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- Carcinomas are cancers that arise in the epithelium (the layer of cells covering the body's surface and lining the internal organs and various glands). Ninety percent of human cancers fall into this category. Carcinomas can be subdivided into two types: adenocarcinomas and squamous cell carcinomas. Adenocarcinomas are cancers that develop in an organ or a gland, while squamous cell carcinomas refer to cancers that originate in the skin.
- Melanomas also originate in the skin, usually in the pigment cells (melanocytes).
- Sarcomas are cancers of the supporting tissues of the body, such as bone, muscle and blood vessels.
- Cancers of the blood and lymph glands are called leukemias and lymphomas respectively.
- Gliomas are cancers of the nerve tissue.
Causes and symptoms
|Frequency Of Cancer-Related Death|
|Cancer Site||Number of Deaths Per Year|
|Colon and rectum||56,500|
Sexual and reproductive behavior
|COMMON PATHOGENS AND THE CANCERS ASSOCIATED WITH THEM|
|Causative Agent||Type of Cancer|
|Papillomaviruses||Cancer of the cervix|
|Hepatitis B virus||Liver cancer|
|Hepatitis C virus||Liver cancer|
|Epstein-Barr virus||Burkitt's lymphoma|
|Cancers of the upper
|Hodgkin's lymphoma, Non-Hodgkin's
lymphoma, Gastric cancers
|Kaposi's sarcoma Lymphoma|
|Helicobacter pylori||Stomach cancer Lymphomas|
- Treatment. Treatment of cancer by surgery involves removal of the tumor to cure the disease. This is typically done when the cancer is localized to a discrete area. Along with the cancer, some part of the normal surrounding tissue is also removed to ensure that no cancer cells remain in the area. Since cancer usually spreads via the lymphatic system, adjoining lymph nodes may be examined and sometimes are removed as well.
- Preventive surgery. Preventive or prophylactic surgery involves removal of an abnormal looking area that is likely to become malignant over time. For example, 40% of people with a colon disease known as ulcerative colitis, ultimately die of colon cancer. Rather than live with the fear of developing colon cancer, these people may choose to have their colons removed and reduce the risk significantly.
- Diagnostic purposes. The most definitive tool for diagnosing cancer is a biopsy. Sometimes, a biopsy can be performed by inserting a needle through the skin. However, at other times, the only way to obtain a tissue sample for biopsy is by performing a surgical operation.
- Cytoreductive surgery is a procedure where the doctor removes as much of the cancer as possible, and then treats the remaining area with radiation therapy or chemotherapy or both.
- Palliative surgery is aimed at curing the symptoms, not the cancer. Usually, in such cases, the tumor is so large or has spread so much that removing the entire tumor is not an option. For example, a tumor in the abdomen may be so large that it may press on and block a portion of the intestine, interfering with digestion and causing pain and vomiting. "Debulking surgery" may remove a part of the blockage and relieve the symptoms. In tumors that are dependent on hormones, removal of the organs that secrete the hormones is an option. For example, in prostate cancer, the release of testosterone by the testicles stimulates the growth of cancerous cells. Hence, a man may undergo an "orchiectomy" (removal of testicles) to slow the progress of the disease. Similarly, in a type of aggressive breast cancer, removal of the ovaries (oophorectomy) will stop the synthesis of hormones from the ovaries and slow the progression of the cancer.
Bone marrow transplantation
- eating plenty of vegetables and fruits
- exercising vigorously for at least 20 minutes every day
- avoiding excessive weight gain
- avoiding tobacco (even second hand smoke)
- decreasing or avoiding consumption of animal fats and red meats
- avoiding excessive amounts of alcohol
- avoiding the midday sun (between 11 A.M. and 3 P.M.) when the sun's rays are the strongest
- avoiding risky sexual practices
- avoiding known carcinogens in the environment or work place
The term cancer encompasses a group of neoplastic diseases in which there is a transformation of normal body cells into malignant ones. This probably involves some change in the genetic material of the cells, deoxyribonucleic acid (DNA). oncogenes are the genes that organisms have evolved to regulate growth and repair of tissues. They are genetic codes for the proteins that function as signals that cells send and receive to regulate proliferation. These oncogenes are the targets of carcinogens. mutation and transformation of oncogenes may permanently affect a cell's ability to control cell growth. Damage to the cell's genetic material may be caused by carcinogenic agents. Normal cell lines can be transformed into cancer cells by viruses, chemical carcinogens, and radiation. Transformed cell lines have the ability to develop into malignant neoplasms. Transformed cells may also be recognized by other characteristics which include altered antigenicity, diminished contact inhibition, reduced requirements for certain nutrients, and the ability to grow in suspension. The altered cells pass on inappropriate genetic information to their offspring and begin to proliferate in an abnormal and destructive way. Normally, cells reproduce regularly to replace worn-out tissues, repair injuries, and allow for growth during the developing years. After these processes have taken place, cellular reproduction stops. Clearly the body in its normal processes regulates cell growth in an orderly manner. In cancer, there is no regulation and cell reproduction and growth is disorderly. The dangers of cancer are related to this chaotic reproduction of malignant cells.
