All About Cancer

Mesothelioma & Asbestos Cancer

2007-09-06T08:25:00.000+07:00

What Is Mesothelioma?

Mesothelioma the medical name for cancer of the pleura (the lining of the lung and chest cavity) or cancer of the peritoneum (the lining of the abdomen). It is usually caused by prolonged or persistent exposure to asbestos.

Symptoms of mesothelioma may not appear until between twenty and fifty years after exposure, which explains why so many new cases of this form of cancer are coming to light now, even though the dangers of asbestos were realized long ago and measures taken to reduce the risk of the disease.

As with many forms of cancer, the mesothelioma tumor can spread rapidly, often infecting the opposite pleura, and continuing on to other internal organs. Symptoms include a shortness of breath, chest pains, coughing, and loss of weight.

Testing can be carried out initially by X-Ray, with a Thoric CT and open lung biopsy being used to confirm the findings of the early tests. If it is diagnosed early enough, the tumor can be surgically removed, and with follow-up chemotherapy and radiation treatment, full recovery is often possible.

However, in more advanced cases, cure is usually not possible. In such cases, chemotherapy and radiation treatment can be used alongside other pain relief treatments, to ease the symptoms. Where cure is not possible, the average survival time is between four and eighteen months, depending on the stage of the tumor and the general health of the patient.

Mesothelioma Cancer

Mesothelioma is a type of cancer involving mesothelial tissues of body organs usually lungs or abdominal. It is often caused by exposure to asbestos. However, there are 30-50% of patients without any history of asbestos exposure. People who have received asbestos exposure of as little as one or two months to very low doses are at risk of mesothelioma cancer. Even people who wash clothes of asbestos exposed people are at risk. A person exposed to asbestos could develop mesothelioma after 50 years of exposure.

People in the occupations such as construction jobs in shipyards, insulators, boilermakers, etc. are at the risk of contracting asbestos disease.

The 2 common types of mesothelioma are:

Pleural mesothelioma (lung cancer) and Peritoneal mesothelioma (abdomen organs).

The survival time for a patient with diffuse malignant mesothelioma is from 4 to 24 months from the observance of the symptoms. Mesothelioma is also difficult to diagnose.

The chance of recovery for a patient with mesothelioma depends on size and location of the cancer, age of the patient and his response to the treatment.

Presently, the treatment options for mesotheliomas are:

Radiation therapy

Chemotherapy

Surgery and Photodynamic therapy

There is some evidence that provitamin A or beta-carotene may decrease the risk of mesothelioma.

Who is at Increased Risk For Developing Mesothelioma?

Since the late 1800's Asbestos has been mined and used commercially. The use of Asbestos dramatically increased during World War II and since the early 1940's millions of Americans have been exposed to asbestos dust working within industries where initally the risks were not known. There has been widespread exposure to Asbestos by workers within shipyards, mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople and an increase risk of deveolping mesothelioma has been the result. .

Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. By contrast, the British Government's Health and Safety executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exists at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases. Family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers.

To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

The combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung. The Kent brand of cigarettes used asbestos in its filters for the first few years of production in the 1950s and some cases of mesothelioma have resulted. Smoking current cigarettes does not appear to increase the risk of mesothelioma.

There is no curative treatment. Close monitoring (routine X-rays or even pleural biopsy) for mesothelioma is mandated. Oxygen therapy at home is often necessary to relieve the shortness of breath. Supportive treatment of symptoms includes respiratory treatments to remove secretions from the lungs by postural drainage, chest percussion, and vibration. Aerosol medications to thin secretions may be prescribed

How Is Mesothelioma Treated?

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles. However, they may have been been exposed to asbestos dust and fibre in other ways. This could include working with asbestos or by home renovation using asbestos cement products or even by washing the clothes of a family member who worked with asbestos. The resulting disease is rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs.

Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer.

There are various procedures used for the treatment of mesothelioma. The type of treatment depends on the location of the cancer, the stage of the disease, and the patient's age and general health.

A common treatment of the disease is by means of surgery by the removal of part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura, a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

Another method is Radiation therapy, also called radiotherapy. This involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found .

Anticancer drugs can be used to kill cancer cells throughout the body. This is known as chemotherapy and involves the administration of the drugs by injection into a vein (intravenous, or IV). Currently, doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen.

Because mesothelioma is very hard to control, the U.S. National Cancer Institute (NCI) is sponsoring clinical trials that are designed to find new treatments and better ways to use current treatments.

Mesothelioma - The Largest Man Made Epidemic

It is documented that Australia had the highest per capita use of asbestos in the world from the 1950's until the 1970's. As a tragic consequence, Australia now has the highest per capita incidence of mesothelioma in the world. With more than 500 Australians contracting mesothelioma per year, it is estimated that up to 18,000 Australians will die from this asbestos related cancer by the year 2020.

Despite the growing awareness of the dangers of asbestos, there are many people who have not heard of Mesothelioma. This asbestos related cancer is defined as: a malignant spreading tumor of the mesothelium of the pleura, pericardium, or peritoneum, arising form the inhalation of asbestos fibers.

One of the most baffling and frightening known facts concerning Mesothelioma is that many years may pass, between inhalation of asbestos dust and its deadly legacy of disease; it is not uncommon for four decades or more to pass before symptoms due to asbestos dust inhalation become apparent.

In November 2004, I was an invited speaker at the Global Asbestos Congress 2004, held in Tokyo Japan. Over 800 participants from 40 countries around the world were in attendance. To be a part of such a large gathering of fellow humans, united in a quest to rid the poison of asbestos from our environments was an intensely moving experience. Having lost my husband to mesothelioma I know first hand the suffering this cruel disease places on its innocent victims.

There were many speakers and each told a tale, of pain, death and heartache. We listened, we understood and we ached for the past, present and future victims of the killer asbestos and its legacy of mesothelioma and other asbestos related diseases. We listened and we were shocked and angered to learn that despite the growing awareness of the dangers of asbestos and the increasing incidence of asbestos related disease, there remains some countries who are mining asbestos with little or no regard for their workers or people who will come into contact with asbestos products.

Asbestos disease Association member's world wide are working tirelessly and fighting almost insurmountable odds to ban asbestos from all countries of the world. It is a sobering and frightening fact, that even if we were successful today in this quest, the legacy of asbestos related diseases will continue for five decades.

Add your voice to the many who want this killer product erased from the worlds environments ? Add your voice to the call that pleads for adequate compensation for victims and their families. Sign the online petition at Asbestos Disease Awareness Organization:

The Asbestos Disease Awareness Organization (ADAO) continues to raise public awareness about the dangers of asbestos exposure and the incurable and often deadly asbestos related diseases. ADAO is quickly expanding and uniting veterans, fire-fighters, shipbuilders, teachers and thousands of other innocent people around the world. Asbestos Awareness leads to education, prevention, new treatments and ultimately a cure.

Protect Against Mesothelioma by Avoiding Asbestos

Mesothelioma is a rare cancer that attacks the body's mesothelial cells around the organs. The mesothelium provides a protective membranous lining for the internal organs and allows moving organs (i.e. the heart and the lungs) to glide easily against adjacent structures. The names of the three regions of mesothelial cells that provide protective coating are 1) pleura, the sac which surrounds the lungs; 2) peritoneum, the lining which protects the abdominal cavity; and 3) pericardium, the sac which surrounds the heart. Three different types of mesothelioma cancer attack these three different regions.

Pleural mesothelioma: A type of lung cancer which attacks the pleura surrounding the lungs, this is the most common type of mesothelioma, affecting approximately two-thirds of all mesothelioma patients. Symptoms include horseness, fever, blood in sputum, swollen arms and face, coughing, loss of weight, difficulty breathing, chest pain, weak muscles, and reduced tactile sensitivity.

Peritoneal mesothelioma: A cancer of the abdomen which attacks the peritoneum lining the abdominal cavity. This affects approximately one-third of all mesothelioma patients. Symptoms include abdominal bloating, impaired bowl function, fever, swollen feet, and nausea.

Pericardial mesothelioma: This form of mesothelioma which attacks the pericardium surrounding the heart is extremely rare. Symptoms include chest pain, dyspnea, cough, and palpitations.

Mesothelioma has been linked to asbestos exposure. Asbestos is a type of building material used in thermal insulation products and ceiling tiles. In the United States, asbestos usage peaked during the 1950s - 1970s. During the late 1960s, concerns over the health consequences of asbestos exposure began to arise, thereby decreasing the amount of asbestos manufactured in next two decades. By the 1980s, a new industry of asbestos abatement began to flourish. But according to the United States Environmental Protection Agency (EPA), as many as 733,000 schools and public buildings still contain asbestos.

Small asbestos fibers that enter the air do not evaporate and can remain suspended in the air for a long time. These fibers, when breathed into the body, are toxic. There are three types of asbestos exposure.

Occupational asbestos exposure: People working in factories that manufacure asbestos are likely to have a high exposure to asbestos and are most at risk of developing asbestosis or mesothelioma.

Paraoccupational asbestos exposure: Family members of workers exposed to asbestos in the workplace are susceptible to exposure from asbestos dust brought home by the worker on his clothes or skin.

Neighborhood asbestos exposure: Those who live in the vicinity of an asbestos manufacturing plant are also at risk.

Mesothelioma is still a relatively rare form of cancer. There are an estimated 2,000 - 3,000 new cases per year in the United States. Approximately 7-13 per one million male patients with a history of asbestos exposure contract mesothelioma. Diagnosis usually occurs 20-40 years after initial exposure to asbestos.

Brain / CNS Tumors in Children

2007-09-05T09:10:00.000+07:00

What Are Brain and Spinal Cord Tumors in Children?

Brain tumors are masses of abnormal cells that have grown out-of-control. In most other parts of the body, it is critically important to distinguish benign (noncancerous) tumors from malignant (cancerous) ones. Benign tumors are almost never life threatening. The main reason cancers are so dangerous is because they can spread throughout the body. Most brain cancers can spread through the brain tissue but rarely spread to other areas of the body. Even so-called benign tumors are can, as they grow, compress brain tissue, causing damage that is often disabling and sometimes fatal. For this reason, doctors usually speak of "brain tumors" rather than "brain cancers." The major distinction is how readily they spread through the rest of the brain central nervous system and whether they can be removed and not come back.

The central nervous system is the medical name for the brain and spinal cord. Central nervous system tumors of adults and children often form in different areas, develop from different cell types, and may have a different outlook and treatment. This document refers to children's tumors.

The brain is the center of thought, feeling, memory, speech, vision, hearing, movement, and much more. The spinal cord and special nerves in the head called cranial nerves carry messages between the brain and the rest of the body. These messages tell our muscles how to move, transmit information gathered by our senses, and help coordinate our internal organs. The brain is located within and protected by the skull. Likewise, the spinal cord is protected by the bones of the spinal column. The brain and spinal cord are surrounded and cushioned by a special fluid, called cerebrospinal fluid. Cerebrospinal fluid is produced by the choroid plexus, which is located in cavities within the brain called ventricles. The ventricles as well as the spaces around the brain and spinal cord are filled with cerebrospinal fluid.

Parts of the Brain and Spinal Cord

The brain and spinal cord are the 2 main parts of the central nervous system.

The main areas of the brain include the cerebral hemispheres, cerebellum, and brain stem. Each of these parts has a special purpose. Tumors of different parts of the central nervous system disrupt different functions and cause different symptoms. Any disease involving that particular location within the brain can cause these symptoms, and they do not necessarily mean a brain tumor is present. Also, tumors in different areas of the central nervous system may be treated differently and have a different prognosis (outlook for survival). In very young children, less than 3 years of age, its often hard to tell which part of the brain is affected during its early development. Very young children may not have the usual symptomns coming from that part of the brain involved as would be seen in adults. In this age group the only symptoms may be nonspecific and include irritability, crying, poor feeding, or vomiting.

The 2 cerebral hemispheres control reasoning, thought, emotion, and language. They are also responsible for your planned muscle movements (throwing a ball, walking, chewing, etc.) and for taking in sensory information such as vision, hearing, smell, touch, and pain.

The symptoms caused by a tumor in a cerebral hemisphere depend on the part of the hemisphere in which the tumor arises. Common symptoms include:

seizures
trouble speaking
a change of mood such as depression
a change in personality
numbness, weakness or paralysis of part of the body
changes in vision, hearing, and sensation

The cerebellum controls coordination of movement. Tumors of the cerebellum cause difficulty with coordination in walking, difficulty with fine movements of arms and legs, and changes in rhythm of speech.

The brain stem contains bundles of very long nerve fibers (axons) that carry signals controlling muscles and sensation or feeling from the cerebrum to and from the rest the body. In addition, most cranial nerves (which carry signals to and from the face, eyes, tongue, and mouth) start in the brain stem. Special centers in the brain stem also control breathing and the beating of the heart.

Tumors in this critical area of the brain may cause weakness, stiff muscles, or problems with sensation, hearing, facial movement, and swallowing. Double vision is a common early symptom of brain stem tumors, as are problems with coordination in walking. Because tumors of the brain stem often intermingle with normal nerve cells and the brain stem is so essential for life, it may not be possible to surgically remove these tumors from the brain stem.

The spinal cord, like the brain stem, contains bundles of very long axons (wire-like extensions) that carry signals controlling muscles, sensation or feeling, and bladder and bowel control. Spinal cord tumors may cause weakness, paralysis, or numbness. Because the spinal cord is such a narrow structure, tumors arising within it usually cause symptoms involving both sides of the body (for example, weakness or numbness of both legs). This is different than tumors of the brain, which usually affect only one side of the body. Moreover, most tumors of the spinal cord arise below the neck after nerves to the arms have branched off the spinal cord, so that only lower body functions – bowel, bladder, or leg – are affected.

Tumors may also arise from cranial nerves. The most common cranial nerve tumor in children is optic glioma, a tumor of the optic nerve (the optic nerve is actually an extension of brain tissue to the eye) causing blindness. Tumors arising from other cranial nerves may cause hearing loss (acoustic nerve) in one or both ears, facial paralysis (facial nerve), or facial numbness or pain (trigeminal nerve). Tumors arising in the nerves of the peripheral nervous system (parts of the nervous system other than the brain and spinal cord) generally cause pain, weakness,and/or loss of sensation in the area served by that nerve. They can also weaken the muscles controlled by that nerve.

Types of Cells and Tissues in the Brain and Spinal Cord

The brain consists of different kinds of tissues and cells. Different types of tumors can start in these different cell and tissue types. These different types of tumors have varying outlooks for survival and may be treated differently.

Neurons: These are the most important cells within the brain. They send signals through the axons. Axons may be very short (in the brain) or 2 to 3 feet long (in the spinal cord). Electric signals carried by neurons determine thought, memory, emotion, speech, muscle movement, and just about everything else that the brain and spinal cord do. Unlike many other types of cells that can grow and divide to repair damage from injury or disease, neurons quit dividing about 1 year after birth (with a few exceptions). Neurons do not usually form tumors, but they are damaged by tumors that start nearby.

Glial cells: Most brain and spinal cord tumors develop from glial cells. There are 3 types of glial cells – astrocytes, oligodendrocytes, and ependymal cells. Tumors of glial cells are sometimes referred to as a group and called gliomas. A fourth cell type called microglia is part of the immune system and is not truly glial in origin. Normal glial cells grow and divide very slowly. Glial cells are the supporting cells of the brain and continue to increase in number until the child is 5 years of age. At this time, the brain reaches its maximum size and will be the same size throughout ones lifetime.

Astrocytes help support and nourish neurons. When the brain is injured, astrocytes form scar tissue that helps repair the damage.
Oligodendrocytes make myelin, a substance that surrounds and insulates axons of the brain and spinal cord. This allows oligodendrocytes to help neurons transmit electric signals through axons.
Ependymal cells line the ventricles within the central part of the brain and form part of the pathway through which cerebrospinal fluid travels.
Microglia represent 10% to 20% of the total population of glial cells in the brain. They are the immune (infection fighting) cells of the central nervous system.

Neuroectodermal cells: These are primitive cells that are probably the remains of embryonic cells and are found throughout the brain. The most common tumor that comes from these cells is the medulloblastoma, which arises in the cerebellum.

Meninges: These are specialized tissues that line the cerebrospinal fluid-filled spaces surrounding the brain and spinal cord. The meninges help form the spaces through which cerebrospinal fluid travels.

Choroid plexus: The choroids plexus is the area of the brain within the ventricles that makes cerebrospinal fluid, which nourishes and protects the brain.

Pituitary gland and hypothalamus: The pituitary is a gland found at the base of the brain. The hypothalamus is a part of the brain next to the pituitary gland. Both of these tissues help regulate the activity of several other glands. For example, they control the production of thyroid hormone by the thyroid gland, the production and release of milk by the breasts, and the production of male or female hormones by the testicles or ovaries. They also produce growth hormone, which stimulates body growth, and vasopressin, which regulates water balance by the kidneys.

The growth of tumors in or near the pituitary or hypothalamus, as well as surgery and/or radiation therapy in this area, can interfere with these functions. Consequently, a child may have low levels of one or more hormones and may need hormone treatments to correct any hormone deficiency.

Pineal gland: The pineal gland is not strictly part of the brain. It is, in fact, an endocrine gland that sits between the cerebral hemispheres. Its function is probably to make melatonin, a hormone that responds to changes in light.

Blood-brain barrier: Unlike most other organs, there is a barrier between the blood and the tissues of the central nervous system (brain and spinal cord) that keeps many drugs from getting into the brain, including most chemotherapy drugs that are used to kill cancer cells. However, some chemotherapy drugs can cross the blood-brain barrier to treat some malignant brain tumors.

Types of Brain and Spinal Cord Tumors

Sometimes brain tumors are found not to have started in the brain but rather to have spread, or metastasized, from some other part of the body. Tumors that start in other organs and then spread to the brain are called metastatic brain tumors and those that start in the brain are called primary brain tumors. This is important because metastatic and primary brain tumors are usually treated differently.

In children, metastatic tumors to the brain are much less common than primary brain tumors. Unlike other cancerous tumors, tumors arising within the brain or spinal cord rarely metastasize to distant organs. They cause damage because they spread locally and destroy normal tissue where they arise. This document only covers primary brain tumors.

Gliomas: This is not a specific type of cancer. Glioma is a general category that includes glioblastoma multiforme, primitive neuroectodermal tumors, anaplastic astrocytoma, astrocytomas, oligodendrogliomas, ependymomas, brain stem gliomas and optic gliomas. Because this word is often used in discussing brain tumors, it is defined here in an attempt to reduce confusion with it.

Tumors can form in any type of tissue or cell within the brain or spinal cord. Some tumors contain a mixture of cell types. The most common brain and spinal cord tumors of children are astrocytomas. The second most common are primitive neuroectodermal tumors (23%), and the third most common are other kinds of gliomas such as brain stem gliomas (15%). Ependymomas are the fourth most common at 9%. All the others are fairly uncommon and account for only 3%.

Astrocytoma: Most tumors that arise within the brain itself start in brain cells called astrocytes, a kind of glial cell. These tumors are called astrocytomas. About half of all childhood brain tumors are astrocytomas. Many astrocytomas cannot be cured because they spread widely throughout, and intermingle with, the normal brain tissue. They are called infiltrating astrocytomas. Sometimes infiltrating astrocytomas spread along the cerebrospinal fluid pathways. But it is very rare for them to spread outside of the brain or spinal cord.

