treatment. Targeted drugs attack specific abnormalities within cancer cells. The targeted drug erlotinib (Tarceva) blocks chemicals that signal cancer cells to grow and divide. Erlotinib is usually combined with chemotherapy for use in people with advanced pancreatic cancer.

Many other targeted drug treatments are under investigation in clinical trials. One such drug being studied is cetuximab (Erbitux), which targets the same signals as erlotinib but goes about it a different way.

Clinical trials
Clinical trials are studies to test new forms of treatment, such as new drugs, new approaches to surgery or radiation treatments, and novel methods such as gene therapy. If the treatment being studied proves to be safer or more effective than are current treatments, it will become the new standard of care.

Clinical trials can't guarantee a cure, and they may have serious or unexpected side effects. On the other hand, cancer clinical trials are closely monitored by the federal government to ensure they're conducted as safely as possible. And they offer access to treatments that wouldn't otherwise be available to you.

Talk to your doctor about what clinical trials are available and whether these may be appropriate for you.

New treatments currently under investigation in clinical trials include:

• Drugs that stop cancer from growing new blood vessels. Drugs called angiogenesis inhibitors may help stop cancer from using new blood vessels to get the nutrients it needs to grow. Blood vessels also give cancer cells a pathway to spread to other parts of the body.
• Pancreatic cancer vaccines. Cancer vaccines are being studied to treat cancer, rather than prevent disease, as vaccines are traditionally used. Cancer treatment vaccines use various strategies to enhance the immune system to help it recognize cancer cells as intruders. In one example, a vaccine may help train the immune system to attack a certain protein secreted by pancreatic cancer cells.

Prevention

Although there's no proven way to prevent pancreatic cancer, you can take steps to reduce your risk, including:

• Quit smoking. If you smoke, quit. Talk to your doctor about ways to help you quit, including support groups, medications and nicotine replacement therapy. If you don't smoke, don't start.
• Maintain a healthy weight. Being overweight increases your risk of pancreatic cancer. If you need to lose weight, aim for a slow, steady weight loss — 1 or 2 pounds (0.5 or 1 kilogram) a week. Combine daily exercise with a plant-focused diet with smaller portions to help you lose weight.
• Exercise regularly. Aim for 30 minutes of exercise on most days. If you're not used to exercising, start out slowly and work up to your goal.
• Eat a healthy diet. A diet full of colorful fruits and vegetables and whole grains is good for you, and may help reduce your risk of cancer.

Types of Cancer : Thyroid Gland Cancer

Definition

Thyroid cancer occurs in the cells of the thyroid — a butterfly-shaped gland located at the base of your neck, just below your Adam's apple. Your thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight.

Thyroid cancer isn't common in the United States. About 37,000 people are diagnosed with thyroid cancer each year, according to the National Cancer Institute. Thyroid cancer rates seem to be increasing, which doctors think may be due to new technology that allows them to find small thyroid cancers that may not have been found previously.

Symptoms

Thyroid cancer typically doesn't cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:

• A lump that can be felt through the skin on your neck
• Changes to your voice, including increasing hoarseness
• Difficulty swallowing
• Pain in your neck and throat
• Swollen lymph nodes in your neck

When to see a doctor
If you experience any signs or symptoms that worry you, make an appointment with your doctor. Thyroid cancer isn't common, so your doctor may investigate other causes of your signs and symptoms first.

Causes

It's not clear what causes thyroid cancer. Thyroid cancer occurs when cells in your thyroid undergo genetic changes (mutations). The mutations allow the cells to grow and multiply rapidly. The cells also lose the ability to die, as normal cells would. The accumulating abnormal thyroid cells form a tumor. The abnormal cells can invade nearby tissue and can spread throughout the body.

Types of thyroid cancer
The type of thyroid cancer determines treatment and prognosis. Types of thyroid cancer include:

• Papillary thyroid cancer. The papillary type of thyroid cancer is the most common, making up about 80 percent of all thyroid cancer diagnoses. Papillary thyroid cancer can occur at any age, but is most commonly diagnosed in people ages 30 to 50.
• Follicular thyroid cancer. Follicular thyroid cancer also includes Hurthle cell cancer. Follicular thyroid cancer typically occurs in people older than 50.
• Medullary thyroid cancer. Medullary thyroid cancer may be associated with inherited genetic syndromes that include tumors in other glands. Most medullary thyroid cancers are sporadic, meaning they aren't associated with inherited genetic syndromes.
• Anaplastic thyroid cancer. The anaplastic type of thyroid cancer is very rare, aggressive and very difficult to treat. Anaplastic thyroid cancer typically occurs in people age 60 or older.
• Thyroid lymphoma. Thyroid lymphoma begins in the immune system cells in the thyroid. Thyroid lymphoma is very rare. It occurs most often in adults age 70 or older.

Risk factors

Factors that may increase the risk of thyroid cancer include:

• Exposure to high levels of radiation. Examples of high levels of radiation include those that come from radiation treatment to the head and neck and from fallout from nuclear accidents or weapons testing.
• Personal or family history of goiter. Goiter is a noncancerous enlargement of the thyroid.
• Certain inherited genetic syndromes. Genetic syndromes that increase the risk of thyroid cancer include familial medullary thyroid cancer, multiple endocrine neoplasia and familial adenomatous polyposis.

Complications

Thyroid cancer that comes back
Despite treatment, thyroid cancer can return, even if you've had your thyroid removed. This could happen if microscopic cancer cells spread beyond the thyroid before it's removed. Thyroid cancer recurrence can occur decades after thyroid cancer treatment.

Thyroid cancer most often recurs in:

• Lymph nodes in the neck
• Small pieces of thyroid tissue left behind during surgery
• Other areas of the body — most often the lungs or the bones

Thyroid cancer that recurs can be treated. Your doctor may recommend periodic blood tests or thyroid scans to check for signs of a thyroid cancer recurrence.

Preparing for your appointment

If you suspect thyroid cancer, you're likely to start by first seeing your family doctor or a general practitioner. If your doctor suspects you may have a thyroid problem, you may be referred to a doctor who specializes in diseases of the endocrine system (endocrinologist).

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 can help you make the most of your time together. List your questions from most important to least important in case time runs out. For thyroid cancer, some basic questions to ask your doctor include:

• What type of thyroid cancer do I have?
• What stage is my thyroid cancer?
• What treatments do you recommend?
• What are the benefits and risks of each treatment option?
• Will I be able to work and do my usual activities during thyroid cancer treatment?
• Should I seek a second opinion?
• Should I see a doctor who specializes in thyroid diseases? What will that cost, and will my insurance cover it?
• How quickly do I need to make a decision about thyroid cancer treatment? Can I take some time to explore all of my options?
• 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

Tests and procedures used to diagnose thyroid cancer include:

• A physical exam to feel your neck for thyroid lumps and lymph node swelling
• Blood tests, including a test to measure the level of thyroid-stimulating hormone (TSH) in your body
• Needle biopsy to remove cells from your thyroid and examine them using a microscope to look for cancer
• Imaging tests, such as ultrasound of the neck to look for enlarged lymph nodes

Treatments and drugs

Your thyroid cancer treatment options depend on the type and stage of your thyroid cancer, your overall health and your preferences.