As the cancer cells continue to proliferate, the mass of abnormal tissue that they form enlarges, ulcerates, and begins to shed cells that spread the disease locally or to distant sites. This migration is called metastasis. Some cells penetrate neighboring tissues, destroying normal cells and taking their place. Others can enter the blood stream and lymphatic vessels and be carried along in the fluid to another part of the body. Another way malignancy can be spread is by entering a body cavity and coming in contact with a healthy organ; however, this is not common.
Oncologists recognize that environmental, hereditary, and biological factors all play important roles in the development of cancer (see table). Environmental causes are believed to account for at least 50 per cent and perhaps, in some types, as much as 80 per cent of all cancers. For example, cigarette smoking is directly related to approximately 90 per cent of all cases of lung cancer. Other environmental carcinogens include industrial pollutants and radiation. Among the chemical carcinogens are arsenic from mining and smelting industries; asbestos from insulation, at construction sites and power plants; benzene from oil refineries, solvents, and insecticides; and products from coal combustion in steel and petrochemical industries. Each year new products that in all probability are carcinogenic are being produced by industrial operations. A major concern is the occupational and environmental hazards these chemicals present to those who work in or live near these plants.
Radiation from prolonged exposure to the ultraviolet rays of the sun or from injudicious use of diagnostic and therapeutic procedures involving x-rays and radioactive substances is also a significant factor in the incidence of cancer, particularly that of the skin, bone marrow, and thyroid.
Hormones, especially the synthetic estrogens given to prevent spontaneous abortion, are directly related to some cancers of the female reproductive organs.
Viruses as causal agents in the development of cancer have been subjected to intensive research efforts in recent years. The epidemiologic evidence is strongest for a relationship between hepatitis B virus and hepatocellular carcinoma and between human T-lymphotropic virus (HTLV)-1 and T-cell lymphoma. Both have a geographic distribution of cancer prevalence and viral infection as well as case-by-case associations. The association between burkitt's lymphoma and epstein-barr virus (EBV) is likewise strong, except that there seems to be a need for an associated immunodeficiency state, such as that induced by chronic malaria. Similarly, the association between EBV and high-grade lymphoma in Western countries seems to require that an immunodeficiency state be present, either congenital or induced by the human immunodeficiency virus (HIV) or a drug such as cyclosporine.
The intriguing fact has been noted that viruses are capable of introducing new genetic material into a normal cell and transforming it into a malignant one, and that cell reproduction may be altered when viruses interact with such carcinogens as chemicals and radiation. Recent studies have shown that an extracellular enzyme, reverse transcriptase, plays an important role in the transmission of genetic information to the cell and thereby facilitates the reproduction of cancer cells.
The incidence of cancer in certain populations suggests that other factors are important in its development. It is known, for example, that some families show a high incidence of malignancy among their members, but there is no definite hereditary pattern. There also is a high incidence of cancer in persons receiving drugs for immunosuppression, yet cancer itself is immunosuppressive. It is suggested that prolonged suppression of the body's immune response may eventually impair its ability to distinguish between self and nonself and thus render it unable to destroy malignant cells. When cancer itself acts to suppress the immune response, it may be the result of an overwhelming demand on the body to destroy more foreign cells than it is prepared to cope with at any given time.
Aging is another factor to consider in development of malignancy. Although cancer can occur at any age, older persons are more susceptible, perhaps because their powers of adaptability are weakened and they have been exposed to carcinogens longer than have younger persons.
Staging. An approach to describing and categorizing malignant tumors has been developed by the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC). It is hoped that by standardizing the classification and staging of tumors, treatment protocols can be established and end results reporting can be utilized to determine the effectiveness of the suggested treatment. Whereas classification of tumors refers to the anatomical and histological descriptions of the tumor (see above), staging refers to the extent of the tumor. The three components of the staging system are the primary tumor (T), regional nodes (N), and metastasis (M). Subscripts may be used to describe the extent to which the malignancy has increased in size, its involvement of regional nodes, and its metastatic development (see table). For example, a tumor may be described as T1N2M0. dukes' classification is a system of staging colorectal tumors, based on the depth of invasion and degree of metastasis.
Precancers. Some potentially dangerous cancers appear first in the form of harmless changes in the body's tissues. The danger lies in the fact that such changes have a tendency to become malignant; hence they are known as precancers. Among them are sores that appear as thickened white patches (leukoplakia) in the mouth and on the vulva, some moles, and any chronically irritated area on the skin or the mucous membranes of the mouth and tongue. polyps are also possible precancers.
Nutritional balance is also important in the prevention of cancer. Certain foods and food additives contain specific carcinogenic agents. Nutritional deficiency can lower resistance and increase the risk of certain types of cancers. The decrease in incidence of stomach cancer in most Western countries may possibly be the result of an increase in consumption of fruits and vegetables, since vitamin B12 deficiency (pernicious anemia) is known to be related to increased incidence of stomach cancer.
