A: Screening tests allow doctors to find cancer early before any symptoms are present. By discovering the cancer early, your chances of a cure are much higher than if it were found at a later stage.
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A: You should see your doctor for regular checkups and not wait for problems to occur. But you should also know that the following symptoms may be associated with cancer:
changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or any other part of the body, indigestion or difficulty swallowing, obvious change in a wart or mole, or nagging cough or hoarseness. These symptoms are not always a sign of cancer. They can also be caused by less serious conditions. Only a doctor can make a diagnosis. It is important to see a doctor if you have any of these symptoms. Don’t wait to feel pain: Early cancer usually does not cause pain.
A: Cancer is a group of more than 100 different diseases. Cancer occurs when cells become abnormal and keep dividing and forming more cells without control or order. All organs of the body are made up of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be benign or malignant.
Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Most important, cells from benign tumors do not spread to other parts of the body. Benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cancer cells can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. This is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body.
The spread of cancer is called metastasis. Most cancers are named for the type of cell or the organ in which they begin. When cancer spreads, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if lung cancer spreads to the liver, the cancer cells in the liver are lung cancer cells. The disease is called metastatic lung cancer (it is not liver cancer).
A: Cancer is treated with surgery, radiation therapy, chemotherapy, hormone therapy, or biological therapy. Patients with cancer are often treated by a team of specialists, which may include a medical oncologist (specialist in cancer treatment), a surgeon, a radiation oncologist (specialist in radiation therapy), and others. The doctors may decide to use one treatment method or a combination of methods. The choice of treatment depends on the type and location of the cancer, the stage of the disease, the patient’s age and general health, and other factors. Some cancer patients take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.
A: Radiation therapy is among the oldest and most economical ways to treat cancer. In radiation therapy (also called radiotherapy), high-energy rays are used to damage cancer cells and stop them from growing and dividing. Like surgery, radiation therapy is a local treatment; it can affect cancer cells only in the treated area. Radiation may come from a machine (external radiation). It also may come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation). Some patients get both kinds of radiation therapy.
Radiation therapy can be administered to accomplish a wide variety of goals, and can be used at many stages of cancer treatment. In an early stage of cancer, radiation can be used to control or even cure the disease. It can be sued in conjunction with surgery to either shrink a tumor before an operation, or to prevent an excised tumor from growing back. It can also be used in cooperation with chemotherapy to aid in shrinking or reducing cancerous spread.
External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. Patients are not radioactive during or after the treatment. For internal radiation therapy, the patient stays in the hospital for a few days. The implant may be temporary or permanent. Because the level of radiation is highest during the hospital stay, patients may not be able to have visitors or may have visitors only for a short time. Once an implant is removed, there is no radioactivity in the body. The amount of radiation in a permanent implant goes down to a safe level before the patient leaves the hospital. Many medical staff are involved in giving radiation therapy; a medical team may include a radiation oncologist, radiation physicist, dosimetrist, radiation therapist, or radiation therapy nurse. With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. The most common side effects are tiredness, skin reactions (such as a rash or redness) in the treated area, and loss of appetite. Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection. Although the side effects of radiation therapy can be unpleasant, the doctor can usually treat or control them. It also helps to know that, in most cases, they are not permanent.
A: The word “chemotherapy” often conjures up fearful images of nausea, pain, fatigue, and hair loss in people’s minds; however it is also one of the most effective methods of treating or controlling cancer. Chemotherapy literally means treatment with drugs; any drug which enters the body’s system, including the use of aspirin and penicillin, can be described as chemotherapy. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body.
Chemotherapy is given to create the best quality of life possible. This may be accomplished in one of three ways. One way in which chemotherapy can improve the quality of life is to cure; this means that the condition or tumor disappears and does not return. If a cure is not possible, then chemotherapy may be used to control the cancer by halting its spread and growth. If the cancer is so advanced that neither cure nor control are possible, then chemotherapy is administered with the intent of palliation so that the patient’s quality, if not quantity, of life is improved to the highest degree possible. Often, patients who need many doses of IV chemotherapy receive the drugs through a catheter (a thin flexible tube). One end of the catheter is placed in a large vein in the chest. The other end is outside the body or attached to a small device just under the skin. Anticancer drugs are given through the catheter. This can make chemotherapy more comfortable for the patient. Patients and their families are shown how to care for the catheter and keep it clean. For some types of cancer, doctors are studying whether it helps to put anticancer drugs directly into the affected area.
Chemotherapy is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on. Usually a patient has chemotherapy as an outpatient — at the hospital, at the doctor’s office, or at home. However, depending on which drugs are given and the patient’s general health, the patient may need to stay in the hospital for a short time.