Infiltrating astrocytomas are classified as low grade, intermediate grade, or high grade. A pathologist (a doctor specializing in the diagnosis of diseases by laboratory tests) will grade them based on how the cells from a biopsy specimen (sample of the tumor) look under the microscope. Low-grade astrocytomas are the slowest growing and the most common type of astrocytoma in children. Intermediate-grade astrocytomas, or anaplastic astrocytomas, grow at a moderate rate. The highest-grade astrocytomas, glioblastomas, are the fastest growing.

There are some special types of astrocytomas that tend to have a particularly good prognosis. These are juvenile pilocytic astrocytomas and subependymal giant cell astrocytomas.

Juvenile pilocytic astrocytomas most commonly occur in the cerebellum but also occur in the optic nerve, hypothalamus, brain, or other areas.
Subependymal giant cell astrocytomas occur in the ventricles and are almost always associated with tuberous sclerosis (an inherited condition which may also cause epilepsy, mental retardation, and tumors of the skin and kidneys).

Certain tumors possibly of mixed glial and neuronal origin that occur in children and young adults and rarely in older adults also have a good prognosis. One such tumor is the pleomorphic xanthoastrocytoma and another is the dysembryoplastic neuroepithelial tumor. Although they appear malignant under the microscope, these tumors are relatively benign and most are cured by surgery alone.

Oligodendrogliomas: These tumors start in brain glial cells called oligodendrocytes. They spread or infiltrate in a manner similar to astrocytomas and, in most cases, cannot be completely removed by surgery. A small number of oligodendrogliomas, however, are associated with long-term survival of 30 or 40 years. Oligodendrogliomas may spread along the cerebrospinal fluid pathways but rarely spread outside the brain or spinal cord.

Optic Glioma: Optic gliomas are low-grade tumors of childhood and are frequently associated with an inherited condition called neurofibromatosis-type 1. These tumors, which arise from the optic nerve, can sometimes be treated successfully by surgery. At other times radiation therapy or chemotherapy may be required. The tumors are rarely lethal but may cause substantial visual loss.

Ganglioglioma: This tumor contains both mature neurons and glial cells. It has a high rate of cure by surgery alone or surgery combined with radiation therapy.

Primitive neuroectodermal tumors: Almost one fourth of brain tumors in children are of this type. They are rare in adults. When these arise in the cerebellum, they are called medulloblastomas. They are fast-growing tumors that can spread along the spinal cord and meninges but can be treated. Up to 50% of cases are cured by surgery and radiation therapy, sometimes with added chemotherapy. About 15% of childhood brain tumors are medulloblastomas.

Primitive neuroectodermal tumors are called pineoblastomas when they occur in the pineal gland. Other forms of primitive neuroectodermal tumors are all rapidly growing tumors that frequently spread throughout the cerebrospinal fluid pathways. The outlook for pineoblastomas is not as favorable as for medulloblastomas.

Ependymomas: Almost 10% of brain tumors in children are ependymomas. These tumors arise from the ependymal cells that line the ventricles or central canal of the spinal cord. Ependymomas may block the exit of cerebrospinal fluid from the ventricles causing the ventricle to become very large – a condition called hydrocephalus. Unlike astrocytomas and oligodendrogliomas, ependymomas usually do not spread or infiltrate into normal brain tissue. As a result, some but not all ependymomas can be removed and cured by surgery. Spinal cord ependymomas have the greatest chance of surgical cure. Ependymomas may spread along the cerebrospinal fluid pathways but do not spread outside the brain or spinal cord. Ependymomas represent about 9% of childhood brain tumors.

Choroid plexus tumors: These tumors arise in the choroid plexus within the ventricles of the brain. They are usually benign and cured by surgery (choroid plexus papillomas). However, they may also be malignant (choroid plexus carcinomas).

Craniopharyngioma: This type of tumor arises above the pituitary gland but below the brain itself. Most craniopharyngiomas are very close to the optic nerve, making surgical removal difficult, because of possible damage to the childs vision. They may also compress the pituitary gland and the hypothalamus causing hormonal problems. Some are cured by surgery; others require radiation therapy.

Schwannoma (neurilemoma): This type of tumor starts in Schwann cells that surround and insulate cranial nerves and other nerves. Schwannomas are usually benign tumors that often form near the cerebellum and in the cranial nerve, which is responsible for hearing and balance. They also arise from spinal nerves after they have left the spinal cord and can compress the spinal cord causing weakness, sensory loss, and bowel and bladder problems. These tumors are rare in children and when present in this age group, particularly if there is more than one, might suggest an inherited familial tumor syndrome such as neurofibromatosis.

Meningioma: This type of tumor arises from the meninges, the tissue that surrounds the outer part of the brain and spinal cord. Meningiomas cause symptoms by pressing on the brain or spinal cord. Meningiomas are much less common in children than in adults.

Meningiomas are benign and are usually cured by surgery. Some meningiomas, however, are located dangerously close to vital structures within the brain and cannot be cured by surgery. Meningiosarcomas are rare but very malignant (cancerous) tumors that may come back many times after surgery or, in rare occasions, spread to other parts of the body.

Chordoma: This tumor starts in the bone at the back of the skull or at the lower end of the spinal column. Chordomas may come back many times over a period of 10 to 20 years causing progressive neurologic damage and deterioration. But they usually do not spread or metastasize to other organs.

Germ cell tumors: Germ cell tumors develop from germ cells that normally form eggs in women and sperm in men. During normal embryonic and fetal development, germ cells migrate to the ovaries or testicles and develop into eggs or sperm cells. Sometimes, however, a few germ cells may not migrate properly and end up in abnormal locations such as the brain. They may then develop into germ cell tumors similar to those that can form in the ovaries or testicles.

Germ cell tumors of the nervous system usually occur in children, most often in the pineal gland or above the pituitary gland. The most common germ cell tumor of the nervous system is the germinoma, which can be cured by radiation therapy and possibly chemotherapy in almost all cases. Other tumors of germ cell origin such as choriocarcinoma or yolk sac tumors are rarely cured by surgery. Both radiation therapy and chemotherapy are used in their treatment and in some cases this may not control the tumor completely. Germ cell tumors can sometimes be diagnosed without a biopsy by measuring certain chemicals in the cerebrospinal fluid or blood.

Neuroblastoma: Another kind of nerve cell tumor, which is not a brain tumor, is called neuroblastoma. This is the third most common cancer in children. Neuroblastomas rarely develop in the brain or spinal cord; most develop from nerve cells inside the abdomen or chest. This type of cancer is most commonly diagnosed during early infancy.

What Are the Differences Between Cancers in Adults and Children?

Detailed Guide: Brain / CNS Tumors in Children
What Are the Differences Between Cancers in Adults and Children?

Children and adolescents with brain and spinal cord tumors and their families have special needs that can be best met by cancer centers for children and adolescents working closely with the child's primary care physician. Treatment in specialized centers takes advantage of a team of specialists who know the differences between cancers that occur in adults compared to those that occur in children and adolescents, as well as the unique needs of children and adolescents with cancers. This team should include pediatric oncologists, neurosurgeons, radiation oncologists, neuroradiologists, neurologists, neuropathologists, endocrinologists, psychologists, pediatric oncology nurses, and nurse practitioners.

The treatment of cancer in children and adolescents also involves many professionals other than nurses and doctors. Children's cancer centers have social workers, child life specialists, nutritionists, rehabilitation and physical therapists, and educators who can support and educate the entire family. Since the 1960s, most children with cancer have been treated at specialized centers designed for children.

Most children with cancer in the United States are treated at a center that is a member of the Children's Oncology Group (COG). All of these centers are associated with a university or children's hospital.

Do We Know What Causes Brain And Spinal Cord Tumors in Children?

The cause of central nervous system tumors is not fully understood. Nevertheless, researchers are making progress toward understanding some of the chemical changes that occur inside normal brain cells that turn them into brain tumors.

Brain tumors, like other tumors, are caused by abnormal changes in the genes. Genes, the "chemical building blocks of life," are made of DNA and are found in all cells within the body. The genes that we inherit from our parents make us who we are and are the reason that we are often very similar to our parents. In addition to determining how we look, genes also control every aspect of our body's metabolism. This is why abnormal genes can cause some diseases. Abnormalities of genes are called mutations. Gene mutations that cause some diseases (including some tumors) can be inherited.

Recently, researchers have found that gene mutations that cause some rare inherited syndromes (like neurofibromatosis, tuberous sclerosis, Li-Fraumeni, and Von Hippel- Lindau) are associated with an increased risk of developing some central nervous system tumors. For example, the Li-Fraumeni syndrome is caused by mutation of the p53 tumor suppressor gene. Normally, this gene prevents cells with damaged DNA from growing. When mutated, it increases the risk of developing breast cancer, soft tissue sarcomas, and brain tumors (particularly astrocytomas).

Some other gene mutations involved in forming brain and spinal cord tumors that are not inherited are also known. Research into these mutations has led to some experimental treatments for central nervous system tumors that, in the future, may be further refined.

It is not known why people without inherited tumor-causing mutations develop mutations in cells of their central nervous system. Most risk factors for cancer somehow damage genes. For example, cigarette smoke is a risk factor for lung cancer and several other cancers because it contains chemicals that can damage genes. The brain is relatively protected from cigarette smoke and other cancer-causing chemicals that we all breathe or eat. The vast majority of brain tumors happen for no apparent reason and are not associated with anything which the child did or didn't do, or anything that the child was exposed to in the environment.

Can Brain and Spinal Cord Tumors in Children Be Found Early?

No blood test or other screening examination is currently available to detect brain tumors at an early stage. In most cases, survival of patients with brain tumors depends on the type of tumor and its location, not how early it is detected.

For most tumors of the brain or spinal cord there is little evidence that early diagnosis and treatment increases the chance for survival.

How Are Brain and Spinal Cord Tumors in Children Treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Children with central nervous system tumors may be treated by surgery, radiation therapy, and/or chemotherapy. Treatment is different for different kinds of tumors. Each child's treatment must be approached individually to give the child the best chance of cure. Long-term side effects of the treatment must also be considered. Because of this, children under 3 years old are usually not given radiation therapy. Instead, the treatment relies mainly on removing the tumor by surgery and chemotherapy.

This approach is based on the desire to delay the need for radiation therapy, which can cause developmental delay and problems with intellectual development. Even in older children, however, radiation treatment can cause problems. Radiation oncologists (doctors specializing in treatment of tumors with radiation) try very hard to limit the amount of normal brain tissue that they treat.

Surgical Treatment of Brain and Spinal Cord Tumors

Surgery to remove the tumor: Generally, the first step in brain tumor treatment is for the neurosurgeon (a surgeon who specializes in operating on the brain and other parts of the nervous system) to remove as much of the tumor as he or she can. Surgery alone or combined with radiation therapy may cure many tumors, including some cerebellar astrocytomas, pleomorphic xanthoastrocytomas, dysembryoplastic neuroepithelial tumors, ependymomas, craniopharyngiomas, gangliogliomas, meningiomas, and some low-grade gliomas.

Children with infiltrating tumors, such as anaplastic astrocytomas or glioblastomas, are not cured by surgery. But surgery will reduce the amount of tumor that needs to be treated by radiation or chemotherapy, and this may improves the results of these treatments.

In addition, surgery may improve some of the symptoms caused by brain tumors, particularly those caused by a build up of pressure within the skull. These symptoms include headache, nausea, vomiting, and blurred vision. Surgery can also improve symptoms of epilepsy and make the seizures more controllable with medications.

Craniotomy is the most commonly performed surgery for removal of a brain tumor. The neurosurgeon makes an incision in the scalp and then removes a piece of bone to expose the area of brain over the tumor. Next the surgeon locates the tumor and removes as much as is safely possible. The surgeon is always careful to avoid damaging normal brain tissue. After removing the tumor, the surgeon replaces the bone and sews the skin together.

Surgery to place a shunt: Blockage of the cerebrospinal fluid flow can cause increased pressure inside the skull. This pressure can cause the symptoms noted above and may even cause permanent damage to the brain. To drain buildup of cerebrospinal fluid and lower the pressure, the neurosurgeon can place a plastic tube called a shunt. One end of the shunt is placed in the ventricle of the brain (which contains cerebrospinal fluid) and the other end is placed in the abdomen or, less often, the heart. Cerebrospinal flow is controlled by a valve placed along the tubing. The tube runs under the skin of the head, neck, and chest. Shunts may be temporary or permanent and may be placed before or after the surgery to remove the tumor.

Radiation Therapy of Brain and Spinal Cord Tumors

Children whose brain tumors are not completely curable by surgery are usually treated with radiation therapy. The exception to this is children younger than 3 years. Radiation from an external source focused precisely on the tumor is called external beam radiation. This is similar to a diagnostic x-ray except that the dose is much greater, each treatment lasts longer, and many treatments are given over a period of many weeks. Radiation may sometimes be given by placing radioactive material directly within the tumor. This is called interstitial radiotherapy or brachytherapy.

Because high doses of radiation therapy can damage a child's normal brain tissue, the radiation oncologist attempts to deliver high doses of radiation to the tumor with the lowest possible dose to normal surrounding brain areas.

Newer techniques such as 3-dimensional treatment planning (conformal radiation) and stereotactic radiosurgery (with a "gamma knife" or a linear accelerator) have been developed to spare normal tissue. At present, research is being conducted to determine if these techniques are superior to standard external beam radiation therapy. See the section, "What's New in Brain Cancer Research and Treatment?" for more information on this new type of radiation therapy.

If tests such as an MRI scan or lumbar puncture find the tumor has spread along the spinal cord covering, the meninges, and surrounding fluid, radiation may be given to the whole brain and spinal cord. Some tumors such as medulloblastoma or other primitive neuroectodermal tumors are assumed to always involve the cerebrospinal fluid and because of this, nearly always require craniospinal radiation.

Up to one half of all medulloblastomas and virtually all germinomas are cured by radiation therapy. Unfortunately, radiation does not cure most other brain tumors. If there is a minimal amount of the tumor remaining after surgery astrocytomas, oligodendrogliomas and ependymomas can sometimes be controlled (but usually not cured) by radiation therapy.

Radiation is more damaging to tumor cells than it is to normal cells. Nevertheless, normal brain tissue will be damaged by radiation. Rarely (in less than 5% of patients), a large mass of dead tissue forms at the site of an irradiated tumor. This occurs months to many years after radiation is given and is called radiation necrosis (necrosis means dead). In most cases the dead tissue includes both cancerous and noncancerous tissue. Occasionally, surgery is necessary to remove the necrotic tissue.

Children whose brains are treated with radiation may lose some brain function if large areas of the brain received radiation. This can include memory loss, personality changes, and trouble learning at school. Other symptoms would be seizures and slowed growth. There may also be other symptoms depending on the area of brain treated and how much radiation was given. These risks must be balanced against the risks of not using radiation and having less control of the tumor. Sometimes it is difficult to determine whether the brain damage was caused by the tumor, the surgery, the radiation therapy, or a combination of all these. Researchers are continually testing lower doses of radiation to see if these doses can be as effective without as much brain damage.

Radiation can damage genes. As a result, radiation therapy is associated with a very small risk of developing a second cancer in the radiation field – for example, a bone cancer in the skull – usually many years after the radiation is given. This small risk should not prevent children who need radiation from getting treatment. More importantly, parents should continue close follow-up with their child's doctors so that early intervention is possible if problems arise.

Because normal brain cells grow rapidly within the first several years of life, radiation therapy is often postponed if your child is younger than 3 years old to avoid damage that might severely impair his or her future intellectual growth. This delay needs to be balanced with the risk of tumor regrowth. Early radiation therapy may be lifesaving. It is important that you talk with your childs doctor about the risks and benefits of treatment.

During the course of radiation therapy, some children may become irritable and fatigued. Nausea, vomiting, and headache are unusual side effects of radiation therapy. Spinal radiation can cause nausea and vomiting more often than brain radiation. Some weeks after radiation therapy, children may become drowsy or neurologic symptoms may appear to worsen. This phenomenon is called the radiation somnolence syndrome or early-delayed radiation effect and usually passes after a few weeks. Sometimes dexamethasone (Decadron), a cortisone-like drug, can relieve the symptoms.

Chemotherapy of Brain and Spinal Cord Tumors

Chemotherapy uses anticancer drugs that are given into a vein intravenously (IV) or taken by mouth. In brain cancers, sometimes the drugs may be given directly into the ventricles or into the spinal canal below the spinal cord. These drugs, generally used only for high-grade tumors, may be given before or after surgery and radiation therapy. Some types of brain cancer, medulloblastoma for example, respond very well to chemotherapy. Chemotherapy, rather than radiation therapy, may be given to children 3 years and younger.

Some of the chemotherapy drugs used to treat children with brain tumors include:

cyclophosphamide
methotrexate
lomustine (CCNU)
carmustine (BCNU)
etoposide
thiotepa
cisplatin
carboplatin
vincristine
temozolomide

These drugs may be used alone or in various combinations, depending on the specific type of brain tumor.

Chemotherapy drugs kill cancer cells but will also damage normal cells. Your child's doctor will pay careful attention to avoiding or reducing the side effects of chemotherapy. These side effects depend on the type and dose of drugs given and the length of time they are taken. Drugs used in cancer chemotherapy specifically attack cells that are rapidly dividing. These drugs are effective because cancer cells spend more of their time dividing and reproducing than normal cells do.

However, there are some normal tissues such as the bone marrow, the lining of the mouth and intestines, and the hair follicles that also grow rapidly to replace cells that wear out. These rapidly growing cells are the ones most likely to be affected by chemotherapy.

As a result, your child may have hair loss, mouth sores, lowered resistance to infection (due to low white blood cell counts), easy bruising or bleeding (due to low blood platelets), and anemia (due to low red blood cells). Loss of appetite, nausea, and vomiting result in part from damage to intestinal cells, but effects of certain drugs on areas of the brain controlling appetite and vomiting also contribute to these problems. Fatigue may also occur but the cause of the fatigue is not clearly understood. These side effects are temporary and usually go away after treatment is finished.

Cisplatin and carboplatin can also cause kidney damage and hearing loss. Your doctor will check your child's renal function and hearing periodically to prevent excessive damage if he or she is given these drugs. Some of these side effects may persist after treatment is stopped.

If your child has side effects, your cancer care team can suggest steps to ease them. For example, drugs can be given along with the chemotherapy to prevent or reduce nausea and vomiting.

Brain / CNS Tumors in Adults

2007-09-05T08:30:00.000+07:00

What Are Brain and Spinal Cord Tumors?

Many types of tumors start in the brain and spinal cord (central nervous system or CNS). If you have one of these tumors, your symptoms, outlook for survival (prognosis), and treatment depend on your age, the tumor type, and the precise location of the tumor within the CNS.

To help you understand the anatomy, we'll begin with an introduction to the main parts of the brain and spinal cord. Your prognosis and treatment also depend on the type of cells the cancer developed from, so we'll discuss the main types of brain and spinal cord cells and the names of the cancers that they form.

CNS tumors of adults and children often form in different areas and from different cell types, so they may have a different prognosis and treatments. This document refers only to tumors of adults.

The brain is the center of thought, memory, and emotion, as well as a control site for many body processes . The spinal cord and special nerves in the head called cranial nerves carry and receive messages between the brain and the rest of the body. These messages tell our muscles how to move, transmit information gathered by our senses, and help coordinate our internal organs.

The brain is located within and protected by the very hard bones of the skull. Likewise, the spinal cord is protected by the bones of the vertebral column. The brain and spinal cord are surrounded and cushioned by a special fluid called cerebrospinal fluid. Cerebrospinal fluid is produced in cavities within the brain called ventricles. The ventricles, as well as the spaces around the brain and spinal cord, are filled with cerebrospinal fluid.