Surgery
Most people with thyroid cancer undergo surgery to remove all or most of the thyroid. Operations used to treat thyroid cancer include:

• Removing all or most of the thyroid (thyroidectomy). Surgery to remove the entire thyroid is the most common treatment for thyroid cancer. In most cases, the surgeon leaves small rims of thyroid tissue around the parathyroid glands to reduce the risk of parathyroid damage. Sometimes surgeons refer to this as a near-total thyroidectomy.
• Removing lymph nodes in the neck. When removing your thyroid, the surgeon may also remove enlarged lymph nodes from your neck and test them for cancer cells.

Thyroid surgery is performed by making an incision in the skin at the base of your neck. Thyroid surgery carries a risk of bleeding and infection. Damage can also occur to your parathyroid glands during surgery, causing low calcium levels in your body. There's also a risk of accidental damage to the nerves connected to your vocal cords, which can cause vocal cord paralysis, hoarseness, soft voice or difficulty breathing.

Thyroid hormone therapy
After thyroid cancer surgery, you'll take the thyroid hormone medication levothyroxine (Levothroid, Synthroid, others) for life. This has two benefits: It supplies the missing hormone your thyroid would normally produce, and it suppresses the production of thyroid-stimulating hormone (TSH) in your pituitary gland. High TSH levels could conceivably stimulate any remaining cancer cells to grow.

You'll likely have blood tests to check your thyroid hormone levels every few months until your doctor finds the proper dosage for you.

Radioactive iodine
Radioactive iodine treatment uses large doses of a form of iodine that's radioactive. Radioactive iodine treatment is often used after thyroidectomy to kill any remaining healthy thyroid tissue, as well as microscopic areas of thyroid cancer that weren't removed during surgery. Radioactive iodine treatment may also be used to treat thyroid cancer that recurs after treatment or that spreads to other areas of the body.

Radioactive iodine treatment comes as a capsule or liquid that you swallow. The radioactive iodine is taken up primarily by thyroid cells and thyroid cancer cells, so there's a low risk of harming other cells in your body.

Side effects may include:

• Nausea
• Dry mouth
• Dry eyes
• Altered sense of taste or smell
• Pain where thyroid cancer cells have spread, such as the neck or chest

Most of the radioactive iodine leaves your body in your urine in the first few days after treatment. During that time you'll need to take precautions to protect other people from the radiation. For instance, you may be asked to temporarily avoid close contact with other people, especially children and pregnant women.

External radiation therapy
Radiation therapy can also be given externally using a machine that aims high-energy beams at precise points on your body. Called external beam radiation therapy, this treatment is typically administered a few minutes at a time, five days a week, over several weeks. During treatment, you lie still on a table while a machine moves around you.

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is typically given as an infusion through a vein. The chemicals travel throughout your body, killing quickly growing cells, including cancer cells.

Clinical trials
Clinical trials are studies of new cancer treatments or new ways of using existing treatments. Enrolling in a clinical trial gives you the chance to try out the latest in cancer treatment options, but clinical trials can't guarantee a cure. Ask your doctor whether you might be eligible to enroll in a clinical trial. Together you can discuss the benefits and risks of a trial and decide whether participating in a clinical trial is right for you.

Types of Cancer : Prostate Cancer

Definition

Prostate cancer is cancer of the small walnut-shaped gland in males that produces seminal fluid, the fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men, affecting about one in six men in the United States. A diagnosis of prostate cancer can be scary not only because it can be life-threatening, but also because treatments can cause side effects such as bladder control problems and erectile dysfunction (impotence). But diagnosis and treatment of prostate cancer have gotten much better in recent years.

Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly. If prostate cancer is detected early — when it's still confined to the prostate gland — you have a better chance of successful treatment.

Symptoms

Prostate cancer usually doesn't produce any noticeable symptoms in its early stages, so many cases of prostate cancer aren't detected until the cancer has spread beyond the prostate. For most men, prostate cancer is first detected during a routine screening such as a prostate-specific antigen (PSA) test or a digital rectal exam (DRE).

When signs and symptoms do occur, they depend on how advanced the cancer is and how far the cancer has spread.

Early signs and symptoms of prostate cancer can include urinary problems, caused when the prostate tumor presses on the bladder or on the tube that carries urine from the bladder (urethra). However, urinary symptoms are much more commonly caused by benign prostate problems, such as an enlarged prostate (benign prostatic hyperplasia) or prostate infections. Less than 5 percent of cases of prostate cancer have urinary problems as the initial symptom. When urinary signs and symptoms do occur, they can include:

• Trouble urinating
• Starting and stopping while urinating
• Decreased force in the stream of urine

Cancer in your prostate or the area around the prostate can cause:

• Blood in your urine
• Blood in your semen

Prostate cancer that has spread to the lymph nodes in your pelvis may cause:

• Swelling in your legs
• Discomfort in the pelvic area

Advanced prostate cancer that has spread to your bones can cause:

• Bone pain that doesn't go away
• Bone fractures
• Compression of the spine

Causes

Cancer is a group of abnormal cells that grow more rapidly than normal cells and that refuse to die. 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 lymph system (metastasize). Microscopic cancer cells develop into small clusters that continue to grow, becoming more densely packed and hard.

What causes prostate cancer and why some types behave differently are unknown. Research suggests that a combination of factors may play a role, including heredity, ethnicity, hormones, diet and the environment.

Risk factors

Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:

• Age. After age 50, your chance of having prostate cancer increases.
• Race or ethnicity. For reasons that aren't well understood, black men have a higher risk of developing and dying of prostate cancer.
• Family history. If your father or brother has prostate cancer, your risk of the disease is greater than that of the average man.
• Diet. A high-fat diet and obesity may increase your risk of prostate cancer. One theory is that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells.
• High testosterone levels. Because testosterone naturally stimulates the growth of the prostate gland, men who use testosterone therapy are more likely to develop prostate cancer than are men who have lower levels of testosterone. Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present. Long-term testosterone treatment also may cause prostate gland enlargement (benign prostatic hyperplasia).

When to seek medical advice

If you have difficulties with urination, see your doctor. This condition doesn't always relate to prostate cancer, but it can be a sign of prostate-related problems.

Beginning at age 50, the American Cancer Society recommends having yearly screening tests for prostate cancer. If you're black or have a family history of the disease, you may want to begin at a younger age. Yearly screenings can help detect prostate cancer early, when it's easier to treat. They include:

• PSA test. This blood test checks levels of prostate-specific antigen (PSA), which can be a sign of prostate cancer. While this test can detect signs of cancer, elevated PSA levels are sometimes caused by conditions other than cancer, such as prostate enlargement, infection or inflammation.
• Digital rectal exam (DRE). This test involves insertion of a lubricated finger into the rectum to feel for bumps on the prostate. While it can be slightly uncomfortable, an annual DRE is a quick, simple exam that can be a lifesaver.

