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- Cancer, also called malignancy or neoplasm, develops when cells in a specific part of the body begin to grow out of control. Unlike normal cells, cancer cells do not stop reproducing after they have doubled 50-60 times.
- Normal body cells grow, divide, and die in an orderly, natural fashion. Normal cells divide more rapidly during the early years of an individual's life. After adulthood is reached, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Cancer cells continue to grow and divide forming new abnormal cells.
- Cancer cells usually form a tumor. Some cancers, such as leukemia or cancer of the bone marrow and blood, do not form tumors. Instead, these cancer cells circulate through other tissues where they grow.
- Not all tumors are cancerous. Benign (non-cancerous) tumors do not metastasize (spread) to other parts of the body and, with very rare exceptions, are not life threatening. Different types of cancer can grow at different rates and respond to different treatments. Malignant, or cancerous, tumors may metastasize and cause further damage to organs and tissues in the body.
- Cancer cells develop because of damage to DNA (the material inside the nucleus of a cell that carries genetic information). DNA occurs in most cells of the body and is the blueprint for how the body grows, functions, and stays healthy. Usually, when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not able to be repaired. Individuals can inherit damaged DNA, such is the case with inherited cancers. More often, though, an individual's DNA becomes damaged by exposure to something in the environment, such as smoking or radiation from the sun.
- The immune system, which is made up of special cells, proteins, tissues, and organs, defends individuals against invasion by pathogens (disease-causing agent), such as cancer cells, bacteria, and viruses. The differences between cancer cells and normal cells may not be as easily detected, and the immune system may not always recognize cancer cells as pathogens. Most healthy individuals have immune systems that can keep up with the pathogens but, sometimes problems with the immune system can lead to illness and infection.
- Cancer cells sometimes travel through the blood or lymphatic system to other parts of the body. The cancerous cells begin to grow and replace normal tissue in a process called metastasis. Regardless of where cancer may spread, it is always named for the place it began. For instance, colon cancer that spreads to the liver is still called colon cancer, not liver cancer.
- Symptoms and treatment depend on the cancer type and how advanced it is. Treatment plans may include surgery, radiation, and/or chemotherapy. The most common cancers are breast cancer, lung cancer, bowel or colon cancer, prostate cancer, bladder cancer, non-Hodgkin's lymphoma, stomach cancer, melanoma, esophageal cancer, pancreatic cancer, leukemia, and ovarian cancer.
- According to the American Cancer Society (ACS), cancer is the leading cause of death among Americans under the age of 85. Half of all men and one third of all women in the United States will develop cancer during their lifetimes. Although cancer occurs in Americans of all racial and ethnic groups, the rate of cancer occurrence varies from group to group. Two-thirds of individuals diagnosed with cancer are aged over 65 years. In 2005, 7.6 million people died of cancer out of 58 million deaths worldwide. Based on projections, cancer deaths will continue to rise and an estimated 9 million people will die from cancer in 2015, and 11.4 million may die in 2030.
- Early diagnosis makes it more likely that cancer can be treated successfully. It is important that individuals are aware of possible symptoms and that individuals see a doctor for regular check ups.
Risk factors and causes
- Age: The chances of developing cancer increases with age. In the United States, more than 60% of cancers occur in people older than 65. The risk of developing cancer doubles every five years after the age of 25. The increased cancer rate is probably due to a combination of increased and prolonged exposure to carcinogens and weakening of the body's immune system.
- Environmental Factors: The environment we live in can cause an individual to have an increased risk of developing various types of cancers. Studies have reported that individuals exposed to high amounts of benzene, which is commonly found in gasoline, cigarettes, and pollution, are at an increased risk for developing cancer.
- Certain chemicals found in pesticide products, such as lawn and garden chemicals, may increase the risk of developing cancers such as lymphoma. Long-term use of hair products, including permanent hair dyes (especially dark colors) and hair straightening chemicals doubles an individual's risk of developing lymphoma, particularly among women and persons who used hair dyes before 1980. These dyes contained more carcinogenic (cancer-causing) substances than the dyes used today, due to changes in regulation by the U.S. Food and Drug Administration (FDA).
- Studies have reported that exposure to chemicals and pesticides can significantly increase the chances of developing breast cancer. Being overweight increases the chances of developing many types of cancer, such as ovarian cancer. A high fat diet may increase the chances of developing colon cancer. Exercising at least 30 minutes a day, five days a week may reduce the risk of developing cancer.
- Diet and lifestyle: Exposure to charred red meat has been reported to increase the risk of developing colon cancer. Diets low in fruits and vegetables are linked to an increased risk of cancers including cervical cancer.
- Heredity: Heredity or genetics plays a large role in cancer development. A family history of cancer, such as breast, ovarian, or colon cancer, increases the risk of the individual developing that type of cancer. When cancer is genetic, a mutated gene has been passed down. However, this does not always mean that the genetically pre-disposed individual will always develop cancer. Genetic tests are available for many cancers that are hereditary.
- Personal history of cancer: If an individual has had any type of cancer, there is an increased risk of developing that cancer again. Cancer can be in remission, or a period of time when the cancer is responding to treatment or is under control, and then return at a later time.