Parts of the Brain and Spinal Cord

The main areas of the brain include the cerebral hemispheres, basal ganglia, cerebellum, and brain stem. Each of these parts has a special purpose. Tumors of different parts of the CNS disrupt different functions and cause different symptoms. These symptoms are not specific for brain tumors and may be caused by any disease that damages that particular location within the brain. Also, tumors in different areas of the CNS may be treated differently and have a different prognosis (outlook for survival).

The cerebral hemispheres control reasoning, thought, emotion, and language. They also direct muscle movements and receive sensory information, such as vision, hearing, touch, and pain sensation. The symptoms caused by a tumor of a cerebral hemisphere depend on the part of the hemisphere in which the tumor arises. A tumor in the motor area would cause weakness of a part of the body. A tumor in the frontal lobe, which accounts in part for personality, could cause personality changes. Depending on the site, there could also be changes in vision, hearing, and sensation. Tumors anywhere in this region could cause seizures. The character of the seizures (loss of consciousness, shaking movements, or sensations) depend on the location of the tumor.

The basal ganglia help control our muscle movements. Tumors or other problems in this part of the brain typically cause weakness, but in rare circumstances chorea (abnormal movements) or athetosis (abnormal positioning) can occur.

The cerebellum controls coordination of movement. Tumors of the cerebellum cause lack of coordination in walking, difficulty with fine movements of arms and legs, and changes in rhythm of speech.

The brain stem contains bundles of very long nerves that carry signals controlling muscles and sensation or feeling. In addition, most cranial nerves start in the brain stem. Cranial nerves have an important role in the senses of smell, vision, hearing, and taste and in controlling muscles of the face, tongue, and neck. Special centers in the brain stem control breathing, beating of the heart, and wakefulness. Tumors in this critical area of the brain may cause weakness, stiff muscles, or problems with sensation, hearing, facial movement, and swallowing. Double vision is a common early symptom of brain stem tumors, as is lack of coordination in walking. Because the brain stem is so essential, it is usually impossible to completely remove tumors from the brain stem with surgery.

The spinal cord, like the brain stem, contains bundles of very long nerves that carry signals controlling muscles, sensation or feeling, and bladder and bowel control. Spinal cord tumors may cause weakness, paralysis, or numbness. Although the spinal cord of an adult is about 18-inches long, it is less than 1-inch wide. Because the spinal cord is so narrow, tumors arising within it usually cause symptoms involving both sides of the body (for example, weakness or numbness in both legs). This distinguishes them from tumors of the brain, which usually cause symptoms affecting only one side of the body. Moreover, most tumors of the spinal cord arise below the neck after nerves to the arms have branched off the spinal cord, so only leg function is affected.

Tumors may also arise from cranial nerves or peripheral nerves. The most common cranial nerve tumor, the acoustic neuroma, arises from the acoustic or hearing nerve and causes loss of hearing in one ear. Tumors arising from other cranial nerves may cause vision loss (optic nerve), facial paralysis (facial nerve) or facial pain (trigeminal nerve). Tumors arising in the peripheral nervous system generally cause numbness or pain in the area where that nerve goes, as well as weakness of muscles controlled by that nerve.

Types of Cells and Tissues in the Brain and Spinal Cord

The brain consists of different kinds of tissues and cells. This is important to understand because different types of tumors can start in these different cell and tissue types. These tumors vary in prognosis and the ways they are treated. For most other parts of the body, we try to distinguish tumors that are benign (do not spread to other sites) from those that are malignant (likely to spread). This is less important in brain and spinal cord tumors. That's because these tumors grow in such a vital area of the body that they can cause severe damage even if they don't spread elsewhere. Still, some tumors can be defined as more 'malignant' because they grow rapidly and spread within the brain.

Neurons:

These are the most important cells within the brain. They send signals through long, wire-like extensions called axons. Axons may be very short or 2 to 3 feet long. Electric signals sent by neurons determine all the functions of the brain and spinal cord, such as thought, memory, emotion, speech, and muscle movement. Unlike most other types of cells, which can grow and divide to repair damage from injury or disease, neurons do not divide after birth (with very rare exceptions). Neurons only rarely develop into cancers.

Glial cells:

Glial cells are the main brain cells that can develop into cancer. Most adult brain tumors are glial cell cancers � sometimes called gliomas. There are 3 types of glial cells: astrocytes, oligodendrocytes, and ependymal cells. A fourth type called microglia are not truly glial in origin. Normal glial cells grow and divide very slowly. Most brain and spinal cord tumors develop from glial cells.

Astrocytes: This type of glial cell helps support and nourish neurons. When the brain is injured, astrocytes form scar tissue that helps repair the damage.
Oligodendrocytes: These cells make myelin. Myelin forms a layer that surrounds and insulates axons of the brain and spinal cord. In this way, oligodendrocytes help neurons transmit electric signals through axons.
Ependymal cells: These cells line the ventricles within the central part of the brain and spinal cord that provide the pathway through which cerebrospinal fluid
Microglia: The microglia that represent 10% to 20% of the total population of glial cells in the brain are the immune cells of the CNS.

Meninges:

The outer covering of the brain and spinal cord is formed by a specialized tissue called the meninges. Like the ependymal cells of the ventricles, the meninges also help form spaces through which cerebrospinal fluid travels.

Schwann cells:

These cells make myelin outside the brain that surrounds and insulates axons in cranial nerves and in the peripheral nerves that connect the CNS to the rest of the body.

Choroid plexus:

This tissue is located within the ventricles and makes cerebrospinal fluid.

Lymphocytes:

These are the main type of cell of the immune system. They help the body fight infections. Most lymphocytes are found in the blood, in bone marrow, and in collections of immune cells throughout the body called lymph nodes. Under normal circumstances, there are few, if any, lymphocytes in the CNS. The origin of lymphocytes that become brain lymphomas is not clear.

Pituitary gland:

The pituitary is not a part of the brain, although it is connected to the brain. It is an endocrine (hormone-producing) gland at the base of the brain.

Pineal gland:

The pineal gland is not strictly part of the brain. It is, like the pituitary, another hormone-producing gland that sits between the cerebral hemispheres. It makes melatonin, a hormone that responds to changes in light.

Types of Brain and Spinal Cord Tumors

Tumors that start in other organs, such as the lung or breast, and then spread to the brain are called metastatic or secondary brain tumors, and those that start in the brain are called primary brain tumors. Most brain tumors come from cancers that started somewhere else in the body and spread, or metastasized, to the brain. Primary brain tumors can start in any of the different types of tissues or cells within the brain or spinal cord. Some tumors contain a mixture of cell types. This is an important point because metastatic and primary brain tumors are usually treated differently.

Metastatic tumors to the brain are more common than primary brain tumors. Unlike other cancers, tumors arising within the brain or spinal cord rarely metastasize to distant organs. They cause damage because they spread locally and destroy normal brain tissue in the place where they arise. This document is only about primary brain and spinal cord tumors, not those that have spread from elsewhere in the body.

With a few exceptions, tumors of the brain or spinal cord are never benign (noncancerous). Unless it is possible to completely remove brain or spinal cord tumors, they will continue to grow and eventually (sometimes after many years) lead to death.

Meningioma: Strictly speaking, meningiomas are not brain tumors because they arise from the meninges, the layers of tissue that surround the outer part of the brain and spinal cord. Meningiomas cause symptoms by pressing on the brain or spinal cord. Meningiomas are quite common; they account for about 25% of primary brain tumors and the majority of spinal cord tumors. They are the most common brain tumor in adults. Their incidence rate increases with age, being highest in people in their 70s and 80s. They are almost twice as common in women. Occasionally these occur in families, mostly those with a syndrome of multiple benign tumors of nerve tissue called von Recklinghausen disease. Another risk factor for meningiomas is cranial radiation, particularly in young individuals.

Most meningiomas (about 85%) are benign and can be cured by surgery. Some meningiomas, however, are located dangerously close to vital structures within the brain and cannot be cured by surgery alone. A small number of meningiomas are malignant and may come back many times after surgery or, rarely, even spread to other parts of the body.

Astrocytoma: Most tumors that arise within the brain itself start in brain cells called astrocytes. These tumors are called astrocytomas. About 35% of brain tumors are astrocytomas. Most astrocytomas cannot be cured because they spread widely throughout the surrounding normal brain tissue. Sometimes astrocytomas spread along the cerebrospinal fluid pathways. With only rare exceptions, astrocytomas, however, do not spread outside of the brain or spinal cord.

In general terms, astrocytomas are classified, or graded, as low grade, intermediate grade, or high grade. Their grade is based on examining a biopsy specimen (sample of the tumor) under the microscope. The pathologist (a doctor specializing in diagnosis of diseases by laboratory tests) examining an astrocytoma will look for the following:

how closely cells are packed together within the tumor
how abnormal the cells are
how many of the cells are dividing or multiplying
whether abnormal blood vessels are growing within the tumor
whether some of the cancer cells have broken down or died on their own

Low-grade astrocytomas are the slowest growing. Intermediate-grade astrocytomas, or anaplastic astrocytomas, grow at a moderate rate. The highest-grade astrocytomas, glioblastomas, are the fastest growing. These make up about two-thirds of all astrocytomas and are the most common malignant brain tumors of adults

Some special types of astrocytomas tend to have a particularly good prognosis. These are called noninfiltrating astrocytomas (for example, juvenile pilocytic astrocytomas).

Oligodendrogliomas: These tumors start in brain cells called oligodendrocytes. They spread or infiltrate in a manner similar to astrocytomas and, in most cases, cannot be completely removed by surgery. Oligodendrogliomas sometimes spread along the cerebrospinal fluid pathways but rarely spread outside the brain or spinal cord. Only about 4% of brain tumors are oligodendrogliomas.

Ependymomas: About 2% of brain tumors are ependymomas. These tumors arise from the ependymal cells, which line the ventricles. Ependymomas may block the exit of cerebrospinal fluid from the ventricles, causing the ventricles to become very large a condition called hydrocephalus. Unlike astrocytomas and oligodendrogliomas, ependymomas characteristically do not spread or infiltrate into normal brain tissue. As a result, some but not all ependymomas can be completely removed and cured by surgery. Spinal cord ependymomas have the greatest chance of surgical cure. Ependymomas may spread along the cerebrospinal fluid pathways but do not spread outside the brain or spinal cord.

Gliomas: This is not a specific type of cancer. Glioma is a general category that includes astrocytomas, oligodendrogliomas, and ependymomas. About 42% of all brain tumors, including benign ones, are gliomas. Counting only malignant tumors, 77% are gliomas. They are uncommon in children, but their incidence rate goes up with age and peaks in the age group from 75 to 84.

Medulloblastomas: Tumors arising from the neurons are rare. Medulloblastomas are tumors that develop from neurons of the cerebellum. They are fast-growing tumors, but they can be treated and are often cured by radiation therapy. Medulloblastomas occur most commonly in children and often spread throughout the cerebrospinal fluid pathways.

Ganglioglioma: A tumor containing both neurons and glial cells is called a ganglioglioma. These are very uncommon and have a high rate of cure by surgery alone or surgery combined with radiation therapy.

Schwannoma (neurilemoma): Schwannomas start in Schwann cells, which are a part of cranial nerves and other nerves. These are usually benign tumors that often form near the cerebellum and in the cranial nerve responsible for hearing and balance. These make up about 7% of all CNS tumors.

Chordoma: These tumors start in the bone at the back of the skull or at the lower end of the spine. These tumors are not from the central nervous system. Typically they come back many times over 10 to 20 years, causing progressive injury to the adjacent central nervous system. They usually do not spread to other organs.

Lymphoma: Lymphomas start in lymphocytes (the main cell type of the immune system). Many of these occur in people infected with HIV, the virus that causes AIDS. Because of new treatments for AIDS, brain lymphomas have become less common. Also, in the past, lymphomas of the brain have been thought of as highly malignant, usually leading to death within approximately 1 year. Recent advances in chemotherapy, however, have dramatically changed the prognosis of people with these cancers.

Do We Know What Causes Brain and Spinal Cord Tumors in Adults?

We do not fully understand the cause of central nervous system (CNS) cancers. Nevertheless, researchers are making progress toward understanding some of the chemical changes that occur inside normal brain cells that turn them into brain cancer.

Brain cancer, like other cancers, is caused by abnormalities of genes. Genes, the "chemical building blocks of life," are made of DNA and are found in all cells within the body. The genes that we inherit make us who we are, which is why we usually resemble our parents. In addition to determining how we look, genes also control every aspect of our body's metabolism. This is why abnormal genes can cause some diseases.

Abnormalities of genes are called mutations. Gene mutations that cause some diseases (including some cancers) can be inherited. Recently, researchers have found that gene mutations that lead to some rare inherited syndromes (like neurofibromatosis, tuberous sclerosis, or von Hippel-Lindau disease) are associated with an increased risk of developing some CNS cancers.

Some other gene mutations involved in formation of brain and spinal cord cancers are not inherited. Research into these mutations has led to some experimental treatments for CNS tumors that, in the future, may be further refined.

Many CNS tumors have been found to have a host of genetic abnormalities. We do not know why people without inherited cancer-causing mutations develop mutations in their CNS cells. Most risk factors for cancer somehow damage genes. For example, cigarette smoke is a risk factor for lung cancer and several other cancers because it contains chemicals (carcinogens) that can damage genes.

The brain is relatively protected from cigarette smoke and other cancer-causing chemicals that we breathe or eat. Most brain cancers develop genetic abnormalities for no apparent reason and are not associated with anything that the person did or didn't do or with anything he or she was exposed to in the environment.

Can Brain and Spinal Cord Tumors in Adults Be Found Early?

No blood test or other screening exam is currently available to detect brain tumors or cancer in the brain. In most cases, the patients survival is determined by their age, the type of tumor, and its location, not by how early it is detected. For most tumors of the brain or spinal cord, there is little evidence that early diagnosis and treatment increase survival.

How Are Brain and Spinal Cord Tumors Treated?

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Central nervous system (CNS) tumors may be treated by surgical removal, radiation therapy, or chemotherapy. Often a combination of treatments is used. Although treatment may prolong survival, most malignant brain tumors are not curable.

What Should You Ask Your Doctor about Brain and Spinal Cord Tumors?

It is important for you to have honest, open discussions with your cancer care team. They want to answer all of your questions, no matter how trivial you might think they are. Here are some questions to consider:

What kind of cancer do I have?
Where within the brain or spinal cord is the cancer located and how far has it spread?
What treatments are appropriate for me? What do you recommend and what are the alternatives? Why?
What are the risks or side effects that I should expect?
What are the chances my cancer will recur (come back) even with the treatment programs we have discussed?
What should I do to be ready for treatment?
Based on what you learned about my cancer, how long do you think I'll survive?
Will any disability I now have get better and what disabilities may I develop?
What is my expected prognosis, based on my cancer as you view it?

In addition to these sample questions, be sure to write down any others you might want to ask. For instance, you might want specific information about anticipated recovery times so you can plan your work and activity schedule. Or, you may want to ask about second opinions concerning the clinical and pathological diagnosis and the treatment program, as well as about experimental programs or clinical trials for which you may qualify.

New Research in Cancer Treatment

2007-09-04T21:32:00.000+07:00

New Research in Cancer Treatment

Genetically engineered bacteria and viruses

Some new promising research uses genetically engineered bacteria and viruses to infect and destroy cancer cells. This could be useful when cancer is already advanced and there are large masses of cancer cells. The potential drawback of these methods is the generation of large amounts of toxins from dying cancer cells, which in turn can suppress the immune system or even kill the patient. Also bacteria and viruses very often mutate which in turn can lead to infection and attack on healthy, non-cancerous cells.

Anti-cancer vaccines

Anti-cancer vaccines or even custom-made anti-cancer vaccines for a particular patient and cancer type are also a very promising line of research. By providing fragments of cancer cells to the immune system, one can potentially get the immune system response to destroy live cancer cells.

Cancer markers

Another promising line of research is related to chemical substances which could be used to mark cancer cells. This in turn will allow easier recognition of these cells by the immune system.

Cancer growth retarders / inhibitors

This line of research is related to the use of chemical substances which could retard / inhibit the growth of cancer cells. An interesting research topics are the substances blocking activity of telomerase, the enzyme responsible for the management/elongation of telomeres. Telomerase is found in high concentrations in 80% of tumors and allows tumor cells to gain "immortality" by removing restrictions on the number of cell divisions. This enzyme may also be useful in extending the lifespan of healthy cells and in turn extend the lifespan of the organism (cancer cells and their growth may hold much valuable information about fountain of youth and immortality).

All the above mentioned methods show some promise. However these methods by themselves do not provide reliable cancer treatment. It is possible that some of them in conjunction with the non-traditional treatment of cancer (listed below) will become the standard cancer treatment, in the 21st or 22nd century.

Traditional Treatment of Cancer

2007-09-04T20:25:00.000+07:00

Traditional Treatment of Cancer

Cancer can be a very scary thing. The survival rates of some cancers is very low and treatments are not very effective, if one uses traditional medicine (one estimate puts it at 3%). On top of that, cancer is demonized as this scary thing which is growing in you and is going to kill you. Many people feel helpless and put blind trust in traditional medicine for treatment. Traditional medicine is very good in detecting and monitoring cancer but it is very poor and ineffective in the treatment of cancer. Detection is good and aided by imaging techniques such as NMR, CT-scan, ultrasound, PET, etc. and many other chemical, genetic, tissue, etc. tests. Below a few conventional medical treatments techniques are mentioned:

Radiation Therapy

Attempts to locally destroy cancer cells with the various types of radiation such as X-ray, Gamma-ray, particle beams, isotopes, ultrasound, etc. Beams of radiation are focused mainly on the cancer growth and doses are calculated to minimize the collateral damage to surrounding tissues, which nevertheless occurs. This kind of treatment increases the entropy of the organism, suppresses the immune system, destroys healthy cells and potentially forms new mutated cells some of which could become cancerous (and possibly more dangerous than original cancer cells).

Chemotherapy

This aims to destroy the cancer cells with various types of chemicals. The substances used are supposed to target mainly the cancer cells (sometimes via direct injection to cancer tissue) and doses are calculated to minimize the collateral damage to surrounding tissues, which nevertheless occurs. This kind of treatment increases the entropy of the organism, suppresses the immune system, forms a toxic cell environment, destroys healthy cells and potentially forms new mutated cells some of which could become cancerous (and more dangerous than original cancer cells).

Surgery

This is another very invasive technique. Underlying logistics is to locally remove cancer cells with as few healthy cells as possible. This in turn should stop any further growth, since there are no cancer cells left in the body. This is a wrong assumption, since it is very difficult to find the exact boundaries of the cancer growth and remove all cells. Besides that, cancer cells can enter the blood stream and lymphatic fluid during an operation and spread to other parts of the body. This kind of treatment also increases the entropy of the organism, suppresses the immune system and destroys healthy cells and organs.

All mentioned above methods are very invasive, destroy healthy cells and suppress the immune system. This approach leads to an increase of entropy of the organism and lowers the chances of recovery from cancer. All these methods are designed to treat symptoms (cancerous growth), not the cause of cancer (non-functioning immune system and factors contributing to cancer cells formation). Since the cause of cancer is not addressed and treatment is not provided, cancer will, in the majority of cases, spread and recur (the 5-year survival rate for conventional treatments quoted by The American Cancer Society is 63% and it is much lower for longer periods of time - one estimate puts it at 3%). Very often cancer patients in hospitals are consuming poor quality food with hydrogenated fats, which are very unhealthy and dangerous. This only illustrates that a holistic approach is not considered or followed. Cancer treatment is a very good money-making machine/system and the patients' welfare is largely ignored.

