EYE CANCER

Photos: This nodular, but somewhat irregularly-shaped basal cell carcinoma becomes more obvious when the skin is stretched. Due to its location on the eyelid, it was treated by the more precise, tissue-sparing method-- Mohs micrographic surgery.

Radiation Therapy

Understanding Radiation Therapy

For many people, the word “radiation” conjures up frightening images. But radiation therapy, also called radiotherapy, is an effective, carefully controlled means of fighting cancer. Although therapy can cause side effects, the treatment sessions themselves are painless. And in the skilled hands of a radiation oncologist and well-trained technologist, the side effects can be minimized. Radiation therapy is one of the most common treatments for cancer; it is used in more than half of all cases.

What exactly is it?

Radiation therapy uses beams of high-energy waves or particles (for example, x-rays, gamma rays, or alpha and beta particles) to kill or damage cancer cells. The powerful stream of energy, which is thousands of times more intense than the rays used for a routine chest x-ray, damages the DNA of cancer cells, rendering them unable to reproduce and grow. Although radiation damages both cancer cells and normal cells, normal cells are able to repair themselves and function properly.

When is it used?

Radiation therapy is the primary treatment for many types of cancer, including certain cancers of the lung, breast, cervix, prostate, testicles, bladder, thyroid, larynx and brain, as well as early-stage Hodgkin’s disease and non-Hodgkin’s lymphoma.

In some cases, radiation therapy is the only treatment needed; in others, it is used in combination with surgery or chemotherapy. Radiation can be used before surgery to shrink a tumor so that it is easier to remove. After surgery, it is used to destroy microscopic extensions of cancerous tissue around a tumor that surgery might have missed.

Unlike chemotherapy, in which cancer-killing drugs travel throughout the entire body via the bloodstream, radiation therapy affects only the tumor and the surrounding tissue.When cancer has spread to distant areas of the body, chemotherapy is needed.

Treatment and Trials

Living with and managing HIV disease requires a thorough understanding of the treatments that are available to you. It also demands that drug companies develop new and more effective HIV drugs through clinical trials and research. If you’re frustrated about the lack of information specific to women, consider participating in a clinical trial (there are many kinds)! Even if you don’t participate in a drug study, you’re still helping us learn more about HIV disease in women!

Injecting drugs, drug users, HIV & AIDS

The effect of injection drug use on HIV rates

Roughly one tenth of new HIV infections result from needle sharing, with this figure rising to just under a third outside of sub-Saharan Africa.¹³ One study estimates that just under one-in-five IDUs globally may be infected with HIV.¹⁴ Among the regions where injecting drug use accounts for a majority or highly significant share of HIV prevalence are:¹⁵

• Eastern Europe and Central Asia
  • Russia: 83%
  • Kyrgyzstan: 75%
  • Kazakhstan: 73.6%
  • Ukraine: 64.1%

• East and South-East Asia
  • Malaysia: 72%
  • Indonesia: 54%
  • Vietnam: 52%
  • China: 44.3%

In many other parts of Asia, the Middle East and the Southern cone of Latin America, the sharing of injecting equipment is the primary route of HIV transmission.1

Transmission through blood OF AIDS

What works?

People who share equipment to inject recreational drugs risk becoming infected with HIV from other drug users. Methadone maintenance and other drug treatment programmes are effective ways to help people eliminate this risk by giving up injected drugs altogether. However, there will always be some injecting drug users who are unwilling or unable to end their habit, and these people should be encouraged to minimise the risk of infection by not sharing equipment.²⁰

Sexual transmission of AIDS

Someone can eliminate or reduce their risk of becoming infected with HIV during sex by choosing to:

• Abstain from sex or delay first sex
• Be faithful to one partner or have fewer partners
• Condomise, which means using male or female condoms consistently and correctly

There are a number of effective ways to encourage people to adopt safer sexual behaviour, including media campaigns, social marketing, peer education and small group counselling. These activities should be carefully tailored to the needs and circumstances of the people they intend to help. Specific programmes should target key groups such as young people, women, men who have sex with men, injecting drug users and sex workers.^{5 6 7}

Comprehensive sex education for young people is an essential part of HIV prevention. This should include training in life skills such as negotiating healthy sexual relationships, as well as accurate and explicit information about how to practise safer sex. Studies have shown that this kind of comprehensive sex education is more effective at preventing sexually transmitted infections than education that focuses solely on teaching abstinence until marriage.^{8 9}

How can HIV transmission be prevented?