- Pre-existing medical conditions: Pre-existing medical conditions can increase an individual's risk of developing various forms of cancer. Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease increase the risk of colon cancer. Individuals with diabetes have as high as a 40% increased risk of developing colorectal cancer. A recent report found that men with testicular cancer had a higher rate of colorectal cancer. Men who receive radiation therapy for prostate cancer have also been reported to have a higher risk of rectal cancer.
- Ethnicity: Some research suggests that ethnicity may play a role in the development of various types of cancer. However, it is important to note that the following statistics may be correlations that do no necessarily have to do with ethnicity/genetics, but may be influenced by social factors associated with people of certain ethnicities (such as diet, access to healthcare, and quality of healthcare). Caucasian families have about a 17% risk for developing lung cancer, while African-Americans have a much higher risk, around 25%. Jews of Eastern European descent (Ashkenazi Jews) have a higher incidence of developing colon cancer. Caucasian women are more likely to develop breast cancer than African-American or Latino women. In the United States, African American men have a 60% higher incidence rate of developing prostate cancer as compared to Caucasian men.
- Sun Exposure: Individuals who spend a considerable amount of time in the sun can develop skin cancer, especially if the skin is not protected by sunscreen or clothing. UV rays from the sun can damage the DNA of skin cells and cause the mutation into cancerous cells. Tanning is the skin's injury response to excessive UV radiation, and increases the risk of skin cancer. Every time an individual gets sunburned or is exposed to too much UV radiation, there is an increased risk of damaging skin cells and developing skin cancer. One or more severe, blistering sunburns can increase the risk of skin cancer as an adult.
- Tobacco: Smoking cessation decreases the risk for developing various types of cancer. According to the National Cancer Institute (NCI), smoking causes 30% of all cancer deaths in the United States and is responsible for 87% of cases of lung cancer. Smoking affects the lungs and kidneys and has been reported to cause pancreatic, cervical, and stomach cancers and acute myeloid leukemia. Cancers of the mouth, larynx, bladder, cervix, and esophagus are also related to tobacco. A study found that exposure to secondhand smoke increases the risk of breast cancer in pre-menopausal women and lung cancer in the general population.
- Weak immune system: Individuals with a weakened immune system, including those living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), leukemia, and those taking immunosuppressant drugs after an organ transplant, are at a greater risk for developing certain types of cancer, including skin cancer.
- Viral infections: Practicing unsafe sex can increase the risk of developing human papillomavirus (HPV). HPV is a group of over 100 viruses that increases the risk of developing cervical, anal, vulvar, and vaginal cancer. Hepatitis B virus can cause liver cancer. Some human retroviruses cause lymphomas and other cancers of the blood system. Some viruses produce cancer in certain countries but not in others. For instance, the Epstein-Barr virus causes Burkitt's lymphoma (a type of cancer) in Africa and cancers of the nose and pharynx in China.
- Cancer is diagnosed based on an individual's symptoms, the results of a physical examination, and sometimes the results of screening tests. Confirmation that cancer is present requires diagnostic tests.
- Screening tests serve to detect the possibility that a cancer is present before symptoms occur. Screening tests are an important prophylactic measure for detecting cancer early, and healthcare professionals recommend cancer screening. Screening tests usually are not perfect; results are confirmed or disproved with further examinations and tests. Diagnostic tests are performed once a doctor suspects that an individual has cancer.
- Although screening tests can help save lives, they can be costly and can produce false-positive results, or results that suggest a cancer is present when it actually is not. False-positive results can create undue psychological stress and can lead to other tests that are expensive and risky. Screening tests can also produce false-negative results, or results that show no presence of a cancer that is actually present. However, cancer screening is important for individuals with risk factors for cancer, including age, race, heredity, and lifestyle (such as smoking, lack of exercise, or being overweight). The American Cancer Society has cancer screening guidelines that are widely used by healthcare providers.
- Recommendations for cancer screening are influenced by many factors, including age, race, previous medical history, and lifestyle. These screening recommendations are for individuals with no symptoms and with an average risk of cancer. For individuals with a higher risk, such as those with a strong family history of certain cancers or those who have had a previous cancer, screening may be recommended more frequently or to start at a younger age. Screening tests other than those listed here may also be recommended. An individual's physician will help decide when to begin screening and which tests should be used.
- Breast cancer: Breast self-examination is recommended monthly after age 20. A physical examination by a healthcare provider is recommended every three years between the ages of 20 and 39, then yearly. A mammography is recommended yearly starting at age 40.
- Cervical cancer: A papanicolaou (Pap) test is recommended yearly for individuals younger than 30 years of age. Some women 65-70 years of age or older who have had three or more normal Pap tests in a row may choose to stop having cervical cancer screening. For women over 30, some doctors recommend testing every three years with a conventional Pap test plus the human papillomavirus DNA test.
- Lung cancer: Chest x-ray, sputum cytology (examining the sputum for changes in cells), and computed tomography (CT) are not recommended on a routine basis. If an individual presents with symptoms of lung cancer, such as persistent hoarseness or cough, these tests may be performed.
- Prostate cancer: A rectal examination is recommended yearly for men after age 50. A prostate-specific antigen (PSA) blood test is also recommended yearly after age 50.
