Types of Cancer : Ovarian Cancer

Definition

Receiving a diagnosis of ovarian cancer is difficult and life changing. Fortunately, medical advances have made treatments more effective. Women diagnosed in the earliest stages have a five-year survival rate of nearly 93 percent, according to the American Cancer Society (ACS).

Until recently, ovarian cancer was known as a "silent killer" because it usually wasn't found until it had spread to other areas of your body. But new evidence shows that most women may have symptoms even in the early stages, and awareness of symptoms may hopefully lead to earlier detection.

Early detection is important; still, only about 20 percent of ovarian cancers are found before tumor growth has spread beyond the ovaries. Your chance of surviving ovarian cancer is better if the cancer is found early.

Symptoms

Symptoms of ovarian cancer are nonspecific and mimic those of many other more common conditions, including digestive and bladder disorders. A woman with ovarian cancer may be diagnosed with another condition before finally learning she has cancer. Common misdiagnoses include irritable bowel syndrome, stress and depression.

The key seems to be persistent or worsening signs and symptoms. With most digestive disorders, symptoms tend to come and go, or they occur in certain situations or after eating certain foods. With ovarian cancer, there's typically little fluctuation — symptoms are constant and gradually worsen.

Recent studies have shown that women with ovarian cancer are more likely than are other women to consistently experience the following symptoms:

• Abdominal pressure, fullness, swelling or bloating
• Urinary urgency
• Pelvic discomfort or pain

Additional signs and symptoms that women with ovarian cancer may experience include:

• Persistent indigestion, gas or nausea
• Unexplained changes in bowel habits, such as constipation
• Changes in bladder habits, including a frequent need to urinate
• Loss of appetite or quickly feeling full
• Increased abdominal girth or clothes fitting tighter around your waist
• Pain during intercourse (dyspareunia)
• A persistent lack of energy
• Low back pain
• Changes in menstruation

When to see a doctor
See your doctor if you have swelling, bloating, pressure or pain in your abdomen or pelvis that lasts for more than a few weeks. If you've already seen a doctor and received a diagnosis other than ovarian cancer, but you're not getting relief from the treatment, schedule a follow-up visit with your doctor or get a second opinion. Make sure that a pelvic exam is a part of your evaluation.

If you have a history of ovarian cancer or a strong history of breast cancer in your family, strongly consider seeing a doctor trained to detect and care for ovarian cancer patients so that you can talk about screening, genetic testing and treatment options while you are disease-free.

Causes

Women have two ovaries, one on either side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the female sex hormones estrogen and progesterone. An ovarian tumor is a growth of abnormal cells that may be either noncancerous (benign) or cancerous (malignant). Although benign tumors are made up of abnormal cells, these cells don't spread to other body tissues (metastasize). Ovarian cancer cells metastasize in one of two ways. Generally, they spread directly to adjacent tissue or organs in the pelvis and abdomen. They can also spread through your bloodstream or lymph channels to other parts of your body.

Three basic types of ovarian tumors exist, designated by where they form in the ovary. They include:

• Epithelial tumors. About 85 to 90 percent of ovarian cancers develop in the epithelium, the thin layer of tissue that covers the ovaries, according to the American Cancer Society.
• Germ cell tumors. These tumors occur in the egg-producing cells of the ovary and generally occur in younger women.
• Stromal tumors. These tumors develop in the estrogen- and progesterone-producing tissue that holds the ovary together.

The exact cause of ovarian cancer remains unknown. Some researchers believe it has to do with the tissue-repair process that follows the monthly release of an egg through a tiny tear in an ovarian follicle (ovulation) during a woman's reproductive years. The formation and division of new cells at the rupture site may set up a situation in which genetic errors occur. Others propose that the increased hormone levels before and during ovulation may stimulate the growth of abnormal cells.

Risk factors

Certain factors may increase your risk of ovarian cancer. Having one or more of these risk factors doesn't mean that you're sure to develop ovarian cancer, but your risk may be higher than that of the average woman. These risk factors include:

• Inherited gene mutations. While the vast majority of women who develop ovarian cancer don't have an inherited gene mutation, the most significant risk factor for ovarian cancer is having an inherited mutation in one of two genes called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but people with these mutations also have a significantly increased risk of ovarian cancer.

  Women with the BRCA1 mutation have a 35 to 70 percent higher risk of ovarian cancer than do women without this mutation, and for women with a BRCA2 mutation, the risk is between 10 and 30 percent higher. For most women, the overall lifetime risk is about 1.5 percent, according to the ACS. You're at particularly high risk of carrying these types of mutations if you're of Ashkenazi Jewish descent.

  Another known genetic link involves an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC). Women in HNPCC families are at increased risk of cancers of the uterine lining (endometrium), colon, ovary and stomach. Risk of ovarian cancer associated with HNPCC is lower than is that of ovarian cancer associated with BRCA mutations.

• Family history. Sometimes, ovarian cancer occurs in more than one family member but isn't the result of any known inherited gene alteration. Having a family history of ovarian cancer increases your risk of the disease by 10 to 15 percent, according to the ACS.
• A history of breast cancer. If you've been diagnosed with breast cancer, your risk of ovarian cancer also is elevated.
• Age. Ovarian cancer most often develops after menopause. Your risk of ovarian cancer increases with age through your late 70s. Although most cases of ovarian cancer are diagnosed in postmenopausal women, the disease also occurs in premenopausal women.
• Childbearing status. Women who have had at least one pregnancy appear to have a lower risk of developing ovarian cancer. Similarly, the use of oral contraceptives appears to offer some protection against ovarian cancer.
• Infertility. If you've had trouble conceiving, you may be at increased risk. Although the link is poorly understood, studies indicate that infertility increases the risk of ovarian cancer, even without use of fertility drugs. Some research has also suggested that taking fertility drugs, such as clomiphene (Clomid), for more than one year may increase your risk of ovarian cancer, but it's not clear whether the increased risk actually comes from the drug or from the infertility.
• Hormone replacement therapy (HRT). Findings about the possible link between postmenopausal use of the hormones estrogen and progestin and risk of ovarian cancer have been inconsistent. However, a recent analysis of numerous studies, published in the journal Gynecologic Oncology, confirmed an association between HRT and ovarian cancer, particularly for those who took estrogen only. The risk appears to be highest among women who took HRT for more than five years.
• Obesity. Women who are obese have a greater risk of ovarian cancer. Obesity may also be linked to more-aggressive ovarian cancers, which can result in a shorter time to disease relapse and a decrease in the overall survival rate.
• Male hormones. The medication danazol, a male hormone (androgen), is used to treat endometriosis and has been linked to an increased risk of ovarian cancer. More study is needed to further define this association.

Preparing for your appointment

You're likely to start by first seeing your family doctor, general practitioner or a gynecologist. If your primary care physician suspects you have ovarian cancer, he or she may refer you to a specialist in female reproductive cancers (gynecologic oncologist), or you may ask for a referral yourself. A gynecologic oncologist is an obstetrician and gynecologist (OB-GYN) who has additional training in the diagnosis and treatment of ovarian and other gynecologic cancers.

Because appointments can be brief and 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

• 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.
• Ask a family member or friend to join you, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions you want to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions before your appointment 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 ovarian cancer, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need?
• What type of ovarian cancer do I have?
• What types of treatments are available, and what kinds of side effects can I expect?
• What do you feel is the best course of action?
• What is my prognosis?
• If I still want to have children, what options are available to me?
• Will I have to stop working?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

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

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• Does anything appear to worsen your symptoms?
• Any first-degree relatives with ovarian or breast cancer? Other cancers in the family?

Tests and diagnosis

Because no standardized screening test exists to reliably detect ovarian cancer, doctors don't recommend screening for this type of cancer for most women. If you have a high risk of ovarian cancer, you need to have a careful discussion with your doctor about the risks and benefits of undergoing screening tests. While you may wonder what harm could come from a screening test, such tests can lead to unnecessary operations or other procedures that have significant side effects. Along with the potential complications of surgery, unnecessary procedures can cause anxiety, loss of work and substantial financial costs.

Several screening tests for ovarian cancer are commercially available, but none has been proved to lead to an early diagnosis that improves outcome. Additionally, these tests may lead to false-positives, which may subject women to unnecessary procedures and worry.

If your doctor suspects your symptoms suggest the presence of ovarian cancer, he or she may recommend one or more of the following tests to diagnose ovarian cancer:

• Pelvic examination. Your doctor examines your vagina, uterus, rectum and pelvis, including your ovaries, for masses or growths. If you've had your uterus removed (hysterectomy) but still have your ovaries, continue getting regular pelvic exams.
• Ultrasound. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. Pelvic ultrasound provides a safe, noninvasive way to evaluate the size, shape and configuration of the ovaries. If a mass is found, however, ultrasound can't reliably differentiate a cancerous growth from one that's not cancerous. Ultrasound can also detect fluid in your abdominal cavity (ascites), a possible sign of ovarian cancer. Because ascites develops in many conditions other than ovarian cancer, however, its presence necessitates more testing.
• CA 125 blood test. CA 125 is a protein made by your body in response to many different conditions. Many women with ovarian cancer have abnormally high levels of CA 125 in their blood. However, a number of noncancerous conditions also cause elevated CA 125 levels, and many women with early-stage ovarian cancer have normal CA 125 levels. Because of this lack of specificity, the CA 125 test isn't used for routine screening in average-risk women and is of uncertain benefit in high-risk women.