Studies have shown that a relationship exists between obesity and cancer, and between dietary excess, particularly consumption of large amounts of fats, and certain types of cancers. In general, overweight women are at increased risk for cancer of the endometrium, gallbladder, and kidney. Cancers associated with a high dietary intake of fat, with or without obesity, are those affecting the breast, ovary, endometrium, prostate, colon, and pancreas. Although neither saturated nor unsaturated fats are themselves carcinogenic, they act on the endocrine system and affect hormonal activity. The relationship of fat consumption to colon cancer is thought to be due to the effect of bile acids and their metabolites, which have been shown to act as tumor promoters in laboratory animals. In humans, patients with cancer of the colon typically have elevated levels of bile acid metabolites. Studies of various populations throughout the world have shown that bowel cancer is more prevalent among groups who eat large amounts of fat and very little food fiber. Hence the American Cancer Society recommends a low fat, high fiber diet for Americans.
The judicious use of hormones for therapeutic purposes also can reduce the incidence of some cancers. The widespread use of diethylstilbestrol (DES) to prevent threatened or habitual abortion and premature labor, beginning in the 1940s, eventually resulted in development of vaginal and cervical cancer in a significant number of the female offspring of women who took the drug while pregnant. As was previously mentioned, estrogens prescribed for relief of menopausal symptoms have been implicated in cancer in women. It is recommended that the lowest possible therapeutic dose be given to relieve the symptoms of menopause and prevent osteoporosis.
Cancer of the skin and malignant melanoma are related to prolonged exposure to the ultraviolet radiation in sunlight. The incidence of cancer of the skin is increasing in those persons who value a deep suntan and spend a significant amount of time engaged in outdoor leisure activities. Also at risk are those whose work requires that they be exposed to sunlight for prolonged periods of time, such as farmers.
Since most occupational cancers are preventable, increased awareness on the part of industry and the provision of a safe workplace environment can decrease the incidence of many kinds of cancer. It is also necessary for workers to cooperate with management in reducing exposure to carcinogens by complying with rules for preventive measures.
Ultimately, the prevention of cancer depends upon knowledge of each person's risk factors for development of cancer, and that person's decision to avoid whenever possible those habits and practices that predispose to the disease. There also should be frequent examination and monitoring of those who are known to be at greater risk.
Monthly self-examination of the breast is advocated for all adult women, including those who are postmenopausal. Monthly self-examination of the testes is recommended for all males, particularly those in the age group most at risk for testicular cancer, that is, between the ages of 15 and 34 years.
Another self-administered screening technique is the test for occult blood, a symptom of colorectal cancer. This requires only that a smear of fecal material be applied to a slide, which is sent to a clinical laboratory for examination. To avoid a false positive reading, the person participating in the test is given instructions regarding ingestion of meat and other foods that could interfere with accurate test findings.
can·cer (CA),(kan'ser), Do not confuse this word with canker or chancre.
cancer/can·cer/ (kan´ser) a neoplastic disease the natural course of which is fatal. Cancer cells, unlike benign tumor cells, exhibit the properties of invasion and metastasis and are highly anaplastic. The term includes the two broad categories of carcinoma and sarcoma, but is often used synonymously with the former.can´cerous
cancerAn insidious disease which develops from DNA mutations that alter crucial pathways that normally regulate tissue homeostasis, cell survival and/or cell death.
cancerMalignancy A malignancy of any embryologic origin, defined by WH Clark, Jr as a '…population of abnormal cells showing temporally unrestricted growth preference (continually increasing number of cells in the population) over normal cells. Such abnormal cells invade surrounding tissues, traverse at least one basement membrane zone, grow in the mesenchyme at the primary site, and may metastasize to distant sites. It is the totality of properties that determines whether a given lesion should be designated as a cancer.' See Actinic cancer, Anal cancer, Apoptosis, Bilateral cancer, Bladder cancer, Bone cancer, Brain cancer, BRCA-related gynecologic cancer, Breast cancer, Burn cancer, Cervical cancer, Chimney sweeps' cancer, Coelomic epithelial cancer, Colorectal cancer, Distant cancer, Early stage breast cancer, Endocrine cancer, Endometrial cancer, Environmental cancer, Epithelial ovarian cancer, Esophagus cancer, Extensive-stage small cell lung cancer, Familial cancer, Gastric cancer, Gynecologic cancer, Head & neck cancer, Hereditary nonpolyposis colorectal cancer, In situ cancer, Infiltrating cancer, Inflammatory breast cancer, Invasive cancer, Interval cancer, Invasive cervical cancer, Islet cell cancer, Kang cancer, Kangri cancer, Khaini cancer, Kidney cancer, Laryngeal cancer, Limited-stage small cell lung cancer, Liver cancer, Localized cancer, Locally advanced cancer, Lung cancer, Major cancer, Meningeal cancer, Microfocal cancer, Minimal breast cancer, Minor cancer, Nonmelanoma cancer, Oral cancer, Nonsmall cell lung cancer, Osteophilic cancer, Ovarian cancer, Pancreatic cancer, Pelvic cancer, Penile cancer, Prostate cancer, Pitch workers' cancer, Radiation-induced cancer, Recurrent cancer, Refractory cancer, Regional cancer, Residual cancer, Scar cancer, Second cancer, Skin cancer, Small cell lung cancer, Solid cancer, Solid cancer, Spontaneous regression of cancer, Terminal cancer, Testicular cancer, Thyroid cancer, Unresectable cancer, Uterine cancer, Vaginal cancer, Virally induced cancer, Yang cancer, Yin cancer, Yin and yang cancer. Cf Carcinoma, Neoplasm, Tumor.