Tests and diagnosis

Prostate cancer may not cause any symptoms at first. The first indication of a problem may come during a routine screening test, such as:

• Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.
• Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein and analyzed for PSA, a substance that's naturally produced by your prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer. Studies have not been able to show that routine screening decreases the chance that anyone will die of prostate cancer, but screening with PSA and DRE can help identify cancer at an earlier stage.
• Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to get a picture of your prostate gland.
• Prostate biopsy. If initial test results suggest prostate cancer, your doctor may recommend biopsy. To do a prostate biopsy, your doctor inserts a small ultrasound probe into your rectum. Guided by images from the probe, your doctor uses a fine, spring-propelled needle to retrieve several very thin sections of tissue from your prostate gland. A pathologist who specializes in diagnosing cancer and other tissue abnormalities evaluates the samples. From those, the pathologist can tell if the tissue removed is cancerous and estimate how aggressive your cancer is.

Determining how far the cancer has spread
Once a cancer diagnosis has been made, you may need further tests to help determine if or how far the cancer has spread. Many men don't require additional studies and can directly proceed with treatment based on the characteristics of their tumors and the results of their pre-biopsy PSA tests.

• Bone scan. A bone scan takes a picture of your skeleton in order to determine whether cancer has spread to the bone. Prostate cancer can spread to any bones in your body, not just those closest to your prostate, such as your pelvis or lower spine.
• Ultrasound. Ultrasound not only can help indicate if cancer is present, but also may reveal whether the disease has spread to nearby tissues.
• Computerized tomography (CT) scan. A CT scan produces cross-sectional images of your body. CT scans can identify enlarged lymph nodes or abnormalities in other organs, but they can't determine whether these problems are due to cancer. Therefore, CT scans are most useful when combined with other tests.
• Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional images of your body using magnets and radio waves. An MRI can help detect evidence of the possible spread of cancer to lymph nodes and bones.
• Lymph node biopsy. If enlarged lymph nodes are found by a CT scan or an MRI, a lymph node biopsy can determine whether cancer has spread to nearby lymph nodes. During the procedure, some of the nodes near your prostate are removed and examined under a microscope to determine if cancerous cells are present.

Grading
When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly.

Cancer cells may vary in shape and size. Some cells may be aggressive, while others aren't. The pathologist identifies the two most aggressive types of cancer cells when assigning a grade. The most common scale used to evaluate prostate cancer cells is called a Gleason score. Based on the microscopic appearance of cells, individual ratings from 1 to 5 are assigned to the two most common cancer patterns identified. These two numbers are then added together to determine your overall score. Scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).

Staging
After the level of aggressiveness of your prostate cancer is known, the next step, called staging, determines if or how far the cancer has spread. Your cancer is assigned one of four stages, based on how far it has spread:

• Stage I. Signifies very early cancer that's confined to a microscopic area that your doctor can't feel.
• Stage II. Your cancer can be felt, but it remains confined to your prostate gland.
• Stage III. Your cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
• Stage IV. Your cancer has spread to lymph nodes, bones, lungs or other organs.

Complications

Complications from prostate cancer are related to both the disease and its treatment. One of the biggest fears of many men who have prostate cancer is that treatment may leave them incontinent or unable to maintain an erection firm enough for sex (erectile dysfunction). Fortunately, therapies exist to help cope with or treat these conditions.

The typical complications of prostate cancer and its treatments include:

• Spread of cancer. Prostate cancer can spread to nearby organs or travel through your bloodstream or lymphatic system, affecting your bones or other organs. Treatments for prostate cancer that has spread can include hormone therapy, radiation therapy and chemotherapy.
• Pain. Although early-stage prostate cancer typically isn't painful, once it's spread to bones it can be. Not all people with cancer that has spread to bones have pain, but in some cases, pain is intense and doesn't go away. Treatments directed at shrinking the cancer often can produce significant pain relief. Medications ranging from over-the-counter pain relievers to prescription narcotics can alleviate pain. If your pain is severe, you may need to see a pain specialist. While it's not always possible to make all of your pain go away, your doctor will work with you to try to control pain to a point where you're comfortable. If you're in serious pain, tell your doctor. Pain can be controlled, and there's no reason you have to suffer.
• Difficulty urinating (urinary incontinence). Both prostate cancer and its treatment can cause incontinence. Treatment depends on the type of incontinence you have, how severe it is and the likelihood it will improve over time. Treatments include behavior modifications (such as going to the bathroom at set times rather than just according to urges), exercises to strengthen pelvic muscles (commonly called Kegel exercises), medications and catheters. If incontinence continues for a prolonged period without getting better, your doctor may suggest more aggressive procedures. These may include implanting an artificial urinary sphincter, placement of a sling of synthetic material to compress the urethra, or the injection of bulking agents into the lining of the urethra at the base of the bladder to reduce leakage.
• Erectile dysfunction (ED) or impotence. Like incontinence, ED can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications and vacuum devices that assist in achieving erection are available to treat ED. Medications include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). If other treatments fail, penile implants can be inserted surgically to help create an erection.
• Depression. Many men may feel depressed after a diagnosis of prostate cancer or after trying to cope with the side effects of treatment. These feelings may last for only a short time, they may come and go, or they may linger for weeks or even months. Talk to your doctor if you have depression that interferes with your ability to get things done or enjoy your life. Treatment such as counseling or antidepressant medication can make a big difference.

Treatments and drugs

There's more than one way to treat prostate cancer. For some men a combination of treatments — such as surgery followed by radiation or radiation paired with hormone therapy — works best. The treatment that's best for each man depends on several factors. These include how fast your cancer is growing, how much it has spread, your age and life expectancy, as well as the benefits and the potential side effects of the treatment. The most common treatments for prostate cancer include the following:

External beam radiation therapy (EBRT)
External beam radiation treatment uses high-powered X-rays to kill cancer cells. This type of radiation is effective at destroying cancerous cells, but it can also scar adjacent healthy tissue.

The first step in radiation therapy is to map the precise area of your body that needs to receive radiation. Computer-imaging software helps your doctor find the best angles to aim the beams of radiation. Precisely focused radiation kills cancer in your prostate while minimizing harm to surrounding tissue.

Treatments are generally given five days a week for about eight weeks. Each treatment appointment takes about 10 minutes. However, much of this is preparation time — radiation is received for only about one minute. You don't need anesthesia with external beam radiation, because the treatment isn't painful.

You'll be asked to arrive for therapy with a full bladder. This will push most of your bladder out of the path of the radiation beam. A body supporter holds you in the same position for each treatment. Ink marks on your skin help guide the radiation beam, and small gold markers may be placed in your prostate to ensure the radiation hits the same targets each time. Custom-designed shields help protect nearby normal tissue, such as your bladder, erectile tissues, anus and rectal wall.

EBRT can cause mild side effects, but in most cases they disappear shortly after your course of treatment is finished.