Other diagnostic tests may include computerized tomography (CT) and magnetic resonance imaging (MRI), which both provide detailed, cross-sectional images of the inside of your body. Your doctor may also order a chest X-ray to determine if cancer has spread to the lungs or to the pleural space surrounding the lungs, where fluid can accumulate. If fluid is present, a needle may be inserted into the space to remove it. The fluid is then checked in the laboratory for cancer cells.

Confirming the diagnosis
If these tests suggest ovarian cancer, you'll need an operation to confirm the diagnosis. In a surgical procedure called laparotomy, a gynecologic oncologist makes an incision in your abdomen and explores your abdominal cavity to determine whether cancer is present. The surgeon may collect samples of abdominal fluid and remove an ovary for examination by a pathologist.

In certain cases, a less invasive surgical procedure called laparoscopy may be used. Laparoscopy requires only a couple of small incisions, through which a lighted instrument is inserted, along with small tools used to perform the surgery. Laparoscopy may be used if a surgeon wants to remove a tissue mass to determine whether it's cancerous before proceeding with a more invasive operation.

If ovarian cancer is confirmed, the surgeon and pathologist identify the type of tumor and determine whether the cancer has spread. This will help determine the stage of the disease. The surgeon usually will then need to extend the incision so that he or she can perform a more extensive operation to remove as much cancer as possible. It's important that this type of surgery be performed by a doctor specifically trained to treat gynecologic cancers.

Before you have a diagnostic operation, talk with your doctor about what your treatment options will be if you turn out to have a noncancerous abnormality on your ovary. If you're near or past menopause, your doctor may recommend removing both of your ovaries to decrease your risk of ovarian cancer.

Staging your cancer
Ovarian cancer is classified in stages I through IV, with stage I being the earliest and stage IV, the most advanced. Staging is determined at the time of surgical evaluation of the disease:

• Stage I. Ovarian cancer is confined to one or both ovaries.
• Stage II. Ovarian cancer has spread to other locations in the pelvis, such as the uterus or fallopian tubes.
• Stage III. Ovarian cancer has spread to the lining of the abdomen (peritoneum) or to the lymph nodes within the abdomen. This is the most common stage of disease identified at the time of diagnosis.
• Stage IV. Ovarian cancer has spread to organs beyond the abdomen.

Treatments and drugs

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery
In most cases, you'll want to have a gynecologic oncologist perform ovarian cancer surgery because they often have more training and experience with this type of operation.

Generally, women with ovarian cancer require an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads.

During this procedure, your surgeon also removes as much cancer as possible from your abdomen (surgical debulking). Ideally, less than a total of 1 cubic centimeter of tumor matter remains in your abdominal cavity after surgery (optimal debulking). This may involve removing part of your intestines.

In addition, your surgeon will take samples of tissue and fluid from your abdomen to examine for cancer cells. This evaluation is critical in identifying the stage of your disease and determining if you need additional therapy.

If you want to preserve the option to have children and if your tumor is discovered early, your surgeon may be able to remove only the involved ovary and its fallopian tube. But, subsequent chemotherapy may cause infertility. However, in some cases, it is possible to successfully bear children after treatment. Be sure to discuss your desire to have children with your doctor.

Chemotherapy
After surgery, you'll most likely be treated with chemotherapy — drugs designed to kill any remaining cancer cells. The initial regimen for ovarian cancer includes the combination of carboplatin (Paraplatin) and paclitaxel (Taxol) injected into the bloodstream (intravenous administration). Clinical trials have found that this combination is effective, though researchers are continually looking for ways to improve on it.

A more intensive regimen has recently been shown to improve survival in women with advanced ovarian cancer by combining standard intravenous chemotherapy with chemotherapy injected directly into the abdominal cavity through a catheter placed at the time of the initial operation. This intra-abdominal infusion exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously.

Side effects — including abdominal pain, nausea and vomiting — may leave many women unable to complete a full course of treatment or others to forego treatment entirely. But even an incomplete course of this treatment may help women live longer.

Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the immune system to help combat cancer. The newest option, if standard chemotherapy fails, is a drug called bevacizumab (Avastin). It works by disrupting the blood supply to the tumor, possibly causing it to shrink. The most serious side effect associated with bevacizumab is bowel perforation, which occurs in about 7 percent of people taking it.

Radiation
While a mainstay in the treatment of some other cancers, radiation generally isn't considered effective for ovarian cancer. Sometimes, your doctor may recommend external beam radiation therapy (EBCT) to treat the symptoms of advanced cancer.

Types of Cancer : Brain tumor

Definition

A brain tumor is a mass or growth of abnormal cells in your brain. Many different types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in your brain (primary brain tumors), or cancer can begin in other parts of your body and spread to your brain (secondary, or metastatic brain tumors).

The number of brain tumors diagnosed each year is increasing. There's evidence the increase has been occurring for decades. But it's not clear why.

Symptoms

The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor's size, location and rate of growth.

General signs and symptoms caused by brain tumors may include:

• New onset or change in pattern of headaches
• Headaches that gradually become more frequent and more severe
• Unexplained nausea or vomiting
• Vision problems, such as blurred vision, double vision or loss of peripheral vision
• Gradual loss of sensation or movement in an arm or a leg
• Difficulty with balance
• Speech difficulties
• Confusion in everyday matters
• Personality or behavior changes
• Seizures, especially in someone who doesn't have a history of seizures
• Hearing problems
• Hormonal (endocrine) disorders

Causes

Brain tumors that begin in the brain
Primary brain tumors originate in the brain or close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary gland or pineal gland. Primary brain tumors begin when normal cells acquire errors (mutations) in their DNA. These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor.

Primary brain tumors are much less common than are secondary brain tumors, in which cancer begins elsewhere and spreads to the brain. Many different types of primary brain tumors exist. Each gets its name from the type of cells involved. Examples include:

• Acoustic neuroma (schwannoma)
• Astrocytoma, also known as glioma, which includes anaplastic astrocytoma and glioblastoma
• Ependymoma
• Ependymoblastoma
• Medulloblastoma
• Meningioma
• Neuroblastoma
• Oligodendroglioma
• Pineoblastoma

Cancer that begins elsewhere and spreads to the brain
Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain. In some cases you may have a history of cancer when a brain tumor is discovered. In other cases, a brain tumor is the first sign of cancer that began elsewhere in your body.

Secondary brain tumors are far more common than are primary brain tumors. Any cancer can spread to the brain, but the most common ones include:

• Breast cancer
• Colon cancer
• Kidney cancer
• Lung cancer
• Melanoma
• Neuroblastoma
• Sarcoma

Risk factors

Though doctors aren't sure what causes the genetic mutations that can lead to primary brain tumors, they've identified factors that may increase your risk of a brain tumor. Risk factors include:

• Your race. Brain tumors occur more frequently in whites than they do in others. One exception is meningioma, which occurs most frequently in blacks.
• Your age. Your risk of a brain tumor increases as you age. The majority of brain tumors occur in people 45 and older. However, a brain tumor can occur at any age. And certain types of brain tumors, such as medulloblastomas, occur almost exclusively in children.
• Exposure to radiation. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs. More-common forms of radiation, such as electromagnetic fields from power lines and radiofrequency radiation from cell phones and microwave ovens, have not been conclusively linked to brain tumors.
• Chemical exposure on the job. People working in certain industries have an increased risk of brain tumors, possibly because of the chemicals they're exposed to on the job. Studies don't always agree, but there is some evidence of an increased risk of brain tumor in certain industries, including agricultural, electrical, health care and oil refineries.
• Family history of brain tumors. A small portion of brain tumors occur in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.

When to seek medical advice

Make an appointment with your doctor if you have signs and symptoms that concern you. These may include headaches that progressively worsen, are particularly severe, are always in the same location or are accompanied by nausea or vomiting or by blurred or double vision.

Tests and diagnosis

If it's suspected that you have a brain tumor, your doctor may recommend a number of tests and procedures, including:

• A neurological exam. A neurological exam may include, among other things, checking your vision, hearing, balance, coordination and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumor.
• Imaging tests. Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. MRI uses magnetic fields and radio waves to generate images of the brain. In some cases a dye may be injected through a vein in your arm before your MRI. A number of specialized MRI scans may help your doctor in evaluation and treatment planning, including functional MRI, perfusion MRI and magnetic resonance spectroscopy.
• Tests to find cancer in other parts of your body. If it's suspected that your brain tumor may be a result of cancer that has spread from another area of your body, your doctor may recommend tests and procedures to determine where the cancer originated. One example might be a chest X-ray to look for signs of lung cancer.

• Collecting and testing a sample of abnormal tissue (biopsy). A biopsy can be performed as part of an operation to remove the brain tumor, or a biopsy can be performed using a needle. A stereotactic needle biopsy may be done for brain tumors in hard to reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. Your neurosurgeon drills a small hole, called a burr hole, into your skull. A narrow, thin needle is then inserted through the hole. Tissue is removed using the needle, which is frequently guided by computerized tomography (CT) or MRI scanning.