can·cer(CA, Ca) (kan'sĕr)
cancer(kan'ser) [L. cancer, crab, suppurating ulcer]
Cancer cells have several reproductive advantages over normal cells. They can make proteins that stimulate their own growth or new blood vessels to bring them nourishment. They can produce enzymes that prevent their chromosomes from aging. They can invade the lymphatic system and bloodstream and find places to grow in new tissues (metastasis).
Usually, as cancer cells proliferate, they become increasingly abnormal and require more of the body's metabolic output for their growth and development. Damage caused by their invasion of healthy tissues results in organ malfunction, pain, and, often, death. See: table (Estimated New Cancer Cases and Deaths by Sex, U.S. 2008)
Ionizing radiation, ultraviolet light, some viruses, and drugs that damage nucleic acids may initiate the genetic lesions that result in cancers. The best-known and most widespread type of carcinogen exposure, however, is consumption of tobacco. The ACS estimates that one third of the cancer deaths that occur annually in the U.S. are related to nutrition and other lifestyle factors. Some cancers are familial, i.e., genetic; others result from occupational exposures to carcinogens. Ironically, chemotherapeutic drugs used to treat some cancers may damage chromosomes and occasionally cause secondary malignancies.
Symptoms of widespread cancer include pain, malnutrition, weakness, fatigue, bone fractures, and strokelike syndromes. Early warning signs of cancer may be remembered by the mnemonic CAUTION: Change in bowel or bladder habit; A sore that does not heal; Unusual bleeding or discharge; Thickening or mass in the breast or other body parts; Indigestion or difficulty in swallowing; Obvious change in a wart or a mole; Nagging cough or hoarseness. People should seek prompt medical attention if they observe any of these signs.
The location of a suspected lesion often dictates the means to diagnose cancer: men with urinary symptoms may be screened for prostate cancer with a prostate specific antigen (PSA) test; an alpha-fetoprotein (AFP) test may be used to screen for liver cancer. Several other tumor markers (such as the CA 125 test for ovarian cancer) are used only after a diagnosis has already been made by other means. Endoscopy and radiography are typically used to locate and assess the extent of the disease, but definitive diagnosis still rests on the examination of cytological specimens (such as the Papanicolaou [Pap] test) or the pathological review of biopsy specimens. See: illustration; table (Controversies in Cancer Screening in the General Population)
Screening for cancers can identify some malignancies before they have invaded neighboring tissues or become widespread. The most widely used screening tests include the Pap test for cervical cancer, mammography for breast cancer, prostate specific antigen tests for prostate carcinoma, and occult blood tests and colonoscopy for intestinal cancers.
Surgery, chemotherapy, immunotherapy, hormone therapy, radiation therapy, and combined-modality therapies often are effective methods for treating patients with cancer. The specific treatment used depends on the type, stage, and location of the cancer and the patient's general health.
The pain associated with cancer is often severe. Cancer patients may suffer depression and anxiety and have nutritional deficits. Guidelines addressing these issues are readily available, e.g., from the U.S. Department of Health and Human Services' Agency for Health Care Policy and Research. Publications may be obtained by calling 1-800-4-CANCER or from websites such as from the ACS (www.cancer.org). See: chemotherapy.
There must be close collaboration among the entire health care team and the patient and family must be encouraged to participate in care . The patient's knowledge of the disease is determined, misinformation corrected, and information supplied about the disease, its progression, its treatment, and expected outcome. Such information should be updated regularly. The patient's and family's coping mechanisms are supported, and verbalization of feelings and fears, esp. with changes in body image, pain and suffering, and dying and death, is encouraged. Participation in local support groups is encouraged for both patients and families.
Assistance is provided with personal hygiene and physical care as needed. Physical care is directed at the maintenance of fluid and electrolyte balance and proper nutrition. Nutrition is a special concern because tumors compete with normal tissues for nutrients and grow at their expense and because the disease or treatments can cause anorexia, altered taste sensations, mouth ulcerations, vomiting, diarrhea, and draining fistulas. Nutritional support includes assessing the patient's status and problems, experimenting to find foods that the patient can tolerate, avoiding highly aromatic foods, and offering frequent small meals of high-calorie, high-nutrient soft foods along with fluids to limit fatigue and to encourage overall intake. Intake of noncaffeinated liquids should be encouraged: 2 quarts per day of juices or other caloric beverages in frequent, small amounts rather than water alone. Elimination is maintained by administering stool softeners as necessary if analgesic drugs result in constipation.