The described above methods are primitive and barbaric. As a result, millions of people die prematurely while suffering (according to WHO, the World Health Organization, 7.6 million people died of cancer in the year 2005). There is also a great effort, burden and expense which is put on the families and society at large. The only explanation for this state of affairs is total scientific incompetence, greed and lack of integrity and moral standards on the part of the majority of cancer researchers and people and organizations who deliver cancer treatments (and consume billions of dollars in public funding in the process).

Non-traditional Treatment of Cancer

2007-09-04T19:00:00.000+07:00

Non-traditional Treatment of Cancer

The development of cancer usually takes many years. Therefore, full treatment also can take several months or years (one has to be patient). What is important is to reverse the process in order to stop and reverse cancerous growth. There are no silver bullets to accomplish this task. People have to do all things right in order to have the best chance of reversing the process. In the majority of cases (probably in 90-95%) total reversal of cancer is possible.

Here are major factors contributing to good health and cancer reversal:

try to live in a healthy macro-environment which means one with good air quality, water, soil, light, humidity, temperature range, local organic food supply, etc. Play a pro-active role in preserving a safe macro-environment for you and others living there.

try to live in a healthy micro-environment, one which you create at home and at your workplace. This means one with good air quality, water, light, humidity, temperature range, etc. Play a pro-active role in preserving a safe micro-environment for you and others living and working there.

try to find if there are any internal carcinogenic pathogens such as bacteria, viruses, parasites, fungi and other foreign substances. They should be eliminated using available safe and natural methods such as cleansing diets, herbs, etc. This will minimize the number of produced cancer cells and it will lower the burden on the immune system.

the diet should be low-entropy, organic, raw food-based and calorie-restricted. Acidity and pH balance should be monitored (with a pH meter or lacmus/litmus paper) since consumption of some foods can increase acidity (for example sugars) which promotes cancer and creates a toxic and cell-damaging environment.

chemicals should be eliminated from your home. Dishes could be washed with just warm water. Most of the things around the house can be cleaned with warm water, soap and vinegar. Chemicals should be eliminated also from your backyard and garden (such as pesticides, herbicides, etc.).

don't keep things totally sterile - small amounts of viruses and bacteria are vital to good health, since they keep your immune system "informed" about what is out there and they help to build better immunity. Bacteria and viruses are an integral part of the environment and the ecosystem and they play an essential role in evolution (exchange and modification of genes) and natural selection (testing of "new genetic designs" and elimination of genetic errors).

a proper amount of sleep in a comfortable bed with no metal parts (they change electromagnetic fields around the body) and in a well-ventilated, dark and quiet room.

avoidance of radiation from underground water and "Swiss Net" which are claimed to suppress or even block the immune system (some people claim it to be EMF at frequency 1420 MHz or wavelength 21 cm). Diviners (people who can find underground water with a divining rod) can find this radiation, since they are highly-sensitive bio-detectors of this low-level energy.

a person should lower the stress level and increase the level of happiness and satisfaction (stress produces a lot of harmful chemicals and free radicals).

a person should be involved in non-strenuous exercise such as walking, biking and swimming (strenuous exercise suppresses immune system probably due to free radicals and tissue damage).

a person should eliminate smoking, alcohol, an unhealthy environment (radiation from various sources such as cell phones, microwave ovens, cell antennas, X-rays, isotopes, chemicals, etc.). Even flying can be dangerous due to ionizing, cell-destroying cosmic radiation at high altitudes and pesticides often sprayed in the cabin to kill insects (sometimes during the flight).

various things such as special herbs, specific food supplements and massage (in particular one which involves the acupressure and adjustments of the chi-energy flow), relaxation and meditation techniques, music and sounds, etc. can be used to boost the immune system. Also a device such as BIO-EMI - Immune System Stimulator can be used to further improve the immune system (more info about this innovative product will be available soon).

Mechanisms responsible for Cancer development

2007-09-03T19:44:00.001+07:00

Mechanisms responsible for Cancer development

Factors which produce cancer cells are: radiation (such as X-rays, nuclear, microwaves, cosmic, ultrasound, etc.), toxic cell environment, chemicals in the air, water and food, bacteria, viruses and fungi. Factors which suppress immune functions are the same factors as above plus poor diet, stress, lack of proper exercise and lack of sufficient rest and sleep.

Precursors of Cancer and Cancer Prevention

2007-09-03T19:43:00.001+07:00

Precursors of Cancer and Cancer Prevention

A weak or non-functioning immune system, poor health, an unhealthy environment and advanced age (over 80) can contribute to cancer. In the majority of people cancer can be prevented with proper lifestyle which consists of a low-entropy diet, exercise, sleep, stress reduction, etc. In most cases cancer develops slowly over many years. With a positive change of lifestyle and healthy environment this trend can be reversed in the majority of cases (probably in 90% -> 95%) - the cancer will shrink and eventually disappear.

How is Cancer formed?

2007-09-03T19:42:00.001+07:00

How is Cancer formed?

Cancer cells are formed from normal cells due to a modification / mutation of DNA and/or RNA. These modifications / mutations can occur spontaneously (II Law of Thermodynamics - increase of entropy) or they may be induced by other factors such as: nuclear radiation, electromagnetic radiation (microwaves, X-rays, Gamma-rays, Ultraviolet-rays, etc.), viruses, bacteria and fungi, parasites (due to tissue inflamation/irritation), heat, chemicals in the air, water and food, mechanical cell-level injury, free radicals, evolution and ageing of DNA and RNA, etc. All these can produce mutations that may start cancer. Cancer can be called therefore "Entropic Disease" since it is associated with the increase of entropy of the organism to the point where the organism cannot correct this itself. External intervention is required to allow the organism to return to an stable entropic state.

Cancer cells are formed continuously in the organism (it is estimated that there are about 10,000 cancer cells at any given time in a healthy person). The question is why some of these result in macroscopic-level cancers and some don't. First, not all damaged cells can multiply and many of them die quickly. Those which have the potential to divide and form cancer are effectively destroyed by the various mechanisms available to the immune system. This process takes place continuously. Therefore cancer develops if the immune system is not working properly and/or the amount of cells produced is too great for the immune system to eliminate. The rate of DNA and RNA mutations can be too high under some conditions such as: unhealthy environment (due to radiation, chemicals, etc.), poor diet (unhealthy cell environment), people with genetic predispositions to mutations and people of advanced age (above 80).

What is Cancer?

2007-09-03T19:41:00.001+07:00

What is Cancer?

Cancer cells are very similar to cells of the organism from which they originated and have similar (but not identical) DNA and RNA. This is the reason why they are not very often detected by the immune system, in particular if it is weakened. Cancer cells usually have an increased ability to divide rapidly and their number of divisions is not limited by telomeres on DNA (a counter system to limit number of divisions to 40-60). This can lead to the formation of large masses of tissue and in turn may lead to disruption of bodily functions due to destruction of organs or vital structures.

Definition of Cancer

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Definition of Cancer

There are many different forms of cancer. Their manifestation is a growth of cells and tissues, which differ in various aspects from the surrounding tissue. Cancers occur in all living things. All lifeforms share similar DNA and RNA blueprints and cell physiology. Therefore, the mechanisms for cancer development and methods for cancer treatment are similar.

Cancer in Children

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What is Childhood Cancer?

About 10,400 children under the age of 15 in the United States will be diagnosed with cancer in 2007. Because of significant advances in therapy, 79% of these children will survive 5 years or more. This is a major increase from before the 1970s, when the 5-year survival rate was less than 50%.

Despite its rarity and the impressive strides in treatment and supportive care, cancer is still the leading cause of death (an estimated 1,545 deaths in 2007) from disease in children younger than 15 years old, second only to accidents in most age groups.

The types of cancers that occur in children vary greatly from those seen in adults. Leukemias, brain and other nervous system tumors, lymphomas (lymph node cancers), bone cancers, soft tissue sarcomas, kidney cancers, eye cancers, and adrenal gland cancers are the most common cancers of children, while skin, prostate, breast, lung, and colorectal cancers are the most common in adults. The stage of growth and development is another important difference between adults and children. The immaturity of children's organ systems often has important effects on treatment.

What are the Risk Factors and Causes of Childhood Cancer?

A risk factor is anything that is linked to an increased chance of getting a disease such as cancer. Lifestyle-related risks are the main factors that contribute to cancers in adults. Examples include the effect of unhealthy diets (low consumption of fruits and vegetables, etc.), not enough exercise, and habits such as smoking and drinking alcohol. Lifestyle-related risk factors have little or no significance in childhood cancer.

Cancer is caused by a mutation (change) in a gene. During the past few years, scientists have made great progress in understanding how certain changes in a person's DNA can cause cells of the body to become cancerous. DNA carries the instructions for nearly everything our cells do. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than our outward appearance. It influences our risks for developing certain diseases, including some kinds of cancer. When children are born with mutated DNA that was inherited from parents, the mutations are present in every cell of the child's body. That means the mutations can be detected by testing DNA of blood cells.

The great majority of cancers, however, are not caused by inherited DNA mutations. They are the result of mutations acquired early in the child's lifetime. Every time a cell prepares to divide into 2 new cells, it must copy its DNA. This process is not perfect, and errors sometimes occur. Luckily, cells have repair enzymes that "proofread" DNA. Some errors can still slip past, especially when the cells are growing rapidly. This kind of gene mutation can happen at any time in life. Acquired mutations start in one cell of the body, and that cell passes the mutation on to all the cells that spring from it. These acquired mutations are present only in the patient's cancer cells and will not be passed on to his or her children. Although the causes of mutations responsible for certain adult cancers are known (for example, cancer-causing chemicals in cigarette smoke), the reasons for DNA changes that cause childhood cancers are not known. Some of these can occur in developing fetuses and are already present at birth.

Can Childhood Cancer Be Found Early?

Cancers in children often are difficult to recognize. Parents should see that their children have regular medical checkups and watch for any unusual signs or symptoms that persist. These include an unusual mass or swelling; unexplained paleness and loss of energy; sudden tendency to bruise; a persistent pain in one area of the body; limping; prolonged, unexplained fever or illness; frequent headaches, often with vomiting; sudden eye or vision changes; and excessive, rapid weight loss.

Although many adult cancers can be prevented by lifestyle changes that reduce certain risk factors, there is currently no known way to prevent most childhood cancers.

Children who are known to have a higher chance of developing cancer due to known genetic risks should receive careful periodic medical checkups.

How are Childhood Cancers Treated?

Childhood cancers can be treated with a combination of treatments (chemotherapy, surgery, radiation therapy) that are chosen based on the type and stage of cancer. Although there are exceptions, childhood cancers tend to respond well to chemotherapy because they are cancers that grow fast. Most forms of chemotherapy affect only cells that are growing.

Children with cancer and their families have special needs that can be best met by children's cancer centers. Treatment of childhood cancer in specialized centers is coordinated by a team of experts who know the differences between adult and childhood cancers, as well as the unique needs of children with cancers. This team usually includes pediatric oncologists, surgeons, radiation oncologists, pediatric oncology nurses and nurse practitioners.

The treatment of childhood cancer also involves many professionals other than nurses and doctors. Children's cancer centers have psychologists, social workers, child life specialists, nutritionists, rehabilitation and physical therapists, and educators who can support and educate the entire family.

Since the 1960s, most children with cancer have been treated at specialized centers designed for children. About 94% of children with cancer in the United States are treated at a children's cancer center that is a member of the Children's Oncology Group (COG). All of these centers are associated with a university and most with a children's hospital.

These centers will be able to offer your child the most up-to-date-treatment through participation clinical trials, or studies of promising new therapies. Because childhood cancers are uncommon, treatment outcomes are more successful when the treatment is managed by a cancer center. Be sure your child is treated at a center that can offer him or her the option of a clinical trial.

Five-year survival rates vary considerably, depending on the type of cancer your child has. Overall, 5-year relative survival rates have improved greatly over the past 30 years, from less than 50% before the 1970s to nearly 80% today, due to new and improved treatments. The 5-year survival rate for neuroblastoma is 69%; brain and other nervous system, 74%; bone and joint, 72%; leukemia, 81%; Wilms tumor (kidney), 92%; and Hodgkin lymphoma, 95%, and non-Hodgkin lymphoma, 86%.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Five-year rates are used to produce a standard way of discussing prognosis (outlook for recovery and survival). Of course, many children live much longer than 5 years. Five-year survival rates are based on patients who were diagnosed and treated more than 5 years ago. Improvements in treatment often result in a better outlook for recently diagnosed patients.

Survivors of childhood cancer may experience treatment-related side effects months or years after their childhood cancer. These effects can include organ malfunction, second cancers, and problems with mental tasks. The Children's Oncology Group (COG) has recently developed long-term follow-up guidelines for screening and management of late effects in survivors of childhood cancer. For more information on follow up after treatment of childhood cancer, see their Web site at www.survivorshipguidelines.org.

Bone Cancer

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What Is Bone Cancer?

Bone is the framework that supports the body. Most bones are hollow. Bone marrow is the soft tissue inside hollow bones. The bone itself is very hard and strong. At each end of the bone is a softer bone-like tissue called cartilage that acts as a cushion between bones. The outside of the bone is covered with a layer of fibrous tissue.

The bone itself is made up of 2 kinds of cells. Osteoblasts are cells that form the bone. Osteoclasts are cells that dissolve bone. Although we think that bone does not change, the truth is that it is very active. New bone is always forming and old bone dissolving.

The marrow of some bones is made up only of fatty tissue. In other bones the marrow is a mixture of fat cells and blood-forming cells. These blood-forming cells make red blood cells, white blood cells, and platelets.

All of these parts of bone can develop into cancer.

Types of Bone Cancers

Most of the time when someone is told they have bone cancer, the doctor is talking about a cancer that started somewhere else and then spread to the bone. This is called metastatic cancer and can happen to people with advanced breast cancer, prostate cancer, and lung cancer, as well as many others. When these cancer cells are looked at under a microscope, they look like the cancer cells that they came from. If someone has lung cancer that has spread to the bone, the cells there will look and act like lung cancer cells and they will be treated the same way.

To learn more about cancer that has spread to the bones, please see “Bone Metastases” as well as the document on the place where the cancer started (“Breast Cancer,” “Prostate Cancer,” etc.)

Other kinds of cancers that are sometimes called “bone cancers” start in the bone marrow—in the blood-forming cells. The most common of these is multiple myeloma. Certain lymphomas (which more often start in lymph nodes) and all leukemias start in bone marrow. You can get more information about all of these types of cancers from the American Cancer Society.

The main type of true bone cancers are called sarcomas. A sarcoma is a cancer that starts in connective tissue such as bone, muscle, tendons, ligaments, or some other tissues in the body.

Primary Bone Tumors

There are several different types of bone tumors. Their names are based on the bone or tissue that is involved and the kind of cells that make up the tumor. Some are cancerous (malignant). Others are not cancerous (benign). Most bone cancers are called sarcomas.

Benign bone tumors do not spread to other tissues and organs. They can usually be cured by surgery. This information does not cover benign bone tumors.

Cancerous Bone Tumors

Osteosarcoma: Osteosarcoma is cancer of the bone itself. It most often occurs in young people between the ages of 10 and 30. But about 10% of cases occur in people in their 60s and 70s. This cancer is rare during middle age. More males than females get this cancer. These tumors start most often in bones of the arms, legs, or pelvis.

Chondrosarcoma: This is a cancer of cartilage cells and is the second most common true bone cancer. Chondrosarcoma is not often found in people younger than 20. After age 20, the risk of this cancer keeps on rising until about age 75. It occurs in men and women at about the same rate.

Cartilage is softer than bone but more firm than most other tissues. Ears are mainly cartilage. Cartilage is actually the tissue from which most bones form. It is mainly found at the end of long bones and at the place in the chest where the ribs meet the breastbone. Chondrosarcoma most often starts in cartilage of the pelvis, leg or arm, but it can start in many other places as well.

Chondrosarcomas are given a grade, depending on how fast-growing they are. A lower grade means the cancer is not likely to spread while a high grade means it is more likely to spread. Most are low grade. There are also other differences among chondrosarcomas that can be seen under a microscope which help to predict the response to treatment and outlook for survival.

Ewing tumor: This cancer is named after Dr. James Ewing, the doctor who first described it in 1921. Unlike osteosarcoma, Ewing tumors form in the hollow part of the bone. This cancer usually appears in children and teenagers. It is not common in adults over 30 years old.

Fibrosarcoma and malignant fibrous histiocytoma: These cancers usually start in the soft tissues around bones (such as ligaments, tendons, fat, and muscle) rather than the bone itself. They usually occur in older and middle-aged adults. These cancers most often affect bones of the legs, arms, or jaw.

Giant cell tumor of bone: This type of bone tumor has both benign and malignant forms. Only about 10% of giant cell bone tumors are cancerous and spread to other parts of the body. But they often come back after surgery. When they do come back after surgery they are more likely to spread to other parts of the body. These tumors often affect the arm or leg bones of young and middle-aged adults.

Chordoma: This tumor usually occurs in the base of the skull and bones of the spine. It is found most often in adults older than 30 years, and is about twice as common in men than in women. Chordomas tend to grow slowly and usually do not spread to other parts of the body, but they often come back in the same place if they are not removed completely. When they do spread, lymph nodes, the lungs, and the liver are the most common places.

What Causes Bone Cancer?

The exact cause of most bone cancers is not known. But we do know that certain risk factors are linked to this disease. A risk factor is something that increases a person's chance of getting a disease. Some risk factors, such as smoking, can be controlled. Others, like a person’s age or race, can’t be changed. But having a risk factor, or even several, does not mean that you will get cancer. Most people with bone cancer do not have any apparent risk factors.

The risk factors for bone cancer are often linked to having had other diseases, treatments for other diseases, or age. The following conditions can slightly increase the risk of bone cancer. If you have any of these, you should ask your doctor for more information.

Li-Fraumeni syndrome
Rothmund-Thompson syndrome
Retinoblastoma (a rare eye cancer of children)
Paget disease
Multiple exostoses (multiple osteochondromas)

People who have been treated with radiation for an earlier cancer have a higher risk of getting bone cancer later. Being treated at a younger age and being treated with high doses of radiation increase the risk of bone cancer.

Bone cancer has been reported in a few people who have had bone marrow (stem cell) transplantation.

There is no evidence to show that an injury to a bone can lead to bone cancer.

How Is Bone Cancer Found?

For some types of cancer there are tests that can find the cancer early, before it causes any symptoms. But right now, there are no special tests to find bone cancer early. The best approach is to report any symptoms promptly to the doctor. In most cases a biopsy will be done to see if bone cancer is really present (see below).

Signs and Symptoms of Bone Cancer

Pain: Pain in a bone is the most common symptom of bone cancer. At first, the pain is not constant and may be worse at night or when the bone is used. As the cancer grows, the pain will be there all the time.

Swelling: Swelling in the area of the pain may not happen until weeks later. Depending on the where the tumor is found, it may be possible to feel a lump.

Breaks (fractures): Although the cancer may weaken the bone it grows in, the bones do not usually break.