  The biopsy sample is then viewed under a microscope to determine if it is cancerous or benign. This information is helpful in guiding treatment.

Complications

A brain tumor can cause complications depending on the part of your brain that's affected. Complications can include:

• Weakness. A brain tumor can damage any part of the brain. But if the part of the brain involved happens to control strength or movement of an arm or leg, it could produce definite weakness in that part of the body. Weakness caused by a brain tumor can be very similar to that caused by a stroke.
• Vision changes. A brain tumor that damages the nerves that connect to the eyes or the part of the brain that processes visual information (visual cortex) can lead to vision problems, such as double vision or a reduced field of vision.
• Headaches. A brain tumor that causes increased pressure within the brain can cause headaches. These headaches can be severe and unrelenting and may be accompanied by nausea and vomiting. Headaches can be due to the tumor itself, or they can result from fluid building up in the brain (hydrocephalus).
• Personality changes. Tumors in certain areas of the brain may cause personality changes or changes in behavior.
• Hearing loss. Brain tumors that affect the auditory nerves — especially acoustic neuromas — may cause hearing loss in the ear on the involved side of the brain.
• Seizures. A brain tumor can cause irritation to the brain that can result in a seizure.

Treatments and drugs

Treatment for a brain tumor depends on the type, size and location of the tumor, as well as your overall health and your preferences. Your doctor can tailor treatment to fit your particular situation.

Surgery
If the brain tumor is located in a place that makes it accessible for an operation, your surgeon will work to remove as much of your brain tumor as possible. In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumors are located near sensitive areas in your brain, making surgery risky. In these situations your doctor may try to remove as much of the tumor as is safe. Even removing a portion of the brain tumor may help reduce signs and symptoms you experience. In some cases only a small biopsy is taken to confirm the diagnosis.

Surgery to remove a brain tumor carries risks, such as infection and bleeding. Other risks may depend on the part of your brain where your tumor is located. For instance, surgery on a tumor near nerves that connect to your eyes may carry a risk of vision loss.

Radiation therapy
Radiation therapy uses beams of high-energy particles, such as X-rays, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, radiation can be placed inside your body close to your brain tumor (brachytherapy).

External beam radiation can focus just on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole brain radiation). Whole brain radiation is sometimes used after surgery to kill tumor cells that might have been left behind. Whole brain radiation may also be an option if you have several brain tumors that can't be removed through surgery. Whole brain radiation is often used in situations where cancer has metastasized to the brain.

Side effects of radiation therapy will depend on the type and dose of radiation you receive. In general it can cause fatigue, headaches and scalp irritation.

Radiosurgery
Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn't particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.

Radiosurgery may be an option if your brain tumor can't be removed with traditional surgery. Radiosurgery is typically done in one treatment, and in most cases you can go home the same day. Side effects may include fatigue, headache and nausea.

Chemotherapy
Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally or injected into a vein (intravenously) so that they travel throughout your body. Chemotherapy drugs can also be administered into your spinal column, so treatment affects only your central nervous system.

Another type of chemotherapy can be placed during surgery. When removing all or part of the brain tumor, your surgeon may place one or more disk-shaped wafers in the void left by the tumor. These wafers slowly release a chemotherapy drug over the next several days.

Chemotherapy side effects depend on the type and dose of drugs you receive. Systemic chemotherapy can cause nausea, vomiting and hair loss.

Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Many targeted drug therapies are very new and still undergoing careful study in clinical trials.

One targeted drug therapy used to treat brain tumors is bevacizumab (Avastin). This drug, given through a vein (intravenously), stops the formation of new blood vessels, cutting off blood supply to a tumor and killing the tumor cells.

Clinical trials
Clinical trials are studies of the latest treatments, such as new drugs or new ways of using existing drugs and new surgical techniques. A clinical trial may offer you a chance at the latest treatment advances. But clinical trials can't guarantee a cure. And, in some cases, side effects of new treatments may not be fully known.

Talk to your doctor about clinical trials. Together you can discuss the benefits and risks and decide if a trial is appropriate for you.

Rehabilitation after treatment
Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. The brain can sometimes heal itself after trauma from or treatment of a brain tumor — but this can take time and patience.

• Cognitive rehabilitation can help you cope with or regain lost cognitive abilities.
• Physical therapy can help you regain lost motor skills or muscle strength.
• Vocational therapy can help you get back to work after a brain tumor or other illness.
• Specialists in speech difficulties (speech pathologists) are just one of many types of therapists who can help you recover.

School-age children with brain tumors may especially benefit from tutoring as a part of their overall treatment plan. A brain tumor can cause changes in the brain that affect thinking and learning. The earlier these problems are identified, the earlier they can be addressed with strategies that provide the most benefits to the child.

Alternative medicine

No complementary and alternative brain tumor treatments have been proved to cure brain tumors. However, they may help you cope with the side effects of your brain tumor and its treatment. Talk to your doctor about your options.

Some complementary and alternative treatments that may help you cope include:

• Acupuncture
• Massage
• Meditation
• Relaxation exercises
• Yoga

Types of Cancer : Mouth Cancer

Definition

Mouth cancer refers to cancer that develops in any of the parts that make up the mouth. Mouth cancer can occur on the lips, gums, tongue, inside lining of the cheeks, and the roof and floor of the mouth.

Cancer that occurs on the inside of the mouth is sometimes called oral cancer or oral cavity cancer.

Mouth cancer is one of several types of cancer grouped in a category called head and neck cancers. Mouth cancer and other head and neck cancers are often treated similarly.

Symptoms

Signs and symptoms of mouth cancer may include:

• A sore that doesn't heal
• A lump or thickening of the skin or lining of your mouth
• A white or reddish patch on the inside of your mouth
• Loose teeth
• Poorly fitting dentures
• Tongue pain
• Jaw pain or stiffness
• Difficult or painful chewing
• Difficult or painful swallowing
• Sore throat
• Feeling that something is caught in your throat

When to see a doctor
Make an appointment with your doctor or dentist if you have any persistent signs and symptoms that bother you and last more than two weeks. Your doctor will likely investigate other more common causes for your signs and symptoms first, such as an infection.

Causes

Mouth cancer occurs when cells on your lips or in your mouth develop changes (mutations) in their DNA. These mutations allow cancer cells to grow and divide when healthy cells would die. The accumulating mouth cancer cells can form a tumor. With time they may spread to other areas of the mouth and on to other areas of the head and neck or other parts of the body.

Mouth cancers most commonly begin in the flat, thin cells (squamous cells) that line your lips and the inside of your mouth. Most oral cancers are squamous cell carcinomas.

It's not clear what causes the mutations in squamous cells that lead to mouth cancer. But doctors have identified factors that may increase the risk of mouth cancer.

Risk factors

Factors that can increase your risk of mouth cancer include:

• Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others
• Heavy alcohol use
• Excessive sun exposure to your lips
• A sexually transmitted virus called human papillomavirus (HPV)
• Previous cancer or radiation treatments in the head or neck area

Complications

Mouth cancer treatment can cause complications that make it difficult to speak, swallow or chew. Your doctor may anticipate some of these complications and may refer you to specialists who can prepare you for changes and help you recover after your treatment.

Depending on your situation, you may be referred to specialists who can help you with:

• Speech problems
• Difficulty swallowing
• Difficulty eating
• Coping with changes in your appearance

Preparing for your appointment

If you suspect that you have mouth cancer, you're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a dentist or a dentist who specializes in diseases of the gums and related tissue in the mouth (periodontist).

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 soak up 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 mouth cancer, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• What are the approximate costs of the medicines, and do most insurance plans cover these?
• Are there any brochures or other printed material that I can take home 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.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you now or have you ever used tobacco?
• Do you drink alcohol?
• Have you ever received radiation therapy to your head or neck area?

What you can do in the meantime
Avoid doing things that worsen your signs and symptoms. If you have pain in your mouth, avoid spicy foods or hard foods that may cause further irritation. If you're having trouble eating because of pain, consider drinking nutritional supplement beverages. These can give you the nutrition you need until you can meet with your doctor or dentist.

Tests and diagnosis

Tests and procedures used to diagnose mouth cancer include:

• Physical exam. Your doctor or dentist will examine your lips and mouth to look for abnormalities — areas of irritation, such as sores and white patches (leukoplakia).
• Biopsy. If a suspicious area is found, your doctor or dentist may remove a sample of cells for laboratory testing. Unusual cells can be scraped away with a brush or cut away using a scalpel. In the laboratory, the cells are analyzed for cancer or precancerous changes that indicate a risk of future cancer.

Mouth cancer stages
Once mouth cancer is diagnosed, your doctor works to determine the extent, or stage, of your cancer. Mouth cancer staging tests may include:

• Using a scope to inspect your throat. During a procedure called endoscopy, your doctor may pass a lighted scope down your throat to look for signs that cancer has spread beyond your mouth.
• Imaging tests. A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, among others. Not everyone needs each test. Your doctor determines which tests are appropriate based on your condition.