Side effects of EBRT can include:

• Urinary problems. The most common signs and symptoms are urgency to urinate and frequent urination. These problems usually are temporary and gradually diminish in a few weeks after completing treatment. Long-term problems are uncommon.
• Loose stools, rectal bleeding, discomfort during bowel movements or a sense of needing to have a bowel movement (rectal urgency). In some cases these problems persist for months after treatment, but they improve on their own in most men. If you do have long-term rectal symptoms, medications can help. Rarely, men develop persistent bleeding or a rectal ulcer after radiation. Surgery may be necessary to alleviate these problems.
• Sexual side effects. Radiation therapy doesn't usually cause immediate sexual side effects such as erectile dysfunction, but some men who've had the treatment have sexual problems later in life.

Radioactive seed implants
Radioactive seeds implanted into the prostate have gained popularity in recent years as a treatment for prostate cancer. The implants, also known as brachytherapy, deliver a higher dose of radiation than do external beams, but over a substantially longer period of time. The therapy is generally used in men with smaller or moderate-sized prostates with small and lower grade cancers.

During the procedure, between 40 and 100 rice-sized radioactive seeds are placed in your prostate through ultrasound-guided needles. The implant procedure typically lasts one to two hours and is done under general anesthesia — which means you won't be awake. Most men can go home the day of the procedure. Sometimes, hormone therapy is used for a few months to shrink the size of the prostate before seeds are implanted. The seeds may contain one of several radioactive isotopes — including iodine and palladium. These seeds don't have to be removed after they stop emitting radiation. Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond their location. This type of radiation isn't likely to escape your body in significant doses. However, doctors recommend that for the first few months you stay at least six feet (1.83 meters) away from children and pregnant women, who are especially sensitive to radiation. All radiation inside the pellets is generally exhausted within a year.

Side effects of radioactive seed implants can include:

• Urinary problems. The procedure causes urinary signs and symptoms such as frequent, slow and painful urination in nearly all men. You may require medication to treat these signs and symptoms. Some men need medications or the use of intermittent self-catheterization to help them urinate. Urinary symptoms tend to be more severe and longer lasting with seed implants than with external beam radiation.
• Sexual problems. Some men experience erectile dysfunction due to radioactive seed implants.
• Rectal symptoms. Sometimes this treatment causes loose stools, discomfort during bowel movements or other rectal symptoms. However, rectal symptoms from radioactive seed implants are generally less severe than with external beam radiation.

Hormone therapy
Hormone therapy involves trying to stop your body from producing the male sex hormones testosterone, which can stimulate the growth of cancer cells. This type of therapy can also block hormones from getting into cancer cells. Sometimes doctors use a combination of drugs to achieve both. In most men with advanced prostate cancer, this form of treatment is effective in helping both shrink the cancer and slow the growth of tumors. Sometimes doctors use hormone therapy in early-stage cancers to shrink large tumors so that surgery or radiation can remove or destroy them more easily. In some cases, hormone therapy is used in combination with radiation therapy or surgery. After these treatments, the drugs can slow the growth of any stray cancer cells left behind.

Some drugs used in hormone therapy decrease your body's production of testosterone. The hormones — known as luteinizing hormone-releasing hormone (LH-RH) agonists — can set up a chemical blockade. This blockade prevents the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Viadur) and goserelin (Zoladex). They're injected into a muscle or under your skin once every three or four months. You can receive them for a few months, a few years or the rest of your life, depending on your situation.

Other drugs used in hormone therapy block your body's ability to use testosterone. A small amount of testosterone comes from the adrenal glands and isn't suppressed by LH-RH agonists. Certain medications — known as anti-androgens — can prevent testosterone from reaching your cancer cells. Examples include bicalutamide (Casodex) and nilutamide (Nilandron). They come in tablet form and, depending on the particular brand of drug, are taken orally one to three times a day. These drugs typically are given along with an LH-RH agonist.

Simply depriving prostate cancer of testosterone usually doesn't kill all of the cancer cells. Within a few years, the cancer often learns to thrive without testosterone. Once this happens, hormone therapy is less likely to be effective. However, several treatment options still exist. To avoid such resistance, intermittent hormone therapy programs have been developed. During this type of therapy, the hormonal drugs are stopped after your PSA drops to a low level and remains steady. You will need to resume taking the drugs if your PSA level rises again.

Side effects of hormone therapy can include:

• Breast enlargement (gynecomastia)
• Reduced sex drive
• Erectile dysfunction
• Hot flashes
• Weight gain
• Reduction in muscle and bone mass

Certain hormone therapy medications can also cause:

• Nausea
• Diarrhea
• Fatigue
• Liver damage

Recent reports have shown that men who undergo hormone therapy for prostate cancer may have a higher risk of having a heart attack in the first year or two after starting hormone therapy. So your doctor should carefully monitor your heart condition and aggressively treat any other conditions that may predispose you to a heart attack, such as high blood pressure, high cholesterol or smoking.

Surgery to remove the testicles, which produce most of your testosterone, is as effective as other forms of hormonal therapy. Many men are not comfortable with the idea of losing their testicles, so they opt for the above-noted methods of lowering testosterone in the body. However, removing the testicles has the advantage of not having to have an injection every three or four months and can be less expensive. The surgery can be done on an outpatient basis using a local anesthetic.

Radical prostatectomy
Surgical removal of your prostate gland, called radical prostatectomy, is used to treat cancer that's confined to the prostate gland. During this procedure, your surgeon uses special techniques to completely remove your prostate and nearby lymph nodes. This surgery can affect muscles and nerves that control urination and sexual function. Two surgical approaches are available for a prostatectomy — retropubic surgery and perineal surgery.

• Retropubic surgery. The gland is taken out through an incision in your lower abdomen that typically runs from just below the navel to an inch (2.54 centimeters) above the base of the penis. It's the most commonly used form of prostate removal for two reasons. First, your surgeon can use the same incision to remove pelvic lymph nodes, which are tested to determine if the cancer has spread. Second, the procedure gives your surgeon good access to your prostate, making it easy to save the nerves that help control bladder function and erections.
• Perineal surgery. An incision is made between your anus and scrotum. There's generally less bleeding with perineal surgery, and recovery time may be shorter, especially if you're overweight. With this procedure, your surgeon isn't able to remove nearby lymph nodes.

During either type of operation, a catheter is inserted into your bladder through your penis to drain urine from the bladder during your recovery. The catheter will likely remain in place for one to two weeks after the operation while the urinary tract heals.

Side effects of radical prostatectomy can include:

• Bladder control problems (urinary incontinence). These symptoms can last for weeks or even months, but most men eventually regain bladder control. Many men experience stress incontinence, meaning they're unable to hold urine flow when their bladders are under increased pressure. This can happen when you sneeze, cough, laugh or lift something heavy. In some men, urinary incontinence doesn't get better and surgery is needed to help correct the problem.
• Erectile dysfunction. This is a common side effect of radical prostatectomy, because nerves on both sides of your prostate that control erections may be damaged or removed during surgery. Most men younger than age 50 who have nerve-sparing surgery are able to achieve erections afterward, and even some men in their 70s are able to maintain normal sexual functioning. Men who had trouble achieving or maintaining an erection before surgery have a higher risk of being impotent after the surgery.