General symptoms: Problems such as weight loss and tiredness (fatigue) may mean that the cancer has spread. If it has spread to organs inside the body, there may be other symptoms as well. For example, if the cancer spreads to the lung, the person may have trouble breathing.

Bone pain and swelling are usually due to other problems, like an injury or arthritis. Most people with these symptoms do not have cancer. But doctors should test for cancer if signs and symptoms don’t go away and can’t be explained.

Doctors can use several methods to find bone cancer. Symptoms, a physical exam, imaging tests, and blood tests may all suggest bone cancer. But in most cases, a biopsy is needed to make sure since other diseases can cause the same symptoms. See below to learn more about these tests.

Imaging Tests to Detect Bone Cancer

X-rays: Most of the time, bone cancer will show up on x-rays of the bone. The radiologist (a doctor who specializes in reading x-rays) can often tell if a tumor is cancer by the way it looks on the x-ray.

CT scans (computed tomography): In this test, many x-rays of the body are taken from different angles. These images are combined by a computer to produce cross-sectional pictures of internal organs. Before the x-ray is taken, a harmless dye may be injected into a vein to highlight details. Some people have a reaction to the dye (hives, flushing, trouble breathing). Be sure to tell the doctor if you have ever had problems with contrast dye. CT scans can also be used to guide a biopsy needle into a tumor or mass.

CT scans take longer than regular x-rays. You will need to lie still on a table as the part of your body being scanned is placed within the scanner, a doughnut-shaped machine that completely surrounds the table. The test is painless, but you may find it hard to hold still for minutes at a time.

MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays. MRI pictures look a lot like those of a CT scan, but MRIs are more detailed. A contrast dye might be injected, just as with CT scans, but is used less often.

MRI scans are the best test for outlining a bone tumor. They are also useful for looking at the brain and spinal cord.

MRI scans take longer than CT scans, often up to an hour. And you have to be placed inside a tube, which can upset some people. The machine makes a thumping noise but many places will provide headphones with music to block this out.

Radionuclide bone scan: A bone scan helps show if cancer has spread to other bones. It can also show how much the cancer has damaged the bone. In this test, the patient is injected with a radioactive material. (The radioactivity is very low and causes no long-term effects.) The material is attracted to diseased bone cells throughout the body. A special camera takes a picture. The picture shows the diseased bone as dense, gray to black areas, called "hot spots." These areas may be cancer. But arthritis, infection, and other bone diseases can look much the same. The doctor may use other tests or biopsies to find out for sure what is causing the hot spots.

PET scan (positron emission tomography): PET scans involve injecting radioactive glucose (a type of sugar), which can be detected by a special camera. Cancer cells absorb high amounts of the sugar because they are very active. PET can be more helpful than several x-rays because it scans the whole body. It can sometimes show whether a tumor is cancerous or is benign. It is sometimes combined with a CT scan.

Biopsy

A biopsy involves taking a tiny piece of the tumor and looking at it under a microscope. Doctors study the piece to see whether it is cancer. The biopsy can also help tell if it is a primary or a secondary bone cancer. The surgeon doing the biopsy needs to have experience diagnosing and treating bone tumors. Mistakes at this point can lead to removing too much tissue, which can limit options for saving an arm or leg (limb-sparing surgery).

There are 2 different types of biopsies, the needle biopsy and the surgical bone biopsy:

Needle biopsy: This can be done with a thin (fine) or a thick needle. The fine needle biopsy removes a small amount of fluid and tissue fragments. The doctor can aim the needle at an area near the surface of the body. If the tumor is deep inside the body, the needle can be guided by a CT scan. A thick needle biopsy is called a core biopsy. With a core biopsy, the doctor removes a small cylinder of tissue. In both cases, the skin is numbed before the biopsy is done.

Surgical bone biopsy: First the area around the tumor will be numbed, or in some cases, the patient may have general anesthesia (be put into a deep sleep). Then the surgeon cuts through the skin to remove a small part of a large tumor.

How Is Bone Cancer Treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

There has been great progress in the treatment of bone cancer during the last 30 years. In the 1960s the only treatment available was amputation. Now, because of new methods, amputation isn’t needed most of the time

Chemotherapy

Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they reach throughout the body. This treatment is useful for cancer that has spread to other organs. Except for Ewing’s sarcoma and osteosarcoma, chemotherapy is seldom used for bone cancer unless it has spread.

Before giving chemotherapy drugs, your doctor will check your lab test results to be sure your liver, kidney, and bone marrow (which produces the cells in the blood) are working well.

Chemotherapy kills cancer cells, but it will also damage some normal cells. This can cause some side effects. These will depend on the type of drugs given, the amount taken, and how long treatment lasts. These side effects could include the following:

nausea and vomiting
loss of appetite
hair loss (the hair grows back after treatment ends)
mouth sores
increased chance of infection (from a shortage of white blood cells)
bleeding or bruising after small cuts or injuries (from a shortage of platelets)
tiredness or shortness of breath (from low red blood cell counts)

Most side effects go away once treatment stops. There are also treatments for many of the side effects of chemotherapy. For example, certain drugs can help with nausea and vomiting.

Surgery

Surgery for bone cancer includes the biopsy done to find the cancer and the surgery done to remove it. It is very important that the biopsy and surgical treatment be planned together. If possible, the same surgeon at a cancer center should do both the biopsy and the surgical treatment.

The goal of surgery is to remove the tumor and at least about 1 inch (2 to 3 centimeters) of the tissue around it. If the cancer is in one place but cannot be removed with surgery (for example, at the base of the skull, or in the spine or pelvis), then a cure is not likely, even if it treated with chemotherapy.

The surgery can be either limb-salvage (or limb-sparing, which removes the cancer without amputation) or amputation (removing the cancer and all or part of an arm or leg).

Limb-salvage surgery is very complex. The surgeons who do it must have special skills and experience. The bone that is removed is replaced with a bone graft from donors or with a rod made of metal or other materials. This rod is called an endoprosthesis (meaning internal prosthesis).

Anywhere from 5 to 8 patients out of 10 might be able to have their limbs spared. Ask the surgeon to explain the best way to remove the cancer and keep as much use of the arm or leg as possible. Because the rods or grafts are often used in growing children, they are designed to grow with the child. They can be made longer without any extra surgery. Some have tiny devices in them that can lengthen the implant when needed to make room for growth.

Problems with this approach can include infection and grafts or rods that become loose or broken. Patients may also need more surgery during the next 5 years, and some may need an amputation after all. It takes an average time of 1 year for patients to learn to walk again after such surgery on a leg. Rehabilitating the patient is more intense than after amputation. If the patient does not take part in the rehabilitation program, the salvaged arm or leg may become useless.

Amputation may be the only option for some patients. If there is a large tumor that extends into the nerves and/or the blood vessels, it may not be possible to save the limb. Surgery is planned so that muscles and the skin will form a cuff around the end of the arm or leg. This cuff will fit into the end of an artificial limb (called a prosthesis). With proper physical therapy the person is often walking on his/her own 3 to 6 months after leg amputation.

Sometimes if the leg must be removed at mid-thigh, the lower leg and foot are turned and attached to the thigh bone. The ankle then serves as a knee joint. This type of surgery is called rotationplasty. Of course, the person will need an artificial limb to extend the leg.

If the cancer is in the upper arm, the tumor may be removed and the lower arm reattached so the person has an arm that works, though it is much shorter.

If the cancer is in the lower jaw bone, the whole lower half of the jaw may be removed and later replaced with bones from other parts of the body.

After Surgery

The time after surgery may be the hardest part. The patient (and parents) need to meet with a rehabilitation specialist to learn about all the options.

Both limb-sparing and amputation surgeries have their own problems as well as unique benefits. If a limb was removed, the person must learn to deal with the artificial limb. This is especially hard for growing children where the device needs to be changed to keep up with their growth. The limb-sparing method, although more acceptable than amputation, can lead to more complications.

It turns out that, in terms of how people react and quality of life, there is little difference in the approaches. Perhaps the biggest problem has been for teen-agers who are afraid of the social effects of their operation. These feelings and concerns are very important and support and encouragement are needed for all patients and their families.

Treatment of metastasis: Treatment to remove bone cancer metastases to the lungs must be planned very carefully. Removing all the lung metastases likely gives the patient the only chance for cure. But sometimes all the metastases can’t be removed. They might be too big or too close to large blood vessels. If the patient is not otherwise in good health, he or she may not be able to withstand the stress of surgery.

For some types of bone tumors such as giant cells tumors a method called curettage might be used. This involves scooping out the tumor from the bone, without removing a section of the bone. In some cases, after most of the tumor has been removed, the surgeon will treat the nearby bone tissue to kill any remaining tumor cells. The hole left behind is filled in with a bone graft or an artificial material.

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells. External beam radiation uses radiation delivered from outside the body. The beam is focused on the cancer. This is the type of radiation that has been tried as a treatment for bone cancer. But bone cancers are not easily killed by radiation. Radiation does not play a major role in the treatment of most types of bone tumors. It may be useful, though, in some cases where the tumor cannot be completely removed by surgery. It is also helpful in controlling symptoms like pain and swelling if the cancer has come back or if surgery is not possible.

Treatment of Specific Bone Cancers

Chondrosarcoma: Treatment consists mainly of the biopsy and then surgery to remove the tumor. If the tumor can’t be totally removed, high-dose radiation therapy may be used. If the cancer has spread to a few places in the lung, those metastases may be removed.

If the tumor is in a place where it can’t be removed (for example, the skull) it is sometimes treated with curettage and cryosurgery (a treatment that uses freezing to kill cancer cells) or with radiation therapy.

Malignant fibrous histiocytoma: MFH is treated using the same approach as for osteosarcoma. The usual treatment plan starts with chemotherapy. This shrinks the tumor and makes it easier to remove. Next, surgery may be done to remove the tumor and bone close to it. After that, the bone may be reconstructed with a bone graft or metal rod. Amputation is done less often now than in the past. In some cases, chemotherapy is also given after surgery.

Fibrosarcoma: Surgery is the main treatment for this kind of cancer. If the tumor cannot be removed completely, radiation therapy is used instead of or along with surgery. Radiation is also used if the cancer returns after surgery.

Giant cell tumor of bone: These are treated mainly with surgery. The extent of surgery can vary, and is influenced by the location of the tumor. Another option that is becoming more common is curettage, sometimes followed by applying extreme hot or cold temperatures to kill any remaining cancer cells. In some cases, radiation might be used.

If there are only a few metastatic tumors in the lungs, it may be possible to remove them surgically. Metastases can also be treated with radiation.

Chordoma: This tumor usually occurs in the base of the skull and bones of the spine. Removing the cancer completely would be best, but it might not be possible. If some of the tumor remains after surgery, radiation is often used but must be aimed carefully. Chemotherapy is sometimes used if a chordoma has spread widely. Long-term follow-up is important because these tumors can come back, even 10 or more years after treatment.

The outlook for people with primary bone cancer varies greatly, depending on the specific type of cancer and how far it has spread. If you have questions about your own treatment plan, chances of a cure, or how long you might survive, talk with your cancer care team.

Breast Cancer in Men

2007-09-03T18:41:00.000+07:00

What Is Breast Cancer in Men?

Breast cancer is a malignant tumor that has developed from cells of the breast. The disease occurs primarily in women but occasionally occurs in men. Many people do not realize that men have breast tissue and that they can develop breast cancer.

Normal Breast Structure

The breast is made up mainly of lobules (milk-producing glands in women), ducts (tiny tubes that carry the milk from the lobules to the nipple in women), and stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels).

Until puberty, young boys and girls have a small amount of breast tissue consisting of a few ducts located under the nipple and areola (area around the nipple). At puberty, a girl's ovaries produce female hormones, causing breast ducts to grow, lobules to form at the ends of ducts, and the amount of stroma to increase. On the other hand, male hormones produced by the testicles prevent further growth of breast tissue. Men's breast tissue contains ducts, but only a few if any lobules.

Like all cells of the body, a man's breast duct cells can undergo cancerous changes. Because women have many more breast cells than men do and perhaps because their breast cells are constantly exposed to the growth-promoting effects of female hormones, breast cancer is much more common in women.

Many types of breast disorders can affect both men and women. Most breast disorders are benign (not cancerous). Benign breast tumors do not spread outside of the breast and are not life threatening. Other tumors are malignant (cancerous) and may become life threatening. Benign tumors, such as papillomas and fibroadenomas, are common in women but are extremely rare in men.

As in most tissues of the body, fluids are circulated to and from the breast by 2 main forms of channels. Blood vessels carry blood to and from the breast. Lymphatic vessels carry lymph instead of blood. Lymph is a clear fluid that contains tissue fluid and waste products and immune system cells (cells that are important in fighting infections). Lymph nodes are small, bean-shaped collections of immune system cells that are found along lymphatic vessels. This is important in cancer, because cancer cells can enter lymphatic vessels and spread to lymph nodes. This becomes important when we talk about staging (see ”Staging” section).

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary lymph nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and either above or below the collarbone (supraclavicular or infraclavicular nodes).

Knowing if the cancer cells have spread to lymph nodes is important because that lets us know that there is a higher chance that the cells could have gotten into the bloodstream and spread to other sites in the body. This is why it is important to find out if breast cancer has spread to your axillary lymph nodes when you are choosing a treatment. The more lymph nodes that are involved with the breast cancer, the more likely it is that the cancer will eventually be found in other organs as well. However, not all men with lymph node involvement develop metastases, and it is not unusual for a man to have negative lymph nodes and later develop metastases.

Benign Breast Conditions

Gynecomastia is the most common male breast disorder. It is not a tumor but rather an increase in the amount of a man's breast tissue. Usually, men have too little breast tissue to be felt or noticed. A man with gynecomastia has a button-like or disk-like growth under his nipple and areola, which can be felt and sometimes seen. Gynecomastia, common among teenage boys, is due to changes in hormone balance during adolescence. The same condition is also common in older men and is also due to changes in their hormone balance.

Rarely, gynecomastia occurs because tumors or diseases of certain endocrine (hormone-producing) glands cause a man's body to produce more estrogen (the main female hormone). Although men's glands normally produce some estrogen, it is not enough to cause breast growth. Diseases of the liver, which is an important organ in male and female hormone metabolism, can change a man's hormone balance and lead to gynecomastia. Obesity may be another cause of elevated estrogens in men.

Many commonly prescribed medicines can sometimes cause gynecomastia, too. These include some drugs used to treat ulcers and heartburn, high blood pressure, and heart failure. Men with gynecomastia should ask their doctors about whether any medicines they are taking might be causing this condition.

Klinefelter syndrome, a rare genetic condition, can lead to gynecomastia and increase a man's risk of developing breast cancer. This condition is discussed further in the section on risk factors for male breast cancer.

Types of Breast Cancer

Adenocarcinoma: Nearly all breast cancers start in the ducts or lobules of the breast. Because this is glandular tissue, they are called adenocarcinomas, a term applied to cancers of glandular tissue anywhere in the body. The 2 main types of breast adenocarcinomas are ductal carcinomas and lobular carcinomas.

Ductal carcinoma in situ (DCIS): DCIS is an uncommon type of breast adenocarcinoma in men (about 10%). Cancer cells fill the ducts but do not invade through the walls of the ducts into the fatty tissue of the breast or spread outside the breast. It is almost always curable with surgery.

In situ is the term used for the early stage of cancer, when it is confined to the immediate area where it began. Specifically in breast cancer, in situ means that the cancer remains confined to ducts (ductal carcinoma in situ) or lobules (lobular carcinoma in situ). It has not invaded surrounding fatty tissues in the breast nor spread to other organs in the body.

Infiltrating (or invasive) ductal carcinoma (IDC): Starting in a duct of the breast, this type of adenocarcinoma breaks through the wall of the duct and invades the fatty tissue of the breast. At this point, it can metastasize (or spread) to other parts of the body. IDC (alone or mixed with other types of invasive or in situ breast cancer) accounts for 80% to 90% of male breast cancers.

Lobular breast cancers in men are very rare, accounting for only 2% of adenocarcinomas. This is because men do not usually have lobular tissue, the milk-producing glands.

Paget disease of the nipple: This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple. It may also spread to the areola (the dark circle around the nipple). The skin of the nipple usually appears crusted, scaly, and red, with areas of itching, oozing, burning, or bleeding. Using the fingertips, a lump may be detected within the breast. If no lump can be felt, the prognosis (outlook for survival) is generally good. Paget disease may be associated with in situ carcinoma or with infiltrating breast carcinoma. It accounts for about 1% of female breast cancers and a higher percentage of male breast cancers. Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so spread to the nipple is more likely.

Do We Know What Causes Breast Cancer in Men?

Although certain risk factors may increase a man's chances of developing breast cancer, the cause of most breast cancers in men is unknown.

Researchers are making great progress in understanding how certain changes in DNA can cause normal cells to become cancerous. DNA is the chemical that carries the instructions for nearly everything our cells do. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than our outward appearance.

Some genes (parts of our DNA) contain instructions for controlling when our cells grow, divide, and die. Certain genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the appropriate time are called tumor suppressor genes. Cancers can be caused by DNA mutations (defects) that activate oncogenes or inactivate tumor suppressor genes. Certain inherited DNA changes can cause a high risk of developing certain cancers and are responsible for cancers that run in some families.

Most DNA mutations related to male breast cancer occur during life rather than having been inherited before birth. Acquired mutations of oncogenes and/or tumor suppressor genes may result from cancer-causing chemicals in our environment or diet, but so far, studies have not identified any individual chemical in the environment or in our diet that appears responsible for these mutations or the subsequent male breast cancers.

Genetic risk factors: Some breast cancers are linked to inherited mutations of the BRCA tumor suppressor genes. Normally, these genes make a protein that helps cells recognize and/or repair DNA damage and prevents them from growing abnormally. However, if a person has inherited a mutated gene from either parent, the chances of developing breast cancer are higher. In women, mutations of 2 different BRCA genes (BRCA1 and BRCA2) are responsible for about 5% to 10% of breast cancers. Women with either of these altered genes have a lifetime breast cancer risk of up to 85%.

In men, the BRCA2 gene is responsible for about 5% to 10% of breast cancer cases. Some studies have found even higher rates. The lifetime breast cancer risk for men with BRCA2 mutations is about 7%, which is nearly 100 times greater than other men. In Jewish men, BRCA1 can play a role in a small number.

Testing of your DNA from blood samples can determine if you have inherited a mutated BRCA2 gene. This should only be done if you have a strong family history of breast cancer and/or ovarian cancer suspected to be caused by the BRCA2 mutation. If the test detects a mutated BRCA2 gene, you and your health care team can watch carefully for early signs of cancer. Mammography is very effective in finding early breast cancer in men. The health care team also can warn close male and female relatives that they also may be at risk.

The role of BRCA1 mutations in male breast cancer is less clear. Recent studies suggest that BRCA1 mutations may slightly increase the risk of breast cancer in men, although by a much smaller extent than BRCA2 mutations. A large study found about half as many BRCA1 mutations in men with breast cancer as BRCA2 mutations. Both BRCA genes can also increase a man’s risk for certain other cancers, such as prostate cancer.

If you are considering genetic testing, you should speak to a genetic counselor or a doctor specially qualified in interpreting and explaining these test results. For additional information, see our policy statement on genetic testing.

Can Breast Cancer in Men Be Found Early?

Early detection improves the chances that male breast cancer can be treated successfully. Many men's breast cancers could have been found earlier by their health care professional with regular checkups.

Differences Between Male and Female Breast Cancers: Relevance to Early Detection

Although there are many similarities between breast cancer in men and women, several important differences affect early detection.

