Cancer Chart

Doctors refer to some brain tumors by grade, ranging from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells look under a microscope. Cells from higher grade tumors are more abnormal looking and generally grow faster than cells from lower grade tumors; higher grade tumors are more malignant than lower grade tumors.

The most frequent symptoms of brain tumors include:

• headaches that tend to be worse in the morning and ease during the day;
• seizures (convulsions);
• nausea or vomiting;
• Weakness or loss of feeling in the arms or legs;
• stumbling or lack of coordination in walking (ataxic gait);
• abnormal eye movements or changes in vision;
• drowsiness;
• changes in personality or memory;
• changes in speech

Depending on the results of the physical and neurologic examinations, the doctor may perform a combination of the following:

• a CAT scan consisting of a series of detailed pictures of the brain, and sometimes done with a special dye injected into a vein before the scan;
• MRI (magnetic resonance imaging) that gives pictures of the brain using a magnet linked to a computer;
• a skull x-ray which can show changes in the bones of the skull caused by a tumor, and calcium deposits, which are present in some types of brain tumors;
• brain scan using a small amount of radioactive material injected into a vein to reveal areas of abnormal growth in the brain recorded on special film;
• angiogram or arteriogram consisting of a series of x-rays taken after a special dye is injected into an artery (usually the area where the abdomen joins the top of the leg) enabling x-rays to see the tumor and the blood vessels that lead to it
• myelogram, using a special dye injected into the cerebrospinal fluid in the spine with the patient tilted to allow the dye to mix with the fluid. This test is done most when the doctor suspects a tumor is in the spinal cord.

• Tumors that begin in brain tissue are known as primary brain tumors. Primary brain tumors are classified by the type of tissue in which they begin. The most common brain tumors are gliomas, which begin the the glial tissue. There are several types of gliomas:
• Astrocytomas that may grow anywhere in the brain of spinal cord;
• brain stem gliomas that occur in the lowest, stemlike part of the brain;
• Ependymomas that usually develop in the lining of the ventricles, but can also occur in the spinal cord;
• Oligodendrogliomas which arise in the cells that produce myelin, and whose tumors arise in the cerebrum
• Medulloblastomas, Meningiomas, Schwannomas, Craniopharyngiomas, germ cell tumors and pineal region tumors are other types of brain tumors that do not begin in glial tissue.
• Cancer that starts in other parts of the body can spread (also known as metastasis) to the brain and cause secondary tumors. These tumors are not the same as primary brain tumors. Cancer that spread to the brain is the same disease and has the same name as the original (primary) cancer. If lung cancer spreads to the brain, the affliction is called metastatic lung cancer because the cells in the secondary tumor resemble abnormal lung cells, not abnormal brain cells. Treatment for secondary brain tumors depends on where the cancer started and the extent of the spread.

• Brain tumors are treated with surgery, radiation therapy, and chemotherapy. Depending on the patient's needs, several methods may be used. The patient may be referred to doctors who specialize in different kinds of treatment and work together as a team. This medical team can consist of a neuro-surgeon, a medical oncologist, a radiation oncologist, a nurse, a dietitian, and a social worker.
• Before treatment starts, patients may be given steroids – drugs used to relieve swelling (edema). They may also be given anticonvulsant medicine to prevent or control seizures. If hydrocephalus is present, the patient may need a shunt to drain the cerebrospinal fluid. A shunt is a long, thin tube placed in a ventricle of the brain and then threaded under the skin to another part of the body such as the abdomen, in effect creating a drainpipe.

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Cancer that spreads has the same name as the original (primary) cancer. When breast cancer spreads, it is called metastatic breast cancer, even though the secondary tumor is in another organ. Doctors sometimes call this "distant" disease.

• Personal history of breast cancer. Women who have had breast cancer face an increased risk of getting breast cancer again.
• Genetic alterations. Changes in certain genes (BRCA1, BRCA2, and others) make women more susceptible to breast cancer. In families in which many women have had the disease, gene testing can show whether a woman has specific genetic changes known to increase the susceptibility to breast cancer. Doctors may suggest ways to try to delay or prevent breast cancer, or improve the detection of breast cancer in women who have the genetic alterations.
• Family history. A woman's risk for developing breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer, especially at a young age.
• Certain breast changes. Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) or having had two or more breast biopsies for other benign conditions may increase a woman's risk for developing cancer.

Other factors associated with an increased risk for breast cancer include:

• Breast density. Women age 45 and older whose mammograms show at least 75 percent dense tissue are at increased risk. Dense breasts contain many glands and ligaments, which makes breast tumors difficult to "see," and the dense tissue itself is associated with an increased chance of developing breast cancer.
• Radiation therapy. Women whose breasts were exposed to radiation during their childhood, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer throughout their lives. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing breast cancer later in life.
• Late childbearing. Women who had their first child after the age of 30 have a greater chance of developing breast cancer than women who had their children at a younger age.