The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may have side effects, such as loss of appetite, nausea and vomiting, hair loss, or mouth sores. For some patients, the doctor may prescribe medicine to help with side effects, especially with nausea and vomiting. Usually, these side effects gradually go away during the recovery period or after treatment stops.
Hair loss, another side effect of chemotherapy, is a major concern for many patients. Some chemotherapy drugs only cause the hair to thin out, while others may result in the loss of all body hair. Patients may feel better if they decide how to handle hair loss before starting treatment.
In some men and women, chemotherapy drugs cause changes that may result in a loss of fertility (the ability to have children). Loss of fertility may be temporary or permanent depending on the drugs used and the patient’s age. For men, sperm banking before treatment may be a choice. Women’s menstrual periods may stop, and they may have hot flashes and vaginal dryness. Periods are more likely to return in young women.
A: People of all ages get cancer, but nearly all types are more common in middle-aged and elderly people than in young people. Skin cancer is the most common type of cancer for both men and women. The next most common type among men is prostate cancer; among women, it is breast cancer. Lung cancer, however, is the leading cause of death from cancer for both men and women in the United States. Brain cancer and leukemia are the most common cancers in children and young adults.
The more we can learn about what causes cancer, the more likely we are to find ways to prevent it. Scientists study patterns of cancer in the population to look for factors that affect the risk of developing this disease. In the laboratory, they explore possible causes of cancer and try to determine what actually happens when normal cells become cancerous. Our current understanding of the causes of cancer is incomplete, but it is clear that cancer is not caused by an injury, such as a bump or bruise. And although being infected with certain viruses may increase the risk of some types of cancer, cancer is not contagious; no one can “catch” cancer from another person.
Cancer develops gradually as a result of a complex mix of factors related to environment, lifestyle, and heredity. Scientists have identified many risk factors that increase the chance of getting cancer. They estimate that about 80 percent of all cancers are related to the use of tobacco products, to what we eat and drink, or, to a lesser extent, to exposure to radiation or cancer-causing agents (carcinogens) in the environment and the workplace. Some people are more sensitive than others to factors that can cause cancer.
Many risk factors can be avoided. Others, such as inherited risk factors, are unavoidable. It is helpful to be aware of them, but it is also important to keep in mind that not everyone with a particular risk factor for cancer actually gets the disease; in fact, most do not. People at risk can help protect themselves by avoiding risk factors where possible and by getting regular checkups so that, if cancer develops, it is likely to be found early. These are some of the factors that are known to increase the risk of cancer:
- Tobacco. Tobacco causes cancer. In fact, smoking tobacco, using “smokeless” tobacco, and being regularly exposed to environmental tobacco smoke without actually smoking are responsible for one-third of all cancer deaths in the United States each year. Tobacco use is the most preventable cause of death in this country. Smoking accounts for more than 85 percent of all lung cancer deaths. If you smoke, your risk of getting lung cancer is affected by the number and type of cigarettes you smoke and how long you have been smoking. Overall, for those who smoke one pack a day, the chance of getting lung cancer is about 10 times greater than for nonsmokers. Smokers are also more likely than nonsmokers to develop several other types of cancer (such as oral cancer and cancers of the larynx, esophagus, pancreas, bladder, kidney, and cervix).
The risk of cancer begins to decrease when a smoker quits, and the risk continues to decline gradually each year after quitting. The use of smokeless tobacco (chewing tobacco and snuff) causes cancer of the mouth and throat. Precancerous conditions, or tissue changes that may lead to cancer, begin to go away after a person stops using smokeless tobacco. Exposure to environmental tobacco smoke, also called involuntary smoking, increases the risk of lung cancer for nonsmokers.
The risk goes up 30 percent or more for a nonsmoking spouse of a person who smokes. Involuntary smoking causes about 3,000 lung cancer deaths in this country each year. If you use tobacco in any form and you need help quitting, talk with your doctor or dentist, or join a smoking cessation group sponsored by a local hospital or voluntary organization. For information on such groups or other programs, call the Cancer Information Service or the American Cancer Society.
- Diet. Your choice of foods may affect your chance of developing cancer. Evidence points to a link between a high-fat diet and certain cancers, such as cancer of the breast, colon, uterus, and prostate. Being seriously overweight appears to be linked to increased rates of cancer of the prostate, pancreas, uterus, colon, and ovary, and to breast cancer in older women. On the other hand, studies suggest that foods containing fiber and certain nutrients help protect us against some types of cancer. You may be able to reduce your cancer risk by making some simple food choices. Try to have a varied, well- balanced diet that includes generous amounts of foods that are high in fiber, vitamins, and minerals. At the same time, try to cut down on fatty foods. You should eat five servings of fruits and vegetables each day, choose more whole-grain breads and cereals, and cut down on eggs, high-fat meat, high-fat dairy products (such as whole milk, butter, and most cheeses), salad dressings, margarine, and cooking oils.