The most obvious difference between the male and female breast is size. Because men have very little breast tissue, it is easier for men and their health care professionals to feel small masses. On the other hand, because men have so little breast tissue, cancers do not need to grow very far to reach the skin covering the breast or the muscles underneath the breast. Therefore, although male breast cancers tend to be slightly smaller than female breast cancers when they are first found, they have more often spread beyond the breast. The extent of spread beyond the breast is the most important factor in the prognosis (outlook for chances of survival) of a breast cancer.

Another difference is that breast cancer is common among women and rare among men. So many women are aware of this disease, while most men do not realize they have even a small risk of being affected. Some men ignore breast lumps or think they are caused by an infection or some other reason and they do not get medical treatment until the mass has grown significantly. Also, some men who think breast lumps occur only in women are embarrassed about finding one and worry that someone might question their masculinity. This attitude may also delay diagnosis and reduce a man's odds for successful treatment.

Because breast cancer is so uncommon, there is no value in screening mammography in most men. However, mammography along with careful examination might be useful as a screening examination for men with a strong family history and BRCA mutations found by genetic testing.

How Is Breast Cancer in Men Treated?

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Most of the information about treating male breast cancer comes from doctors' experience with treating female breast cancer. There are too few men with breast cancer for doctors to study in clinical trials.

Breast Cancer

2007-09-03T14:35:00.000+07:00

What Is Breast Cancer?

Breast cancer is a malignant (cancerous) tumor that starts from cells of the breast. The disease occurs mostly in women, but men can get breast cancer too. The information here refers only to breast cancer in women.

A woman's breast is made up of glands that make breast milk (lobules), ducts (small tubes that carry milk from the lobules to the nipple), fatty and connective tissue, blood vessels, and lymph (pronounced limf) vessels. Most breast cancers begin in the cells that line the ducts (ductal cancer), some begin in the lobules (lobular cancer), and the rest in other tissues.

Lymph vessels are like veins, except that they carry lymph fluid instead of blood. Lymph is a clear fluid that contains immune system cells and waste products. Most lymph vessels lead to small, bean-shaped collections of tissue called lymph nodes. Most lymph vessels of the breast lead to lymph nodes under the arm. These are called axillary (ax-uh-lair-ee) nodes.

If breast cancer cells reach the underarm lymph nodes and continue to grow, they cause the nodes to swell. Once cancer cells have reached these nodes they are more likely to spread to other organs of the body as well.

Benign Breast Lumps

Most breast lumps are benign (be-nine); that is, they are not cancer. Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening. But some benign breast lumps can increase a woman's risk of getting breast cancer.

Most lumps turn out to be caused by fibrocystic (fi-bro-sis-tik) changes. Cysts are fluid-filled sacs. Fibrosis is the formation of scar-like tissue. Such changes can cause breast swelling and pain. The breasts may feel lumpy, and sometimes there is a clear or slightly cloudy nipple discharge.

Main Types of Breast Cancer

Understanding key words as they relate to breast cancer can be a challenge. Here are the most common types of breast cancer:

Carcinoma in situ (in sigh-to): This term is used for early stage cancer, when it is confined to the place where it started. In breast cancer, it means that the cancer is confined to the ducts or the lobules, depending on where it started. It has not gone into the tissues in the breast nor spread to other organs in the body.

Ductal carcinoma in situ (DCIS): This is the most common type of noninvasive breast cancer. DCIS means that the cancer is confined to the ducts. It has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. The best way to find DCIS early is with a mammogram.

Lobular carcinoma in situ (LCIS): This condition begins in the milk-making glands but does not go through the wall of the lobules. Although not a true cancer, having LCIS increases a woman's risk of getting cancer later. For this reason, it's important that women with LCIS to follow the screening guidelines for breast cancer..

Invasive (infiltrating) ductal carcinoma (IDC): This is the most common breast cancer. It starts in a milk passage or duct, breaks through the wall of the duct, and invades the tissue of the breast. From there it can spread to other parts of the body. It accounts for about 80% of invasive breast cancers.

Invasive (infiltrating) lobular carcinoma (ILC): This cancer starts in the milk glands or lobules. It can spread to other parts of the body. About 10% of invasive breast cancers are of this type. There are also several other less common types of breast cancer.

What Causes Breast Cancer?

We do not yet know exactly what causes breast cancer, but we do know that certain risk factors are linked to the disease. A risk factor is anything that increases a person's chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person's age or family history, can't be changed. But having a risk factor, or even several, doesn't mean that a person will get the disease.

Some women who have one or more risk factors never get breast cancer. And most women who do get breast cancer don't have any risk factors. While all women are at risk for breast cancer, the factors listed below can increase a woman's chances of having the disease.

Risk Factors You Cannot Change

Gender: Simply being a woman is the main risk for breast cancer. While men can also get the disease, it is about 100 times more common in women than in men.

Age: The chance of getting breast cancer goes up as a woman gets older. Nearly 8 out of 10 breast cancers are found in women age 50 or older.

Genetic risk factors: About 5% to 10% of breast cancers are linked to changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk as well.

Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother's or father's side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman's risk.

Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from the first cancer coming back (recurrence).

Race: White women are slightly more likely to get breast cancer than are African-American women. But African American women are more likely to die of this cancer. Many experts now believe that the main reason for this is because they have faster growing tumors. Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer.

Abnormal breast biopsy: Certain types of abnormal biopsy results can be linked to a slightly higher risk of breast cancer.

Earlier breast radiation: Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer.

Menstrual periods: Women who began having periods early (before 12 years of age) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer.

Treatment with DES: In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby. Recent studies have shown that these women (and their daughters who were exposed to DES while in the uterus), have a slightly increased risk of getting breast cancer.

Breast Cancer Risk and Lifestyles

Not having children: Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant more than once and at an early age reduces breast cancer risk.

Birth control pills: It is still not clear what part birth control pills might play in breast cancer risk. Studies have found that women now using birth control pills have a slightly greater risk of breast cancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. It's a good idea to discuss the risks and benefits of birth control pills with your doctor.

Postmenopausal hormone therapy (PHT; also called hormone replacement therapy): It has become clear that long-term use (several years or more) of combined PHT (estrogens together with progesterone) after menopause increases the risk of breast cancer as well as the risk of heart disease, blood clots, and strokes. The breast cancers are also found at a more advanced stage, perhaps because PHT seems to reduce the effectiveness of mammograms. Five years after stopping PHT, the breast cancer risk appears to drop back to normal. Estrogen alone (ERT) does not seem to increase the risk of breast cancer as much, if at all.

At this time, there appear to be few strong reasons to use PHT, other than for short-term relief of menopausal symptoms. Because there are other factors to think about, you should talk with your doctor about the pros and cons of using PHT.

Breast-feeding and pregnancy: Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1 to 2 years. This could be because breast-feeding lowers a woman's total number of menstrual periods, as does pregnancy. One study found that having more children and breast-feeding longer could reduce the risk of breast cancer by half.

Alcohol: Use of alcohol is clearly linked to a slightly increased risk of getting breast cancer. Women who have 1 drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1 times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink.

Obesity and high-fat diets: Being overweight is linked to a higher risk of breast cancer, especially for women after change of life and if the weight gain took place during adulthood. Also, the risk seems to be higher if the extra fat is in the waist area. But the link between weight and breast cancer risk is complex, and studies of fat in the diet as it relates to breast cancer risk have often given conflicting results.

Since diet and weight have been shown to affect the risk of getting several other types of cancer as well as heart disease, the American Cancer Society says it's best to stay at a healthy weight and limit your use of red meats, especially those high in fat or processed.

Exercise: Studies show that exercise reduces breast cancer risk. The only question is how much exercise is needed. One study found that as little as 1 hour and 15 minutes to 2 and a half hours per week of brisk walking reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more. The American Cancer Society suggests that you exercise for 45 to 60 minutes 5 or more days a week.

Uncertain Risk Factors

A lot of research is being done to learn how the environment might affect breast cancer risk. At this time, research does not show a clear link between breast cancer risk and environmental pollutants, such as pesticides and PCBs.

Most studies have found no link between active cigarette smoking and breast cancer. Though both active smoking and secondhand smoke have been suggested to increase the risk of breast cancer in some studies, the issue remains controversial. The US Surgeon General is currently reviewing the evidence on this link, and a report is expected in late 2006. Regardless of the possible link between tobacco and breast cancer, not smoking cigarettes and limiting exposure to secondhand smoke is beneficial for a number of health reasons, including a reduced risk of other cancers and heart disease.

While a direct link between smoking and breast cancer has not been found, some studies suggest it might increase breast cancer risk, particularly for women who start smoking as teens. Smoking affects your overall health and increases the risk for many other cancers, as well as heart disease. If you smoke, you should make every attempt to quit.

Internet e-mail rumors have suggested that underarm antiperspirants can cause breast cancer. There is very little evidence to support this idea. Also, there is no evidence to support the idea that underwire bras cause breast cancer.

Several studies show that induced abortions do not increase the risk of breast cancer. Also, there is no evidence to show a direct link between miscarriages and breast cancer.

Silicone breast implants can cause scar tissue to form in the breast. But several studies have found that this does not increase breast cancer risk. If you have breast implants, you might need special x-ray pictures during mammograms.

A few recent studies have suggested that women who work at night (nurses on the night shift, for example) have a higher risk of breast cancer. But this has not yet been proven.

How Is Breast Cancer Found?

Screening refers to tests and exams used to find a disease, such as cancer, in people who do not have any symptoms. The earlier breast cancer is found, the better the chances that treatment will work. The goal is to find cancers before they start to cause symptoms. The size of a breast cancer and how far it has spread are the most important factors in predicting the outlook for the patient. Most doctors feel that early detection tests for breast cancer save many thousands of lives each year. Following the guidelines given here improves the chances that breast cancer can be found at an early stage and treated successfully.

ACS Guidelines for Early Breast Cancer Detection

The ACS recommends the following guidelines for finding breast cancer early in women without symptoms:

Mammogram: Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.

Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, preferably every 3 years. After age 40, women should have a CBE by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts feel like.

Breast awareness and breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to their health professional right away.

If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes. But it's OK not to do BSE or not to do it on a fixed schedule.

The most important thing is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. But remember that most of the time these breast changes are not cancer.

Women at high risk: Women with a higher risk of breast cancer should talk with their doctor about the best approach for them. This might mean starting mammograms when they are younger, having extra tests, or having more frequent exams.

Mammograms

A mammogram is an x-ray of the breast. This test is used to look for breast disease in women who appear to have no breast problems. It can also be used when women have symptoms such as those listed below.

During a mammogram, the breast is pressed between 2 plates to flatten and spread the tissue. The pressure lasts only for a few seconds. Although this may cause some discomfort for a moment, it is needed to get a good picture. Very low levels of radiation are used. While many people are worried about exposure to x-rays, the low level of radiation used for mammograms does not significantly increase the risk of breast cancer. For example, one mammogram gives off roughly the same amount of radiation a person would get flying from New York to California on a jet plane.

For the mammogram, you undress above the waist. You will have a wrap to cover yourself. A technologist (most often a woman) will position your breast correctly for the test. The pressure lasts only a few seconds while the picture is taken. The whole procedure takes about 20 minutes.

You will get your results within 30 days. If there is a problem, you will hear within 5 working days.

About 1 in 10 women who get a mammogram will need more pictures taken, but most of these women do not have breast cancer, so don't be alarmed if this happens to you. Only 1 or 2 mammograms of every 1,000 leads to a diagnosis of cancer.

Women with a higher risk of breast cancer should talk with their doctor about the best approach for them. They may benefit from starting mammograms when they are younger, having them more often, or having other tests. If you are at higher risk, your doctor might recommend ultrasound or MRI (magnetic resonance imaging).

Medicare, Medicaid, and most private health plans cover all or part of the cost of this test. And breast cancer testing is now more available to women without health insurance for free or at very little cost through a special program called the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Your state's Department of Health will have information about the program. There is also a new program to help pay for breast cancer treatment for women in need.

Clinical Breast Exam

A clinical breast exam (CBE) is an exam of your breasts by a health expert such as a doctor, nurse practitioner, nurse, or physician assistant. For this exam, you undress from the waist up. The examiner will first look at your breasts for changes in size or shape. Then, using the pads of the fingers, she or he will gently feel your breasts for lumps. The area under both arms will also be examined. This is a good time to learn how to do breast self-exam if you don't already know how.

Breast Awareness and Breast Self-Exam

Women should be aware of how their breasts normally look and feel and report any changes to their doctor right away. Finding a change does not mean that you have cancer.

By being aware of how your own breasts look and feel, you are likely to notice any changes that take place. You can also choose to use a step-by-step approach to checking your breasts on a set schedule. The best time to do breast self-examination (BSE) is when your breasts are not tender or swollen. If you find any changes, see your doctor right away.

Women with breast implants can do BSE. It may help to have the surgeon help identify the edges of the implant so that you know what you are feeling. It may be that the implants push out the breast tissue and actually make it easier to examine.

It's OK for women not to do BSE or to do it once in a while. The ACS has detailed information on how to do BSE for women who want to do it.

Symptoms of Breast Cancer

While the widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms, some are still missed.

The most common sign of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded. So it's important to have anything unusual checked by your doctor.

Other signs of breast cancer include the following:

a swelling of part of the breast
skin irritation or dimpling
nipple pain or the nipple turning inward
redness or scaliness of the nipple or breast skin
a nipple discharge other than breast milk
a lump in the underarm area

How Is Breast Cancer Treated?

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Local vs. Systemic Treatment

The purpose of local treatment is to treat a tumor without affecting the rest of the body. Surgery and radiation are examples of local treatment.

Systemic treatment is given into the bloodstream or by mouth to reach cancer cells that may have spread beyond the breast. Chemotherapy, hormone therapy, and immunotherapy are systemic treatments.

When people who seem to have no cancer left after surgery are given more treatment it is referred to as adjuvant therapy. Doctors now think that cancer cells can break away from the main tumor and begin to spread through the bloodstream in the early stages of the disease. It's very hard to tell if this has happened. But if it has, the cancer cells can start new tumors in other organs or the bones. The goal of adjuvant therapy is to kill these hidden cells, but not all patients need adjuvant therapy.

Some people are given systemic treatment (most likely chemotherapy) before surgery to shrink a tumor. This is called neoadjuvant therapy.

Types of Surgery for Breast Cancer

Most women with breast cancer will have some type of surgery to treat the main breast tumor. The purpose of surgery is to remove as much of the cancer as possible. Surgery can also be done to find out whether the cancer has spread to the lymph nodes under the arm (axillary dissection), to restore the breast's appearance (reconstructive surgery), or to relieve symptoms of advanced cancer. Here is a summary of some of the most common types of breast cancer surgery:

Lumpectomy (lump-ek-tuh-me): Also called breast conservation therapy, lumpectomy involves removing only the breast lump and some normal tissue around it. Radiation treatment is often given for about 6 weeks after this type of surgery. If chemotherapy is going to be used too, the radiation may be held until the chemo is finished.

Partial (segmental) mastectomy (mas-tek-tuh-me): This surgery involves removing more of the breast tissue than in a lumpectomy. It is usually followed by radiation therapy.

Simple or total mastectomy: In this surgery the entire breast is removed but not the lymph nodes under the arm or muscle tissue from beneath the breast. Sometimes both breasts are removed, especially if the woman is at very high risk for breast cancer. This surgery usually isn't much harder to recover from than having one breast removed. Either a single or double simple mastectomy has few side effects. Most women, if they are hospitalized, can go home the next day.

Modified radical mastectomy: This operation involves removing the entire breast and some of the lymph nodes under the arm.

Radical mastectomy: This is extensive removal of entire breast, lymph nodes, and the chest wall muscles under the breast. This surgery is rarely done now because modified radical mastectomy has proven to be just as effective with less disfigurement and fewer side effects.

Choosing Between Lumpectomy and Mastectomy

One advantage of lumpectomy is that it saves the way the breast looks. A downside is the need for several weeks of radiation after surgery. But some women who have a mastectomy will still need radiation. For most women with stage I or II breast cancer, lumpectomy or partial mastectomy (along with radiation) is as good as mastectomy. There is no difference in the survival rates of women treated with these 2 methods. Other factors, though, can affect which type of surgery is best for you. And lumpectomy is not an option for all women with breast cancer. Your doctor can tell you if there are reasons why a lumpectomy is not right for you.

Possible side effects of mastectomy and lumpectomy include infection and blood or fluid collecting at the place where the incision is made. If lymph nodes are removed, there could be other side effects as well such as swelling of the arm (lymphedema).

Other Breast Cancer Surgeries

Axillary dissection: This operation is done to find out if the breast cancer has spread to lymph nodes under the arm. Some nodes are removed and looked at under a microscope. Whether or not cancer cells are present in the lymph nodes under the arm is an important factor in choosing adjuvant therapy. It was once believed that removing as many lymph nodes as possible would reduce the risk of spread to other parts of the body and improve the chance of curing the cancer. It is now known that breast cancer cells that have spread beyond the breast and axillary lymph nodes are best treated by systemic therapy. Axillary dissection is used as a test to help guide other breast cancer treatment decisions.

A possible side effect of removing these lymph nodes is swelling of the arm, called lymphedema. It happens to between 1 and 3 out of 10 women who have had these nodes removed. Women who have swelling, tightness, or pain in the arm after lymph node surgery should be sure to tell their doctor right away. Often there are measures to prevent or reduce the effects of the swelling. The American Cancer Society has more information about lymphedema you can get by calling 1-800-ACS-2345 or on our Web site.

Sentinel lymph node biopsy: This is a way to look at the lymph nodes without having to remove all of them first. For this test, a radioactive substance and/or a dye are injected near the tumor. They are carried by the lymph system to the first (sentinel) node to receive lymph from the tumor. This lymph node is the one most likely to contain cancer cells if the cancer has spread. Once this node is found, it is removed and examined. If the sentinel node contains cancer, more lymph nodes are removed. If it is free of cancer, further lymph node surgery might not be needed. This type of biopsy is complex, so it is best to have it done by someone with a lot of experience in doing it.

Reconstructive or breast implant surgery: These operations are not meant to treat the cancer but are done to restore the way the breast looks after mastectomy. If you are having a mastectomy and are thinking about having breast reconstruction, you should talk to a plastic surgeon before your operation. There are several choices about when the surgery can be done and exactly what type it will be.

If you would like to talk to another woman who has had breast cancer, we encourage you connect with a volunteer in our Reach to Recovery program. A specially trained volunteer can provide information, comfort, and support. To learn more about Reach to Recovery or to request a visit, please call us at 1-800-ACS-2345.

What to Expect with Surgery

For many women, the thought of surgery can be frightening. But a better understanding of what to expect before, during, and after the operation may help ease your fears.

A few days after your biopsy you will know whether or not you have cancer, but the extent of the disease will not be known until after surgery. You will most likely meet with your surgeon a few days before the operation to talk about what will happen. You will be asked to sign a consent form giving the doctor permission to do the surgery. This is a good time to ask any questions you might have.

You may be asked to donate blood ahead of time in case you need it during the surgery. Your doctor will also ask you about medicines, vitamins, or supplements you are taking. You might need to stop taking some of them a week or two before surgery.

The type of anesthesia you will have depends largely on the kind of surgery being done and your own situation. How long the surgery will take and how long you will be in the hospital also depends on the type of surgery you are having.

As a rule, women having a mastectomy stay in the hospital for 1 or 2 nights and then go home. Lumpectomy and sentinel lymph node biopsy are usually done on an outpatient basis and do not require an overnight stay in the hospital.