Also at a somewhat increased risk for developing breast cancer are women who started menstruating at an early age (before age 12), experienced menopause late (after age 55), never had children, or took hormone replacement therapy or birth control pills for long periods of time. Each of these factors increases the amount of time a woman's body is exposed to estrogen. The longer this exposure, the more likely she is to develop breast cancer.

In most cases, doctors cannot explain why a woman develops breast cancer. Studies show that most women who develop breast cancer have none of the risk factors listed above, other than the risk that comes with growing older. Also, most women with known risk factors do not get breast cancer. Scientists are conducting research into the causes of breast cancer to learn more about risk factors and ways of preventing this disease.

A lump or thickening in or near the breast or in the underarm area;

A change in the size or shape of the breast;

Nipple discharge or tenderness, or the nipple pulled back (inversion) into the breast;

Ridges or pitting of the breast (the skin looks like the skin of an orange; or

A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly).

A woman should see her doctor when symptoms like these appear. Quite often, they are not cancer, but it's important to check with a doctor to diagnose and treat any problems as early as possible.

• Palpation. The doctor can tell a lot about a lump (its size, its texture, and whether it moves easily) by palpation, carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones.
• Mammography. X-rays of the breast can give the doctor important information about a breast lump. If an area on the mammogram looks suspicious or is not clear, additional mammograms may be needed.
• Ultrasonography. Using high-frequency sound waves, ultrasonography can often show whether a lump is solid or filled with fluid. This exam may be used along with mammography.

Based on these exams, the doctor may decide t hat no further tests are needed and no treatment is necessary. (In such cases, the doctor may need to check the woman regularly to watch for any changes.) Usually, however, fluid or tissue must be removed from the breast to make a diagnosis. A woman's doctor may refer her for further evaluation to a surgeon or other health care professional who has experience with breast diseases. These doctors may perform:

• Fine needle aspiration. A thin needle is used to remove fluid from a breast lump. This procedure may show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). Clear fluid removed from a cyst may not need to be checked by a lab.
• Needle biopsy. Using special techniques, tissue can be removed with a needle from an area that is suspicious on a mammogram but cannot be felt. Tissue removed in a needle biopsy goes to a lab to be checked by a pathologist for cancer cells.
• Surgical biopsy. The surgeon cuts out part or all of a lump or suspicious area. A pathologist examines the tissue under a microscope to check for cancer cells.

Ductal carcinoma in situ, also called intraductal carcinoma or DCIS, refers to cancer cells in an area of abnormal tissue in the lining of a duct that have not invaded the surrounding breast tissue. If DCIS lesions are left untreated, over time cancer cells may break through the duct and spread to nearby tissue, becoming an invasive breast cancer. Patients with DCIS may have a mastectomy or may have breast-sparing surgery followed by radiation therapy. Underarm lymph nodes are not usually removed. Women with DCIS may want to talk with their doctors about the possible usefulness of treatment with tamoxifen.

Stage I and stage II are early stages of breast cancer, but the cancer has invaded nearby tissue. Stage I means that cancer cells have not spread beyond the breast and the tumor is no more than about an inch across. Stage II means one of the following: the tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm; the tumor is between 1 and 2 inches with or without spread to the lymph nodes under the arm; or the tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.

Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy as their primary local treatment, or they may have a mastectomy, with or without breast reconstruction (plastic surgery) to rebuild the breast. Sometimes radiation therapy is also given to the chest wall after mastectomy. These approaches are equally effective in treating early stage breast cancer. The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor, the size of the woman's breast, certain features of the cancer, and how the woman feels about preserving her breast. With either approach, lymph nodes under the arm usually are removed.

Many women with stage I and most with stage II breast cancer have chemotherapy and/or hormonal therapy in addition to surgery or surgery and radiation therapy. This added treatment is called adjuvant therapy. It is given to try to destroy any remaining cancer cells and prevent the cancer from recurring, or coming back.

Stage III is also called locally advanced cancer. The tumor in the breast is large (more than 2 inches across), the cancer is extensive in the underarm lymph nodes, or it has spread to other lymph nodes or tissues near the breast. Inflammatory breast cancer is a type of locally advanced breast cancer. Patients with stage III breast cancer usually have both local treatment to remove or destroy the cancer in the breast and systemic treatment to stop the disease from spreading. The local treatment may be surgery and/or radiation therapy to the breast and underarm. The systemic treatment may be chemotherapy, hormonal therapy, or both; it may be given before or after the local treatment.