Mouth cancer stages are indicated using Roman numerals I through IV. A lower stage, such as stage I, indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger tumor or that cancer has spread to other areas of the head or neck, or to other areas of the body. Your cancer's stage helps your doctor determine your treatment options.

Treatments and drugs

Treatment for mouth cancer depends on your cancer's location and stage, as well as your overall health and personal preferences. You may have just one type of treatment, or you may undergo a combination of cancer treatments. Discuss your options with your doctor.

Surgery
Surgery for mouth cancer may include:

• Surgery to remove the tumor. Your surgeon may cut away the tumor and a margin of healthy tissue that surrounds it. Smaller cancers may be removed through minor surgery. Larger tumors may require more extensive procedures. For instance, removing a larger tumor may involve removing a section of your jawbone or a portion of your tongue.
• Surgery to remove cancer that has spread to the neck. Mouth cancer often spreads to the lymph nodes in the neck. Your surgeon may recommend a procedure to remove cancerous lymph nodes and related tissue in the neck (neck dissection).
• Surgery to reconstruct the mouth. After an operation to remove your cancer, your surgeon may recommend reconstructive surgery to restore the appearance of your face or to help you regain the ability to talk and eat. Your surgeon may transplant grafts of skin, muscle or bone from other parts of your body to reconstruct your face. Dental implants may replace your natural teeth.

Surgery carries a risk of bleeding and infection. Surgery for mouth cancer often affects your appearance, as well as your ability to speak, eat and swallow. Your doctor may refer you to specialists who can help you cope with these changes.

Radiation therapy
Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. Radiation therapy can be delivered from a machine outside of your body (external beam radiation) or from radioactive seeds and wires placed near your cancer (brachytherapy). Mouth cancers are particularly sensitive to radiation therapy.

Radiation therapy may be the only treatment you receive if you have an early-stage mouth cancer. Radiation therapy can also be used before or after surgery. In other cases, radiation therapy may be combined with chemotherapy. This combination increases the effectiveness of radiation therapy, but it also increases the side effects you may experience. In cases of advanced mouth cancer, radiation therapy may help relieve signs and symptoms caused by the cancer, such as pain.

Side effects of radiation therapy to your mouth may include dry mouth, tooth decay, mouth sores, bleeding gums, jaw stiffness, fatigue and red, burn-like skin reactions.

Chemotherapy
Chemotherapy is a treatment that uses chemicals to kill cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or in combination with other cancer treatments. Chemotherapy may increase the effectiveness of radiation therapy, so the two are often combined.

Side effects of chemotherapy depend on which drugs you receive. Common side effects include nausea, vomiting and hair loss.

Targeted drug therapy
Targeted drugs treat mouth cancer by altering specific aspects of cancer cells that fuel their growth. Cetuximab (Erbitux) is one targeted therapy approved for treating head and neck cancers in certain situations. Cetuximab stops the action of a protein that's found in many types of healthy cells, but is more prevalent in certain types of cancer cells.

Other targeted drugs are being studied in clinical trials. Targeted drugs can be used in combination with chemotherapy or radiation therapy.

Lifestyle and home remedies

Quit using tobacco
Mouth cancers are closely linked to tobacco use, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others. Not everyone who is diagnosed with mouth cancer uses tobacco. But if you do, now is the time to stop because:

• Tobacco use makes treatment less effective.
• Tobacco use makes it harder for your body to heal after surgery.
• Tobacco use increases your risk of getting another cancer in the future.

Quitting smoking or chewing can be very difficult. And it's that much harder when you're trying to cope with a stressful situation, such as a cancer diagnosis. Your doctor can discuss all of your options, including medications, nicotine replacement products and counseling.

Quit drinking alcohol
Alcohol, particularly when combined with tobacco use, greatly increases the risk of mouth cancer. If you drink alcohol, stop now. This may help reduce your risk of a second cancer. Stopping drinking may also help you better tolerate your mouth cancer treatments.

Alternative medicine

No alternative treatments have proved helpful in treating mouth cancer. However, some complementary and alternative treatments may help you cope with your diagnosis and with the side effects of mouth cancer treatment. Talk to your doctor about your options.

Alternative treatments you may find helpful include:

• Acupuncture
• Massage therapy
• Meditation
• Relaxation techniques

Prevention

There's no proven way to prevent mouth cancer. However, you can reduce your risk of mouth cancer if you:

• Stop using tobacco or don't start. If you use tobacco, stop. If you don't use tobacco, don't start. Using tobacco, whether smoked or chewed, exposes the cells in your mouth to dangerous cancer-causing chemicals.
• Drink alcohol only in moderation, if at all. Chronic excessive alcohol use can irritate the cells in your mouth, making them vulnerable to mouth cancer. If you choose to drink alcohol, limit yourself to one drink a day if you're a woman or older than age 65. Men should drink no more than two drinks a day.
• Eat a variety of fruits and vegetables. Choose a diet rich in fruits and vegetables. The vitamins and antioxidants found in fruits and vegetables may help reduce your risk of mouth cancer.
• Avoid excessive sun exposure to your lips. Protect the skin on your lips from the sun by staying in the shade when possible. Wear a broad-brimmed hat that effectively shades your entire face, including your mouth. Apply a sunscreen lip product as part of your routine sun protection regimen.
• See your dentist regularly. As part of a routine dental exam, ask your dentist to inspect your entire mouth for abnormal areas that may indicate mouth cancer or precancerous changes.

Types of Cancer : Bone Cancer

Definition

Cancer that originates in the bone — primary bone cancer — is rare. Fewer than 2,500 Americans are diagnosed with this type of cancer each year. The condition affects more children than adults.

The most common forms of primary bone cancer are:

• Osteosarcoma, which occurs primarily in growing bone tissue
• Chondrosarcoma, which occurs in cartilage
• Ewing's sarcoma, which arises primarily in immature tissue in bone marrow

Osteosarcoma and Ewing's sarcoma occur most often in children, adolescents and young adults, ages 10 to 20. Chondrosarcoma is more common in adults over 50.

Treatment of bone cancer depends on the type of bone cancer, as well as its location, size and stage.

Symptoms

Pain is the most common bone cancer symptom. Although bone cancer can arise in any of your bones, it most frequently occurs in the long bones of your arms and legs.

Other possible symptoms and signs of bone cancer include:

• Weakened bones, sometimes leading to fractures
• Joint swelling and tenderness (for tumors in or near joints)
• Fatigue
• Fever
• Unintended weight loss
• Anemia

Causes

Primary bone cancer is different from secondary or metastatic bone cancer. In secondary or metastatic bone cancer, the cancer originates in a different place but spreads (metastasizes) to the bones. For example, someone with prostate cancer may develop bone lesions from the prostate cancer. But, even though the cancer has spread to the bone, it's still prostate cancer.

Metastatic bone cancer is much more common than is primary bone cancer. Additionally, primary bone cancer doesn't refer to cancer that begins in the bone marrow — the soft inner core of your bones that makes your blood cells. Bone marrow cancers include diseases such as multiple myeloma and acute and chronic leukemias.

In general, no one knows for certain what causes most primary bone cancers. Adults with Paget's disease of bone, which involves abnormal development of new bone cells, may be at increased risk of osteosarcoma.

In a few cases, bone cancers may have a hereditary component, such as in:

• Li-Fraumeni syndrome. This condition is characterized by an increased risk of many different cancers, including osteosarcoma, breast cancer, brain cancer and others.
• Rothmund-Thomson syndrome. This condition causes short stature, skeletal problems and rashes, and increases risk of bone cancer.
• Hereditary retinoblastoma. Children with this rare cancer of the eye have an increased risk of osteosarcoma.
• Multiple exostoses. Children with this inherited condition that causes cartilage bumps to form on your bones have an increased risk of chondrosarcoma.

The association with radiation
Radiation is occasionally associated with bone cancer. Exposure to radiation from a diagnostic X-ray won't harm you. But heavy doses of radiation, such as radiation therapy given for other cancers, can increase your risk of developing bone cancer, especially if you receive the therapy at a young age.

Still, radiation therapy is becoming more and more sophisticated, which may lead to fewer of such side effects. For example, doctors today are better able to regulate doses of radiation and more precisely target the tumor being treated.

When to seek medical advice

Talk to your doctor if you develop signs or symptoms that may indicate bone cancer, such as unexplained bone pain. Having bone pain doesn't necessarily mean you have bone cancer. Bone pain is more likely due to injuries or arthritis. And bone tumors are often noncancerous (benign). However, the only way to determine whether a tumor is cancerous is for a doctor to examine a sample of the tissue.

Tests and diagnosis

If your doctor suspects you have bone cancer, he or she will take a medical history and perform a physical exam. In addition, the following tests help in diagnosing bone cancer:

• Imaging tests. Tests such as X-rays, computerized tomography (CT) scans, ultrasound and magnetic resonance imaging (MRI) enable your doctor to evaluate the area of concern.
• Bone scan. Your doctor may also request a bone scan, a procedure in which you're injected with a tiny amount of radioactive material, called a tracer, which can be detected by a special camera used to create images of your bones.