• Sexual transmission
• Transmission through blood
• Mother-to-child transmission

Wherever there is HIV, all three routes of transmission will take place. However the number of infections resulting from each route will vary greatly between countries and population groups.

To be successful, an HIV prevention programme must make use of all approaches known to be effective

For each route of transmission there are things that an individual can do to reduce or eliminate risk. There are also interventions that have been proven to work at the community, local and national level.

To be successful, an HIV prevention programme must make use of all approaches known to be effective, rather than just implementing one or a few select actions in isolation. The share of resources allocated to each area should reflect the nature of the local epidemic - for example, if most infections occur among men who have sex with men then this group should be a primary target for prevention efforts.

Although most of this page looks separately at each transmission route, it should be remembered that many people don’t fit into only one “risk category”. For example, injecting drug users need access to condoms and safer sex counselling as well as help to reduce the risk of transmission through blood.

HIV Is Evolving To Evade Human Immune Responses

Introduction to Cancer Treatment

Choice of cancer treatment is influenced by several factors, including the specific characteristics of your cancer; your overall condition; and whether the goal of treatment is to cure your cancer, keep your cancer from spreading, or to relieve the symptoms caused by cancer. Depending on these factors, you may receive one or more of the following:

• Surgery
• Chemotherapy
• Radiation therapy
• Hormonal therapy
• Targeted therapy
• Biological therapy

One or more treatment modalities may be used to provide you with the most effective treatment. Increasingly, it is common to use several treatment modalities together (concurrently) or in sequence with the goal of preventing recurrence. This is referred to as multi-modality treatment of the cancer.

Surgery

Surgery is used to diagnose cancer, determine its stage, and to treat cancer. One common type of surgery that may be used to help with diagnosing cancer is a biopsy. A biopsy involves taking a tissue sample from the suspected cancer for examination by a specialist in a laboratory. A biopsy is often performed in the physician’s office or in an outpatient surgery center. A positive biopsy indicates the presence of cancer; a negative biopsy may indicate that no cancer is present in the sample.

When surgery is used for treatment, the cancer and some tissue adjacent to the cancer are typically removed. In addition to providing local treatment of the cancer, information gained during surgery is useful in predicting the likelihood of cancer recurrence and whether other treatment modalities will be necessary.

Learn more about surgery.

Chemotherapy

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.

More than half of all people diagnosed with cancer receive chemotherapy. For millions of people who have cancers that respond well to chemotherapy, this approach helps treat their cancer effectively, enabling them to enjoy full, productive lives. Furthermore, many side effects once associated with chemotherapy are now easily prevented or controlled, allowing many people to work, travel, and participate in many of their other normal activities while receiving chemotherapy.

Learn more about chemotherapy treatment and the management of side effects.

Radiation Therapy

Radiation therapy, or radiotherapy, uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment used to eliminate or eradicate visible tumors. Radiation therapy is not typically useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer. Radiation may be used to cure or control cancer, or to ease some of the symptoms caused by cancer. Sometimes radiation is used with other types of cancer treatment, such as chemotherapy and surgery, and sometimes it is used alone.

For more information, go to Radiation Therapy.

Hormonal Therapy

Hormones are naturally occurring substances in the body that stimulate the growth of hormone sensitive tissues, such as the breast or prostate gland. When cancer arises in breast or prostate tissue, its growth and spread may be caused by the body’s own hormones. Therefore, drugs that block hormone production or change the way hormones work, and/or removal of organs that secrete hormones, such as the ovaries or testicles, are ways of fighting cancer. Hormone therapy, similar to chemotherapy, is a systemic treatment in that it may affect cancer cells throughout the body.

Targeted Therapy

A targeted therapy is one that is designed to treat only the cancer cells and minimize damage to normal, healthy cells. Cancer treatments that “target” cancer cells may offer the advantage of reduced treatment-related side effects and improved outcomes.

Conventional cancer treatments, such as chemotherapy and radiation therapy, cannot distinguish between cancer cells and healthy cells. Consequently, healthy cells are commonly damaged in the process of treating the cancer, which results in side effects. Chemotherapy damages rapidly dividing cells, a hallmark trait of cancer cells. In the process, healthy cells that are also rapidly dividing, such as blood cells and the cells lining the mouth and GI tract are also damaged. Radiation therapy kills some healthy cells that are in the path of the radiation or near the cancer being treated. Newer radiation therapy techniques can reduce, but not eliminate this damage. Treatment-related damage to healthy cells leads to complications of treatment, or side effects. These side effects may be severe, reducing a patient's quality of life, compromising their ability to receive their full, prescribed treatment, and sometimes, limiting their chance for an optimal outcome from treatment.