- Rectal and colon cancer: A stool examination for occult (hidden) blood should be performed yearly after age 50. A sigmoidoscopic examination should be performed every five years beginning at age 50, or a colonoscopic examination every 10 years beginning at age 50. In a sigmoidoscopic exam, the doctor uses a flexible, slender, and lighted tube to examine the rectum and sigmoid colon (approximately the last two feet of the colon). The test is fast but can sometimes be uncomfortable. If a polyp or colon cancer is found during this exam, the doctor will recommend a colonoscopy to look at the entire colon and remove any polyps for further examination under a microscope.
- Skin cancer: A physical examination should be part of a routine checkup. More frequent examinations may be needed for individuals at high risk for developing skin cancer, such as those with fair skin or frequent sunburns. Whole-body photography is not routinely needed, although it may be helpful for those with multiple moles or in whom examination of the skin is difficult.
- Generally, when a doctor first suspects cancer, some type of imaging study, such as x-ray, ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) is performed. Although these tests can show the presence, location, and size of an abnormal mass, they usually can not confirm that cancer is the cause. Cancer is confirmed by finding cancer cells on microscopic examination of samples from the suspected area. Usually, the sample must be a piece of tissue, although sometimes examination of the blood is enough (such as in leukemia). Obtaining a tissue sample is termed a biopsy. Biopsies can be performed by cutting out a small piece of tissue with a scalpel (surgical knife), but very commonly the sample is obtained using a hollow needle. Such tests are commonly done without the need for an overnight hospital stay and are called outpatient procedures. Doctors often use ultrasonography or a computerized tomography (CT) scan to guide the needle to the right location. Because biopsies can be painful, the individual is usually given a local anesthetic (such as lidocaine or Xylocaine®) to numb the area.
- In cases with findings on examination or imaging tests that suggest cancer, measuring blood levels of tumor markers may provide additional evidence for or against the diagnosis of cancer. Tumor markers are substances produced by tumor cells or by other cells of the body in response to cancer or certain benign (non-cancerous) conditions. Tumor markers can be found in the blood, the urine, the tumor tissue, or in other tissues. Different tumor markers are found in different types of cancer, and levels of the same tumor marker can be altered in more than one type of cancer. In addition, tumor marker levels are not altered in all people with cancer, especially if the cancer is early stage. Some tumor marker levels can also be altered in patients with non-cancerous conditions. In individuals who have been diagnosed with certain types of cancer, tumor markers may be useful to monitor the effectiveness of treatment and to detect possible recurrence of the cancer. For some cancers, the level of a tumor marker drops following treatment and increases if the cancer recurs. Common cancer tumor markers include: alpha-fetoprotein (AFP), which may be raised in individuals with colon cancer; beta2 (ß2)-microglobulin, which may occur in individuals with multiple myeloma; carcinoembryonic antigen (CEA), which may be raised in individuals with colon cancer; prostate-specific antigen (PSA), which may be increased in individuals with prostate cancer; and carbohydrate antigen 27.29 (CA27.29), which may be increased in individuals with breast cancer. Using tumor markers for cancer diagnosis is beneficial because of the ease of obtaining and measuring their presence; also, there is less discomfort for patients.
- After cancer is diagnosed, it is staged. Staging is the process of finding out how far the cancer has spread. Staging the cancer is a vital step in determining the treatment choices, and it will also give the healthcare team a clearer idea of the outlook for recovery. There can be several different processes for staging each individual cancer, such as with brain cancer, lymphoma, or melanoma.
- The TNM system is the most widely used staging. The "T" describes the size of the tumor, and whether the cancer has invaded nearby tissues and organs. The "N" describes how far the cancer has spread to nearby lymph nodes. The "M" shows whether the cancer has metastasized (spread) to other organs of the body. Once the TNM descriptions have been established, they can be grouped together into a simpler set of stages, stages 0 through stage IV (0-4). In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious, widespread cancer. A T1N2M0 cancer would be a cancer with a T1 tumor, N2 involvement of the lymph nodes, and no metastases (no spreading through the body).
- Metastasis: Metastasis (spreading) to other organs, such as the liver, pancreas, lungs, and lymph nodes, may occur causing an increase chance of death. Metastasis allows cancerous cells to spread to other tissues in the body and more than one body system, causing damage.
- Cardiac tamponade: Cardiac tamponade occurs when fluid accumulates in the pericardium or baglike structure surrounding the heart. This fluid puts pressure on the heart and interferes with its ability to pump blood. Fluid can accumulate when a cancer invades and irritates the pericardium.
- Pleural effusion: Pleural effusion occurs when fluid accumulates in the pleural cavity surrounding the lungs, causing shortness of breath.
- Superior vena cava syndrome:
Superior vena cava syndrome occurs when cancer partially or completely blocks the superior vena cava, which is a vein that drains blood from the upper part of the body into the heart. Blockage of the superior vena cava causes the veins in the upper part of the chest and neck to swell, resulting in swelling of the face, neck, and upper part of the chest.
- Spinal cord compression:
Spinal cord compression occurs when cancer compresses the spinal cord or the spinal cord nerves, resulting in pain and loss of function (such as urinary or fecal incontinence). The longer the compression of the spinal cord or spinal cord nerves persists, the less likely normal nerve function will return when the compression is relieved.
- Brain dysfunction: Brain dysfunction occurs when the brain functions abnormally as a result of a cancer growing within the brain, either as a primary brain cancer or more commonly as a metastasis from a cancer elsewhere in the body. Tumors may develop and put pressure on sensitive nerves and blood vessels, causing symptoms such as confusion, drowsiness, agitation, headaches, abnormal vision, abnormal sensations, weakness, nausea, vomiting, and seizures.