Robot-assisted laparoscopic radical prostatectomy (RALRP)
This is a relatively new procedure for removing the prostate. For robot-assisted laparoscopy, five small incisions are made in the abdomen through which the doctor inserts tube-like instruments, including a long, slender tube with a small camera on the end (laparoscope). This creates a magnified view of the surgical area. The instruments are attached to a mechanical device, and the surgeon sits at a console and guides the instruments through a viewing device to perform the surgery. So far, studies show that traditional open prostatectomy and robotic prostatectomy have had similar outcomes related to cancer-free survival rates, urinary continence and sexual function one year after surgery. Longer term outcomes are not yet known.

Watchful waiting
The PSA blood test can help detect prostate cancer at a very early stage. This allows many men to choose watchful waiting as a treatment option. In watchful waiting (also known as observation, expectant therapy or deferred therapy), regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer.

During watchful waiting no medical treatment is provided. Medications, radiation and surgery aren't used. Watchful waiting may be an option if your cancer isn't causing symptoms, is expected to grow very slowly, and is small and confined to one area of your prostate.

Watchful waiting may be particularly appropriate if you're elderly, in poor health or both. Many such men will live out their normal life spans without treatment and without the cancer spreading or causing other problems. But watchful waiting can also be a rational option if you're a younger man, as long as you know the facts, are willing to be vigilant, and accept the risk of a tumor spreading during the observation period, rendering your cancer incurable.

Chemotherapy
This type of treatment uses chemicals that destroy rapidly growing cells. Chemotherapy can be quite effective in treating prostate cancer, but it can't cure it. Because it has more side effects than hormone therapy does, chemotherapy is reserved for men who have hormone-resistant prostate cancer that has spread to other parts of the body.

Cryotherapy
This treatment is used to destroy cells by freezing tissue. Original attempts to treat prostate cancer with cryotherapy involved inserting a probe into the prostate through the skin between the rectum and the scrotum (perineum). Using a rectal microwave probe to monitor the procedure, the prostate was frozen in an attempt to destroy cancer cells. This method often resulted in damage to tissue around the bladder and long-term complications such as injury to the rectum or the muscles that control urination.

More recently, smaller probes and more-precise methods of monitoring the temperature in and around the prostate have been developed. These advances may decrease the complications associated with cryotherapy, making it a more effective treatment for prostate cancer. Although progress continues, more time is needed to determine how successful cryotherapy may be as a treatment for prostate cancer.

Gene therapy and immune therapy
In the future, gene therapy or immune therapy may be successful in treating prostate cancer. Current technology limits the use of these experimental treatments to a small number of medical centers.

Prevention

Prostate cancer can't be prevented, but you can take measures to reduce your risk or possibly slow the disease's development.

• Eat well. High-fat diets have been linked to prostate cancer. Therefore, limiting your intake of high-fat foods and emphasizing fruits, vegetables and whole fibers may help you reduce your risk. Foods rich in lycopene, an antioxidant, also may help lower your prostate cancer risk. These foods include raw or cooked tomatoes, tomato products, grapefruit and watermelon. Garlic and some vegetables such as arugula, bok choy, broccoli, Brussels sprouts, cabbage and cauliflower also may help fight cancer. Other vitamins and minerals, including vitamin C, vitamin E and selenium, have been linked to lower prostate cancer risk, but studies haven't found a benefit to taking supplements to create high levels of these nutrients in your body. Instead, it may be helpful to choose foods that are rich in vitamins and minerals so that you can maintain healthy levels of these nutrients in your body.
• Get regular exercise. Regular exercise can help prevent a heart attack and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren't as clear-cut, but studies do indicate that regular exercise may reduce your cancer risk, including your risk of prostate cancer. Exercise has been shown to strengthen your immune system, improve circulation and speed digestion — all of which may play a role in cancer prevention. Exercise also helps to prevent obesity, another potential risk factor for some cancers. Regular exercise may also minimize your symptoms and reduce your risk of prostate gland enlargement, or benign prostatic hyperplasia (BPH). Men who are physically active usually have less-severe symptoms than do men who get little exercise.
• Ask your doctor about taking an NSAID. Nonsteroidal anti-inflammatory drugs (NSAIDs) might prevent prostate cancer. These drugs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve). NSAIDs inhibit an enzyme called COX-2, which is found in prostate cancer cells. More studies are needed to confirm whether NSAID use actually results in lower rates of prostate cancer or reduced deaths from the disease.

Research on prostate cancer prevention has shown that the drug finasteride (Proscar, Propecia) may prevent or delay the onset of prostate cancer in men 55 years and older. This drug is currently used to control prostate gland enlargement and hair loss in men. However, finasteride has also been shown to contribute to increasing sexual side effects and to slightly raise the risk of developing higher grade prostate cancer. At this time, this drug isn't routinely recommended to prevent prostate cancer.

Types of Cancer : Salivary Glands Cancer

Definition

Salivary gland cancer is a rare form of cancer that occurs in one of the salivary glands in your mouth, neck or throat.

The cause of salivary gland cancer is not clear, although exposure to radiation, use of tobacco and a family history of salivary gland cancer may increase your risk.

Because predicting who will get salivary gland cancer can be difficult, be sure to pay attention to possible signs and symptoms, such as a painless lump. If you develop a lump or mass on or near your jaw or in your neck or mouth, see your doctor.

Symptoms

Salivary gland cancer is often painless in its early stages. A common sign is a lump, mass or swelling in the area of a salivary gland. Just because you have a lump in the area of a salivary gland, however, doesn't necessarily mean you have cancer. More than half the tumors found in the salivary glands are noncancerous (benign).

Signs and symptoms that may indicate salivary gland cancer and a need to see your doctor include the following:

• A lump or swelling on or near your jaw or in your neck or mouth
• Numbness in part of your face
• Muscle weakness on one side of your face
• Persistent pain in the area of a salivary gland
• Difficulty swallowing
• Trouble opening your mouth widely
• A newly developed, noticeable difference in size between the right and left side of your face

Causes

Salivary glands are located in and around your mouth and throat. Salivary glands make saliva, which aids in digestion, helps prevent tooth decay and keeps your mouth moist.

You have three pairs of major salivary glands under and behind your jaw — parotid, sublingual and submandibular. The parotid gland, which is just in front of your ear, is the most common site of salivary gland cancer. Many other tiny salivary glands are in your lips, inside your cheeks and throughout your mouth and throat.

The exact cause of salivary gland cancer isn't known. In some cases, cancer may develop due to DNA damage, as can occur after years of tobacco use or exposure to radiation. Heredity also may play a role in the development of salivary gland cancer.