Biological Therapy

Biological therapy is referred to by many terms, including immunologic therapy, immunotherapy, or biotherapy. Biological therapy is a type of treatment that uses the body’s immune system to facilitate the killing of cancer cells. Types of biological therapy include interferon, interleukin, monoclonal antibodies, colony stimulating factors (cytokines), and vaccines.

Personalized Cancer Care

There is no longer a “one-size-fits-all” approach to cancer treatment. Even among patients with the same type of cancer, the behavior of the cancer and its response to treatment can vary widely. By exploring the reasons for this variation, researchers have begun to pave the way for more personalized cancer treatment. It is becoming increasingly clear that specific characteristics of cancer cells and cancer patients can have a profound impact on prognosis and treatment outcome. Although factoring these characteristics into treatment decisions makes cancer care more complex, it also offers the promise of improved outcomes.

The idea of matching a particular treatment to a particular patient is not a new one. It has long been recognized, for example, that hormonal therapy for breast cancer is most likely to be effective when the breast cancer contains receptors for estrogen and/or progesterone. Testing for these receptors is part of the standard clinical work-up of breast cancer. What is new, however, is the pace at which researchers are identifying new tumor markers, new tests, and new and more targeted drugs that individualize cancer treatment. Tests now exist that can assess the likelihood of cancer recurrence, the likelihood of response to particular drugs, and the presence of specific cancer targets that can be attacked by new anti-cancer drugs that directly target individual cancer cells.

Head and Neck Cancers

Head and neck cancers originate in the throat, larynx (voice box), pharynx, salivary glands, or oral cavity (lip, mouth, tongue). In 1999, there were 500,000 cases of head and neck cancers worldwide. Most head and neck cancers involve squamous cells, which are cells that line the mouth, throat, or other structures. Also, these cancers are often preceded by non-cancerous sores or an unusual patch of white tissue that cannot be rubbed off, called a leukoplakia.

A cancer that has not spread to deeper tissue layers is non-invasive, referred to as carcinoma in-situ. However, head and neck cancers do tend to spread, particularly to lymph nodes in the neck. On initial diagnosis, more than 70% of patients have cancer that has advanced locally, regionally, and/or to distant locations in the body. Furthermore, 10% to 15% of individuals with a cancer of the head and neck will have a second cancer that may or may not present with symptoms. The esophagus is the most frequent site in which additional primary cancers are discovered.

Diagnosis of head and neck cancers usually involves several tests to help determine the stage of the cancer. The size and extent to which the cancer has spread from its site of origin is referred to as the stage. A procedure called an endoscopy is performed to obtain a biopsy, determine the local extent of the cancer, and look for additional cancers. An endoscope is a lighted tube, which is used to examine the throat, larynx, and upper esophagus. A biopsy involves the removal of a small sample of the suspected cancer. The samples are then examined under a microscope to determine if cancer is present. Additional procedures may including blood tests, a chest x-ray, and sometimes additional surgery for lymph node evaluation. Computed tomographic (CT) scans, magnetic resonance imaging (MRI) scans, ultrasound, and positron emission tomography (PET) scans are often valuable for detecting the extent to which the cancer has spread to the lymph nodes and to further identify the extent of cancer at the primary location.

Patients with head and neck cancers should consider being carefully evaluated in a medical center that treats many patients with these cancers. Patients with head and neck cancer require a multidisciplinary team approach that is often only available at specialty medical centers. A multidisciplinary team may be comprised of a head and neck surgeon, a radiation oncologist, a medical oncologist, a pathologist, a dentist, and social services personnel. Evaluation and treatment by an experienced team is essential for determining optimal treatment.

Treatment for head and neck cancers depend on the stage and location, and is addressed under the following sections: Cancer of the Throat, Cancer of the Larynx, Cancer of the Salivary Glands, and Cancer of the Oral Cavity. These sections consist of general overviews of treatment for each specific type of head and neck cancer. Treatment may consist of surgery, radiation, chemotherapy, biological therapy, or a combination of these treatment techniques. Multi-modality treatment, which is treatment using two or more techniques, may be the most promising approach for increasing a patient's chance of cure or prolonging a patient's survival. However, circumstances unique to each patient’s situation may influence how these general treatment principles are applied and whether the patient decides to receive treatment. The potential benefits of receiving treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

Cervical Cancer

The cervix is a female reproductive organ that forms the lower portion of the uterus or womb. The uterus and cervix lie in the pelvis, on top of the vagina, in between the rectum and bladder. The cervix forms the part of the birth canal that opens to the vagina.