Stage IV is metastatic cancer. The cancer has spread from the breast to other parts of the body. Women who have stage IV breast cancer receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. They may have surgery or radiation therapy to control the cancer in the breast. Radiation may also be useful to control tumors in other parts of the body.

Recurrent cancer means the disease has come back in spite of the initial treatment. Even when a tumor in the breast seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained in the area after treatment or because the disease had already spread before treatment. Most recurrences appear within the first 2 or 3 years after treatment, but breast cancer can recur many years later.

Cancer that returns only in the area of the surgery is called a local recurrence. If the disease returns in another part of the body, it is called metastatic breast cancer. The patient may have one type of treatment or a combination of treatments.

Methods of treatment for breast cancer are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area. Surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have just one form of treatment or a combination. Different forms of treatment may be given at the same time or one after another.

Surgery is the most common treatment for breast cancer. Several types of surgery may be used. The doctor can explain each of them in detail, discuss and compare the benefits and risks of each type, and describe how each will affect the patient's appearance. An operation to remove the breast (or as much of the breast as possible) is a mastectomy. Breast reconstruction is often an option at the same time as the mastectomy, or later on. An operation to remove the cancer but not the breast is called breast-sparing surgery or breast-conserving surgery. Lumpectomy and segmental mastectomy (also called partial mastectomy) are types of breast-sparing surgery. They usually are followed by radiation therapy to destroy any cancer cells that may remain in the area. In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system.

In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed.

In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some of the lymph nodes under the arm may also be removed.

In total (simple) mastectomy, the surgeon removes the whole breast. Some of the lymph nodes under the arm may also be removed.

In modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. The smaller of the two chest muscles is also taken out to help in removing the lymph nodes.

In radical mastectomy (also called Halsted radical mastectomy), the surgeon removes the breast, the chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is very rarely used today and only in cases of advanced cancer in which the cancer has spread to the chest muscles.

Breast reconstruction (surgery to rebuild a breast's shape) is often an option after mastectomy. Women considering reconstruction should discuss this with a plastic surgeon before having a mastectomy.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells and stop them from growing. The rays may come from radioactive material outside the body and be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material placed directly in the breast in thin plastic tubes (implant radiation). Some women receive both kinds of radiation therapy.

For external radiation therapy, patients go to the hospital or clinic each day. When this therapy follows breast-sparing surgery, the treatments are given 5 days a week for 5 to 6 weeks. At the end of that time, an added dose of radiation is sometimes given to the place where the tumor was removed. It may be either external or internal (using an implant). Patients stay in the hospital for a short time for implant radiation.

Radiation therapy, alone or with chemotherapy or hormone therapy, is sometimes used before surgery to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given by mouth or by injection. Either way, chemotherapy is a systemic therapy because the drugs enter the bloodstream and travel throughout the body.

Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment, and so on. Most patients have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Depending on which drugs are given and the woman's general health, however, she may need to stay in the hospital during her treatment.

Hormonal therapy is used to keep cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work or surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy is a systemic treatment; it can affect cancer cells throughout the body.

• Colorectal cancer is more likely in people over 50, but nonetheless can occur those of younger ages
• Colorectal cancer is more likely to occur in those with diets that are high in fat and calories and low in fiber.
• Polyps which are benign growths on the inner wall of the colon and rectum can increase a person's risk. Familial polyposis, an inherited condition, is almost certain to lead to colorectal cancer.
• Women with a history of cancer of the ovary, uterus, or breast have an increased chance of developing colorectal cancer, as does a person who has already had colorectal cancer before.
• First-degree relatives (parents, siblings, children) of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves.
• Ulcerative colitis is a condition in which the lining of the colon becomes inflamed, increasing a person's chance of developing colorectal cancer.

• A change in bowel habits
• Diarrhea, constipation, or feeling that the bowel does not empty completely
• Blood (bright red or very dark) in the stool
• Stools that are narrower than usual
• General abdominal discomfort such as frequent gas pains, bloating, fullness, and/or cramps
• Weight loss
• Constant tiredness
• Vomiting

• A Fecal occult blood test (FOBT) is a test used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed, and FOBT is used to detect small amounts of bleeding.
• A sigmoidoscopy is an examination of the rectum and lower colon (sigmoid colon) using a lighted instrument called a sigmoidoscope.
• A colonscopy is an examination of the rectum and entire colon using a lighted instrument called a colonscope.
• A double contrast barium enema (DCBE) is a series of x-rays of the colon and rectum. The patient is given an enema with a solution that contains barium, which outlines the colon and rectum on the x-rays.
• A digital rectal exam (DRE) is an exam in which the doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas.
• A biopsy is the removal of a tissue sample for examination under a microscope by a pathologist to make a diagnosis.