- Bleeding: At first, a cancer may bleed slightly because its cells are not well attached to each other and its blood vessels are fragile. Later, as the cancer enlarges and invades surrounding tissues, it may grow into a nearby blood vessel, causing bleeding. The bleeding may be slight and undetectable or detectable only with testing. Such is often the case in early-stage colon cancer. Or, particularly with advanced cancer, the bleeding may be more significant, even massive and life threatening. The site of the cancer determines the site of the bleeding. Cancer anywhere along the gastrointestinal tract can cause bleeding in the stool. Cancer anywhere along the urinary tract can cause bleeding in the urine. Other cancers can bleed into internal areas of the body. Bleeding into the lungs can cause the individual to cough up blood.
- The number of treatment choices an individual has will depend on the type of cancer, the stage of the cancer, and other individual factors such as age, health status, and personal preferences. An individual should discuss all treatment options with their cancer team. It is important to ask questions and to understand all the cancer treatment options available.
- The four major types of treatment for cancer are surgery, radiation, chemotherapy, and biologic therapies. The specific cancer treatment will be based on the individual's needs. Certain types of cancer respond very differently to different types of treatment, so determining the type of cancer is a vital step toward knowing which treatments will be most effective. The cancer's stage (how widespread it is) will also determine the best course of treatment, since early-stage cancers respond to different therapies than later-stage ones. The individual's overall health, lifestyle, and personal preferences will also play a part in deciding which treatment options will be best.
- It is important for individuals to understand the goals of treatment. The treatment can either be palliative, which helps control symptoms (such as pain), or curative, which may help cure the cancer and decrease the chances of it returning. The goal of cancer treatments and therapies is to increase the quality of life for the individual suffering from this condition.
- While surgery and radiation therapy are used to treat localized cancers, chemotherapy is used to treat cancer cells that have metastasized (spread) to other parts of the body. Chemotherapy is also used in combination with surgery and/or radiation or to shrink tumors, which helps surgery be easier on the patient and safer. Depending on the type of cancer and its stage of development, chemotherapy can be used to cure cancer, to keep the cancer from spreading, to slow the cancer's growth, to kill cancer cells that may have spread to other parts of the body, or to relieve symptoms caused by cancer. Not all individuals will respond the same way to chemotherapy treatments and some individual's will have more success than others.
- Prior to chemotherapy: The individual undergoing chemotherapy may be asked to take some medications prior to the procedure (called pre-medications), including: steroids, such as prednisone (Deltasone®) or hydrocortisone (Solu Medrol®); antihistamines (allergy medications), such as diphenhydramine (Benadryl®); anti-nausea medications, such as ondansetron (Zofran®); sedatives, such as alprazolam (Xanax®); or antibiotics, such as levofloxacin (Levaquin®).
- During chemotherapy: Individuals will be given the chemotherapy medication(s) by whichever route the doctor thinks best. Chemotherapy drugs can be given by mouth, injected through a syringe into a vein, artery, or muscle; given intravenously though an IV drip device; placed into a catheter (tube) that goes into the bladder, chest cavity, brain, spinal cord, liver, or abdomen; or, they can be applied to the skin. The decision on what route to use depends on several factors, mainly the type of tumor and the drug being used.
- At the same time, individuals may be given other medications to fight the side effects of chemotherapy, including steroids, allergy medications (anti-histamines), anti-nausea medications, sedatives, and antibiotics.
- Chemotherapy drugs: Almost all chemotherapy agents available kill cancer cells by affecting DNA synthesis or function, a process that occurs through the cell cycle. Each drug varies in the way this occurs within the cell cycle.
- The major categories of chemotherapy agents are alkylating agents, antimetabolites, plant alkaloids, antitumor antibiotics, and steroid hormones. Each drug is categorized according to their effect on the cell cycle and cell chemistry.
- Alkylating agents kill cells by directly attacking DNA. Alkylating agents may be used in the treatment of chronic leukemias, Hodgkin's disease, lymphomas, and certain carcinomas of the lungs, breasts, prostate, and ovaries. Cyclophosphamide (Cytoxan®) is an example of a commonly used alkylating agent.
- Nitrosoureas act similarly to akylating agents and also inhibit changes necessary for DNA repair. These agents cross the blood-brain barrier and are therefore used to treat brain tumors, lymphomas, multiple myeloma, and malignant melanoma. Carmustine (BCNU or BiCNU®) and lomustine (CCNU, or CeeNU®) are the major drugs in this category.
- Antimetabolites are drugs that block cell growth by interfering with certain activities, usually DNA synthesis. Once ingested into the cell, they halt normal development and reproduction. Antimetabolites may be used in the treatment of acute and chronic leukemias, choriocarcinoma, and some tumors of the gastrointestinal tract, breast, and ovary. Examples of commonly used antimetabolites are 6-mercaptopurine (Purinethol®) and 5-fluorouracil (5FU, or Leucovorin®).
- Antitumor antibiotics are a diverse group of compounds. In general, they act by binding with DNA and preventing RNA synthesis. These agents are widely used in the treatment of a variety of cancers. The most commonly used drugs in this group are doxorubicin (Adriamycin®), mitomycin-C (Mutamycin®), and bleomycin (Blenoxane®).