The length of the operation also depends on the type of surgery you're having. For example, a mastectomy with lymph node removal will take from 2 to 3 hours.

After surgery you will have a bandage over the surgery site that may wrap snugly around your chest. You may have one or more tubes (drains) from the breast or underarm area to remove fluid that collects during the healing process. Most drains stay in place for a week or two. Once the flow has gone down to about one ounce a day, the drain will be removed.

Most doctors will want you to start moving the arm soon after surgery so that it won't get stiff. Women who have a lumpectomy or mastectomy are usually surprised by how little pain they have in the breast area. But they are less happy with the strange feelings (numbness, pinching/pulling) in the underarm area.

Talk with your doctor about what you should do after the surgery to care for yourself. You'll probably get written instructions that will tell you about the following:

how to take care of the wound and dressing
how to take care of the drains
how to know if you have an infection
when to call the doctor or nurse
when to begin using the arm and how to do arm exercises to prevent stiffness
when to start wearing a bra again
when and how to wear a breast form
what to eat and what not to eat
what medicines to take (including pain medicines and maybe antibiotics)
what activities you should or should not do
what feelings you might have about how you look
how to contact a Reach to Recovery volunteer -- these specially trained women can provide information, comfort, and support.

You will see your doctor a week or 2 after surgery. He or she should explain the results of your pathology report and talk to you about whether you will need further treatment.

Chemotherapy

Chemotherapy (commonly called just "chemo") is the use of cancer-killing drugs injected into a vein or taken as a pill. These drugs enter the bloodstream and reach throughout the body, making the treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.

Even in the early stages of the disease, cancer cells can break away from the first breast tumor and spread through the bloodstream. These cells don't cause symptoms, they don't show up on an x-ray, and they can't be felt during a physical exam. But if they are allowed to grow, they can form new tumors in other places in the body. Chemo can be given to find and kill these cells. Used in this way, it is called adjuvant therapy.

If chemo is given after surgery it can reduce the chance of breast cancer coming back. Chemo can also be used as the main treatment for a woman whose cancer has already spread outside the breast and underarm area or that spreads widely after the first treatment.

Chemo may be given before surgery, often to shrink the tumor in order to make it easier to remove. This approach also allows the doctors to watch how the tumor responds to the drugs. If the tumor does not shrink, different drugs can be used.

Chemo is given in cycles, with each period of treatment followed by a break. The total course of treatment usually lasts for 3 to 6 months. Often several drugs are used together rather than a single drug alone.

The side effects of chemo depend on the type of drugs used, the amount given, and the length of treatment. You could experience some of these temporary side effects:

being very tired (called fatigue, often caused by a shortage of red blood cells)
nausea and vomiting
loss of appetite
hair loss
mouth sores
changes in menstrual cycle (this could be permanent)
a higher risk of infection (from a shortage of white blood cells)
bruising or bleeding after minor cuts (from a shortage of blood platelets)

Most of these side effects go away when treatment is over. For example, your hair will grow back. If you have any problems with side effects, be sure to tell your doctor or nurse because there are often ways to help.

Permanent side effects can include early change of life (menopause) and not being able to become pregnant. But being on chemo does not always prevent pregnancy and getting pregnant while on chemo can lead to birth defects. If you are having sex, you should discuss birth control with your cancer doctor. Heart damage can occur if the drug Adriamycin is used for a long time or in high doses, but doctors are careful to control the dose of this drug and to watch for signs of problems.

Also, many women who have had chemo notice a slight decrease in concentration and memory ("chemo brain"). This may last a long time. Research has not confirmed these findings. Still, whether or not "chemo brain" is a real issue, women can and do function well after chemo. In studies that have found 'chemo brain' to be a side effect of treatment, the symptoms usually disappeared after 1 to 2 years.

Very rarely, years after treatment for breast cancer, certain chemo drugs may cause another cancer called acute myeloid leukemia. But the benefit of treating the breast cancer far outweighs the risk of this rare event.

Fatigue can be another long-lasting problem for women who have received chemotherapy. This may last up to several years, but it can be helped. Talk to your doctor if fatigue is a problem for you.

Radiation Therapy

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (brachytherapy).

Most often, external radiation is used for treating breast cancer. It is much like getting a regular x-ray but for a longer period of time. Radiation therapy may be used to destroy cancer cells remaining in the breast, chest wall, or underarm area after surgery or, less often, to reduce the size of a tumor before surgery.

Treatment is usually given 5 days a week in an outpatient center over a period of about 6 or 7 weeks, beginning about a month after surgery. Each treatment lasts a few minutes. The treatment itself is painless. If it is used along with chemotherapy, radiation is usually given after chemotherapy is finished.

The main side effects of radiation therapy are swelling and heaviness in the breast, sunburn-like changes in the treated area, and fatigue. These changes to the breast tissue and skin usually go away in 6 to 12 months. In some women, the breast becomes smaller and firmer after radiation therapy. Radiation therapy is not given during pregnancy because it can harm the fetus.

Another way to give radiation is to place radioactive seeds (pellets) into the breast tissue next to the cancer. It may be given to add an extra 'boost' of radiation to the tumor. It is also being studied as the only source of radiation. So far the results have been good, but more study is needed with this method before it can be used as standard treatment.

Another method being used is called 'Mammosite'. It consists of a balloon attached to a thin tube. The balloon is placed into the lumpectomy space and filled with salt water. Radioactivity is added through the tube. The radioactive material is added and removed twice a day for 5 days. Then the balloon is removed.

Hormone Therapy

The female hormone estrogen promotes the growth of breast cancer cells in some women. For these women, several methods to block the effect of estrogen or to lower its levels are used to treat breast cancer.

A drug such as tamoxifen, which blocks the effects of estrogen, can be given to counter the effects of estrogen. Tamoxifen is taken in pill form, usually daily for 5 years after surgery, to reduce the risk the cancer will come back. Recent studies have clearly shown that this drug helps women of all ages with early breast cancer if their cancer has estrogen receptors. It is also used to reduce the risk of getting breast cancer in women who are at high risk.

Some studies have shown an increase of early stage cancer of the lining of the uterus among women taking tamoxifen. But this cancer is usually found at a very early stage and is almost always cured by surgery. Tell your doctor right away if you have any unusual vaginal bleeding. Blood clots are another possible side effect of tamoxifen. Others can include hot flashes and mood swings. Still, for most women with breast cancer, the benefits of tamoxifen far outweigh the risks.

Aromatase inhibitors are a type of drug that stops the body from making estrogen. They only work for women who are past menopause and whose cancers are hormone positive. These drugs may be used after, or even instead of, tamoxifen to reduce the risk of the breast cancer coming back. They don't cause uterine cancer and very rarely cause blood clots. They can, however, cause bone thinning and fractures because they remove estrogens from the body.

There are several other treatments and drugs that affect female hormones which are being used for breast cancer. Your doctor can give you more details about any recommended treatments.

Targeted Therapy

As we have learned more about the gene changes that cause cancer, researchers have been able develop newer drugs that are aimed directly at these changes. These targeted drugs work differently than standard chemo drugs. They often have different (and less severe) side effects. At this time, they are most often used along with chemo.

Trastuzumab (Herceptin) is a monoclonal antibody that attaches to a growth-promoting protein (HER2/neu) that is found in small amounts on the surface of normal breast cells and most breast cancers. Some breast cancers have too much of this protein, which can cause the cancer to grow and spread faster. Herceptin can stop this protein from causing breast cancer cell growth. It may also help the immune system to better attack the cancer. (Monoclonal antibodies are man-made versions of the immune system proteins that the body makes to fight diseases.)

Recent studies have shown that adding 1 year of Herceptin treatment to chemo lowers the rate of cancer coming back and the death rate over chemo alone after surgery for certain women. This approach has become standard adjuvant treatment in these cases.

The side effects of this drug are fairly mild. They may include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache. But some women may have heart damage during treatment. This damage can improve if the drug is stopped. If you are having this treatment, you should tell your doctor right away if you have any shortness of breath, swelling, or trouble with physical activities.

Lapatinib (Tykerb) is another drug that targets the HER2/neu protein. This drug is given as a pill, most often along with chemo. It is used for some women with cancer that is no longer helped by chemo and Herceptin. This drug can cause side effects, but does cause the heart problems that Herceptin may cause in some women.

Drugs That Target Tumor Blood Vessels

Bevacizumab (Avastin) is another monoclonal antibody that may be used in patients with breast cancer that has spread. It is also used along with other chemo drugs. This antibody helps to prevent tumors from forming new blood vessels to feed the tumor. Avastin is given by intravenous infusion. There can be some rare, though serious, side effects.

Bisphosophonates

Two drugs (bisphosphonates) that help strengthen bones are used in breast cancer treatment. They can strengthen bones that have been weakened by invading breast cancer cells. The drugs are given into a vein to help prevent bone damage if the cancer has spread to the bone. There have been reports of a serious side effect from bisphosphonates. The jaw bone can deteriorate and become painful. Doctors don't know why this happens. It seems to occur in patients who have had dental work done while on the drugs. Therefore, dental work should be done before starting these drugs.

In the past, it was thought that very high doses of chemotherapy followed by a method called stem cell transplant might offer some women with a high risk of the cancer coming back or with advanced cancer the best chance for a cure. But doctors have found that the women who received high dose therapy did not live any longer than women who had standard dose chemotherapy. And high dose chemotherapy with stem cell support can cause serious side effects. Research in this area is still going on. For now, experts in the field suggest that women receive this treatment only as part of a clinical trial.

Thyroid Cancer

2007-09-03T14:28:00.000+07:00

What Is Thyroid Cancer?

The thyroid gland is located under the Adam's apple in the front part of the neck. In most people, it cannot be seen or felt. It is butterfly shaped, with 2 lobes -- the right lobe and the left lobe -- joined by a narrow isthmus (see diagram).

The thyroid gland contains mainly 2 types of cells -- thyroid follicular cells and C cells (also called parafollicular cells).

The thyroid gland absorbs iodine from the blood and the follicular cells use it to produce thyroid hormone which important for many body functions. Thyroid hormone regulates a person's metabolism. Too much thyroid hormone (a condition called hyperthyroidism) causes a person to have a rapid or irregular heartbeat, be hyperactive, feel nervous, warm, hungry, and often, to lose weight. Too little hormone (called hypothyroidism) causes a person to slow down, feel tired, and gain weight. All this is regulated by the pituitary gland at the base of the brain, which produces a substance called thyroid-stimulating hormone (TSH).

C cells make calcitonin, which helps regulate the body's calcium metabolism.

Different cancers develop from each kind of cell. The differences are important because they determine the seriousness of the cancer and the type of treatment needed.

Many types of tumors can develop in the thyroid gland. Most of these tumors are benignmalignant (cancerous), which means they can spread into nearby tissues and to other parts of the body. (non-cancerous). Others are

Benign Thyroid Enlargement and Nodules

Because the thyroid gland is right under the skin, changes in its size and shape can often be felt or even seen by patients or by their doctor. There are many reasons the thyroid gland might be larger than usual, and most of the time it is not cancer. The medical term for an abnormally large thyroid gland is a goiter. Some goiters are diffuse, meaning that the whole gland is large. Other goiters are nodular, meaning that the gland is large and has one or more bumps in it. Diffuse and nodular goiters are usually caused by an imbalance in certain hormones. Not getting enough iodine in the diet can cause these hormonal problems and lead to a goiter, but there are many other reasons.

Lumps or bumps in the thyroid gland are called thyroid nodules. People can develop thyroid nodules at any age, but they are most common in older adults. Thyroid nodules can be either benign or malignant. About 4%-8% of adults have thyroid nodules that can be felt by a doctor. But when people are tested with an ultrasound of the thyroid anywhere from 10% to 40% of people have nodules. Most of these nodules, however, are too small to feel. Often these nodules are cysts filled with fluid or with a stored form of thyroid hormone called colloid. Colloid nodules are one of the most common types of thyroid nodule. Solid nodules have little fluid or colloid.

Some solid nodules may have too many cells, but the cells are not cancer cells. This type of nodule includes hyperplastic nodules and adenomas. Sometimes hyperplastic nodules or adenomas make too much thyroid hormone and cause hyperthyroidism.

Malignant Thyroid Tumors

Only 5% to10% of thyroid nodules are cancerous. There are several types of thyroid cancer, however, papillary carcinoma and follicular carcinoma are the most common. H�rthle cell carcinoma is a subtype of follicular carcinoma. Other types of thyroid cancer, including medullary carcinoma, anaplastic carcinoma, and thyroid lymphoma occur less often.

Differentiated Thyroid Cancers

In differentiated thyroid cancers, the cells appear similar to normal thyroid tissue. This is easily seen under the microscope. Papillary carcinoma: About 70%-80% of thyroid cancers are papillary carcinomas (also called papillary cancer or papillary adenocarcinoma). Papillary carcinomas develop from the thyroid follicle cells and typically grow very slowly. Usually they develop in only one lobe of the thyroid gland, but about 10% of the time they occur in both lobes. Several different variants (subtypes) of papillary carcinoma can be recognized under the microscope. These include the follicular variant, tall cell variant, columnar cell variant, and diffuse sclerosing variant. Of these variants, the follicular variant of papillary carcinoma occurs most often.

The usual form of papillary adenocarcinoma and the follicular variant have the same outlook for survival (prognosis), and treatment is the same for both. The other variants tend to spread more quickly and have a worse prognosis. Even though papillary cancer cells grow slowly, they often spread quickly to the lymph nodes in the neck. Most of the time, however, this can be successfully treated and is rarely fatal.

Follicular carcinoma: Follicular carcinoma is the next most common type of thyroid cancer. It is also sometimes called follicular cancer or follicular adenocarcinoma. Follicular cancer is much less common than papillary thyroid cancer, making up about 20% of thyroid cancers. It is more common in countries where people don�t get enough iodine in their diet. These cancers usually remain in the thyroid gland but some can spread to other parts of the body, such as lungs and bone. Unlike papillary carcinoma, follicular carcinomas spread to lymph nodes less often. The prognosis of follicular carcinoma is probably the same or slightly worse than that of papillary carcinoma.

H'rthle cell carcinoma, also known as oxyphil cell carcinoma, is thought to be a subtype of follicular cancer. This type accounts for about 4% of thyroid cancers. It may have a worse prognosis than typical follicular carcinoma because this subtype of follicular cancer does not absorb radioactive iodine well.

Other Types of Malignant Thyroid Tumors

Medullary thyroid carcinoma: Medullary thyroid carcinoma (MTC : about 3% of thyroid cancers) is the only thyroid cancer that develops from the C cells of the thyroid gland. Sometimes this cancer can spread to lymph nodes, the lungs, or liver even before a thyroid nodule is discovered or a screening test is done. These cancers usually make calcitonin and carcinoembryonic antigen (CEA). Calcitonin, a hormone also produced by normal C cells, helps control the amount of calcium in blood. CEA is a protein produced by certain cancers, such as colorectal cancer and MTC. Both calcitonin and CEA are released into the blood and can be found by blood tests. Because medullary cancer does not absorb or take up radioactive iodine (used for treatment and to find metastases) it has a worse prognosis than differentiated thyroid cancers.

There are 2 types of MTC. The first type, occurring in 85% of cases, is called sporadic MTC. Sporadic MTC is not inherited; that is, it does not run in families. It occurs mostly in older adults and in only 1 thyroid lobe.

The other type of MTC is inherited and can occur in each generation of a family. When MTC is the only type of cancer found in the family, it is called isolated familial medullary thyroid carcinoma (FMTC). The combination of FMTC and tumors of certain other organs is called type 2 multiple endocrine neoplasia (MEN 2). Type 2 MEN has 2 subtypes, MEN 2a and MEN 2b:

In MEN 2a, MTC occurs with adrenal gland tumors called pheochromocytomas and with parathyroid gland tumors that cause high calcium levels in the blood. The adrenal glands are found next to the upper part of each kidney. Most people have 4 parathyroid glands, 2 behind each lobe of the thyroid.
In MEN 2b, MTC is associated with pheochromocytoma but not parathyroid gland disease. Instead, MEN 2b includes benign growths of nerve tissues on the tongue and elsewhere called neuromas. In these familial or genetic forms of MTC, the cancers often develop during childhood or early adulthood and can spread early. MTC is most aggressive in the MEN 2b syndrome.

Anaplastic carcinoma: Anaplastic carcinoma is an uncommon (about 2% of all thyroid cancers) form of thyroid cancer. It is believed to develop from an existing papillary or follicular cancer. It is an aggressive cancer that rapidly invades the neck, often spreads to other parts of the body, and is usually fatal. Anaplastic carcinoma is sometimes called undifferentiated thyroid cancer. Undifferentiated thyroid tumors have cells that do not look very much like normal thyroid tissue cells under the microscope.

Thyroid lymphoma: Lymphoma can develop in the thyroid gland but is very uncommon in that location. It does not develop from either thyroid follicular cells or C cells. Rather, lymphomas develop from lymphocytes, the main cell type of the immune system. Most lymphocytes are found in pea-sized collections scattered throughout the body called lymph nodes, and that is where most lymphomas begin. These types of lymphomas are discussed in the American Cancer Society document, Non-Hodgkin Lymphoma.

Parathyroid cancer: Behind, but attached to the thyroid gland are 4 tiny parathyroid glands. The parathyroid gland regulates the body's calcium. Cancers of the parathyroid glands are very rare. There are probably fewer than 100 cases each year in the United States. When they occur, the blood calcium level is almost always elevated. This causes a person to become fatigued, weak, and drowsy. It also blocks the ability of the kidneys to regulate the body's water content and excess water is lost through high volumes of urine. This further complicates the weakness and drowsiness by causing dehydration.

The parathyroid cancer may also be detected as a thyroid nodule if it grows too large. No matter how large the nodule is, the only treatment is to remove it surgically. Unfortunately, parathyroid cancer is more deadly than thyroid cancer and much harder to cure. This document only discusses thyroid cancer.

Do We Know What Causes Thyroid Cancer?

Although scientists have found that thyroid cancer is associated with a number of other conditions, the exact cause of most thyroid cancers is not yet known.

Researchers have made great progress in understanding how certain changes in a person's DNA can cause thyroid cells to become cancerous. DNA is the molecule that carries the instructions for nearly everything our cells do. We usually resemble our parents because they are the source of our DNA. However, DNA affects more than our outward appearance. It also can influence our risk for developing certain diseases, such as some kinds of cancer.

Some genes (parts of our DNA) contain instructions for controlling when our cells grow and divide. Genes that can be involved in cancer are called oncogenes. Such genes are often involved in DNA maintenance or repair. Others that slow down cell division or cause cells to die at the appropriate time are called tumor suppressor genes. DNA mutations (defects) that influence the function of these genes can cause cancers.

People inherit 2 copies of each gene -- one from each parent. People can inherit damaged DNA from one or both parents, which accounts for inherited cancers. Many times, though, a person's DNA is damaged by exposure to something in the environment, like smoking or radiation. Sometimes DNA mutates for no apparent reason.