The surface layer of the cervix is mostly composed of squamous cells. The squamous cells of the cervix merge with the glandular cells lining the cervical canal of the uterus. The area of merging is called the squamo-columnar junction and the area on the cervix outside of this junction is called the transformation zone. Cervical cancer occurs when cervical cells grow out of control, typically in the transformation zone. When cells grow out of control, they spread and grow throughout the cervix and may invade and destroy neighboring organs or break away and spread through the bloodstream and lymphatic system to other parts of the body.

Doctors who care for women routinely perform pelvic examinations and a Papanicolaou (Pap) smear to screen for cancer in the cells on the surface of the cervix. During a Pap smear, a sample of cells from the cervix is taken with a small wooden spatula or brush and examined under the microscope. Women may first become aware that they have cervical cancer when a suspicious area is identified during a pelvic examination or an abnormal Pap smear. If a suspicious or a precancerous lesion is found, additional tests will be recommended to determine whether a precancerous lesion or invasive cancer exists.

Cells taken from the surface of the cervix can appear abnormal, but may not be cancer. These abnormal cells, however, may be the first step in a series of changes that lead to cancer. Doctors refer to the abnormal cells as "precancerous" and have used different terms to refer to them, such as squamous intraepithelial lesions, dysplasia, cervical intraepithelial neoplasia or carcinoma in situ. Precancerous disease involves only the surface of the cervix. When the abnormal cells begin to spread deeper into the cervix, they are referred to as invasive cancer of the cervix.

If physicians feel they need more information following an abnormal Pap smear, they may use a colposcope (lighted microscope) to better visualize the cervix or to perform a biopsy, which is the removal of a sample of tissue from the cervix in order to evaluate cervical cells under a microscope. If the doctor cannot determine whether the abnormal cells are only on the surface of the cervix, an endocervical curettage or conization may be recommended. During an endocervical curettage, a small spoon-shaped instrument called a curette is used to scrape cells away from inside the cervical opening. A conization or cone biopsy removes a cone-shaped sample of tissue from the cervical canal. Conization can also serve as the primary treatment of precancerous cervical cancer.

Infrequently, it may still remain unclear whether the abnormal cells are confined to the cervix or arise from inside the uterus. In this situation, a dilatation and curettage (D and C) may be recommended. During a D and C, the cervical opening is stretched (dilated) and a curette is inserted to remove cells from the lining of the uterus and cervical canal. In order to learn more about the most recent information available concerning the treatment of cervical cancer, click on the appropriate stage.

Stage 0: Precancerous lesion involves only the cells on the surface of the cervix.

Stage I: Cancer is confined to the cervix, and may be evident only under microscopic evaluation (stage IA) or apparent by visible or physical examination (stage IB).

Stage II: Cancer has spread beyond the cervix to involve the tissues surrounding the cervix (parametria) or the upper portion of the vagina.

Stage III: Cancer spreads beyond the cervix to the lower vagina or to the sides of the pelvis, or causes a blockage of drainage from the kidney, a condition called hydronephrosis.

Stage IV: Cancer invades structures adjacent to the cervix such as the bladder or rectum or has spread to other parts of the body such as the liver or lungs.

Recurrent/Relapsed: Cervical cancer is still detected or has returned (recurred/relapsed) following an initial treatment with surgery, radiation therapy, and/or chemotherapy.

Skin Cancer

More than one million new cases of skin cancer are diagnosed each year in the United States, making it the most commonly diagnosed type of cancer.[1]

Overview of the Skin

The skin is the largest organ in the body. It protects against germs, covers internal organs, and helps regulate the body’s temperature. The two main layers of the skin are the epidermis and the dermis. The epidermis forms the top, outer layer of the skin. The dermis is a thicker layer beneath the epidermis.

Skin cancer generally develops in the epidermis. The three main types of cells in the epidermis are squamous cells, basal cells, and melanocytes. Squamous cells form a flat layer of cells at the top of the epidermis. Basal cells are round cells found beneath the squamous cells. Melanocytes are pigment-producing cells that are generally found in the lower part of the epidermis.