- Mitotic inhibitors are compounds derived from natural substances that inhibit mitosis (a stage of division) or cellular reproduction. Examples include: paclitaxel (Taxol®), docetaxel (Taxotere®), ixabepilone (Ixempra®), and estramustine (Emcyt®). Ixabepilone (Ixempra®) was approved by the U.S. Food and Drug Administration in October 2007 for use in patients with metastatic or locally advanced breast cancer who have not responded to certain other cancer drugs.
- Plant (vinca) alkaloids are also examples of mitotic inhibitors, which are derived from the periwinkle plant (Vinca sp.). These drugs act specifically by blocking cell division during mitosis. They are commonly used in the treatment of acute lymphoblastic leukemia, Hodgkin's and non-Hodgkin's lymphomas, neuroblastomas, Wilms' tumor, and cancers of the lungs, breasts, and testes. Vincristine (Oncovin®) and vinblastine (Velbe®) are commonly used agents in this group.
- Steroid hormones are useful in treating some types of tumors. This class includes adrenocorticosteroids, estrogens, antiestrogens, progesterones, and androgens. Although their specific mechanism of action is not clear, steroid hormones modify the growth of certain hormone-dependent cancers. Tamoxifen (Nolvadex®) is an example, which is used for estrogen dependent breast cancer.
- Platinum-based chemotherapy drugs contain the metal platinum. They are used to treat various types of cancers, including sarcomas, some carcinomas (e.g. small cell lung cancer and ovarian cancer), lymphomas and germ cell tumors. Examples include platinol (Cisplatin®), carboplatin (Paraplatin®), and oxaliplatin (Eloxatin®).
- Often, a combination of chemotherapy is used instead of a single drug. Chemotherapy is given in cycles, each followed by a recovery period. The total course of chemotherapy is often about six months, usually ranging from three to nine months. After a cancer is removed by surgery, chemotherapy can significantly reduce the risk of cancer returning. The chances of cancer returning and the potential benefit of chemotherapy depend on the type of cancer and other individual factors.
- After chemotherapy: After chemotherapy, individuals may be given any of the following medications: anti-nausea drugs, injections of immune-system boosting drugs (to increase white blood cells that fight potential infections) several days after the chemotherapy has been given, or other drugs, including steroids, antihistamines, anti-nausea medications, sedatives, and/or antibiotics.
- Side effects of chemotherapy: A major concern with chemotherapy is the possibility of long-term side effects and complications, such as heart damage, lung damage, liver damage, and secondary cancers (including leukemia). Although these severe effects occur in only a small number of people, great effort is being put into finding equally effective regimens with less toxicity. Drug regimens have been developed that substantially diminish the likelihood of long-range, life-threatening complications, including acute leukemia in people who have received multiple courses of chemotherapy and radiation therapy.
- Side effects of chemotherapy depend on the type of drugs, the amounts taken, and the length of treatment. The most common are nausea and vomiting, temporary hair loss, increased chance of infections, and fatigue (extreme tiredness). Many of these side effects can be uncomfortable or emotionally upsetting. However, most side effects can be controlled with medicines, supportive care measures, or by changing the treatment schedule.
- Fatigue is one of the most common side effects of radiation and chemotherapy. Like most other side effects, fatigue will usually disappear once the treatment is complete. Individuals need to get plenty of rest, eat a well-balanced diet (less meats, dairy, and fats, and more vegetables), and drink plenty of water.
- Hair loss may occur with some types of chemotherapy. Some individuals experience hair loss during chemotherapy treatments (and sometimes with radiation treatment to the head) while others do not, even with the same drugs. If hair loss does occur, it usually begins within two weeks of the start of therapy and gets worse one to two months after the start of therapy. Hair growth often begins even before therapy is completed. Most people are able to find suitable ways of managing the hair loss until it grows back, with specially designed hats, scarves, and wigs.
- Medications for side effects of chemotherapy: Some individuals who experience certain side effects of chemotherapy may be prescribed medications to counteract these effects. Several drugs are now available for use alone or in combination to help reduce a few of the most common side effects, such as nausea, vomiting, and fatigue.
- Anzemet® (dolasetron mesylate): Anzemet® helps prevent and relieve nausea and vomiting from surgery or chemotherapy. Researchers believe that nausea and vomiting during chemotherapy is associated with the release of serotonin from special cells in the small intestine. Anzemet® blocks these nerve endings in the intestine and prevents signals to the central nervous system. Anzemet® is available in tablet form and by injection.
- Compazine® (prochlorperazine): Prochlorperazine helps control nausea and vomiting after surgery or chemotherapy. Prochlorperazine is available in capsule, tablet, and liquid form, and by suppository or injection. Prochlorperazine can cause drowsiness and may interact with other medications or alcohol.
- Kytril® (granisetron hydrochloride): Kytril® is an anti-nausea medication FDA-approved for patients undergoing chemotherapy. Kytril® is typically given 60 minutes before chemotherapy. In some cases, a second dose is given about 12 hours after the first dose. Kytril® is available in tablet form and by injection.
- Phenergan® (promethazine): Promethazine has sedative, antihistamine, and mild anti-nausea properties. It may be used to help prevent or treat nausea due to chemotherapy. Promethazine may be available in tablet form or as an oral syrup, suppository, or injection.