Examining a tissue sample
Determining whether a tumor is malignant requires removal of a sample of tissue (biopsy) from the tumor for examination. If your doctor suspects you have bone cancer, ask for a referral to a cancer center that specializes in bone cancer before the biopsy is performed. Treatment of bone cancer requires a specialized team who work together to treat bone cancer. This team includes a medical oncologist, orthopedic surgeon, radiation oncologist and physical therapist.

Techniques for removing a sample of a suspected bone cancer include:

• Needle biopsy. Your doctor uses a thin needle to remove small pieces of tissue from the tumor. There are two types of needle biopsy — fine-needle aspiration and core biopsy. A core biopsy involves using a slightly larger needle to remove a small, solid core of tissue.
• Surgical biopsy. Your doctor makes an incision through your skin and removes either the entire tumor (excisional biopsy) or a portion of the tumor (incisional biopsy). In some cases you may need only local anesthesia. For a larger or deep-seated tumor, you'll likely require general anesthesia for the procedure. It's important that a doctor experienced in the treatment of sarcomas perform the excisional biopsy.

Grading and staging
Besides determining whether the tissue is cancerous, examining tissue can determine how aggressive the cancer is (its grade). Further testing, such as scans and blood tests, will determine if the cancer has spread and how far (its stage).

Childhood bone cancers, such as osteosarcoma or Ewing's sarcoma, are generally grouped into two stages, depending on whether the cancer is contained in one part of the body (localized) or has spread to other parts (metastasized).

Survival is based on a number of factors, including the type of cancer, at what stage the cancer was discovered and where the tumor is located. If the tumor is very small and localized, the prognosis is generally more promising than if the cancer has begun to spread.

Treatments and drugs

As with other cancers, bone cancer treatment depends on the size, type, location and stage of the cancer, including whether it has spread to the lungs or other parts of your body, and your overall health.

Surgery
Surgery is the most common treatment for bone cancer. Surgery for cancer that hasn't spread involves removing the cancer and a rim of healthy bone surrounding it.

In the past, amputation was common for bone cancer in an arm or leg. Today, advances in surgical techniques and chemotherapy before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy) and radiation therapy make limb-sparing surgery possible in many cases. With osteosarcoma, limb-sparing surgery involves replacing the cancerous bone with an artificial device (prosthesis) or bone from another part of your body or from another person (transplant).

A well-coordinated team of doctors — including surgeons, medical oncologists, radiation oncologists, and physical medicine and rehabilitation specialists who are familiar with treatment of sarcomas — is important for increasing the chance you'll be able to have limb-sparing treatment. Specialized centers for treatment of sarcoma exist in many areas.

If osteosarcoma spreads, treatment may involve surgical removal of both the bone tumor and the metastasized cancer.

Ewing's sarcoma has a tendency to metastasize rapidly. Treatment may involve chemotherapy with multiple drugs as well as radiation therapy and surgery to remove the primary tumor.

Radiation therapy
Radiation therapy — also called radiotherapy or X-ray therapy — involves treating cancer with beams of high-energy particles, or waves (radiation), such as gamma rays or X-rays. Although radiation can affect healthy cells as well as cancer cells, it's much more harmful to cancer cells. In addition, normal cells can recover from the effects of radiation more easily than cancer cells can.

Many people with cancer undergo some type of radiation therapy. Your doctor may suggest using radiation therapy at different times during your cancer treatment and for different reasons, such as before surgery to shrink a cancerous tumor or after surgery to stop the growth of any remaining cancer cells. Radiation may also be used at the same time as chemotherapy. In addition, doctors sometimes use radiation therapy to shrink tumors to decrease the pressure, pain or other symptoms they may cause.

Chemotherapy
Chemotherapy uses medications to kill rapidly dividing cells. These cells include cancer cells, which continuously divide to form more cells, and healthy cells that divide quickly, such as those in your bone marrow, gastrointestinal tract, reproductive system and hair follicles. Healthy cells usually recover shortly after chemotherapy is complete — so, for example, your hair soon starts growing again.

Unlike radiation therapy, which treats only the part of your body exposed to the radiation, chemotherapy treats the body as a whole (systemically). Its purpose is to treat cells that may have escaped from where the cancer originated.

Depending on the type of cancer you have and whether it has spread, your doctor may use chemotherapy to:

• Shrink the cancer prior to an operation, making the operation easier
• Eliminate all cancer cells in your body, even when cancer is widespread
• Prolong your life by controlling cancer growth and spread
• Relieve symptoms and enhance your quality of life

In some cases, chemotherapy may be the only treatment you need. More often, doctors use it in conjunction with other treatments, such as surgery or radiation, to improve results.

Types of Cancer : Breast Cancer

Definition

Breast cancer is cancer that forms in the cells of the breasts. Breast cancer can occur in both men and women, but it's far more common in women.

After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. But breast cancer rates have fallen in recent years, though doctors aren't certain why. Still, for many women, breast cancer is the disease they fear most.

Public support for breast cancer awareness and research funding has helped improve the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased and the number of deaths has been declining, thanks to earlier detection, new treatments and a better understanding of the disease.

Symptoms

Signs and symptoms of breast cancer may include:

• A breast lump or thickening that feels different from the surrounding tissue
• Bloody discharge from the nipple
• Change in the size or shape of a breast
• Changes to the skin over the breast, such as dimpling
• Inverted nipple
• Peeling or flaking of the nipple skin
• Redness or pitting of the skin over your breast, like the skin of an orange

When to see a doctor
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor.

Causes

It's not clear what causes breast cancer. Doctors know that breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do. The accumulating cells form a tumor that may spread (metastasize) through your breast, to your lymph nodes or to other parts of your body.

Breast cancer most often begins with cells in the milk-producing ducts. Doctors call this type of breast cancer invasive ductal carcinoma. Breast cancer may also begin in the lobules (invasive lobular carcinoma) or cells within the breast.

Researchers have identified things that can increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex combination of your genetic makeup and your environment.

Inherited breast cancer
Doctors estimate that 5 to 10 percent of breast cancers are linked to gene mutation passed through generations of a family. A number of inherited defective genes that can increase the likelihood of breast cancer have been identified. The most common are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which increase the risk of both breast and ovarian cancer.

If you have a strong family history of breast cancer or other cancers, blood tests may help identify defective BRCA or other genes that are being passed through your family. Consider asking your doctor for a referral to a genetic counselor who can review your family health history. A genetic counselor can also discuss the benefits, risks and limitations of genetic testing with you.

Risk factors

A risk factor is anything that makes it more likely you'll get a particular disease. But having one or even several risk factors doesn't necessarily mean you'll develop cancer — most women with breast cancer have no known risk factors other than simply being women.

Things that can increase your risk of breast cancer include:

• Being female. Women are much more likely than men are to develop breast cancer.
• Increasing age. Your risk of breast cancer increases as you age. Women older than 60 have a greater risk than do younger women.
• A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
• A family history of breast cancer. If you have a mother, sister or daughter with breast cancer, you have a greater chance of being diagnosed with breast cancer. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
• Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most common gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
• 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.
• Obesity. Being overweight or obese increases your risk of breast cancer.
• Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
• Beginning menopause at an older age. If you began menopause after age 55, you're more likely to develop breast cancer.
• Having your first child at an older age. Women who give birth to their first child after age 35 may have an increased risk of breast cancer.
• Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer.
• Drinking alcohol. Drinking alcohol may increase the risk of breast cancer.

Preparing for your appointment

Consulting with your health care team
Women with breast cancer may have appointments with their primary care doctors, as well as several other doctors and other health professionals, including:

• Breast surgeons
• Doctors who specialize in diagnostic tests, such as mammograms (radiologists)
• Doctors who specialize in treating cancer (oncologists)
• Doctors who treat cancer with radiation (radiation oncologists)
• Genetic counselors
• Plastic surgeons

What you can do to prepare

• 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.
• Write down your family history of cancer. Note any family members who have had cancer, including how each member is related to you, the type of cancer, the age at diagnosis and whether each person survived.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Keep all of your records that relate to your cancer diagnosis and treatment. Organize your records in a binder or folder that you can take to your appointments.
• 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.

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 breast cancer, some basic questions to ask your doctor include:

• What type of breast cancer do I have?
• What is the stage of my cancer?
• Can you explain my pathology report to me? Can I have a copy for my records?
• Do I need any more tests?
• What are the treatment options for my cancer?
• What are the side effects of each treatment option?
• How will each treatment option affect my daily life? Can I continue working?
• Is there one treatment you recommend over the others?
• How do you know that these treatments will benefit me?
• What would you recommend to a friend or family member in my situation?
• How quickly do I need to make a decision about cancer treatment?
• What happens if I don't want cancer treatment?
• What will cancer treatment cost?
• Does my insurance plan cover the tests and treatment you're recommending?
• Should I seek a second opinion? Will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites or books 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 breast cancer
Tests and procedures used to diagnose breast cancer include:

• Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality.
• Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Your doctor may recommend an ultrasound to help determine whether a breast abnormality is likely to be a fluid-filled cyst rather than a breast tumor.
• Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye.
• Removing a sample of breast cells for testing (biopsy). A biopsy to remove a sample of the suspicious breast cells helps determine whether cells are cancerous or not. The sample is sent to a laboratory for testing. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer and whether the cancer cells have hormone receptors.