• Stage 0: The cancer is very early. It is found only in the innermost lining of the colon or rectum.
• Stage 1: The cancer involves more of the inner wall of the colon or rectum.
• Stage II: The cancer has spread outside the colon or rectum to nearby tissue, but not to the lymph nodes.
• Stage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body.
• Stage IV: The cancer has spread to other parts of the body. Colorectal cancer tends to spread to the liver and/or lungs.

• Treatment depends on
• Surgery
• Chemotherapy
• Radiation therapy
• Biological therapy
• Clinical trials

Because lymphatic tissue is present in many parts of the body, Hodgkin's disease can start almost anywhere. Hodgkin's disease may occur in a single lymph node, a group of lymph nodes, or sometimes, or sometimes in other parts of the lymphatic system such as the bone marrow and spleen. This type of cancer tends to spread in a fairly orderly way from one group of lymph nodes to the next group.

The following are some of the risk factors associated with the disease:

• Age/Sex. Hodgkin's disease occurs most often in people between 15 and 34 and in people over the age of 55. It is more common in men than in women.
• Family History. Brothers and sisters of those with Hodgkin's disease have a higher-than-average chance of developing the disease.
• Viruses. Epstein-Barr virus is an infectious agent that may be associated with an increased chance of getting Hodgkin's disease.

• A painless swelling in the lymph nodes in the neck, underarm, or groin
• Unexplained recurrent fevers
• Night sweats
• Unexplained weight loss
• Itchy skin
• When symptoms like these occur, they are not sure signs of Hodgkin's disease, but may in most cases be caused by other, less serious conditions, such as the flu. When symptoms like these persist, however, it may be necessary to see a doctor. Only a doctor can make a diagnosis of Hodgkin's disease.

The doctor may also order tests that produce pictures of the inside of the body. They include:

• X-rays. High-energy radiation used to take pictures of areas inside the body, such as the chest, bones, liver and spleen.
• CT (CAT) scan. A series of detailed pictures of areas inside the body. The pictures are created by a computer linked to an x-ray machine.
• MRI (magnetic resonance imaging). Detailed pictures of areas inside the body produced with a powerful magnet linked to a computer.

The diagnosis depends on a biopsy. A surgeon removes a sample of lymphatic tissue so that a pathologist can examine it under a microscope to check for cancer cells. The pathologist studies the tissue and checks for Reed-Sternberg cells, large abnormal cells that are usually found with Hodgkin's disease.

• The number and location of affected lymph nodes;
• Whether the affected lymph nodes are on one or both sides of the diaphragm; and
• Whether the disease has spread to the bone marrow, spleen, or places outside the lymphatic system, such as the liver.

In staging, the doctor may use some of the same tests used for the diagnosis of Hodgkin's disease. Other staging procedures may include additional biopsies of lymph nodes, the liver, bone marrow, or other tissue. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone. Rarely, an operation called a laparotomy may be performed. During this operation, a surgeon makes an incision through the wall of the abdomen and removes samples of tissue. A pathologist examines tissue samples under a microscope to check for cancer cells

Treatment for Hodgkin's disease also depends on the stage of the disease, the size of the enlarged lymph nodes, which symptoms are present, the age and general health of the patient, and other factors.

The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and medical background. This resource, produced by the American Board of Medical Specialties, is available in most public libraries and on the Internet.

Nonsmall cell lung cancer is more common than small cell lung cancer, and it generally grows and spreads more slowly. There are three main types of nonsmall cell lung cancer. They are named for the type of cells in which the cancer develops: squamous cell carcinoma (also called epidermoid carcinoma), adenocarcinoma, and large cell carcinoma.

Small cell lung cancer sometimes called oat cell cancer, is less common than nonsmall cell lung cancer. This type of lung cancer grows more quickly and is more likely to spread to other organs in the body.