Types of Skin Cancer

Skin cancer is often categorized as melanoma or non-melanoma. Melanoma is a cancer that begins in melanocytes. It is less common than non-melanoma skin cancer, but tends to be more aggressive. In 2006 an estimated 62,000 individuals in the U.S. will be diagnosed with melanoma, and close to 8,000 will die of the disease.[1]

The most common type of non-melanoma skin cancer is basal cell carcinoma. This type of cancer rarely spreads to distant sites in the body, but it can be disfiguring and may invade nearby tissues.

The second most common type of non-melanoma skin cancer is squamous cell carcinoma. Although this type of cancer is more likely to metastasize (spread to lymph nodes or other sites in the body) than basal cell carcinoma, metastasis is still rare. Both basal cell carcinoma and squamous cell carcinoma most commonly develop on sun-exposed parts of the skin, but can develop on other parts of the skin as well.

An alarming trend in both melanoma and non-melanoma skin cancers is that the frequency of these cancers in children and young adults appears to be increasing.[2] This highlights the importance of prevention at all ages.

Because of their very different characteristics and treatment, melanoma and non-melanoma skin cancer are discussed further in separate sections.

Brain Tumors: An Overview of Symptoms, Diagnosis, and Treatment

Introduction

An abnormal growth of cells in the brain is called a brain tumor. Brain tumors may be malignant (cancerous) or benign (non-cancerous).

Suspicions of a brain tumor may first arise from abnormal behavior or other symptoms. Symptoms are typically investigated with a series of tests aimed at making a diagnosis. If a brain tumor is the diagnosis, further information about the cancer cells is necessary to determine the best possible approach to treatment. There are many types of brain tumors that differ based on which type of cells make up the tumor. Also, determining the extent of the cancer helps the doctor to understand the likelihood that the tumor will spread into other brain tissues, a characteristic which may also be referred to as the aggressiveness of the cancer.

Leukemia

Overview

Leukemia is a cancer of the blood cells. There are many different types of leukemia, depending upon which specific blood cells are affected. Each leukemia has different disease characteristics and therefore different treatment options. Several clinical diagnostic tests are utilized in order to determine the type and extent of leukemia. In order to better understand leukemia and its treatment, a basic understanding of normal blood cell production is useful.

Normal blood is made up of fluid called plasma and three main types of blood cells. Plasma is mainly water, but contains minerals, proteins and antibodies. The three major blood cell types are white cells, red cells and platelets. Each type of blood cell has a specific function. White blood cells, also called leukocytes, help the body fight infections and other diseases. Red blood cells, also called erythrocytes, make up half the blood’s total volume. They contain hemoglobin, which picks up oxygen from the lungs and carries it to the body’s organs. Platelets, or thrombocytes, help form blood clots to control bleeding.

Blood cells are produced inside the bones in a spongy space called the bone marrow. The process of blood cell formation is called hematopoiesis. All blood cells have a common origin called a stem cell. Stem cells develop into specific mature blood cells by a process called differentiation. Early immature cells are called blasts, which grow into mature blood cells. Once the cells are matured, they are released into the blood where they circulate throughout the body and perform their respective functions. In healthy individuals, there are adequate stem cells to continuously produce new blood cells. Normal production of mature blood cells occurs in an orderly fashion.

When leukemia occurs, the body produces large numbers of abnormal or immature blood cells. Leukemia cells look different and act different than normal blood cells and are often unable to perform their intended functions. Most leukemias occur in white blood cells and are classified as either myelocytic or lymphocytic, depending upon the type of white blood cell is affected. Leukemia is further classified by how fast the disease develops. When leukemia develops quickly and is composed of immature cells that do not properly mature, it is called acute leukemia. When leukemia is referred to as chronic, the cells are more mature and the accumulation of the abnormal cells occurs less rapidly.

Although leukemia is a cancer of the blood, it may affect other organs. In acute leukemias, the abnormal cells may collect in the central nervous system, the testicles, the skin and any other organ in the body. The most common place to detect the leukemia, however, is the blood and bone marrow. The following tests may be used to diagnose leukemia:

Bone marrow aspirate and biopsy: Since all blood cells ultimately originate in the bone marrow, an examination of the bone marrow consisting of a bone marrow aspirate and biopsy, provides useful information regarding the diagnosis and management of leukemia. Bone marrow aspirates and biopsies are typically performed on the hip bone with the patient laying face down. Patients are given an anesthetic under the skin to numb the area of the biopsy. The physician places a needle through the skin into the middle of the bone, typically a hip bone, and draws out a small amount of marrow (aspiration). This is followed by a biopsy, during which time the physician removes a small amount of bone as well as bone marrow from the same place the aspirate was drawn. Patients typically feel pressure and minimal pain from the procedure. The collected cells and the bone marrow biopsy are viewed under a microscope and special tests are performed to distinguish which type of blood cell is cancerous and the aggressiveness of the cancer.