Other tests and procedures may be used depending on your situation.

Staging breast cancer
Once your doctor has diagnosed your breast cancer, he or she works to determine the extent (stage) of your cancer. Your cancer's stage helps determine your prognosis and your treatment options. Complete information about your cancer's stage may not be available until after you undergo breast cancer surgery.

Tests and procedures used to stage breast cancer may include:

• Blood tests, such as a complete blood count
• Mammogram of the other breast to look for signs of cancer
• Chest X-ray
• Breast MRI
• Bone scan
• Computerized tomography (CT) scan
• Positron emission tomography (PET) scan

Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests.

Breast cancer stages range from 0 to IV, with 0 indicating cancer that is very small and noninvasive. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body.

Treatments and drugs

Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage, whether the cancer cells are sensitive to hormones, your overall health and your own preferences. Most women undergo surgery for breast cancer and also receive additional treatment, such as chemotherapy, hormone therapy or radiation.

There are many options for breast cancer treatment and you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Talk to other women who have faced the same decision.

Breast cancer surgery
Operations used to treat breast cancer include:

• Removing the breast cancer (lumpectomy). During lumpectomy, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors that are easily separated from the surrounding tissue.
• Removing the entire breast (mastectomy). Mastectomy is surgery to remove all of your breast tissue. Mastectomy can be simple, meaning the surgeon removes all of the breast tissue — the lobules, ducts, fatty tissue and skin, including the nipple and areola. Or mastectomy can be radical, meaning the underlying muscle of the chest wall is removed along with surrounding lymph nodes in the armpit.
• Removing one lymph node (sentinel node biopsy). Breast cancer that spreads to the lymph nodes may spread to other areas of the body. Your surgeon determines which lymph node near your breast tumor receives the lymph drainage from your cancer. This lymph node is removed and tested for breast cancer cells. If no cancer is found, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed.
• Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel node, then your surgeon removes additional lymph nodes in your armpit. Knowing if cancer has spread to the lymph nodes helps determine the best course of treatment, including whether you'll need chemotherapy or radiation therapy.

Complications of breast cancer surgery depend on the procedures you choose. Surgery carries a risk of bleeding and infection. Surgery to remove your lymph nodes increases your risk of arm swelling (lymphedema).

Some women choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon. Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a synthetic breast implant or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.

Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).

External beam radiation is commonly used after lumpectomy for early-stage breast cancer. Doctors may also recommend radiation therapy after mastectomy for larger breast cancers.

Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more serious problems may occur, including arm swelling (lymphedema), broken ribs and damage to the lungs or nerves.

Chemotherapy
Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high chance of returning or spreading to another part of your body, your doctor may recommend chemotherapy after surgery to decrease the chance that the cancer will recur. This is known as adjuvant systemic chemotherapy.

Chemotherapy is sometimes given before surgery in women with larger breast tumors. Doctors call this neoadjuvant chemotherapy. The goal is to shrink a tumor to a size that makes it easier to remove with surgery. This may also increase the chance of a cure. Research is ongoing into neoadjuvant chemotherapy to determine who may benefit from this treatment.

Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.

Chemotherapy side effects depend on the drugs you receive. Common side effects include hair loss, nausea, vomiting, fever and frequent infections.

Hormone therapy
Hormone therapy — perhaps more properly termed hormone blocking therapy — is often used to treat breast cancers that are sensitive to hormones. Doctors sometimes refer to these cancers as estrogen and progesterone receptor positive cancers.

Hormone therapy can be used after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.

Treatments that can be used in hormone therapy include:

• Medications that block hormones from attaching to cancer cells. Tamoxifen is a type of drug called a selective estrogen receptor modulator (SERM). SERMs act by blocking any estrogen present in the body from attaching to the estrogen receptor on the cancer cells, slowing the growth of tumors and killing tumor cells. Tamoxifen can be used in both pre- and postmenopausal women.
• Medications that stop the body from making estrogen after menopause. Called aromatase inhibitors, these drugs block the action of an enzyme that converts androgens in the body into estrogen. These drugs are effective only in postmenopausal women. Aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).
• Surgery or medications to stop hormone production in the ovaries. In premenopausal women, surgery or medications can shutdown hormone production in the ovaries.

Side effects of hormone therapy vary according to which medication you receive, but typically include menopausal symptoms, such as hot flashes, vaginal dryness, decreased sex drive and mood changes. Side effects of aromatase inhibitors include joint and muscle pain, as well as an increased risk of bone thinning (osteoporosis).

Targeted drugs
Targeted drug treatments attack specific abnormalities within cancer cells. Targeted drugs approved to treat breast cancer include:

• Trastuzumab (Herceptin). Trastuzumab targets a protein called HER2 that helps some breast cancer cells grow and survive. If your breast cancer cells make too much HER2, trastuzumab may help block that protein and cause the cancer cells to die.
• Bevacizumab (Avastin). Bevacizumab is a drug designed to stop the signals cancer cells use to attract new blood vessels. Without new blood vessels to bring oxygen and nutrients to the tumor, the cancer cells die. Bevacizumab is approved for breast cancer that has spread to other areas of the body.
• Lapatinib (Tykerb). Lapatinib targets the HER2 protein and is approved for use in advanced breast cancer. Lapatinib is reserved for women who have already tried trastuzumab and their cancer has progressed.

Side effects of targeted drugs depend on the drug you receive. Targeted drugs can be very expensive and aren't always covered by health insurance.

Clinical trials
Clinical trials are used to test new and promising agents in the treatment of cancer. Clinical trials represent the cutting edge of cancer treatment, but they're often unproven treatments that may or may not be superior to currently available therapies. Talk with your doctor about clinical trials to see if one is right for you.

Examples of treatments being studied in breast cancer clinical trials include:

• New combinations of existing drugs. Researchers are studying new ways of combining existing chemotherapy, hormone therapy and targeted therapy drugs. Testing new combinations may help determine if certain breast cancers are more susceptible to specific combinations.
• Bone-building drugs to prevent breast cancer recurrence. In early 2009, a study reported adding a bone-building drug to hormone therapy treatment after surgery for premenopausal women reduced the risk of breast cancer recurrence. The drug used in the study, zoledronic acid (Reclast, Zometa), is a type of drug called a bisphosphonate that's used to treat bone loss (osteoporosis) and other bone diseases. The group of women who received zoledronic acid experienced fewer cancer recurrences than did the group that didn't receive the drug during the study, which lasted four years. Doctors are awaiting the results of other studies of zoledronic acid before widely recommending this treatment.
• Using higher doses of radiation over a shorter period of time on a smaller portion of the breast. Researchers are studying partial breast irradiation in women who've undergone lumpectomy. Partial breast irradiation involves higher doses of radiation aimed at only a portion of the breast, rather than the entire breast. Radiation used in partial breast irradiation can come from a machine outside your body or it can come from tubes or catheters placed within the breast tissue.

Alternative medicine

No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your doctor's care.

Alternative medicine for fatigue
Many breast cancer survivors experience fatigue during and after treatment that can continue for years. Doctors aren't sure what causes cancer-related fatigue and it can persist despite treatment. When combined with your doctor's care, complementary and alternative medicine therapies may help relieve fatigue. Ask your doctor about:

• Gentle exercise. If you get the OK from your doctor, start with gentle exercise a few times a week and work your way up to more if you feel up to it. Consider walking, swimming, yoga or tai chi.
• Managing stress. Take control of the stress in your daily life. Try stress reduction techniques such as muscle relaxation, visualization and spending time with friends and family.
• Relaxation strategies. Balance activity with periods of relaxation. Try listening to music, writing in a journal, meditating or taking a warm bath.

Prevention

Breast cancer prevention for women with an average risk
Making changes in your daily life may help reduce your risk of breast cancer. Try to:

• Ask your doctor about breast cancer screening. Ask your doctor at what age you should begin routine clinical breast exams and mammograms. Most guidelines recommend women with an average risk begin annual mammograms to screen for breast cancer at age 40. Talk to your doctor about the benefits and risks of screening and together you can decide what breast cancer screening strategies are right for you.
• Become familiar with your breasts through breast self-exams. Ask your doctor to show you how to do a breast self-exam to check for any lumps or other unusual signs in your breasts. A breast self-exam can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo each month and identify any unusual signs and symptoms.
• Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to less than one drink a day, if you choose to drink.
• Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your doctor whether it's OK and start slowly.
• Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy. Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms. To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.
• Maintain a healthy weight. If your current weight is healthy, work to maintain that weight. If you need to lose weight, ask your doctor about healthy strategies to accomplish this. Reduce the number of calories you eat each day and slowly increase the amount of exercise. Aim to lose weight slowly — about 1 or 2 pounds a week.

Breast cancer prevention for women with a high risk
If your doctor has assessed your family history and other factors and determined that you may have an increased risk of breast cancer, options to reduce your risk include:

• Preventive medications (chemoprevention). Estrogen-blocking medications help reduce the risk of breast cancer. Options include tamoxifen and raloxifene (Evista). These medications carry a risk of side effects, so doctors reserve these medications for women who have a very high risk of breast cancer.
• Preventive surgery. Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.