- Procrit® (epoetin alfa): Procrit® helps the body produce more red blood cells, which help relieve fatigue due to chemotherapy. Since chemotherapy affects both normal and cancerous cells, it can decrease the number of red blood cells, which leads to anemia (lack of red blood cells to carry oxygen) and a feeling of extreme tiredness.
- Neupogen® (filgrastim):
Neupogen® is the trade name for granulocyte colony stimulating factor (G-CSF, or filgrastim). Neupogen® is a protein-based drug that stimulates the production of white blood cells. White blood cells are important for protecting the body from infection. Neupogen® is used to increase white blood cells, and to decrease the risk of infection, in conditions such as cancer. Neupogen® can be used subcutaneously (SC) or intravenously (IV). Side effects may include nausea, bone pain, and swelling or redness at the injection site. Contacting a doctor immediately is recommended by healthcare providers if the individual develops a fever, chills, sore throat, congestion, diarrhea, or redness, pain, or swelling around a wound or sore while using Neupogen®.
- Zofran® (ondansetron): Zofran® helps to relieve nausea and vomiting associated with chemotherapy. Zofran® is available in pill form, as a liquid solution, and by injection. The first dose of Zofran® (tablet form) is usually administered 30 minutes before chemotherapy and then at regular intervals for one to two days after chemotherapy.
- Myelodysplastic syndrome: Myelodysplastic syndromes are diseases of the blood and bone marrow, often caused by chemotherapy. Blood cells, such as red blood cells that carry oxygen to tissues and white blood cells that help produce cells for immunity, are damaged by chemotherapy medicines. Symptoms of myelodysplastic syndrome include fatigue and chronic tiredness, shortness of breath, chilled sensation, chest pain (occasionally), an increased susceptibility to infection, and an increased susceptibility to bleeding. Patients who experience low blood cells counts during chemotherapy may also be given medications to help raise blood cell or platelet counts. For example, patients who suffer from neutropenia, a decrease in the number of neutrophils (a type of white blood cell), may be given certain growth factors, such as the granulocyte-macrophage colony stimulating factor (GM-CSF, sargramostim, or Leukine®) or Neupogen®.
- Radiation therapy:
- Radiation therapy uses high-energy rays to kill cancer cells. It is considered a local therapy, meaning that it should be used to target areas of the body invaded by tumor masses. A radiation oncologist will plan and supervise therapy. The area to be treated will be carefully mapped out and the treatment machine will be adjusted so that only the lymphoma cells are exposed to a full dose of radiotherapy. Because of the need to target the radiation at exactly the right area of the body, a mold is sometimes made that will help to hold that part of the body still and in position during the treatment sessions.
- Normal cells surrounding the lymphoma are spared the full dose, and these cells are usually able to repair themselves more easily than lymphoma cells. Therefore, radiotherapy can often control or destroy lymphoma cells, while causing only temporary damage to normal cells.
- Radiotherapy is usually given on an outpatient basis, with the patient visiting the hospital up to five times a week. Before each treatment, the patient is carefully positioned, usually lying on a treatment table. Parts of the body that are not being treated may be covered. It is important to remain completely still during the treatment. Each treatment usually lasts only a few minutes and causes no discomfort. Although the patient is left alone during the actual treatment, the radiotherapy technician watches from an observation room and it is possible to talk to the individual through a microphone. A course of radiotherapy typically lasts between two and six weeks, depending on the patient's individual circumstances. The length of radiation treatment varies depending on the stage of the disease. Radiation therapy may be used alone, but is commonly used in conjunction with chemotherapy.
- Depending on how and where the radiation is administered, it may cause certain side effects such as fatigue (extreme tiredness), loss of appetite, nausea, diarrhea, and skin problems. Radiation of lymph node areas may result in suppression of the immune system to varying degrees. Irradiation of the underlying bone and the marrow within the bone may result in suppression of the blood counts.
- Surgery is the treatment of choice for many types of cancer, such as colon or breast. Treatment depends on the stage of the disease and the overall health of the patient. Chemotherapy and radiation therapy may be used as adjuvant treatment or in addition to surgery.
- Cryosurgery: During cryosurgery, a doctor uses very cold material, such as liquid nitrogen spray, or a cold robe to freeze and destroy cancer cells or cells that may become cancerous (such as irregular cells in the cervix that could become cervical cancer).
- Electrosurgery: Electrosurgery is the application of high-frequency electrical currents by a doctor. These currents can kill cancer cells, such as in the mouth or on the skin.
- Laser surgery: Laser surgery is used to treat many types of cancer. Laser therapy uses high-intensity light to treat cancer and other illnesses. Lasers can be used to shrink or destroy tumors. Lasers are most commonly used to treat superficial cancers (cancers on the surface of the body or the lining of internal organs) such as basal cell skin cancer and the very early stages of some cancers, such as cervical, penile, vaginal, vulvar, and non-small cell lung cancer.
- Mohs' surgery: Mohs' surgery is useful for removing cancer from sensitive areas such as near the eye. Mohs' surgery is also useful for assessing how deep a cancer is growing. Mohs' surgery is performed by carefully removing cancer layer by layer with a scalpel or knife. After removing a layer, the doctor will evaluate the cells under a microscope until all the abnormal cells have been removed and the surrounding tissue shows no evidence of cancer.