Using careful and gentle handling, the health care professional assists with range-of-motion exercises, encourages ambulation and mobility, and turns and repositions the immobile patient frequently to decrease the deleterious multisystemic effects of immobilization. The patient is made comfortable by correct body alignment, noninvasive measures (such as guided imagery and cutaneous stimulation), and medication (preferably administered on a regular schedule to prevent pain, with additional dosing to relieve breakthrough pain). Emotional assistance includes allaying the patient's fears of helplessness and loss of control; providing hope for remission or long-term survival but avoiding giving false hope; and providing the patient with realistic reassurance about pain control, comfort, and rest. Psychological counseling and antidepressant therapies may be helpful.
Hospice care (at home or in a dedicated center), if needed, is discussed with the patient and family. The goal is to provide good quality of life with minimal discomfort, pain, and restrictions rather than to continue specific therapy. Family members are encouraged to assume an active role in caring for the patient. Communication is fostered between patient and family and other health care providers, and the patient is helped to maintain control and to carry out realistic decisions about issues of life and death.
To provide effective emotional support to the patient and family, health care professionals must understand and cope with their own feelings about terminal illness and death and seek assistance with grieving and in developing a personal philosophy about dying and death. They will then be better able to listen sensitively to patients' concerns, to offer genuine understanding and comfort, and to help patients and family work through their grief.
breast cancerSee: breast cancer
Some strains of the human papillomavirus (HPV) are carcinogenic to cervical epithelium. While there are other risk factors (such as tobacco smoking, early age at first intercourse, and having multiple sex partners), HPV is the major factor responsible for the development of this cancer.
Periodic Pap tests are recommended for all sexually active women. The tests identify cellular changes with 95% accuracy. Dilatation and curettage, punch biopsy, and colposcopy may be done if Pap test findings raise the suspicion of cancer. If abnormal cells are detected, HPV testing is often performed to screen for presence of one of the high risk types of the virus. See: Bethesda System, The; cervical intraepithelial neoplasia; colposcopy; cryosurgery; loop electrode excision procedure; Papanicolaou test
Management varies from cryotherapy or laser therapy for low-grade squamous intraepithelial lesions, conization for carcinoma in situ, to hysterectomy for preinvasive cervical cancer in women who are not planning to have children. Stage-related management of invasive cervical carcinoma includes radiation and/or hysterectomy.
Vaccination against human papillomavirus virus (HPV).See: HPV vaccine.
chimney sweeps' cancer
colorectal cancerAbbreviation: CRC
The cancer occurs more often in people with a family history of the disease, those with familial adenomatous polyposis, and in those with inflammatory bowel diseases such as ulcerative colitis. It also occurs more often in people who are obese than in those who are not and in those who consume a high fat, low-fiber diet.
Symptoms may be absent or may include change in the usual pattern of bowel habits, esp. in those over 40; recent onset of constipation, diarrhea, or tenesmus in an older patient; bright red or dark blood in the stool. Laboratory findings may include iron-deficiency anemia or positive fecal occult blood tests.
Diagnosis may be suggested by findings on digital rectal examination, anoscopy, flexible or rigid sigmoidoscopy, colonoscopy, virtual colonoscopy, or barium enema examination. It is confirmed by biopsy of suspicious lesions. Prevention includes screening of asymptomatic men and women of average risk starting at age 50, annual home fecal occult blood testing (over a three-day period), and colonoscopy every 10 years. During colonoscopy, removal of benign polyps prevents progression to malignant tumors. If polyps are found, colonoscopy should be repeated in 3 to 5 years (depending on the presence of other risk factors). Detection of colorectal cancer at an early stage via colonoscopy offers patients a very high likelihood of cure rate at 5 years. Neither digital rectal examination nor testing of a single stool specimen from the digital exam provides adequate screening. Patients at increased risk for colorectal cancer (those who have had previous colorectal adenomas or resected cancers or a history of ulcerative colitis or of colon cancer in a first-degree relative younger than 60) should undergo screening more frequently and at an earlier age. When colorectal carcinoma is diagnosed, additional tests are conducted to determine the stage of the disease (chest radiographs, CT, MRI, and blood studies, including carcinoembryonic antigen levels, and liver function studies).
Surgical resection performed by laparotomy, minimally invasive surgery, microsurgery, or laparoscopy can cure localized colorectal cancer. Whatever procedure is used, the type of surgery depends on the location of the tumor, and the goal of the surgery is removal of the malignant tumor and adjacent tissue and any lymph nodes that may contain cancer cells. Adjuvant therapies may include chemoembolization of blood vessels that feed the primary tumor or metastases; radiation therapy; brachytherapy; chemotherapy; or monoclonal antibody therapy. Carcinoembryonic antigen is helpful in monitoring patients during and following treatment to determine effectiveness and detect recurrence or metasasis.