Types of Cancer : Colon Cancer

Definition

The colon is the part of the digestive system where the waste material is stored. The rectum is the end of the colon adjacent to the anus. Together, they form a long, muscular tube called the large intestine (also known as the large bowel). Tumors of the colon and rectum are growths arising from the inner wall of the large intestine. Benign tumors of the large intestine are called polyps. Malignant tumors of the large intestine are called cancers. Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can be easily removed during colonoscopy and are not life-threatening. If benign polyps are not removed from the large intestine, they can become malignant (cancerous) over time. Most of the cancers of the large intestine are believed to have developed from polyps. Cancer of the colon and rectum (also referred to as colorectal cancer) can invade and damage adjacent tissues and organs. Cancer cells can also break away and spread to other parts of the body (such as liver and lung) where new tumors form. The spread of colon cancer to distant organs is called metastasis of the colon cancer. Once metastasis has occurred in colorectal cancer, a complete cure of the cancer is unlikely.

Globally, cancer of the colon and rectum is the third leading cause of cancer in males and the fourth leading cause of cancer in females. The frequency of colorectal cancer varies around the world. It is common in the Western world and is rare in Asia and Africa. In countries where the people have adopted western diets, the incidence of colorectal cancer is increasing.

Causes

Doctors are certain that colorectal cancer is not contagious (a person cannot catch the disease from a cancer patient). Some people are more likely to develop colorectal cancer than others. Factors that increase a person's risk of colorectal cancer include high fat intake, a family history of colorectal cancer and polyps, the presence of polyps in the large intestine, and chronic ulcerative colitis.

Diet and colon cancer

Diets high in fat are believed to predispose humans to colorectal cancer. In countries with high colorectal cancer rates, the fat intake by the population is much higher than in countries with low cancer rates. It is believed that the breakdown products of fat metabolism lead to the formation of cancer-causing chemicals (carcinogens). Diets high in vegetables and high-fiber foods such as whole-grain breads and cereals may rid the bowel of these carcinogens and help reduce the risk of cancer.

Colon polyps and colon cancer

Doctors believe that most colon cancers develop in colon polypz. Therefore, removing benign colon polyps can prevent colorectal cancer. Colon polyps develop when chromosome damage occurs in cells of the inner lining of the colon. Chromosomes contain genetic information inherited from each parent. Normally, healthy chromosomes control the growth of cells in an orderly manner. When chromosomes are damaged, cell growth becomes uncontrolled, resulting in masses of extra tissue (polyps). Colon polyps are initially benign. Over years, benign colon polyps can acquire additional chromosome damage to become cancerous.

Ulcerative colitis and colon cancer

Chronic ulcerative colitis causes inflammation of the inner lining of the colon. For further information, please read the Ulcerative Colitis article. Colon cancer is a recognized complication of chronic ulcerative colitis. The risk for cancer begins to rise after eight to 10 years of colitis. The risk of developing colon cancer in a patient with ulcerative colitis also is related to the location and the extent of his or her disease.

Current estimates of the cumulative incidence of colon cancer associated with ulcerative colitis are 2.5% at 10 years, 7.6% at 30 years, and 10.8% at 50 years. Patients at higher risk of cancer are those with a family history of colon cancer, a long duration of colitis, extensive colon involvement, and those with primary sclerosing cholangitis (PSC).

Since the cancers associated with ulcerative colitis have a more favorable outcome when caught at an earlier stage, yearly examinations of the colon often are recommended after eight years of known extensive disease. During these examinations, samples of tissue (biopsies) can be taken to search for precancerous changes in the lining cells of the colon. When precancerous changes are found, removal of the colon may be necessary to prevent colon cancer.

Genetics and colon cancer

A person's genetic background is an important factor in colon cancer risk. Among first-degree relatives of colon cancer patients, the lifetime risk of developing colon cancer is 18% (a threefold increase over the general population in the United States).

Even though family history of colon cancer is an important risk factor, majority (80%) of colon cancers occur sporadically in patients with no family history of colon cancer. Approximately 20% of cancers are associated with a family history of colon cancer. And 5 % of colon cancers are due to hereditary colon cancer syndromes. Hereditary colon caner syndromes are disorders where affected family members have inherited cancer-causing genetic defects from one or both of the parents.

Chromosomes contain genetic information, and chromosome damages cause genetic defects that lead to the formation of colon polyps and later colon cancer. In sporadic polyps and cancers (polyps and cancers that develop in the absence of family history), the chromosome damages are acquired (develop in a cell during adult life). The damaged chromosomes can only be found in the polyps and the cancers that develop from that cell. But in hereditary colon cancer syndromes, the chromosome defects are inherited at birth and are present in every cell in the body. Patients who have inherited the hereditary colon cancer syndrome genes are at risk of developing large number of colon polyps, usually at young ages, and are at very high risk of developing colon cancer early in life, and also are at risk of developing cancers in other organs.

FAP (familial adenomatous polyposis) is a hereditary colon cancer syndrome where the affected family members will develop countless numbers (hundreds, sometimes thousands) of colon polyps starting during the teens. Unless the condition is detected and treated (treatment involves removal of the colon) early, a person affected by familial polyposis syndrome is almost sure to develop colon cancer from these polyps. Cancers usually develop in the 40s. These patients are also at risk of developing other cancers such as cancers in the thyroid gland, stomach, and the ampulla (the part where the bile ducts drain into the duodenum just beyond the stomach).

AFAP (attenuated familial adenomatous polyposis) is a milder version of FAP. Affected members develop less than 100 colon polyps. Nevertheless, they are still at very high risk of developing colon cancers at young ages. They are also at risk of having gastric polyps and duodenal polyps.

HNPCC (hereditary nonpolyposis colon cancer) is a hereditary colon cancer syndrome where affected family members can develop colon polyps and cancers, usually in the right colon, in their 30s to 40s. Certain HNPCC patients are also at risk of developing uterine cancer, stomach cancer, ovarian cancer, and cancers of the ureters (the tubes that connect the kidneys to the bladder), and the biliary tract (the ducts that drain bile from the liver to the intestines).

MYH polyposis syndrome is a recently discovered hereditary colon cancer syndrome. Affected members typically develop 10-100 polyps occurring at around 40 years of age, and are at high risk of developing colon cancer.

Symptoms

ymptoms of colon cancer are numerous and nonspecific. They include fatigue, weakness, shortness of breath, change in bowel habits, narrow stools, diarrhea or constipation, red or dark blood in stool, weight loss, abdominal pain, cramps, or bloating. Other conditions such as irritable bowel syndrome (spastic colon), ulcerative colitis, Crohn's disease, diverticulosis, and peptic ulcer disease can have symptoms that mimic colorectal cancer. For more information on these conditions, please read the following articles: Irritable Bowel Syndrome, Ulcerative Colitis, Crohn's Disease, Diverticulosis, and Peptic Ulcer Disease. Colon cancer can be present for several years before symptoms develop. Symptoms vary according to where in the large bowel the tumor is located. The right colon is spacious, and cancers of the right colon can grow to large sizes before they cause any abdominal symptoms. Typically, right-sided cancers cause iron deficiency anemia due to the slow loss of blood over a long period of time. Iron deficiency anemia causes fatigue, weakness, and shortness of breath. The left colon is narrower than the right colon. Therefore, cancers of the left colon are more likely to cause partial or complete bowel obstruction. Cancers causing partial bowel obstruction can cause symptoms of constipation, narrowed stool, diarrhea, abdominal pains, cramps, and bloating. Bright red blood in the stool may also indicate a growth near the end of the left colon or rectum.

Tests and diagnosis

When colon cancer is suspected, either a lower GI series (barium enema x-ray) or colonoscopy is performed to confirm the diagnosis and to localize the tumor.

A barium enema involves taking x-rays of the colon and the rectum after the patient is given an enema with a white, chalky liquid containing barium. The barium outlines the large intestines on the x-rays. Tumors and other abnormalities appear as dark shadows on the x-rays. For more information, please read the Lower Gastrointestinal Series (Barium Enema) article.

Colonoscopy is a procedure whereby a doctor inserts a long, flexible viewing tube into the rectum for the purpose of inspecting the inside of the entire colon. Colonoscopy is generally considered more accurate than barium enema x-rays, especially in detecting small polyps. If colon polyps are found, they are usually removed through the colonoscope and sent to the pathologist. The pathologist examines the polyps under the microscope to check for cancer. While the majority of the polyps removed through the colonoscopes are benign, many are precancerous. Removal of precancerous polyps prevents the future development of colon cancer from these polyps. For more information, please read the Colonoscopy article.

If cancerous growths are found during colonoscopy, small tissue samples (biopsies) can be obtained and examined under the microscope to confirm the diagnosis. If colon cancer is confirmed by a biopsy, staging examinations are performed to determine whether the cancer has already spread to other organs. Since colorectal cancer tends to spread to the lungs and the liver, staging tests usually include chest x-rays, ultrasonography, or a CAT scan of the lungs, liver, and abdomen.

Sometimes, the doctor may obtain a blood test for CEA (carcinoembyonic antigen). CEA is a substance produced by some cancer cells. It is sometimes found in high levels in patients with colorectal cancer, especially when the disease has spread.