The DNA mutations that cause some forms of papillary thyroid cancer are known to involve over-activation or specific parts of the RET gene. The altered form of this gene, known as the PTC oncogene is found in 10%-30% of papillary thyroid cancers overall, and in a larger percentage of papillary thyroid cancers occurring in children and/or associated with radiation exposure. These RET mutations usually are acquired during a person's lifetime rather than being inherited. They are present only in the cancer cell and are not passed on to the patient's children. Recently scientists have discovered that many (30%-70%) papillary thyroid cancers contain a mutation of the BRAF gene. The BRAF mutation is less common in thyroid cancers in children and in those thought to arise from exposure to radioactivity -- such as around Chernobyl. Both BRAF and RET/PTC changes are thought to cause cells to grow and divide. It is extremely rare for papillary cancers to have changes in both the BRAF and RET/PTC genes. Most cases have either one or the other affected gene, and those with BRAF changes tend to have more aggressive growth and a greater likelihood of spreading to other parts of the body.

Acquired changes in other oncogenes and tumor suppressor genes, such as ras and p53, also have a role in causing follicular anaplastic thyroid cancers, respectively.

Single point mutations in people who have medullary thyroid carcinoma (MTC) involve different parts of the RET gene compared to papillary carcinoma patients. Nearly all patients with the inherited form of MTC and about 1 of every 5 with the sporadic form of MTC have a mutation in the RET gene. Most patients with sporadic MTC have acquired mutations present only in their cancer cells. Those with familial MTC and MEN 2 inherit the RET mutation from a parent. These mutations are present in every cell of the patient's body and can be detected by testing the DNA of blood cells.

Because every person has 2 RET genes but passes only 1 to a child (the child's other RET gene comes from the other parent), the odds that a patient with familial MTC will pass a mutated gene to a child are 1 in 2 (or a 50% chance).

How Is Thyroid Cancer Treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

After thyroid cancer is found, your doctor will discuss treatment options or choices with you. It is important to take the time to consider each of them. In choosing a treatment plan, factors to consider include the type and stage of the cancer and your overall physical health. Sometimes it is a good idea to get a second opinion, and many experienced physicians encourage this. Some insurance companies even require a second opinion before they will agree to pay for certain treatments. A second opinion can provide more information and help you feel confident about the treatment plan you choose.

The methods of treatment for thyroid cancer include surgery, radioactive iodine treatment, thyroid hormone therapy, external beam radiation therapy, and chemotherapy. The best approach to treatment usually uses 2 or more of these methods, and most patients are cured of their thyroid cancer in this way.

If a cure is not possible, the goal may be to remove or destroy as much of the cancer as possible and to prevent the tumor from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at palliation (relieving symptoms, such as pain or problems with breathing and swallowing).

Vaginal Cancer

2007-09-03T14:20:00.000+07:00

What Is Vaginal Cancer?

The vagina is a 3 to 4 inch (7 1/2 to 10 cm) tube. Its upper part ends at the cervix, the lower part of the uterus (womb). The lower end opens to the outside onto the vulva, the external genitals. The vagina is sometimes called the birth canal. A thin layer called the epithelium lines the walls of the vagina. The epithelium is formed by squamous epithelial cells.

The part of the vaginal wall underneath the epithelium contains connective tissue, muscle tissue, lymph vessels, and nerves. The vagina is usually in a collapsed state with its walls touching each other. The vaginal walls have many folds that help the vagina to open and expand during sexual intercourse or birth of a baby. Glands in its wall secrete mucus to keep the vaginal lining moist.

There are several types of vaginal cancer. About 85% to 90% of vaginal cancers are squamous cell carcinomas that begin in the epithelial lining of the vagina. They tend to occur in the upper area of the vagina near the cervix. Vaginal squamous cell carcinomas do not appear suddenly; they develop over a period of many years from precancerous changes called vaginal intraepithelial neoplasia (often abbreviated as VAIN).

About 5% to 10% of vaginal cancers are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50. One special type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother's womb). In the past some pregnant women were given DES to prevent miscarriage. The drug became available during the late 1940s and was banned in the USA in 1971. (See the section on risk factors for more information on DES and clear cell carcinoma.)

Malignant melanoma is a cancer that develops from pigment-producing cells called melanocytes. These cancers usually are found on sun-exposed areas of the skin but occasionally form on the vagina or other internal organs. They account for about 2% to 3% of all vaginal cancers. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern.

About 2% to 3% of vaginal cancers are sarcomas. These cancers form deep in the wall of the vagina, not on its surface epithelium. There are several types of vaginal sarcomas. The most common, leiomyosarcoma, typically affects women older than 50. Leiomyosarcomas resemble the involuntary muscle cells of the vaginal wall. Rhabdomyosarcoma is a childhood cancer, usually found before the age of 3. Its cells resemble voluntary muscle cells – a tissue not normally found in the vaginal wall.

Cancers of the vagina are much less common than cancers that start in other organs (such as the uterus, rectum, or bladder) and secondarily spread to the vagina. This document refers only to primary vaginal cancers, that is, those starting in the vagina.

Do We Know What Causes Vaginal Cancer?

The exact cause of most vaginal cancers is not known. However, scientists have found that the disease is associated with a number of other conditions, which are described in the section on risk factors. A great deal of research is now underway to learn more about how these risk factors cause cells of the vagina to become cancerous.

Research has shown that substances called tumor suppressor gene products are made by normal cells to prevent them from growing too rapidly and becoming cancers. Two proteins (E6 and E7) produced by high-risk (like 16 and 18) HPV (human papilloma virus) types can interfere with the functioning of known tumor suppressor gene products.

As mentioned in the section on risk factors, women exposed to diethylstilbestrol (DES) as a fetus (that is, their mothers took DES during pregnancy) are at increased risk for developing clear cell carcinoma. DES clearly increases the likelihood of vaginal adenosis (gland-type cells in the vaginal lining rather than the usual squamous cells).

Studies suggest that although the majority of women with vaginal adenosis never develop vaginal clear cell carcinoma, those with an uncommon type of adenosis (atypical tuboendometrial adenosis) have an increased risk of developing this cancer.

Can Vaginal Cancer Be Found Early?

Many cases of vaginal cancer can be found early in the course of the disease.

Although some early vaginal cancers may produce symptoms that cause patients to seek medical attention, other vaginal cancers do not cause symptoms until after they have reached an advanced stage. Pre-cancerous areas of vaginal intraepithelial neoplasia (VAIN) do not usually produce any symptoms. Fortunately, most cases of VAIN and early invasive vaginal cancer can be found by routine Pap testing.

How Is Vaginal Cancer Treated?

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

After the diagnostic tests are done, your cancer care team will recommend a treatment plan. Don't feel rushed about considering your options. If there is anything you do not understand, ask to have it explained again. The choice of treatment depends largely on the type of cancer and stage of the disease when it is diagnosed.

Other factors might play a part in choosing the best treatment plan. These might include your age, your overall state of health, whether you plan to have more children, and other personal considerations. Be sure you understand all the risks and side effects of the various therapies before making a decision about treatment.

You may want to get a second opinion. This can provide more information and help you feel confident about the treatment plan you choose. Some insurance companies require a second opinion before they will pay for treatments.

The 2 main methods of treatment of vaginal cancer are radiation therapy and surgery. Chemotherapy in combination with radiation may be used to treat advanced disease (see section on chemotherapy).

Whenever possible, treatment is given with the intention of completely removing or destroying the cancer. If a cure is not possible, the goal may be to remove or destroy much of the cancer in order to prevent the tumor from growing, spreading, or returning for as long as possible. If the cancer has spread widely, the main goal of treatment is palliation (relieving pain, blockage of the urinary or intestinal system, or other symptoms).

Wilms Tumor

2007-09-03T14:10:00.000+07:00

What Is Wilms Tumor?

Wilms tumor (also called Wilms' tumor or nephroblastoma) is the most common type of kidney cancer in children. Most kinds of cancer are named for the place where the cancer starts. Although Wilms tumor starts in the kidney, it is named for the German doctor (Max Wilms) who first wrote about it in 1899. About 90% of kidney cancers in children are Wilms tumors.

About the Kidneys

The kidneys are 2 curved organs in the abdomen. Each kidney is about the size of a fist. One kidney is just to the left and the other just to the right of the backbone. The lower rib cage protects the kidneys.

The kidney's main job is to filter the blood and get rid of extra water, salt, and waste products in the form of urine. Urine leaves the kidneys through long slender tubes called ureters. Each kidney has a single ureter. The ureters empty into the bladder where urine is stored until you urinate. Although the kidneys are important, people can get by with just a single kidney. Many people are living normal, healthy lives with just one kidney.

Wilms tumors usually form only in 1 kidney, but in a small number of cases they can form in both. Wilms tumors are often found only after they have grown quite large. But most are found before they have spread to other organs. The average weight of a newly-found Wilms tumor is about a pound. That's larger than the kidney it started in.

Types of Wilms Tumors

There are 2 main types of Wilms tumors. Doctors look at cells from the tumor through a microscope to decide which type it is.

Wilms tumor of favorable appearance under the microscope
Wilms tumor of unfavorable appearance under the microscope

If a tumor has an unfavorable appearance (histology), it means that the center of the cells (the nucleus) is very large and not the right shape. This is called anaplasia. The more anaplasia is found, the worse the chance for a cure. A favorable appearance means there is no anaplasia and the chance of cure is good. About 95% of Wilms tumors have a favorable appearance.

Rarely, children can have other kinds of kidney cancer. The information here applies only to Wilms tumor and not to other kinds of kidney cancer.

What Causes Wilms Tumor? Can It Be Prevented?

Researchers are learning more about how changes in the genes and other factors work together to cause Wilms tumors and other cancers. Although they don't know exactly why some children get Wilms tumors, they have made great progress in understanding what happens as the kidneys form in a fetus. When this process goes wrong, Wilms tumor can be the result.

The kidneys develop very early as babies grow in the womb. Sometimes a mistake happens as the kidney grows. Some of the cells don't mature. Instead, they remain as early (fetal) cells. Small or large clusters of these early kidney cells can still be there after the baby is born. Most often, these cells will mature by the time the child is 3 or 4 years old. But if this doesn't happen, the cells may begin to grow out of control. The result could be a Wilms tumor.

A risk factor is something that is linked to a greater chance of getting a disease. Some risk factors, such as smoking, can be controlled. Others, like a person's age or race, can't be changed. Different cancers have different risk factors. Most of the risk factors for Wilms tumor cannot be controlled. They are genetic or hereditary (inherited).

A small number of children with Wilms tumor have a relative with the same cancer. These children may have inherited an abnormal gene from one parent. This gene increases the risk of Wilms tumor, but it does not mean the child will have Wilms tumor.

There is a strong link between Wilms tumors and certain kinds of birth defects. Most birth defects linked to Wilms tumors occur in syndromes. Syndromes are groups of symptoms or conditions that often occur together in the same person. Several different syndromes are linked to Wilms tumors. These syndromes are associated with certain changes in genes. A part of a gene or even a whole gene may be missing. These missing or changed genes can cause Wilms tumors and other birth defects.

But most children with Wilms tumors do not have any known gene changes or birth defects. We cannot explain why they develop these tumors. There is nothing their parents could have done to prevent the cancer.

Can Wilms Tumor Be Prevented?

Right now there is no known way to prevent Wilms tumors. Experts think the cancer comes from cells that were in the fetus, but failed to develop into mature kidney cells. This doesn't seem to be caused by anything that a mother could avoid.

How Is Wilms Tumor Found?

Children who have birth defects known to be linked to Wilms tumor should be checked regularly. The doctor will schedule physical exams and other tests to watch for signs of a tumor. Ultrasound exams are usually done every 3 months until the child is 6 or 7 years old. You should tell your doctor if you have family members who have had Wilms tumor. If so, the other children in the family may need to have regular tests.

There are no blood tests or other tests to look for Wilms tumors in otherwise healthy children.

Symptoms of Wilms Tumor

Wilms tumors can be hard to find early. They sometimes grow quite large without causing any pain. Children may look healthy and seem normal. The first sign is usually a large lump in the belly. Chances are parents will notice the swelling. Some children may also have other symptoms such as:

stomach pain
fever
blood in the urine
high blood pressure

If your child has these symptoms, see a doctor right away.

If there is any reason to suspect Wilms tumor, the doctor will ask questions to check for risk factors and symptoms. A physical exam can provide information about possible signs of Wilms tumor and other health problems. After that, the doctor may want to conduct certain tests to find out if the disease is present.

Imaging Tests

Ultrasound: This test uses sound waves to create a picture of the inside of the body. The echoes made by most kidney tumors differ from those of normal kidney tissue. This is often the first test done they suspect your child has Wilms tumor. An ultrasound is painless and allows the doctor to see the entire abdomen.

CT (computed tomography) scan: This scan uses x-rays to take many pictures of the body that are then combined by a computer to give a detailed cross-sectional image. A CT scan is one of the most useful methods of finding a mass inside the kidney. It is also useful to see whether the cancer has spread beyond the kidney.

MRI (magnetic resonance imaging): MRI uses radio waves and strong magnets instead of x-rays. Like CT scans, MRIs display a cross-section of the body but in greater detail, which can help doctors see if the cancer is in one of the major blood vessels near the kidney.

Angiography (an-jee-og-ruh-fee): In this test, a contrast dye is injected into the artery leading to the kidney. The dye outlines the blood vessels on x-ray pictures. This is useful in helping the surgeon plan an operation.

Chest x-rays: Chest x-rays are used to see whether the Wilms tumor has spread to the lungs.

Bone scan: For this test, a small amount of radioactive material is injected into a vein. The material collects in areas of diseased bone and can be seen with a special camera. This can help find cancer that has spread to the bones.

Other Lab Tests

Certain blood tests are done to count the number of white blood cells and red blood cells and to measure other substances in the blood. Urine may be tested as well. Although these tests are not used to find Wilms tumor, they do give clues about how well the liver and kidneys are working.

How Is Wilms Tumor Treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

More than 90% of children with Wilms tumor are cured. Much of the progress in treatment has happened because of the work of the National Wilms Tumor Study Group (now part of the Children's Oncology Group). This group organizes clinical trials of new treatments for most children with Wilms tumor in this country.

After your child's Wilms tumor is found and staged, the doctor will suggest a treatment plan. Today, most children with this cancer are treated as part of a clinical trial to try to further improve on what doctors believe is the best treatment.

Because Wilms tumor is rare, few doctors except those in children's cancer centers have much experience in treating these children. A team approach that includes the child's pediatrician as well as experts at the cancer center is recommended. If you decide to get a second opinion, it should be done quickly because Wilms tumor is usually very large and tends to grow fast.

Treatment for Wilms tumor usually involves surgery, chemotherapy, and sometimes radiation. The first goal of treatment is to remove the primary tumor even if there are distant areas of spread (metastases). If any cancer remains after the first operation, radiation therapy or more surgery might be needed.

Sometimes the tumor may be too large to remove. It may have spread into nearby blood vessels or other vital structures, or it may be in both kidneys. In these cases, doctors might use chemotherapy or radiation therapy (or both) to shrink the tumor before removing it.

Surgery

Surgery is the main treatment for Wilms tumor. It should be done by a doctor who specializes in operating on children. Also, it's better if the surgeon has experience in treating children with cancer.

The most common operation is a radical nephrectomy (nuh-frek-tuh-me). The cancer and the whole kidney are removed as well as the ureter, the adrenal gland, and some fatty tissue around the kidney. The surgeon may also remove lymph nodes (small, bean-sized collections of immune system cells that help the body fight infections) next to the kidney since cancer often spreads to these nodes.

During surgery the doctor will look at the liver and the other kidney and perhaps take samples of any suspicious areas. These will be looked at under a microscope to see if they contain cancer cells. If an x-ray or scan suggests that the cancer might have spread to the lungs, then the doctor may also take a sample of lung tissue. Knowing whether or not a Wilms tumor has spread is important in determining its stage and choosing a treatment.

Often, if chemotherapy is to be given, the surgeon will insert a small plastic tube (called a venous access device) into a large blood vessel. The end of the tube is under the skin of the chest area or upper arm. This cuts down on the number of needle sticks needed to take blood samples for tests and to give medicines and blood transfusions. Someone will teach you how to care for your child's device.

Chemotherapy

Chemotherapy refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein, by mouth, or through a venous access device. Once the drugs enter the bloodstream, they reach throughout the body. This makes chemotherapy especially useful for cancer that has spread beyond the kidney.

Chemotherapy drugs are given in different combinations and strengths and at different times, depending on the stage of the tumor. They are usually given by a nurse in the doctor's office or in the outpatient section of the hospital.

These drugs can have some side effects, depending on the type of drug, how much is given, and for how long. Temporary side effects could include the following:

nausea and vomiting
loss of appetite
mouth sores and pain
constipation
pain in the arms, legs, and jaw
weakness, tingling, numbness in the arms and legs
diarrhea
hair loss (the hair grows back after treatment ends)
an increased chance of infection (from a shortage of white blood cells)
bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
tiredness or shortness of breath (from low red blood cell counts)

These side effects go away when treatment is over, but be sure and talk to the doctor if your child has problems. Often there are ways to lessen these. For example, there are drugs that can be taken at the same time as the chemotherapy to lessen or prevent mouth pain, nausea, and vomiting.

There are other risks as well. One type of drug can sometimes damage the heart. Your child's doctor will check for this possibility with heart studies. Chemotherapy can also increase your child's risk of getting a second type of cancer in the future. But the importance of treating Wilms tumor far outweighs these risks.

Radiation Therapy

Radiation therapy is treatment with high energy rays (such as x-rays) to kill or shrink cancer cells. External beam radiation is given in a way similar to that used to find broken bones. This type of radiation is often used along with surgery for stages III, IV, or V Wilms tumor. It is generally not used for stages I or II unless it is stage II with an unfavorable appearance (histology).

Side effects from radiation can include nausea, diarrhea, tiredness, and sunburn-like skin changes. Often, these will go away after a short while. Radiation can also cause a second cancer to develop or can damage other organs or tissues that are in the radiation field. But this usually doesn't happen because the amount of radiation used is low.

Recurrent Wilms Tumor

The outlook for children whose tumor comes back depends on what treatment they first had and the cancer's histology. The outlook is better for children with a favorable histology who did not have abdominal radiation. The recurrent cancer is then treated with surgery, radiation, and more chemotherapy.

The outlook is often poor for children with recurrent Wilms tumor with any of the following features:

unfavorable histology
earlier treatment with radiation therapy
chemotherapy with the drug doxorubicin
recurrence within 6 months of the first surgery
failure of the tumor to completely disappear with the first treatment

Treatment for these children usually involves strong chemotherapy, often with new drugs being studied in clinical trials. Very high-dose chemotherapy with a bone marrow transplant may also be an option.

Most parents find it stressful to watch their child go through cancer treatment. Sometimes this will lead to a minor form of what is called post traumatic stress disorder or PTSD. Parents might find they are irritabe and have outbursts of anger. It may also affect the child's treatment, because parents with this problem will try to avoid the thing that is causing the problem, namely their child's treatment. If you find that you are having trouble coping with your child's illness or treatment, talk to your child's doctor and ask for help in dealing with the problem.

Survival Rates for Wilms Tumor

The 5-year survival rate for children with Wilms tumor varies with the stage of the tumor. It also depends on the histology (appearance) of the tumor cells under a microscope. These rates refer to the percentage of patients who live at least 5 years after their cancer is found. Most of these patients are cured. Ask your doctor to explain the stage and the histology of your child's cancer.

These numbers provide an overall picture, but keep in mind that every child's situation is unique and the statistics can't predict exactly what will happen. Talk with your cancer care team if you have questions They know your child's situation best.

Stage	Favorable histology	Unfavorable histology
I	96%	93%
II	91%	70%
III	91%	56%
IV	81%	17%
V	82%	(unknown)