Health care providers should teach patients the importance of colorectal screening and indicate applicable lifestyle modifications (a low-fat diet, maintenance of a normal body mass index). Patients with familial colon cancer syndromes, such as familial adenomatous polyposis, should be counseled about the need for close surveillance by professional gastroenterologists.
Aspirin and other nonsteroidal anti-inflammatory drugs appear to reduce the number of colon polyps, thus decreasing the risk of developing colorectal cancer. Patients interested in such therapy should discuss its potential risks and benefits with their health care providers.
Patients diagnosed with colorectal cancer who undergo surgery need counseling about the operation, the duration of recovery, and, in many cases, the use of a postoperative colostomy . Before surgery, a stomal therapist consults with the surgeon regarding appropriate stoma location, and the abdomen is marked. The therapist answers questions from the patient and family and begins to develop a relationship that will support the patient through postoperative care and teaching. Patient and family are encouraged to access the ACS (800-ACS-2345 or www.cancer.org) for additional information.
epithelial cancerBasal cell carcinoma.
epithelial cancer of the ovarySee: ovarian cancer
esophageal cancerSee: esophageal cancer
fallopian tube cancer
familial medullary thyroid cancerAbbreviation: FMTC
From 1930 to the 1990s, the incidence of gastric cancer declined from about 38 cases per 100,000 to about 6 cases per 100,000. In 2010, the ACS estimated there would be 21,000 new cases of gastric cancer in the U.S. and 10,570 deaths from this disease. The prognosis for a particular patient depends on the stage of the disease at the time of diagnosis, but overall the 5-year survival rate is about 19%.
Although the cause of gastric cancer is unknown, predisposing factors include a diet rich in pickled or smoked foods, a history of gastric surgery, and a history of infection by Helicobacter pylori. The disease runs in some families; therefore, there may also be a genetic component.
Malnutrition occurs as a result of impaired eating, the metabolic demands of the growing tumor, or obstruction of the GI tract. Iron deficiency anemia results as the tumor causes ulceration and bleeding. The tumor can interfere with the production of the intrinsic factor needed for vitamin B12 absorption, resulting in pernicious anemia. As the cancer spreads to regional lymph nodes and nearby structures and metastasizes to other structures, related complications occur.
Signs and Symptoms
In the early stages, the patient may occasionally experience pain in the back or in the epigastric or retrosternal areas that is relieved with nonprescription analgesics. As the tumor grows, the patient may notice a vague feeling of fullness, heaviness, and abdominal distention after meals. Depending on the progression of the cancer, the patient may report weight loss due to disturbance of the appetite; nausea; and vomiting. There may be dysphagia and coffee-ground vomitus if the tumor is located in the cardia and slowly bleeds. Weakness and fatigue are common. Because early symptoms include chronic dyspepsia and epigastric discomfort, patients may self-treat with OTC antacids or histamine blockers, delaying prescribed therapies and allowing the cancer to progress.
Palpation of the abdomen may disclose a mass. A skilled examiner may be able to palpate enlarged lymph nodes, esp. in the supraclavicular and axillary regions.
Gastric cancer is diagnosed by fiber-optic endoscopy with biopsy. Studies to rule out specific organ metastases include endoscopic ultrasonography, computed tomography scans, chest radiographs, liver and bone scans, and liver biopsy.
Radical surgery to remove the tumor is possible in more than one third of patients. Even in the patient whose disease is not considered surgically curable, resection may temporarily ease symptoms and improve the patient’s response to chemotherapy and radiation therapy. The nature and extent of the lesion determine the type of surgery. Surgical procedures include gastroduodenostomy, gastrojejunostomy, partial gastric resection, and total gastrectomy. If metastasis has occurred, the omentum and spleen may have to be removed.
Chemotherapy for GI tumors may help control signs and symptoms and prolong survival. Gastric adenocarcinomas respond to several agents, including fluorouracil, carmustine, doxorubicin, and mitomycin. Tumors that express HER2 antigens respond to treatment with trastuzumab (a monoclonal antibody that targets the human epidermal growth factor). Antispasmodics, antacids, and proton pump inhibitors may help relieve GI acidity and reflux symptoms. Antiemetics can control nausea, which intensifies as the tumor grows. Analgesics, sedatives, and tranquilizers are used to control pain and anxiety.
Nutritional intake is monitored, and the patient is weighed periodically. The health care provider initiates comprehensive clinical and laboratory investigations, including serial studies as indicated, if these have not already been done. The patient is prepared physically and emotionally for surgery, chemotherapy, or radiotherapy. During hospitalization, all general patient care concerns apply.
Throughout the course of the illness, a high-protein, high-calorie diet with vitamin supplementation helps the patient avoid or recover from weight loss, malnutrition, and anemia, and promote wound healing. Frequent small meals are offered.
To stimulate a poor appetite, antidepressant or steroid drugs may be administered. The patient is instructed in use of all drugs and the expected adverse effects of treatment, as well as in management strategies for these effects.