Immunophenotyping: Different types of leukemias have unique proteins and/or carbohydrates called antigens found on the surface or inside of the cell. Certain antigens are correlated to specific disease characteristics, leading to further classification of leukemia to help define optimal treatment options. The detection of specific antigens is called immunophenotyping. A laboratory test called immunohistocompatibility (IHC) testing is able to test for a multitude of antigens from a sample of blood or tissue.

Chromosomal Abnormalities: The detection of chromosomal abnormalities, often referred to as “cytogenetic analysis”, is the testing of cancer cells to determine if specific genetic abnormalities exist. Chromosomes contain the genetic makeup or DNA of an individual, with a full copy of DNA present in every cell. Mutations, or alterations, in DNA can be responsible for the development of cancer and attribute to specific characteristics of the cancer. Different laboratory tests, including fluorescent in-situ hybridization (FISH), polymerase chain reaction (PCR) and flow cytometry, are able to detect specific genetic mutations within a cancer cell. Results from cytogenetic tests may become key factors in determining appropriate treatment options for patients.

Bladder Cancer

Overview

The bladder is a hollow organ in the lower abdomen. Its primary function is to store urine, the waste that is produced when the kidneys filter the blood. Urine passes from the two kidneys into the bladder through two tubes called ureters and urine leaves the bladder through another tube called the urethra. The bladder has a muscular wall that allows it to get larger and smaller as urine is stored or emptied.

The wall of the bladder is lined with several layers of cells called transitional cells. Cancer arising from these cells makes up more than 90% of all bladder cancers and these are referred to as transitional cell carcinomas. Because transitional cell carcinomas are the most common type of bladder cancer, the information in this section only addresses treatment of transitional cell cancer of the bladder.

Bladder cancer occurs predominantly in elderly men and less frequently in women and younger men. Many bladder cancers are thought to be caused by exposure to cancer-causing agents that pass through the urine and come into contact with the bladder lining. The most important risk factor for bladder cancer is smoking, which increases risk by at least four-fold.[1]

The most common sign of bladder cancer is hematuria or blood in the urine, which will turn the urine rust or red in color.[2] Other signs of bladder cancer may include pain during urination and frequent urination. Most patients with bladder cancer do not have symptoms other than hematuria. Unfortunately, most bladder cancers are not diagnosed until they have become very large. As a result, research is ongoing in order to develop urine tests that would enable earlier detection of bladder cancer when it is small and more easily treated. There are several promising tests under evaluation, but currently none are reliable enough for routine use.

An outpatient procedure called a cystoscopy is usually used to diagnose bladder cancer. During a cystoscopy, the physician (a urologist) inserts a thin, lighted tube (cystoscope) into the bladder through the urethra to examine the internal lining of the bladder. The procedure enables the urologist to remove (biopsy) small samples of any abnormal appearing areas of the bladder and examine them under the microscope. When bladder cancer is diagnosed, the urologist will want to learn the stage or extent of the cancer, as well as the grade (aggressiveness) of the cancer as determined by its appearance under the microscope. Grade is important because it indicates how closely the cancer resembles normal tissue and suggests how fast the cancer is likely to grow. Low-grade cancers more closely resemble normal tissue and are likely to grow and spread more slowly than high-grade cancers.

Staging is an attempt to determine the extent to which the cancer has spread. The stage of bladder cancer may be determined at the time of diagnosis or it may be necessary to perform additional tests such as computerized tomography (CT) scans, magnetic resonance imaging (MRI) or an intravenous pyelogram (IVP), a procedure which involves the injection of dye into the blood. When the dye (contrast) travels through the kidneys and ureters, it allows them to be visualized with X-rays (fluoroscopy).

Some risk factors, such as a genetic mutation within a gene called the p53 gene, are associated with a poor outcome following treatment with chemotherapy and/or radiation therapy. Therefore, physicians may look for the presence of such risk factors upon a diagnosis of bladder cancer in order to best plan a treatment regimen. Research is ongoing to identify risk factors that are associated with a poor outcome, as well as factors that indicate that some patients may require less treatment. By identifying such factors, physicians are better able to tailor treatment to meet the needs of individual patients.