• Cigarettes. Smoking cigarettes causes lung cancer. Harmful carcinogens in tobacco damage cells in the lungs. Over time, the damaged cells may become cancerous. The likelihood that a smoker will develop lung cancer is affected by the age at which smoking began, how long the person has smoked, the number of cigarettes smoked per day, and how deeply the smoker inhales.
• Cigars and Pipes. Cigar and pipe smokers have a higher risk of lung cancer than nonsmokers. Even cigar and pipe smokers who do not inhale are at increased risk for lung, mouth, and other types of cancer.
• Environmental Tobacco Smoke. The chance of developing lung cancer is increased by exposure to environmental tobacco smoke (also known as secondhand smoke) or the smoke in the air when someone else smokes.
• Radon. Radon is an invisible, odorless, and tasteless radioactive gas that occurs naturally in soil and rocks. People who work in mines may be exposed to radon and in some parts of the country radon is found in houses. A kit available at most hardware stores allows homeowners to measure radon in their homes.
• Asbestos. Asbestos is the name of a group of minerals that occur naturally as fibers and are used in certain industries. Asbestos fibers tend to break easily into particles that can float in the air and stick to clothes. When the particles are inhaled, they can lodge in the lungs, damaging cells and increasing the risk for lung cancer. This exposure has been observed in such industries as shipbuilding, asbestos mining and manufacturing, insulation work, and brake repair.
• Pollution. Researchers have found a link between lung cancer and exposure to certain air pollutants, such as by-products of the combustion of diesel and other fossil fuels. More research is being done to clarify things.
• Lung Diseases. Certain lung diseases, such as tuberculosis (TB), increase a person's chance of developing lung cancer. The cancer tends to develop in areas of the lung that are scarred from TB.
• Medical History. A person who has had lung cancer once is more likely to develop a second lung cancer compared with a person who has never had lung cancer. Quitting smoking after the lung cancer is diagnosed may prevent the development of a second lung cancer.

The best known way to prevent lung cancer is to quit or never start smoking.

• Repeated problems with pneumonia or bronchitis
• Shortness of breath, wheezing, or hoarseness
• Coughing up blood
• Constant chest pain
• A cougn that doesn't go away and gets worse over time
• Swelling of the neck and face
• Loss of appetite or weight loss
• Fatigue

• Bronchoscopy. The doctor puts a bronchoscope (a thin lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages. Through this tube, the doctor can collect cells or small samples of tissue.
• Needle aspiration. A needle is inserted through the chest into the tumor to remove a sample of tissue.
• Thoracentesis. Using a needle, the doctor removes a sample of the fluid that surrounds the lungs to check for cancer cells.
• Thoracotomy. Surgery to open the chest is sometimes needed to diagnose lung cancer. This procedure is a major operation performed in a hospital.

• CAT (or CT) scan. A computer linked to an x-ray machines creates a series of detailed pictures of areas inside the body.
• MRI (magnetic resonance imaging). A strong magnet linked to a computer makes detailed pictures of areas inside the body.
• Radionuclide scanning. Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.
• Bone scan. A bone scan, one type of radionuclide scanning, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into the bloodstream. It collect in areas of abnormal bone growth. A scanner measures the radioactivity levels in these areas and records them on x-ray film.
• Mediastinoscopy/Mediastinotomy. A mediastinoscopy can show whether the cancer has spread to the lymph nodes in the chest. Using a lighted viewing instrument, called a scope, the doctor examines the center of the chest (mediastinum) and nearby lymph nodes. In mediastinoscopy, the scope is inserted through a small incision in the neck; in mediastinotomy, the incision is made in the chest. In either procedure, the scope is also used to remove a tissue sample.

• Surgery is used to remove the cancer. The type of surgery a doctor performs depends on the location of the cancer in the lung, and usually specifies a certain size segment of the lung to be removed.
• Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Chemotherapy may be used to control cancer growth or to relieve symptoms. Most Chemotherapy treatments are given by injection into a vein, also known as IV treatment.
• Radiation therapy, also called radiotherapy, involves the use of narrowly focused high-energy rays to kill cancer cells. Radiation therapy may be used before surgery to shrink a tumor, or after surgery to destroy any cancer cells that remain in the treated area. Doctors also use radiation therapy, often combined with chemotherapy, as primary treatment instead of surgery.
• Photodynamic therapy is the use of a special chemical that is injected into the bloodstream and absorbed by cells. The chemical rapidly leaves normal cells but remains in cancer cells for a longer period of time. A laser light is pointed at the cancer to activate the chemical and kill the cancer cells that have absorbed it. Photodynamic therapy is used for lung cancers that are localized.

Patients with nonsmall cell lung cancer may be treated in different ways. The choice of treatment depends mainly on the extent of the disease. Surgery is the most common way to treat this type of lung cancer. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of nonsmall cell lung cancer. Radiation therapy and chemotherapy may also be used to slow the progress of the disease and to manage symptoms.

Small cell lung cancer spreads quickly. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy. Treatment may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body (such as in the brain). Some patients have radiation therapy to the brain even though no cancer is found there. This treatment, called prophylactic cranial iradiation (PCI), is given to prevent tumors from forming in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.