Risk factors

In general, these factors may increase the likelihood that you'll develop salivary gland cancer:

• Tobacco use. Smoking or using chewing tobacco can increase your risk of some types of salivary gland cancer.
• Radiation exposure. Because radiation has the potential to damage DNA, if you've had radiation treatment to your head or neck, or if you're exposed to radioactive materials in your work, you may be more likely to develop some types of cancer, including salivary gland cancer, than may people who haven't been exposed to radiation.
• Family history. If members of your family have had salivary gland cancer, you may be at a higher risk of getting the disease.
• Diet. Eating large amounts of animal fats and low quantities of vegetables may increase the risk of salivary gland cancer.
• Age. Additionally, people older than 60 are more likely to develop salivary gland cancer.

When to seek medical advice

See your doctor if you develop any of the following signs or symptoms:

• A lump or swelling in your face, neck or mouth
• Numbness in part of your face
• Muscle weakness on one side of your face
• Persistent pain in the area of a salivary gland

Tests and diagnosis

If your doctor suspects you might have salivary gland cancer, he or she will first do a physical exam, feeling for lumps in your jaw, neck and throat, feeling inside your mouth and inspecting your mouth with a small mirror and lights.

In order to detect abnormal tissue, your doctor may have you undergo imaging tests:

• Computerized tomography (CT) scan. A CT scan allows your doctor to see your organs in two-dimensional slices. Split-second computer processing creates these images as a series of very thin X-ray beams are passed through your body.
• Magnetic resonance imaging (MRI) scan. An MRI scanner uses no X-rays. Instead, a computer creates tissue-slice images from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane.

CT and MRI scans can help your doctor determine if you have a tumor, how large it is, and if it has spread outside of the salivary gland. If test results show an abnormality, your doctor will need to take a small tissue sample (biopsy) that will be examined in the laboratory. Results of the biopsy will show if the abnormal tissue is cancerous.

Further identification of your cancer
If the biopsy reveals salivary gland cancer, your doctor will then determine the type of cell in which the cancer began, as well as the disease's grade and stage, in order to recommend the most appropriate treatment. The grade of cancer is a factor your doctor will use to determine how quickly the tumor may grow or spread, and the stage defines the extent or spread of the cancer. Additional MRI or CT scans may be necessary to determine the cancer's stage.

Treatments and drugs

Treatment for salivary gland cancer usually involves surgery, with or without radiation therapy. Your treatment plan should be tailored specifically for you by a team of doctors including head and neck surgeons (otolaryngologists), cancer specialists (oncologists) and doctors who specialize in treating cancer with radiation (radiation oncologists).

Surgery
If the cancer hasn't spread outside the salivary gland, and if the tumor is small and low grade, surgery alone may be all you need to remove the cancer.

Removing a tumor from the salivary glands can be complicated because several important nerves are located in and around these glands. For example, a nerve that controls facial movement runs through the parotid gland. Complications of removing a tumor from the parotid gland may include nerve damage, which can affect movement in your face. Nerves near the submandibular and sublingual glands include those that control tongue movement, feeling and taste. If the cancer has spread outside the salivary gland, some of those nerves may need to be removed.

Your surgeon may need to remove lymph nodes in your neck (neck dissection) to see if the cancer has spread. In addition to removing the lymph nodes, neck dissection may involve removal of other muscles and nerves in your neck, as well. Complications from neck dissection may include ear numbness, weakness in your lower lip and weakness in raising your arm above your head.

Physical therapy
You may need physical therapy to help you overcome complications from surgery, such as difficulty speaking, chewing or swallowing. A dietitian can help you choose foods that are suitable for you if you've lost some of your ability to chew and swallow. You'll also receive instructions on how to learn to swallow again.

Reconstructive therapy
If a large amount of bone or tissue is taken during surgery, you may need reconstructive surgery. The goal of reconstructive surgery is to improve your appearance and to help you adjust to difficulties you may have with chewing, swallowing, speaking or breathing. You may need grafts of skin or tissue from other parts of your body to rebuild areas in your mouth, throat or jaw. You may also need to have a dental prosthesis implanted to replace a part of your jaw removed during surgery.

Radiation therapy
Radiation therapy destroys cancer cells using high-energy radiation. Radiation for salivary gland cancer usually comes from a machine outside the body (external radiation therapy).

If the tumor is large or high grade, if the cancer has spread outside the salivary glands or if your doctor is concerned that other areas may be affected, radiation after surgery may be part of your treatment. If a tumor cannot be removed by surgery, radiation alone may be used to treat salivary gland cancer.

Side effects from radiation to the head and neck are usually temporary and may include changes in skin color and texture (similar to a suntan or sunburn), dry mouth, sore throat, hoarseness, problems swallowing, loss of or changes in taste, or fatigue.

Chemotherapy
Chemotherapy is not used as a standard treatment for salivary gland cancer, although researchers are investigating its effectiveness in treating this condition.

Prevention

Take these steps to help prevent salivary gland cancer or its progression:

• Avoid or limit exposure to radiation, when possible.
• Avoid using tobacco and other known cancer-causing substances (carcinogens)
• Eat a nutrient-rich diet that includes more than five servings of fruits and vegetables daily, and limit your intake of animal fat.
• Check your mouth and jaw periodically for lumps or bumps.
• Have your doctor or dentist check your salivary glands during routine checkups.

If you notice a lump, don't ignore it. See your doctor or dentist. It's often difficult to tell if a lump is benign or cancerous without imaging tests or a biopsy.

Types of Cancer : Vulvar Cancer

Definition

Vulvar cancer is an uncommon cancer of the outer surface area of the female genitalia.

Most vulvar cancers are squamous cell carcinomas — a type of skin cancer — that develop slowly over years. A small number of vulvar cancers begin as melanoma. Rarely, vulvar cancers develop in the mucus-producing glands on the sides of the vaginal opening. The sexually transmitted infection human papillomavirus (HPV) is believed to play a role in developing this form of vulvar cancer.

Getting regular gynecologic exams may increase your chance of early detection of vulvar cancer, which means a better chance of successful treatment. You may also be able to prevent vulvar cancer by engaging in safe sexual practices, and you may be able to control other risk factors as well.

Symptoms

Recognizing possible signs and symptoms of vulvar cancer may help you detect the disease early, before it reaches a later stage. This may give you a better chance for successful treatment and long-term recovery. If you experience any of the following vulvar signs and symptoms, see your doctor:

• Itching that doesn't go away
• Burning, pain and tenderness
• Bleeding that isn't from menstruation
• Skin changes, such as color changes or thickening
• A lump, wart-like bumps or an open sore (ulcer)

When to see a doctor
Because an early diagnosis of vulvar cancer increases the likelihood of successful treatment, it's important that you see your primary care doctor or gynecologist if you experience irregular bleeding, persistent itching, burning, pain or tenderness in your genital area, or if you notice skin changes or a lump or open sore on your vulvar area.

If you have already been treated for vulvar cancer, be sure to see your doctor for regular follow-up exams to guard against recurrence of the disease.

Causes

he exact cause of each type of vulvar cancer isn't known. Vulvar cancers that occur in older women that aren't linked to HPV infection may be related to a mutation or defect in the p53 tumor suppressor gene. This gene plays a role in keeping cells from becoming cancerous. This type of cancer may also be seen in women with lichen sclerosus — a condition that causes the vulvar skin to become thin and itchy.