Radiation therapy may cause nausea, vomiting, local skin damage, malaise, diarrhea, and fatigue. Chemotherapy may cause bone marrow suppression, infection, nausea, vomiting, mouth ulcers, and hair loss. During radiation or chemotherapy, oral intake is encouraged to remove toxic metabolites. Bland fruit juices, ginger ale, or other fluids, and prescribed antiemetics are provided to minimize nausea and vomiting; comfort and reassurance are offered as needed. The patient is advised to report persistent adverse reactions.
The patient is encouraged to follow a normal routine as much as possible after recovery from surgery and during radiation therapy and chemotherapy. He should stop activities that cause excessive fatigue (at least temporarily) and incorporate rest periods. The patient should avoid crowds and people with known infections. Home-health care is provided as necessary. If curative treatment fails, palliative care and psychological support continues, with questions answered honestly but tactfully. Home or in-patient hospice care referrals are suggested as available.
Synonym: stomach cancer
head and neck cancer
kidney cancerRenal cell carcinoma.
The disease may cause severe pain and tenderness; cachexia (loss of weight); and encephalopathy. Jaundice is common. The liver is enlarged, its surface is nodular, and a central depression or umbilications can often be detected.
Treatment includes lung surgery, radiation therapy, and chemotherapy usually in combination.
Staging determines the extent of the disease and aids in planning treatment and predicting the prognosis. Lung cancer is relatively difficult to cure but much easier to prevent. Children and adolescents should be discouraged from smoking tobacco products, and current smokers should be assisted in their efforts to quit, e.g., through referrals to local branches of the ACS, smoking-cessation programs, individual counseling, or group therapy.
Screening and Public Health
Chest x-rays do not show small, early cancers, but CT scanning can be used to screen people who have a long history of smoking and who are 50 to 60 years old. In this high-risk group, screening detects the disease in its early stages when it is most likely to be curable. However, since screening is very expensive, and since there are millions of smokers, the public health costs of mass screening are high compared with the cost of encouraging smokers to quit or of teaching teenagers not to start smoking.
oral cavity cancer
Currently, more women die of epithelial ovarian cancer than of all other gynecological cancers combined. A small percentage of patients with ovarian cancer may have a hereditary predisposition, e.g., they have BRCA-1 or BRCA-2 genes. High-risk women include those with multiple first-degree relatives (mother, sister, daughter) or second-degree relatives (aunt, grandmother, cousin) with histories of breast or ovarian cancer. Preventive surgery to remove the ovaries and fallopian tubes is the only way such women can significantly reduce their risk.
Ovarian cancer patients may feel threatened or vulnerable. They benefit from pretreatment support and education. Health care professionals address the patient's psychosocial needs while preparing her for treatment and manage the potential adverse reactions and the treatment and changes related to advancing disease.
The first step in care is typically surgical debulking of the tumor. In this phase of care, the surgical oncologist attempts to remove not only the primary tumor, but also as many small tumorlets found within the peritoneum. The patient and family should be taught about the extensive surgical procedure and what to expect after surgery. After surgery, the patient is monitored for infection, circulatory complications, fluid and electrolyte imbalances, and pain. The patient who is to receive chemotherapy should be taught about major adverse reactions to the usual medications employed, taxanes and platinum-based drugs, such as fatigue, nausea and vomiting, hair loss, diarrhea, constipation, mucositis, neuropathy, arthralgia and myalgia, difficulty concentrating (chemobrain), and myelosuppression, as well as about measures to be taken to prevent and manage these problems. Chemotherapy may be given directly into the peritoneum or intravenously. Depression, anger, frustration, and anxiety are common.
After the acute phase of treatment, the patient may undergo premature menopause; loss of fertility; alterations in body image, sexual function, and family relationships; impaired functional capacity; financial difficulties; and loss of spiritual well-being. The patient should be assessed for mood changes, inability to concentrate, fatigue, insomnia, and other symptoms of depression. Her medical history, current medications and treatments, nutritional status, pain rating, elimination pattern, and sexual history should be reviewed for factors that contribute to depression. Participating in a support group, meeting with mental health professionals, and taking an antidepressant or anti-anxiety medication can help alleviate depression and anxiety.
Advancing or relapsing ovarian cancer may cause complications. These may include development of ascites, intestinal obstruction, deep vein thrombosis, malnutrition and cachexia, lymphedema, and pleural effusion. Current five-year survival rates for ovarian cancer are about 30% to 40%. If ovarian cancer recurs after treatment or fails to regress with treatment, palliative and end-of-life care may aid both patients and their families.
cancer of the pancreasPancreatic cancer.
prostate cancerSee: prostate cancer
scirrhous cancerHard cancer.