- Laparoscopic surgery: In laparoscopic surgery (or minimally invasive surgery), a surgeon uses a laparoscope to see inside the body without making large incisions. A laparoscope is a telescopic rod lens system that is usually connected to a video camera. Several small incisions are made and a tiny camera and surgical tools are inserted into the body. The surgeon watches a monitor that projects what the camera sees inside the body. The smaller incisions mean faster recovery and a reduced risk of complications. Laparoscopic surgery is used in cancer diagnosis, staging, treatment, and symptom relief.
- Robotic surgery: In robotic surgery, the surgeon sits away from the operating table and watches a screen that projects a three-dimensional image of the area being operated on. The surgeon uses hand controls that tell a robot how to maneuver surgical tools to perform the operation. Robotic surgery helps the surgeon operate in hard-to-reach areas. But robotic surgical systems are expensive and require specialized training, so robotic surgery is only available in specialized medical centers.
- Clinical trials:
- Human studies of promising new or experimental treatments are known as clinical trials. A clinical trial is only done when there is some reason to believe that the treatment being studied may be valuable to the patient. Treatments used in clinical trials are often found to have real benefits. Clinical trials are not commonly used as treatments for cancer, but are an option. A doctor will help get information on various clinical trials available for certain types of cancer. There is no guarantee of success in clinical trials for the patients, and some individuals will actually not receive medication (the placebo).
- Types of clinical trials: There are three phases of clinical trials in which a treatment is studied before it can be approved by the U.S. Food and Drug Administration (FDA).
- Phase I clinical trials: The purpose of a phase I study is to find the best way to give a new treatment and find out how much of it can be given safely. Doctors watch patients carefully for any harmful side effects. The treatment has been well tested in lab and animal studies, but the side effects in patients are not completely known. Doctors running the clinical trial start by giving very low doses of the drug to the first patients and increasing the dose for later groups of patients until side effects appear. Although doctors are hoping to help patients, the main purpose of a phase I study is to test the safety of the drug.
- Phase II clinical trials: These studies are designed to see if the drug works. Patients are given the best dose of the drug (based on the results of the phase I study) and closely observed for an effect on the cancer. The doctors will also look for side effects.
- Phase III clinical trials: Phase III studies are done to see if the new treatment is better than what is already available. They involve large numbers of patients. One group (the control group) receives the standard (most accepted) treatment. The other group receives the new treatment. All patients in phase III studies are closely watched. The study will be stopped if the side effects of the new treatment are too severe or if one group has had much better results than the others.
- If an individual enrolls in a clinical trial, a team of experts will monitor their progress very carefully. The study is especially designed to pay close attention to the individual with cancer. However, there may be risks. Even with animal testing and laboratory studies, it is difficult to determine what side effects may occur in individuals undergoing clinical trials for cancer. It is important to discuss all potential risks and benefits carefully with a healthcare provider before making a decision to enroll in a clinical trial.
- Other therapies:
- Photodynamic therapy: Photodynamic therapy (PDT) is another type of cancer treatment that uses lasers. In PDT, a drug called a photosensitizer or photosensitizing agent is injected into a patient and absorbed by cells all over the individual's body. After a couple of days, the agent is found mostly in cancer cells. Laser light is then used to activate the agent and destroy cancer cells. Because the photosensitizer makes the skin and eyes sensitive to light for approximately six weeks, individuals undergoing PDT are advised to avoid direct sunlight and bright indoor light during that time.
- Perillyl alcohol:
Perillyl alcohol is a naturally occurring chemical with anticancer activity. Perillyl alcohol is found in lavender, cherries, and mint. The use of perillyl alcohol for cancer treatments is in phase I clinical trials.
- Laetrile: Laetrile is a substance derived from a chemical called amygdalin, which is found in the seeds of apricots, plums, and bitter almonds. Laetrile is publicized as an antineoplastic (prevents the development of a tumor or neoplasm) drug, although there is no supporting evidence.
- Pain control:
- Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals. Chronic or persistent pain may range from mild to severe, and it is present to some degree for long periods of time. Some individuals with chronic pain that is controlled by medicine can have breakthroughpain. This occurs when moderate to severe pain "breaks through" or is felt for a short time. Breakthrough pain may occur several times a day, even when the proper dose of medicine is given for chronic and persistent pain.
- Pain may be caused by the cancer itself. Whether the individual has pain and the amount of pain they have may depend on the type of cancer, the stage (extent) of the disease, and the individual's pain threshold (tolerance for pain). Most of the pain comes when a tumor presses on bones, nerves, or body organs. Pain can also be caused by the treatment or procedures for diagnosing cancer.
- Cancer pain is usually treated with analgesic (pain relieving) drugs, both prescription and non-prescription, and with non-drug treatments such as relaxation techniques, biofeedback, imagery, and others. Healthcare providers recommend asking a doctor or pharmacist for advice before taking any medicine for pain.
- Pain will generally be graded on a Pain Intensity Scale. Using a pain scale is helpful in describing how much pain a patient is feeling. Using the Pain Intensity Scale, individuals answer questions and assign a number from zero to 10 according to their pain level. No pain gets a zero, while a 10 is the highest level of pain imaginable. Questions can include the severity of pain, how pain changes with medication, and how bad the pain is during the day and night. If one medicine or treatment does not work for the pain, there is almost always another one that can be tried. Changes may also be made in the frequency and dosages to help increase the pain relief.