- Sunlight. Ultraviolet radiation from the sun and from other sources (such as sun lamps and tanning booths)damages the skin and can cause skin cancer. Repeated exposure to ultraviolet radiation increases the risk of skin cancer, especially if you have fair skin or freckle easily. The sun’s ultraviolet rays are strongest during the summer from about 11 a.m. to about 3 p.m. (daylight saving time). The risk is greatest at this time, when the sun is high overhead and shadows are short. As a rule, it is best to avoid the sun when your shadow is shorter than you are. Protective clothing, such as a hat and long sleeves, can help block the sun’s harmful rays. You can also use sunscreens to help protect yourself. Sunscreens are rated in strength according to their SPF (sun protection factor), which ranges from 2 to 30 and higher. Those rated 15 to 30 block most of the sun’s harmful rays.
- Alcohol. Drinking large amounts of alcohol increases the risk of cancer of the mouth, throat, esophagus, and larynx. (People who smoke cigarettes and drink alcohol have an especially high risk of getting these cancers.) Alcohol can damage the liver and increase the risk of liver cancer. Some studies suggest that drinking alcohol also increases the risk of breast cancer. So if you drink at all, do so in moderation — not more than one or two drinks a day.
- Radiation. Exposure to large doses of radiation from medical x-rays can increase the risk of cancer. X-rays used for diagnosis expose you to very little radiation and the benefits nearly always outweigh the risks. However, repeated exposure can be harmful, so it is a good idea to talk with your doctor or dentist about the need for each x-ray and ask about the use of shields to protect other parts of your body. Before 1950, x-rays were used to treat noncancerous conditions (such as an enlarged thymus, enlarged tonsils and adenoids, ringworm of the scalp, and acne)in children and young adults. People who have received radiation to the head and neck have a higher-than-average risk of developing thyroid cancer years later. People with a history of such treatments should report it to their doctor and should have a careful exam of the neck every 1 or 2 years.
- Chemicals and other substances in the workplace. Being exposed to substances such as metals, dust, chemicals, or pesticides at work can increase the risk of cancer. Asbestos, nickel, cadmium, uranium, radon, vinyl chloride, benzidene, and benzene are well-known examples of carcinogens in the workplace. These may act alone or along with another carcinogen, such as cigarette smoke. For example, inhaling asbestos fibers increases the risk of lung diseases, including cancer, and the cancer risk is especially high for asbestos workers who smoke. It is important to follow work and safety rules to avoid contact with dangerous materials.
- Hormone replacement therapy. Many women use estrogen therapy to control the hot flashes, vaginal dryness, and osteoporosis (thinning of the bones) that may occur during menopause. However, studies show that estrogen use increases the risk of cancer of the uterus. Other studies suggest an increased risk of breast cancer among women who have used high doses of estrogen or have used estrogen for a long time. At the same time, taking estrogen may reduce the risk of heart disease and osteoporosis. The risk of uterine cancer appears to be less when progesterone is used with estrogen than when estrogen is used alone. But some scientists are concerned that the addition of progesterone may also increase the risk of breast cancer. Researchers are still studying and finding new information about the risks and benefits of taking replacement hormones. A woman considering hormone replacement therapy should discuss these issues with her doctor.
- Diethylstilbestrol (DES). DES is a form of estrogen that doctors prescribed from the early 1940s until 1971 to try to prevent miscarriage. In some daughters of women who were given DES during pregnancy, the uterus, vagina, and cervix do not develop normally. DES-exposed daughters also have an increased chance of developing abnormal cells (dysplasia) in the cervix and vagina. In addition, a rare type of vaginal and cervical cancer has been found in a small number of DES-exposed daughters. Women who took DES during pregnancy may have a slightly increased risk of developing breast cancer. DES-exposed mothers and daughters should tell their doctor about this exposure. DES daughters should have regular special pelvic exams by a doctor familiar with conditions related to DES. Exposure to DES before birth does not appear to increase the risk of cancer in DES-exposed sons; however, reproductive and urinary system problems may occur. These men should tell the doctor and should have regular medical checkups.
- Close relatives with certain types of cancer. A small number of cancers (including melanoma and cancers of the breast, ovary, and colon) tend to occur more often in some families than in the rest of the population. It is not always clear whether a pattern of cancer in a family is due to heredity, factors in the family’s environment, or chance. Still, if close relatives have been affected by cancer, it is important to let your doctor know this and then follow the doctor’s advice about cancer prevention and checkups to detect problems early. For an interactive Risk Assessment Program, see the CCI’s Prevention and Screening Guide.