Melanoma occurs when melanocytes become malignant. Most pigment cells are in the skin; when melanoma starts in the skin, the disease is called cutaneous melanoma. Melanoma may also occur in the eye and is called ocular melanoma or intraocular melanoma. Rarely, melanoma may arise in the meninges, the digestive tract, lymph nodes, or other areas when melanocytes are found. Melanoma can occur on any skin surface. In men, it is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the lower legs. Melanoma is rare in black people and others with dark skin. When it does develop in dark-skinned people, it tends to occur under the fingernails or toenails or on the palms or soles. The chance of developing melanoma increases with age, but is still one of the most common cancers in young adults.

When melanoma spreads, cancer cells are also found in the lymph nodes. If the cancer has reached the lymph nodes, it may mean that cancer cells have spread to other parts of the body such as the liver, lungs or brain. In such cases, the cancer cells are still melanoma cells, and the disease is called metastatic melanoma rather than brain, lung or liver cancer.

Risk factors for melanoma can include:

• Many freckles
• Severe, blistering sunburns
• Many ordinary moles (more than 50)
• Immunosuppressive therapy
• Previous melanoma
• Dyplastic nevi
• Family history of melanoma
• Fair skin, light eyes

Nonetheless, scientists have observed that certain factors do increase a person's chance of developing melanoma. For example, having two or more close relatives who have had this disease is a risk factor because melanoma sometimes runs in families. Certain types of mole patterns are associated with an increased risk of developing melanoma, such as having dysplastic nevi or atypical moles. Dyplastic nevi are more likely than ordinary moles to become cancerous.

The number of people who develop melanoma is increasing. Researchers believe that the number of melanomas may be increasing because people are spending more time in the sun. It is known that ultraviolet (UV) radiation from the sun causes premature aging of the skin and skin damage that can lead to melanoma. Two types of ultraviolet radiation, UVA and UVB, should be of concern. Artificial sources of UV radiation can be just as harmful.

People who have had one or more severe, blistering sunburns as a child or teenager are at increased risk for melanoma. Sunburns in adulthood are also a risk factor for melanoma. Melanoma occurs more frequently in people who have fair skin that burns or freckles easily than in people with dark skin. To help prevent and reduce the risk of melanoma, people should avoid exposure to the midday sun (from 10 a.m. to 2 p.m. standard time, or from 11 a.m. to 3 p.m. daylight saving time) whenever possible. Another indication of intense sun, and a good time to protect yourself, is when your shadow is shorter than you are. Many doctors believe sunscreens may help prevent melanoma, especially those that block or absorb both types of ultraviolet radiation.

Early melanomas may be found when a pre-existing mole changes slightly, such as forming a new black area. Other findings are newly formed fine scales or itching in a mole. In more advanced melanoma, the texture of the mole may change. For example, it may become hard or lumpy. Although melanomas may feel different and more advanced tumors may itch, ooze, or bleed, melanomas usually do not cause pain.

In some cases, doctors may also use chemotherapy, biological therapy, or radiation therapy. The doctors may decide to use one treatment method or a combination of methods. Apart from other cancers, the treatment team or specialists for treating melanoma can include a dermatologist and plastic surgeon.

• What You Need To Know About Moles and Dysplastic Nevi;
• What You Need to Know About Skin Cancer

To order them and/or learn about others that are available, call the Cancer Information Service at 1-800-4-CANCER.

The lymphatic system is part of the body's immune system. It helps the body fight disease and infection. The lymphatic system includes a network of thin tubes that branch, like blood vessels, into tissues throughout the body. Lymphatic vessels carry lymph, a colorless, watery fluid that contains infection-fighting cells called lymphocytes. Along this network of vessels are small organs called lymph nodes. Clusters of lymph nodes are found in the underarm, groin, neck, chest, and abdomen. Other parts of the lymphatic system are the spleen, thymus, tonsils, and bone marrow. Lymphatic tissue is also found in other parts of the body, including the stomach, intestines, and skin.

In non-Hodgkin's lymphoma, cells in the lymphatic system become cancerous, that is, they divide and grow without any order or control, or old cells do not die as cells normally do. Because lymphatic tissue is present in many parts of the body, non-Hodgkin's lymphoma may occur in a single lymph node, a group of lymph nodes, or in another organ. This type of cancer can spread to almost any part of the body, including the liver, bone marrow and spleen.

Over the years, doctors have used a variety of terms to classify the many different types of non-Hodgkin's lymphoma. Most often, they are grouped by how quickly they are likely to grow and spread. Aggressive lymphomas, also known as intermediate and high-grade lymphomas, tend to grow and spread quickly and cause severe symptoms. Indolent lymphomas, also referred to as low-grade lymphomas, tend to grow slowly and cause fewer symptoms.