Treatments and drugs

Surgery is the most common treatment for colorectal cancer. During surgery, the tumor, a small margin of the surrounding healthy bowel, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the bowel. In patients with rectal cancer, the rectum is permanently removed. The surgeon then creates an opening (colostomy) on the abdomen wall through which solid waste in the colon is excreted. Specially trained nurses (enterostomal therapists) can help patients adjust to colostomies, and most patients with colostomies return to a normal lifestyle.

The long-term prognosis after surgery depends on whether the cancer has spread to other organs (metastasis). The risk of metastasis is proportional to the depth of penetration of the cancer into the bowel wall. In patients with early colon cancer which is limited to the superficial layer of the bowel wall, surgery is often the only treatment needed. These patients can experience long-term survival in excess of 80%. In patients with advanced colon cancer, wherein the tumor has penetrated beyond the bowel wall and there is evidence of metastasis to distant organs, the five-year survival rate is less than 10%.

In some patients, there is no evidence of distant metastasis at the time of surgery, but the cancer has penetrated deeply into the colon wall or reached adjacent lymph nodes. These patients are at risk of tumor recurrence either locally or in distant organs. Chemotherapy in these patients may delay tumor recurrence and improve survival.

Chemotherapy is the use of medications to kill cancer cells. It is a systemic therapy, meaning that the medication travels throughout the body to destroy cancer cells. After colon cancer surgery, some patients may harbor microscopic metastasis (small foci of cancer cells that cannot be detected). Chemotherapy is given shortly after surgery to destroy these microscopic cells. Chemotherapy given in this manner is called adjuvant chemotherapy. Recent studies have shown increased survival and delay of tumor recurrence in some patients treated with adjuvant chemotherapy within five weeks of surgery. Most drug regimens have included the use of 5-flourauracil (5-FU). On the other hand, chemotherapy for shrinking or controlling the growth of metastatic tumors has been disappointing. Improvement in the overall survival for patients with widespread metastasis has not been convincingly demonstrated.

Chemotherapy is usually given in a doctor's office, in the hospital as a outpatient, or at home. Chemotherapy is usually given in cycles of treatment periods followed by recovery periods. Side effects of chemotherapy vary from person to person, and also depend on the agents given. Modern chemotherapy agents are usually well tolerated, and side effects are manageable. In general, anticancer medications destroy cells that are rapidly growing and dividing. Therefore, red blood cells, platelets, and white blood cells are frequently affected by chemotherapy. Common side effects include anemia, loss of energy, easy bruising, and a low resistance to infections. Cells in the hair roots and intestines also divide rapidly. Therefore, chemotherapy can cause hair loss, mouth sores, nausea, vomiting, and diarrhea.

Radiation therapy in colorectal cancer has been limited to treating cancer of the rectum. There is a decreased local recurrence of rectal cancer in patients receiving radiation either prior to or after surgery. Without radiation, the risk of rectal cancer recurrence is close to 50%. With radiation, the risk is lowered to approximately 7%. Side effects of radiation treatment include fatigue, temporary or permanent pelvic hair loss, and skin irritation in the treated areas.

Other treatments have included the use of localized infusion of chemotherapeutic agents into the liver, the most common site of metastasis. This involves the insertion of a pump into the blood supply of the liver which can deliver high doses of medicine directly to the liver tumor. Response rates for these treatments have been reported to be as high as eighty percent. Side effects, however, can be serious. Additional experimental agents considered for the treatment of colon cancer include the use of cancer-seeking antibodies bound to cancer-fighting drugs. Such combinations can specifically seek and destroy tumor tissues in the body. Other treatments attempt to boost the immune system, the bodies' own defense system, in an effort to more effectively attack and control colon cancer. In patients who are poor surgical risks, but who have large tumors which are causing obstruction or bleeding, laser treatment can be used to destroy cancerous tissue and relieve associated symptoms. Still other experimental agents include the use of photodynamic therapy. In this treatment, a light sensitive agent is taken up by the tumor which can then be activated to cause tumor destruction.

Prevention

Unfortunately, colon cancers can be well advanced before they are detected. The most effective prevention of colon cancer is early detection and removal of precancerous colon polyps before they turn cancerous. Even in cases where cancer has already developed, early detection still significantly improves the chances of a cure by surgically removing the cancer before the disease spreads to other organs. Multiple world health organizations have suggested general screening guidelines.

Digital rectal examination and stool occult blood testing

It is recommended that all individuals over the age of 40 have yearly digital examinations of the rectum and their stool tested for hidden or "occult" blood. During digital examination of the rectum, the doctor inserts a gloved finger into the rectum to feel for abnormal growths. Stool samples can be obtained to test for occult blood (see below). The prostate gland can be examined at the same time.

An important screening test for colorectal cancers and polyps is the stool occult blood test. Tumors of the colon and rectum tend to bleed slowly into the stool. The small amount of blood mixed into the stool is usually not visible to the naked eye. The commonly used stool occult blood tests rely on chemical color conversions to detect microscopic amounts of blood. These tests are both convenient and inexpensive. A small amount of stool sample is smeared on a special card for occult blood testing. Usually, three consecutive stool cards are collected. A person who tests positive for stool occult blood has a 30% to 45% chance of having a colon polyp and a 3% to 5% chance of having a colon cancer. Colon cancers found under these circumstances tend to be early and have a better long-term prognosis.

It is important to remember that having stool tested positive for occult blood does not necessarily mean the person has colon cancer. Many other conditions can cause occult blood in the stool. However, patients with a positive stool occult blood should undergo further evaluations involving barium enema x-rays, colonoscopies, and other tests to exclude colon cancer, and to explain the source of the bleeding. It is also important to realize that stool which has tested negative for occult blood does not mean the absence of colorectal cancer or polyps. Even under ideal testing conditions, at least 20% of colon cancers can be missed by stool occult blood screening. Many patients with colon polyps are tested negative for stool occult blood. In patients suspected of having colon tumors, and in those with high risk factors for developing colorectal polyps and cancer, flexible sigmoidoscopies or screening colonoscopies are performed even if the stool occult blood tests are negative.

Flexible sigmoidoscopy and colonoscopy

Beginning at age 50, a flexible sigmoidoscopy screening tests is recommended every three to five years. Flexible sigmoidoscopy is an exam of the rectum and the lower colon using a viewing tube (a short version of colonoscopy). Recent studies have shown that the use of screening flexible sigmoidoscopy can reduce mortality from colon cancer. This is a result of the detection of polyps or early cancers in people with no symptoms. If a polyp or cancer is found, a complete colonoscopy is recommended. The majority of colon polyps can be completely removed by colonoscopy without open surgery. Recently doctors are recommending screening colonoscopies instead of screening flexible sigmoidoscopies for healthy individuals starting at ages 50-55. Please read the Colon Cancer Screening article.

Patients with a high risk of developing colorectal cancer may undergo colonoscopies starting at earlier ages than 50. For example, patients with family history of colon cancer are recommended to start screening colonoscopies at an age 10 years before the earliest colon caner diagnosed in a first-degree relative, or five years earlier than the earliest precancerous colon polyp discovered in a first-degree relative. Patients with hereditary colon cancer syndromes such as FAP, AFAP, HNPCC, and MYH are recommended to begin colonoscopies early. The recommendations differ depending on the genetic defect, for example in FAP; colonoscopies may begin during teenage years to look for the development of colon polyps. Patients with a prior history of polyps or colon cancer may also undergo colonoscopies to exclude recurrence. Patients with a long history (greater than 10 years) of chronic ulcerative colitis have an increased risk of colon cancer, and should have regular colonoscopies to look for precancerous changes in the colon lining.

Genetic counseling and testing

Blood tests are now available to test for FAP, AFAP, MYH, and HNPCC hereditary colon cancer syndromes. Families with multiple members having colon cancers, members with multiple colon polyps, members having cancers at young ages, and having other cancers such as cancers of the ureters, uterus, duodenum, etc., should be referred for genetic counseling followed possibly by genetic testing. Genetic testing without prior counseling is discouraged because of the extensive family education that is involved and the complicated nature of interpreting the test results.

The advantages of genetic counseling followed by genetic testing include: (1) identifying family members at high risk of developing colon cancer to begin colonoscopies early; (2) identifying high risk members so that screening may begin to prevent other cancers such as ultrasound tests for uterine cancer, urine examinations for ureter cancer, and upper endoscopies for stomach and duodenal cancers; and (3) alleviating concern for members who test negative for the hereditary genetic defects.

Diet and colon cancer to prevent colon cancer

People can change their eating habits by reducing fat intake and increasing fiber (roughage) in their diet. Major sources of fat are meat, eggs, dairy products, salad dressings, and oils used in cooking. Fiber is the insoluble, nondigestible part of plant material present in fruits, vegetables, and whole-grain breads and cereals. It is postulated that high fiber in the diet leads to the creation of bulky stools which can rid the intestines of potential carcinogens. In addition, fiber leads to the more rapid transit of fecal material through the intestine, thus allowing less time for a potential carcinogen to react with the intestinal lining. For additional information, please read the Colon Cancer Prevention article.