As many as 30 percent to 50 percent of vulvar cancers have been linked to the sexually transmitted HPV infection. Many times these women have a precancerous skin condition called vulvar intraepithelial neoplasia in more than one area of the vulva before developing cancer.

Vulvar cancer is uncommon, accounting for less than 1 percent of all cancers in American women.

Risk factors

Although the exact cause of vulvar cancer isn't known, certain factors appear to increase your risk of the disease. These factors include:

• Age. About 50 percent of women with vulvar cancers are older than 70 when they're diagnosed. This cancer isn't limited to older women, however. As many as 15 percent of new cases occur in women younger than 40.
• HPV infection. This sexually transmitted disease is present in most younger women who have vulvar cancer. Having HPV, or using unsafe sex practices that put you at greater risk of HPV infection, increases your risk of vulvar cancer.
• Smoking. Smoking exposes you to cancer-causing chemicals that may increase your risk of vulvar cancer. Women with a history of genital warts or HPV have an even further increased risk of vulvar cancer if they smoke.
• Human immunodeficiency virus (HIV). This virus weakens the immune system, which may make you more susceptible to HPV infections, thereby increasing your risk of vulvar cancer.
• Vulvar intraepithelial neoplasia. Though most cases of this precancerous condition won't turn into vulvar cancer, the condition does increase your risk of vulvar cancer and should be monitored by your doctor.
• Lichen sclerosus. About 4 percent of women with this condition, which causes the vulva to become thin and itchy, later develop vulvar cancer.
• A history of melanoma or suspicious moles. If you have a family or personal history of this serious type of skin cancer anywhere on your body, or if you have a personal or family history of unusual moles, you're at increased risk of a vulvar melanoma.

Preparing for your appointment

Your first appointment will be with either your primary care physician or a gynecologist. If your doctor or gynecologist suspects or diagnoses cancer, you'll likely be referred to an oncologist who specializes in gynecologic cancers.

Because appointments can be brief, and it can be difficult to remember everything you wanted to discuss, it's a good idea to be well prepared for your appointment. Here are some suggestions for preparing for your appointment, and what you can expect from your doctor.

What you can do

• Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
• Bring a list of any medications or vitamin supplements you take. Write down dosages and how often you take them.
• Bring a family member or close friend with you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything. If someone else is with you, they may remember details that you missed or forgot. They may also think to ask important questions you might not have considered.
• Bring a notebook or notepad with you. That way you can write down important information, such as treatment options.
• Prepare a list of questions to ask your doctor. Knowing ahead of time what you want to ask your doctor can help you make the most of your limited time together. List your most important questions first, in case time runs out.

For vulvar cancer, some basic questions to ask include:

• What kinds of tests will I need?
• Do I need to do anything to prepare for these tests?
• Other than vulvar cancer, are there any other possible causes for these symptoms?
• What type of vulvar cancer do I have?
• What stage is my cancer?
• What types of surgical options are available to me?
• What kind of success rates does each type of surgery have?
• What are the drawbacks to each type of surgery?
• Will I need to wear an ostomy bag?
• What about radiation or chemotherapy? Are those options available to me?
• What kind of success rates do those therapies have?
• What types of side effects does each treatment have?
• How will these treatments affect my sexuality?
• Will I be able to have children after treatment?
• How should I prepare for treatment?
• Which course of action do you recommend?
• What are the odds of recurrence?
• What is my prognosis?

And, if your doctor says something that's not clear, don't hesitate to ask him or her questions until you understand completely.

What to expect from your doctor
Your doctor will likely have a number of questions for you. If you're ready to answer them, it may save time for the rest of your appointment. Some potential questions your doctor might ask include:

• When did you first notice these symptoms?
• How often do you experience these symptoms?
• How severe are your symptoms?
• Does anything improve your symptoms?
• Does anything make your symptoms worse?
• Do you have a family history of skin cancer or atypical moles?

Tests and diagnosis

To check for vulvar cancer, your doctor will first conduct a physical examination, including a pelvic exam. If your doctor finds any irregularities, you'll likely need further testing.

Biopsy
Because signs and symptoms of vulvar cancer can also be caused by a noncancerous (benign) condition, your doctor will need to confirm a diagnosis by removing a small sample of tissue (biopsy) from the irregular area for analysis under a microscope. By examining this tissue, a doctor can usually tell if your condition is benign or cancerous.

To select the best tissue to sample, your doctor may swab a blue dye across your vulva. This dye will react with certain diseased areas, including those affected by a precancerous condition or by vulvar cancer, causing them to turn blue.

Your doctor might also use a special lighted microscope called a colposcope. The colposcope magnifies the surface, helping your doctor identify areas of abnormal cell growth that can't be seen by the naked eye. Your doctor may also swab the area with a weak acetic acid solution (similar to vinegar), which can cause areas affected by a precancerous condition or by vulvar cancer to turn white, making them even more visible.

Once your doctor determines which area to biopsy, the area will be numbed with a local anesthetic. There are two types of biopsies:

• Excisional biopsy. If the abnormal area is small, your doctor may use a scalpel to make an incision through your skin and remove the entire tumor. Your doctor will use a local anesthetic to numb the area and may use stitches to sew up the area depending on how much tissue is removed.
• Punch biopsy. If the irregular area is larger, your doctor may remove a portion of it with a small incision or punch biopsy technique. This technique uses a small cookie-cutter-like device to remove a cylindrical piece of skin about one-sixth of an inch (4 millimeters) across. Stitches aren't required after punch biopsy.

Staging tests
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. To gather this information, your doctor may use the following tests:

• Cystoscopy. Using a lighted tube, your doctor examines the inside surface of your bladder. Later stages of vulvar cancer may spread to this area. If your doctor finds irregularities, he or she will remove a sample for biopsy. You may need local or general anesthesia depending on how large a sample is needed.
• Pelvic examination under anesthesia. With general anesthesia, your doctor can do a more thorough examination of your pelvis for potential spread of the cancer.

Imaging tests also can help determine if your cancer has spread. These tests may include:

• Chest X-ray. This X-ray of your chest will determine whether the cancer has spread to your lungs.

• Computerized tomography. Computerized tomography — also called CT or CT scan — is an X-ray technique that produces more-detailed images of your internal organs than do conventional X-ray exams. This test can take as little as a few seconds in newer machines. A CT scan can help your doctor see if cancer has spread to your liver or other organs.

  Some CT scans may require you to ingest a contrast medium or have a contrast medium administered through intravenous injection before the scan. A contrast medium blocks X-rays and appears white on images, which can help emphasize structures in your body. There's a slight risk of allergic reaction when using an intravenous contrast medium. Let your doctor know if you've ever had a reaction to contrast medium in the past.

  CT scans can give your doctor more accurate information about the position and size of the tumor and can reveal swollen lymph nodes that may contain cancer.

• Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional 3-D images of your body. Because of the strong magnet used for this test, you'll be asked to remove any metal jewelry, glasses, and items of clothing with metal clasps or buttons before the start of the test. MRI scans can take up to an hour, the space is confined, and during the test you'll hear a loud, thumping noise. If you're afraid of enclosed spaces, ask your doctor if you might be more comfortable with a light sedative. If the noise of the test bothers you, most MRI centers have headphones so that you can listen to music. MRI scans can provide a wealth of information in one test, with the potential to spot everything from an enlarged lymph node in the pelvis to a distant spread of the cancer to places such as the brain or spinal column.
• Positron emission tomography (PET). 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 tissue does and may absorb more of a radioactive tracer, which allows the tumors to appear on the scan. This test is helpful in determining whether your cancer has spread to your lymph nodes or elsewhere in your body. Some centers may offer a CT-PET scan combination.

Results of staging tests
Your doctor may refer to your tumor using the initials T, N and M. T stands for tumor extent. N is for lymph node spread, and M is for the distant spread of the cancers. Each of these letters has subcategories that further help doctors define the stage of your vulvar cancer.

• Stage 0 is an early cancer that hasn't spread past your skin's surface.
• Stage I signifies a deeper tumor, but one that is less than about three-quarters of an inch (2 centimeters). This cancer hasn't spread to your lymph nodes or other areas.
• Stage II tumors are those that still haven't spread, but are larger than about three-quarters of an inch (2 centimeters).
• Stage III cancer has spread to lymph nodes, nearby tissue or both.
• Stage IVA signifies a cancer that has spread to the lymph nodes on both sides of your pelvis or to the urethra, bladder, rectum or pelvic bone.
• Stage IVB is a cancer that has spread (metastasized) to distant sites in your body, such as your lungs or brain.

Treatments and drugs

Treatment options for vulvar cancer depend on the type and stage of cancer and include surgical removal of the tumor, radiation therapy, chemotherapy or a combination of these. Be sure to discuss all of your options with your doctor and weigh the benefits and the risks of each treatment. You may also want to get a second opinion before starting treatment, and in some cases, your insurance company may require it.

Surgery
The more advanced a vulvar cancer is, the more tissue that may need to be surgically removed. Options include:

• Laser surgery. If the cancer is in the early noninvasive stages, laser surgery is an option. Your doctor aims a laser beam at the layer of your vulva that contains cancer, killing the cancer cells.
• Excision. This procedure, which may also be called a wide local excision or radical excision, involves cutting out the cancer and about a half-inch (1.3 centimeters) of the normal tissue all the way around it. Cutting out what doctors refer to as a margin of normal-looking tissue helps ensure that all of the cancerous cells have been removed.

• Vulvectomy. Several types of vulvectomy exist. A skinning vulvectomy removes only the top layer of skin where the cancer is. Your doctor may graft skin from another part of your body to cover this area. A simple vulvectomy involves removing the entire vulva. These types of vulvectomies are performed in people with noninvasive vulvar cancer. In a radical vulvectomy, your doctor removes either the cancer and the deep surrounding tissue (partial vulvectomy) or the cancer and the entire vulva, clitoris and nearby tissue (complete radical vulvectomy).

  Removing large areas of skin and tissue in the vulva may create problems with healing, infection and the ability of the skin grafts to take. The risk of such complications rises with greater tissue removal.

  Additionally, women who've undergone vulvectomy may have difficulties achieving orgasm. In some cases, this problem may be temporary. Scar tissue may narrow the vaginal opening, making sexual intercourse uncomfortable or even painful. Devices called vaginal dilators may help stretch the opening, or your surgeon might suggest skin grafts to widen the vaginal opening.

• Pelvic exenteration. If the cancer spread is extensive, your doctor may remove any or all of these organs: the lower colon, rectum, bladder, cervix, uterus, vagina, ovaries and nearby lymph nodes. If your bladder, rectum or colon is removed, your doctor will create an artificial opening in your body (stoma) for your waste to be removed in a bag (ostomy).

• Lymph node removal. Vulvar cancer often spreads to the lymph nodes in the groin, so your doctor may remove these lymph nodes. Your doctor may also tie off a major vein, the saphenous vein. Some doctors will try to avoid closing this vein to prevent additional risk of leg swelling that can occur with this procedure. After the procedure, you'll need a suction drain in the incision for several days.

  Removing lymph nodes can cause problems with fluid retention, leg swelling and an increased risk of infection of the lymph vessels (lymphangitis), a condition called lymphedema. If you develop this complication, your doctor may give you compression devices or support stockings to help ease the symptoms. You'll also need to avoid scratches, sunburn and other injury to your legs because you'll have an increased risk of infection.

• Sentinel lymph node biopsy. A procedure called sentinel node biopsy may help you avoid some of the side effects of lymph node removal. A sentinel node is one that is closest to the area of the tumor that drains fluid from the cancerous area. In this procedure, a blue dye or a radioactive tracer is injected into the tumor area on the day before surgery. The area is then scanned to see where the tumor drains, and this is the side where the surgeon will focus during the next day's surgery.

  On the day of surgery, blue dye or radioactive tracer is once again injected, making the sentinel node easy to find and remove. If no cancer cells are found in the sentinel node, no additional surgery is needed. However, if cancerous cells are found additional lymph nodes on that side of the groin need to be removed. If initial testing reveals an already enlarged lymph node, sentinel node biopsy isn't usually performed. The surgeon removes and biopsies the swollen node.

  Sentinel node biopsy is still considered experimental and isn't yet widely available.

Other complications from vulvar cancer surgery may include the development of cysts near the wounds (lymphoceles), blood clots, urinary infections, loss of sexual desire or pleasure, and painful irritation.

Radiation therapy
Radiation given from outside the body (external beam radiation) is usually used only to treat the lymph nodes in the groin and pelvis, not the vulva itself. Sometimes it's used with the hope of shrinking a large tumor so that it can be removed with less extensive surgery. Treated skin may look and feel sunburned for six to 12 months. Also, if radiation is used on the pelvic area, you may experience problems with urination and premature menopause.

Chemotherapy
Chemotherapy uses drugs, often a combination of drugs, to destroy cancer cells. It can be given through a vein, by mouth or through your skin (topically). Like radiation, chemotherapy may be used to shrink a large tumor before surgery. It's generally not used on its own because surgery is more effective, and vulvar cancers that have spread tend to be resistant to chemotherapy.

The side effects of chemotherapy may include hair loss, nausea, vomiting and fatigue. These 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.

Reconstructive surgery
Treatment of vulvar cancer often involves removal of some skin from your vulva. The wound or area left behind can usually be closed without grafting skin from another area of your body. However, depending on how widespread the cancer is and how much tissue your doctor needs to remove, your doctor may perform reconstructive surgery — grafting skin from another part of your body to cover this area.

Vulvar intraepithelial neoplasia
Generally, the tissue containing these precancerous changes is surgically removed before these cells have a chance to turn into cancer. However, some research has found that imiquimod (Aldara), an immune system modulating medication, may reduce the size of these lesions, possibly offering an additional treatment option.

Follow-up
As many as one in 10 women experiences recurrence of vulvar cancer, so it's important to see your gynecologist at least twice a year after you finish treatment.