• Environment - People who work to a great degree with, or are otherwise exposed to certain chemicals, such as pesticides, solvents, or fertilizers, have a greater chance of developing non-Hodgkin's lymphoma.
• Viruses - T-lymphotropic virus type I (HTLV-1) and Epstein-Barr virus are two infectious agents that increase the chance of getting non-Hodgkin's lymphoma.
• Sex/Age - The likelihood of getting non-Hodgkin's lymphoma increases with age and is more common in men than in women.
• Weakened Immune System - Non-Hodgkin's lymphoma is more common among people with inherited immune deficiencies, autoimmune diseases, or HIV/AIDS, and among people taking immunosuppressant drugs following organ transplants.

People who are concerned about non-Hodgkin's lymphoma should talk with their doctor about the disease, the symptoms to watch for, and an appropriate schedule for checkups. The doctor's advice will be based on the person's age, medical history and other factors.

• Unexplained weight loss
• Itchy skin
• Reddened patches on the skin
• Unexplained fever
• Night sweats
• Constant fatigue

When symptoms are present, it is important to see a doctor so that any illness can be diagnosed and treated as early as possible.

• The number and location of affected lymph nodes
• Whether the disease has spread to the bone marrow, spleen, or to organs outside the lymphatic system such as the liver.
• Whether the affected lymph nodes are above, below, or on both sides of the diaphragm (the thin muscle under the lungs and heart that separates the chest from the abdomen).

In staging, the doctor may use some of the same imaging tests used for diagnosis of non-Hodgkin's lymphoma. A bone marrow biopsy involves removing a sample of bone marrow through a needle inserted into the hip or another large bone. A pathologist examines the sample under a microscope to check for cancer cells.

Like all organs of the body, the mouth and throat are made up of many kinds of cells. Almost all oral cancers are squamous cell carcinomas. Squamous cells line the oral cavity. When oral cancer spreads, it usually travels through the lymphatic system. Cancer cells that enter the lymphatic system are carried along by lymph, the colorless, watery fluid containing cells that help the body fight infection and disease. Oral cancer that spreads usually travels to the lymph nodes in the neck. It can also spread to other parts of thebody,

Heavy users of alcohol also have an increased risk of getting oral cancer, even if they don't use tobacco. And of course, those that use both have an especially high risk of oral cancer. Scientists believe that these substances increase each other's harmful effects.

Cancer of the lip can be caused by exposure to the sun. The risk can be avoided with the use of a lotion or lip balm containing sunscreen. Pipe smokers are especially prone to cancer of the lip. Some studies have shown that many people who develop oral cancer have a history of leukoplakia, a whitish patch inside the mouth. Although the causes of leukoplakia are not well understood, it is commonly associated with heavy use of tobacco and alcohol. The condition usually occurs in irritated areas such as the gums and mouth lining of smokeless tobacco users and the lower lip of pipe smokers. Another condition that most often occurs in people 60 to 70 years of age is Erythroplakia which appears as a red patch in the mouth. Early diagnosis and treatment of leukoplakia and erythroplakia are important because cancer may develop in these patches.

• Unusual bleeding, pain, or numbness in the mouth;
• A white or red patch on the gums, tongue, or lining of the mouth;
• A lump on the lip or in the mouth or throat;
• A sore on the lip or in the mouth that does not heal;
• A sore throat that does not go away, or a feeling that something is caught in the throat;
• Difficulty or pain with chewing or swallowing;
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable;
• A change in the voice;
• Pain in the ear.

Symptoms such as these may or may not be caused by cancer, so it is important to see a dentist or doctor about any symptoms like these to have them properly diagnosed.

Benign prostatic hyperplasia (BPH) is the abnormal growth of benign prostate cells. It may be worth noting that although benign, symptoms may appear remarkably similar for those of a cancerous condition. In BPH, the prostate grows larger and pushes against the urethra and bladder, blocking the normal flow of urine. More than half of the men in the United States between the ages of 60 and 70 and as many as 90 percent between the ages of 70 and 90 have symptoms of BPH.

• Weak or interrupted flow of urine;
• Inability to urinate;
• Difficulty starting urination or holding back urine;
• A need to urinate frequently, especially at night;
• Painful or burning urination;
• Painful ejaculation;
• Blood in urine or semen;
• Frequent pain or stiffness in the lower back, hips, or upper thighs

Any of these symptoms may be caused by cancer or by other, less serious health problems such as BPH or an infection. A man who has symptoms like these should see his family doctor or a urologist. Do not wait to feel pain, as early prostate cancer does not cause pain.