- Medications for pain: The type of medicine and the method by which the medicine is given depend on the type and cause of pain. Non-opiate (non-narcotic) pain medications are given for mild to moderate pain. These drugs can generally be purchased over-the-counter (OTC) and may include acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®). It is best to check with a healthcare professional before taking any OTC medication. NSAIDs can slow blood clotting, especially if the individual is on chemotherapy due to drug interactions.
- For moderate to severe pain, opiate (narcotic) medications may be given. These drugs include morphine (MS Contin®), fentanyl (Duragesic®), hydromorphone (Dilaudid®), and oxycodone (Percocet®, Oxycontin®). Individuals must have a prescription for these medications, and the medications are generally time released, meaning their effects last more than a few hours. Nonopiods may be used along with opioids for moderate to severe pain. Opiate medications may cause side effects such as drowsiness and constipation. Their use may also cause addiction, both physical and psychological, in a short length of time. For breakthrough pain, immediate-release opiates may be given, such as oral morphine (Oramorph®) or oxycodone (Roxicodone®). A prescription is required for these medicines. A short-acting opioid, which relieves breakthrough pain quickly, needs to be used with a long-acting opioid for persistent pain. It is important to tell a doctor or pharmacist if taking any OTC medication, as some OTC medicines may contain acetaminophen (Tylenol®). Some prescription pain medications, such as oxycodone/acetaminophen combination (Percocet®) or hydrocodone/acetaminophen (Lortab®, Vicodin®) may also contain acetaminophen, thereby increasing the potential for acetaminophen induced liver toxicity.
- Individuals who take opiates for pain sometimes find that over time they need to take larger doses. This may be due to an increase in the pain or the development of drug tolerance. Drug tolerance occurs when the body gets used to the medicine and does not relieve the pain as well as it once did. Many individuals do not develop a tolerance to opiates. If tolerance does develop, usually small increases in the dose or a change in the kind of medicine will help relieve the pain. Increasing the doses of opiates to relieve increasing pain or to overcome drug tolerance does not always lead to addiction. Alcohol should be avoided when taking medications for pain due to a potential for interactions. Using alcohol in combination with pain medications can lead to overdose symptoms such as weakness, difficulty in breathing, confusion, anxiety, or more severe drowsiness or dizziness. It is recommended to use caution when driving automobiles or operating heavy machinery when taking opiate pain medications. Medications for pain may also cause nausea and vomiting in sensitive individuals.
- For tingling and burning pain associated with some cancers, antidepressant medications (such as amitriptyline or Elavil®) or anticonvulsant medications (such as gabapentin or Neurontin®) may be used. Both these medications may cause drowsiness and sedation.
- For pain caused by swelling, steroid medications, including prednisone (Deltasone®), may be used. Side effects of steroid medications include edema (swelling) and a decline in immune system function.
- Pain medications may be given by several different routes, including orally (by mouth), topically (on the skin), and rectally (into the anus as a suppository). Pain medications may also be given by injection, including: subcutaneous (SC) injection or injected just under the skin using a small needle), intravenous (IV) or injected directly into the vein through a needle, and intrathecal and epidural injections that are placed directly into the fluid around the spinal cord (intrathecal) or into the space around the spinal cord (epidural). Patient-controlled analgesia (PCA) pumps may also be used. PCA pumps help control the amount of pain medicine an individual takes. When pain relief is needed, the individual can receive a preset dose of pain medicine by pressing a button on a computerized pump that is connected to a small tube placed in the body using a minor surgical technique.
- Non-drug treatments for pain: Non-drug treatments are now widely used to help manage cancer pain. There are many techniques that are used alone or along with medicine. Some individuals find they can take a lower dose of medicine with such techniques. These methods include: acupuncture, art therapy, focusing, healing touch, prayer, psychotherapy, transcutaneous electrical nerve stimulation (TENS), and yoga. See the "Integrative Therapies" section of this monograph for more information on these techniques.
- Support groups:
- Resources exist that provide cancer patients and their loved ones with an opportunity to learn ways of coping with the uncertainty that cancer brings and links to support groups that give them a chance to meet others who face similar issues. Support groups offer patients and loved ones emotional support, an opportunity to learn ways of coping with the uncertainty and changes in their lives, a chance to meet others who face similar issues, and a time to explore issues faced by all cancer survivors. Support groups for cancer patients can be located by asking a healthcare provider, such as a doctor or social worker, for more information.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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Types of cancer
- There are over one hundred types of cancer that can affect the human body. Each of the types of cancer has its own name, behavior, and course of treatment. All cancers involve the abnormal growth of cells. The most commonly found cancers in humans include carcinoma, sarcoma, leukemia, lymphoma, and adenoma.
- Carcinoma: More than 85% of cancers are carcinomas. Carcinomas start in the cells that line and cover internal and external organs. The most common carcinomas are lung cancer, breast cancer, skin cancer, and bowel cancer.
- Sarcoma: Sarcoma begins in supportive tissues of the body, such as muscle, bone, cartilage, blood vessels, fat, and connective tissue.
- Leukemia: Leukemia is cancer of the blood cells that grows in the bone marrow.
- Lymphoma: Lymphomas develop in the lymph nodes and tissues of the immune system.
- Adenoma: An adenoma is a tumor (usually benign) that begins in glandular tissue, such as the adrenal, pituitary, or thyroid gland.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.