According to the U.S. Preventative Services Task Force (USPSTF), benefits from routine screening for skin cancers with a total body skin examination are unproven, even in high-risk patients.
stomach cancerGastric cancer.
testicular cancer, germ-cell
cancer of unknown primary site
Patients with such cancers are usually evaluated for tumors that might respond well to therapy, such as a lymphoma, a thyroid cancer, a germ cell tumor, or neoplasms of the breast or prostate.
cancer of uterus
Vulvar cancer accounts for 4% of all gynecological malignancies. More than 50% of cases occur in postmenopausal women between 65 and 70. Generally, vulvar cancers are localized, slow-growing, and marked by late metastasis to the regional lymph nodes. Treatment may include surgery and/or radiation therapy. See: vulvectomy
|Estimated New Cases||Estimated Deaths|
|Oral cavity & pharynx||25,310||10,000||5,210||2,380|
|Colon & rectum||77,250||71,560||24,260||25,700|
|Liver & intrahepatic bile duct||15,190||6,180||12,570||5,840|
|Lung & bronchus||114,690||100,330||90,810||71,030|
|Kidney & renal pelvis||33,130||21,260||8,100||4,910|
|Brain & other nervous system||11,780||10,030||7,420||5,650|
|Breast self-examination||Breast cancer||Monthly self-examination by women is a noninvasive way to screen for changes in the breast. This method detects many benign and cancerous lumps, but its ability to prolong life is still debated.|
|Mammography||Breast cancer||Mammography is clearly effective screening in women over 50. Most mammograms are obtained by women in their 40s. The incidence of cancer is higher in later life, when mammography use tends to decline.|
|Digital rectal examination (DRE)||Colorectal cancer, prostate cancer||DRE is easy to perform and inexpensive but its cancer screening value is unproven; and, when it detects cancers, there is no proof that the test results in better patient outcomes. In addition, DRE detects a very small number of cancers, only those within the reach of the examiner.|
|Fecal occult blood test||Colorectal cancer||In people over 50, testing stool specimens for hidden bleeding detects many cancers; this detection results in earlier treatment and prolongation of life. The accuracy and value of the test relative to sigmoidoscopy and colonoscopy are uncertain.|
|Chest x-ray, sputum cytology, CT of the chest||Lung cancer||Prospective studies have yielded conflicting results for any method of screening for lung cancer in smokers, and the costs of screening, e.g., with computed tomography of the chest, may be prohibitive. The tests are of no value to nonsmokers.|
|Prostate specific antigen (PSA)||Prostate cancer||PSA testing detects many previously undetected prostate cancers but may result in increased death and disease due to complications from subsequent surgery. Refinements in its application may improve its usefulness as a screening tool.|
|Genetic testing||For predisposition to a variety of cancers||The predictive value of genetic testing for cancer is very small. Experts are debating the emotional and ethical consequences of genetic cancer screening tests.|
cancerA disease of DNA. The term is used by the medical profession as a convenient and comprehensive label for all forms of MALIGNANT growths. There are two broad classes of cancers—those which arise from surface linings (CARCINOMAS) and those which arise from solid tissues (SARCOMAS). Cancers spread by local invasion and by lymph and blood spread (METASTASES) and their degree of malignancy is a measure of the rapidity with which they spread. It has long been believed that cancers start either as the result of small genetic changes to genes called tumour suppressor genes that restrain the ability of cells to divide, or to genes called oncogenes which suffer mutations. Research now suggests that many other abnormalities are probably involved. In early cancers there is much disruption of the chromosomes, some of which are duplicated or lost or truncated and parts fused together. Chromosomal instability appears to be an important element. It is only a matter of time before cancers are classified by their pattern of gene abnormality. Although some aspects of the biology of cancers remain obscure, recent years have shown remarkable advances in the effective treatment of many cancers. See also CANCER STEM CELLS.
cancera disease affecting the growth rate of affected tissues, in which the control mechanisms of cells become altered and the cells divide to form neoplastic growths or tumours. ‘Benign’ tumours consist of well-differentiated cells similar to those in the surrounding tissues and are usually harmless unless located in regions where no operation is possible. ‘Malignant’ tumours are dangerous and usually contain embryonic cells, which are capable of floating away and forming new malignant growths in other sites.
Little is known of the cause of cancer, though exposure to CARCINOGENS such as nicotine and mustard gas or the presence of certain microorganisms are possible causes. Radiation, surgery and chemotherapy are all used in the treatment of cancers.
Patient discussion about cancer
Q. how many types of cancer are they?
Each organ is made up of several different tissue types. For example, there is usually a surface covering of skin or epithelial tissue. Underneath that there will be some connective tissue, often containing gland cells. Underneath that there is often a layer of muscle tissue and so on. Each type of tissue is made up of specific types of cells. Cancer can develop in just about any type of cell in the body. So there is almost always more than one type of cancer that can develop in any one organ.
Q. why does it call "cancer"?can you treat cancer?
some of the cancers are treatable but that is a big subject. there are some very nice videos here on the site that can give you a clue about that. just search them there ^ :)
Q. Cancer - incurable? When i was surfing the internet for the incurable disease, i found CANCER is one among them. Is there not a medicine found yet? Really is it incurable?
Although it is not always possible to be certain, doctors are often able to tell whether or not a particular cancer might be cured. Even if cancer is incurable they will usually still offer treatment in the hope of prolonging life and, controlling, symptoms.'