• Urine test - to check for blood or infection in the urine;
• Blood tests - a measure the levels of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) in the blood is done. The level of PSA in the blood may rise in men who have prostate cancer, BPH, or an infection in the prostate. The level of PAP rises above normal in many prostate cancer patients, especially if the cancer has spread beyond the prostate. In many cases, however, elevated PSA or PAP levels may also indicate oher, noncancerous problems.
• Digital rectal exam - the doctor inserts a gloved, lubricated finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas.
• Cystoscopy - a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube
• Intravenous pyelogram - a series of x-rays of the organs of the urinary tract.
• Transrectal ultrasonography - ultrasound is emitted by a probe inserted into the rectum. The waves bounce off the prostate, and a computer uses the echoes to create a picture called a sonogram.

If the test results suggest that cancer may be present, the patient will need to have a biopsy. A biopsy is a definite way of knowing whether a problem is cancer or not. During a biopsy, the doctor removes a small amount of prostate tissue, usually with a needle.

If cancer is found in the prostate, the doctor needs to know the stage, or extent, of the disease. Various blood and imaging tests can be employed to learn the stage of the disease, and treatment decisions can depend on these findings:

• Stage I(A) – The cancer cannot be detected by rectal exam and causes no symptoms. The cancer is usually found during surgery to relieve problems with urination. Stage I tumors may be in no more than one area of the prostate, but there is no evidence of spread outside the prostate
• Stage II(B) – The tumor is felt in a rectal exam or detected by a blood test, but there is no evidence that the cancer has spread outside the prostate
• Stage III(C) – The cancer has spread outside the prostate to nearby tissue.
• Stage IV(D) – Cancer cells have spread to lymph nodes or to other parts of the body.

• The Directory of Medical Specialists that list doctors by state and specialty and gives information about their background.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
• Your doctor may be able to recommend a specialist. Doctors who specialize in treating prostate cancer are urologists, radiation oncologists, and medical oncologists.
• People can get the names of doctors from their local medical society, a nearby hospital, or a medical school.
• Treatment for prostate cancer depends on the stage of the disease and the grade of the tumor (how fast the cells are likely to grow or spread to other organs). There are a number of available treatments for men with prostate cancer, including surgery, radiation therapy and hormone therapy. Not all men require treatment. The patient and his doctor may want to consider both the benefits and possible side effects of each option, especially the effects on sexual activity and urination, and other quality of life functions.

The risk of developing skin cancer is affected by where a person lives. People who live in areas that get high levels of UV radiation from the sun are more likely to get skin cancer. For instance, skin cancer rates are high in the U.S. where an estimated 40 to 50 percent of Americans who live to age 65 are expected to have skin cancer at least once. Worldwide, the highest rates of skin cancer are found in South Africa and Australia. Interestingly, skin cancer is related to lifetime exposure to UV radiation. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Protection of the skin from the sun should start at childhood to prevent skin cancer later in life.

The greatest chance for harmful exposure is during the time of the midday sun, approximately from 10 a.m. to 2 p.m. standard time, or from 11 a.m. to 3 p.m. daylight savings time.

Changes in the skin are not sure signs of cancer, however, it is important to see a doctor if any symptom lasts longer than 2 weeks. Don't wait for the area to hurt since skin cancers like most other cancers in the early stages seldom cause pain.

Both basal and squamous cell cancers are found primarily on areas of the skin that are exposed to the sun, such as the head, face, neck, hands and arms. However, skin cancer can occur anywhere.

Actinic keratosis can appear as a rough, red or brown, scaly patch on the skin. It is known as a precancerous condition because it sometimes develops into squamous cell cancer.

People should check themselves regularly for new growths or any other changes in the skin. Any new, colored growths or any changes in growths that are already present should be reported to the doctor without delay. People who have already had skin cancer should be sure to have regular exams so that the doctor can check the skin in both the treated areas and other places where cancer may develop.

Procedures for treating skin cancer include

• Surgery – Many skin cancers can be cut from the skin quickly and easly.
• Curettage and Electrodesiccation – The cancer is scopped out with a curette, an instrument with a sharp, spoon-shaped end, and the area is treated by electrodesiccation, an electric current used to control bleeding and kill remaining cancer cells.
• Moh's Surgery – A method helpful in removing cancers whose shape and depth a doctor is not sure of; large tumors; tumors in hard-to-treat places; cancers that have recurred.
• Cryosurgery – Extreme cold from liquid nitrogen that is used to treat precancerous skin conditions, such as actinic keratosis, as well as some small skin cancers.
• Laser Therapy – Used sometimes for cancers that involve only the outer layer of skin.
• Radiation – Used for cancers that occur in areas that are hard to treat with surgery, such as areas of the eyelid, the tip of the nose, or the ear.
• Topical Chemotherapy – A cream or lotion applied to the skin.

Although skin cancer is highly curable, the disease can recur in the same place. Also, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer elsewhere on the skin.