Cancers confined to the inner lining of the bladder are called "superficial" and comprise 70-80% of all bladder cancers.[3] Cancers that have spread into the bladder wall are called "deep" bladder cancers and those that have spread to lymph nodes and/or distantly to lungs, liver or other organs are referred to as "metastatic.” In order to learn more about the most recent information available concerning the treatment of bladder cancer, click on the appropriate stage.

Stage 0 (T0): Patients with stage 0 bladder cancer have the earliest stage of cancer that involves only the innermost layers of cells in the bladder. Depending upon the appearance of the cells under the microscope, stage 0 transitional bladder cancer is pathologically classified as either noninvasive papillary carcinoma or carcinoma in situ (CIS), both of which are considered to be "superficial” bladder cancers.

Stage I (T1): Patients with stage I bladder cancer have cancer that invades beneath the surface of the bladder into connective tissue, but does not invade the muscle of the bladder and has not spread to lymph nodes. This is also classified as a "superficial bladder cancer.”

Stage II (T2): Patients with stage II bladder cancer have cancer that invades through the connective tissue into the muscle wall, but has not spread outside the bladder wall or to local lymph nodes. Patients with cancer invading the inner half of the muscle of the bladder wall have a better outcome than patients with invasion into the deep muscle (outer half of the muscle of the bladder wall). Stage II bladder cancer is classified as a "deep" or "invasive" bladder cancer.

Stage III (T3): Patients with stage III bladder cancer have cancer that invades through the connective tissue and muscle and into the immediate tissue outside the bladder and/or invades the prostate gland in males or the uterus and/or vagina in females. With stage III bladder cancer, there is no spread to lymph nodes or distant sites. Stage III bladder cancer is also classified as a "deep" or "invasive" bladder cancer.

Stage IV (T4): Patients with stage IV bladder cancer have cancer that has extended through the bladder wall and invaded the pelvic and/or abdominal wall and/or has lymph node involvement and/or spread to distant sites. Stage IV bladder cancer is also referred to as "metastatic" bladder cancer. Recurrent Bladder Cancer: Patients with recurrent bladder cancer have cancer that has returned following initial treatment with surgery, radiation, chemotherapy or immunotherapy.

Recurrent: Patients with recurrent bladder cancer have cancer that has returned following initial treatment with surgery, radiation, chemotherapy or immunotherapy.

CANCER Z INFORMATION

What is Cancer?
Cancer is not one disease, but many diseases that occur in different areas of the body. Each type of cancer is characterized by the uncontrolled growth of cells. Under normal conditions, cell reproduction is carefully controlled by the body. However, these controls can malfunction, resulting in abnormal cell growth and the development of a lump, mass, or tumor. Some cancers involving the blood and blood-forming organs do not form tumors but circulate through other tissues where they grow.

A tumor may be benign (non-cancerous) or malignant (cancerous). Cells from cancerous tumors can spread throughout the body. This process, called metastasis, occurs when cancer cells break away from the original tumor and travel in the circulatory or lymphatic systems until they are lodged in a small capillary network in another area of the body. Common locations of metastasis are the bones, lungs, liver, and central nervous system.

The type of cancer refers to the organ or area of the body where the cancer first occurred. Cancer that has metastasized to other areas of the body is named for the part of the body where it originated. For example, if breast cancer has spread to the bones, it is called "metastatic breast cancer" not bone cancer.

How did I get cancer?
Although every patient and family member wants to know the answer to this question, the reason people develop cancer is not well understood. There are some known carcinogens (materials that can cause cancer), but many are still undiscovered. We do not know why some people who are exposed to carcinogens get cancer and others do not. The length and amount of exposure are believed to affect the chances of developing a disease. For example, as exposure to cigarette smoking increases, the chance of developing lung cancer also increases. Genetics also plays an important role in whether an individual develops cancer. For example, certain types of breast cancer have a genetic component.

What’s next?
Following your diagnosis of cancer, your reaction may be one of shock and disbelief. If you have been told that chemotherapy or radiation therapy are an important part of your treatment, many unpleasant images may come to mind. But as you move beyond that initial shock to begin the journey of surviving your cancer, you have many good reasons to be optimistic. Medicine has made—and continues to make—great strides in treating cancer and in making cancer treatment more tolerable, both physically and emotionally.

No one would call cancer a normal experience, but by proactively managing aspects of your treatment, you can maintain a sense of normalcy in your life. Fighting cancer is not a challenge you face alone. It's a team effort that involves family, friends, and your healthcare team. Don't overlook the strength that can come from having your support network by your side.

cancer

The name for diseases in which the body's cells become abnormal and divide without control. Cancer cells may invade nearby tissues. And they may spread through the bloodstream and lymphatic system to other parts of the body.

Types of Breast Cancer

Breast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between. In this section, you can learn about the different types of breast cancer, including non-invasive, invasive, recurrent, and metastatic breast cancers. You can also read about breast cancer in men.

The different types of breast cancer, including ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), inflammatory breast cancer, male breast cancer, recurrent breast cancer, metastatic breast cancer, and more.

Symptoms & Diagnosis

Breast cancer symptoms vary widely — from lumps to swelling to skin changes — and many breast cancers have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like infection or a cyst.

Breast self- exam should be part of your monthly health care routine, and you should visit your doctor if you experience breast changes. If you're over 40 or at a high risk for the disease, you should also have an annual mammogram and physical exam by a doctor. The earlier breast cancer is found and diagnosed, the better your chances of beating it.

The actual process of diagnosis can take weeks and involve many different kinds of tests. Waiting for results can feel like a lifetime. The uncertainty stinks. But once you understand your own unique “big picture,” you can make better decisions. You and your doctors can formulate a treatment plan tailored just for you.

Chemotherapy

Chemotherapy is a systemic therapy; this means it affects the whole body by going through the bloodstream. The purpose of chemotherapy and other systemic treatments is to get rid of any cancer cells that may have spread from where the cancer started to another part of the body.

Chemotherapy is effective against cancer cells because the drugs love to interfere with rapidly dividing cells. The side effects of chemotherapy come about because cancer cells aren't the only rapidly dividing cells in your body. The cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant, rapid division. This means that the chemotherapy is going to affect them, too.

Still, chemotherapy is much easier to tolerate today than even a few years ago. And for many women it's an important "insurance policy" against cancer recurrence. It's also important to remember that organs in which the cells do not divide rapidly, such as the liver and kidneys, are rarely affected by chemotherapy. And doctors and nurses will keep close track of side effects and can treat most of them to improve the way you feel.

Breast Cancer Statistics

• Breast cancer incidence in women in the United States is 1 in 8 (about 13%).
• In 2008, an estimated 182,460 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 67,770 new cases of non-invasive (in situ) breast cancer.
• About 1,990 new cases of invasive breast cancer will be diagnosed in men in 2008. Less than 1% of all new breast cancer cases occur in men.
• From 2001 to 2004, breast cancer incidence rates in the U.S. decreased by 3.5% per year. One theory is that this decrease was due to the reduced use of hormone replacement therapy (HRT) by women after the results of a large study, called the Women’s Health Initiative, were published in 2002. These results suggested a connection between HRT and increased breast cancer risk.
• About 40,480 women in the U.S. are expected to die in 2008 from breast cancer, though death rates have been decreasing since 1990. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness.
• For women in the U.S., breast cancer death rates are higher than those for any other cancer besides lung cancer.
• Besides skin cancer, breast cancer is the most commonly diagnosed cancer among U.S. women. More than 1 in 4 cancers are breast cancer.
• Compared to African American women, white women are slightly more likely to develop breast cancer, but less likely to die of it. One possible reason is that African American women tend to have more aggressive tumors, although why this is the case is not known. Women of other ethnic backgrounds — Asian, Hispanic, and Native American — have a lower risk of developing and dying from breast cancer than white women and African American women.
• As of 2008, there are about 2.5 million women in the U.S. who have survived breast cancer.
• A woman’s risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer.
• About 5-10% of breast cancers are caused by gene mutations inherited from one’s mother or father. Mutations of the BRCA1 and BRCA2 genes are the most common. Women with these mutations have up to an 80% risk of developing breast cancer during their lifetime, and they often are diagnosed at a younger age (before age 50). An increased ovarian cancer risk is also associated with these genetic mutations. Men with a BRCA1 mutation have a 1% risk of developing breast cancer by age 70 and a 6% risk when they have a BRCA2 mutation.
• About 90% of breast cancers are due not to heredity, but to genetic abnormalities that happen as a result of the aging process and life in general.
• The most significant risk factors for breast cancer are gender (being a woman) and age (growing older).

INTRODUCTION OF BREAST CANCER

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.