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Cancer Detection & Treatment
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The information provided below has been modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America.

How can cancer be detected early?

In many cases, the sooner cancer is diagnosed and treated, the better a person's chance for a full recovery. If you develop cancer, you can improve the chance that it will be detected early if you have regular medical checkups and do certain self-exams. Often a doctor can find early cancer during a physical exam or with routine tests, even if a person has no symptoms. Some important medical exams, tests, and self- exams are discussed on the next pages. The doctor may suggest other exams for people who are at increased risk for cancer.

Ask your doctor about your cancer risk, problems to watch for, and a schedule of regular checkups. The doctor's advice will be based on your age, medical history, and other risk factors. The doctor also can help you learn about self-exams. (More information and free booklets about self-exams are available from the Cancer Information Service).

Many local health departments have information about cancer screening or early detection programs. The Cancer Information Service also can tell you about such programs.

EXAMS FOR BOTH MEN AND WOMEN

Skin - The doctor should examine your skin during regular checkups for signs of skin cancer. You should also check regularly for new growths, sores that do not heal, changes in the size, shape, or color of any moles, or any other changes on the skin. Warning signs like these should be reported to the doctor right away.

Colon and Rectum - Beginning at age 50, you should have a yearly fecal occult blood test. This test is a check for hidden (occult) blood in the stool. A small amount of stool is placed on a plastic slide or on special paper. It may be tested in the doctor's office or sent to a lab. This test is done because cancer of the colon and rectum can cause bleeding. However, noncancerous conditions can also cause bleeding, so having blood in the stool does not necessarily mean a person has cancer. If blood is found, the doctor orders more tests to help make a diagnosis.

To check for cancer of the rectum, the doctor inserts a gloved finger into the rectum and feels for any bumps or abnormal areas. A digital rectal exam should be done during regular checkups.

Every 3 to 5 years after age 50, an individual should have sigmoidoscopy. In this exam, the doctor uses a thin, flexible tube with a light to look inside the rectum and colon for abnormal areas.

Mouth - Your doctor and dentist should examine your mouth at regular visits. Also, by looking in a mirror, you can check inside your mouth for changes in the color of the lips, gums, tongue, or inner cheeks, and for scabs, cracks, sores, white patches, swelling, or bleeding. It is often possible to see or feel changes in the mouth that might be cancer or a condition that might lead to cancer. Any symptoms in your mouth should be checked by a doctor or dentist. Oral exams are especially important for people who use alcohol or tobacco products and for anyone over age 50.

EXAMS FOR MEN

Prostate - Men over age 40 should have a yearly digital rectal exam to check the prostate gland for hard or lumpy areas. The doctor feels the prostate through the wall of the rectum.

Testicles - Testicular cancer occurs most often between ages 15 and 34. Most of these cancers are found by men themselves, often by doing a testicular self-exam. If you find a lump or notice another change, such as heaviness, swelling, unusual tenderness, or pain, you should see your doctor. Also, the doctor should examine the testicles as part of regular medical checkups.

EXAMS FOR WOMEN

Breast - When breast cancer is found early, a woman has more treatment choices and a good chance of complete recovery. It is, therefore, important that breast cancer be detected as early as possible. The National Cancer Institute encourages women to take an active part in early detection. They should talk to their doctor about this disease, the symptoms to watch for, and an appropriate schedule of checkups. Women should ask their doctor about:

  • Mammograms (x-rays of the breast),
  • Breast exams by a doctor or nurse, and
  • Breast self-examination (BSE)

A mammogram can often show tumors or changes in the breast before they can be felt or cause symptoms. However, we know mammograms cannot find every abnormal area in the breast. This is especially true in the breasts of young women. Another important step in early detection is for women to have their breasts examined regularly by a doctor or a nurse.

Between visits to the doctor, women should examine their breasts every month. By doing BSE, women learn what looks and feels normal for their breasts, and they are more likely to find a change. Any changes should be reported to the doctor. Most breast lumps are not cancer, but only a doctor can make a diagnosis. Cervix - Regular pelvic exams and Pap tests are important to detect early cancer of the cervix. In a pelvic exam, the doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for any change in size or shape. For the Pap test, a sample of cells is collected from the upper vagina and cervix with a small brush or a flat wooden stick. The sample is placed in a glass slide and checked under a microscope for cancer or other abnormal cells. Women should start having a Pap test every year after they turn 18 or become sexually active. If the results are normal for 3 or more years in a row, a woman may have this test less often, based on her doctor's advice.

What are symptoms of cancer?

You should see your doctor for regular checkups and not wait for problems to occur. But you should also know that the following symptoms may be associated with cancer: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or any other part of the body, indigestion or difficulty swallowing, obvious change in a wart or mole, or nagging cough or hoarseness. These symptoms are not always a sign of cancer. They can also be caused by less serious conditions. Only a doctor can make a diagnosis. It is important to see a doctor if you have any of these symptoms. Don't wait to feel pain. Early cancer usually does not cause pain.

How is cancer diagnosed?

If you have a sign or symptom that might mean cancer, the doctor will do a physical exam and ask about your medical history. In addition, the doctor usually orders various tests and exams. These may include imaging procedures, which produce pictures of areas inside the body, endoscopy, which allows the doctor to look directly inside certain organs, and laboratory tests. In most cases, the doctor also orders a biopsy, a procedure in which a sample of tissue is removed. A pathologist examines the tissue under a microscope to check for cancer cells.

Imaging

Images of areas inside the body help the doctor tell whether a tumor is present. These images can be made in several ways. In many cases, the doctor uses a special dye so that certain organs show up better on film. The dye may be swallowed or put into the body through a needle or a tube.

X-rays are the most common way doctors made pictures of the inside of the body. In a special kind of x-ray imaging, a CT or CAT scan uses a computer linked to an x-ray machine to make a series of detailed pictures. In radionuclide scanning, the patient swallows or is given an injection of a mildly radioactive substance. A machine (scanner) measures radioactivity levels in certain organs and prints a picture on paper or films. By looking at the amount of radioactivity in the organs, the doctor can find abnormal areas. Ultrasonography is another procedure for viewing the inside of the body. High-frequency sound waves that cannot be heard by humans enter the body and bounce back. Their echoes produce a picture called a sonogram. These pictures are shown on a monitor like a TV screen and can be printed on paper. In MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas in the body. These pictures are viewed on a monitor and can also be printed.

Endoscopy

Endoscopy allows the doctor to look into the body through a thin, lighted tube called an endoscope. The exam is named for the organ involved (for example, colonoscopy to look inside the colon). During the exam, the doctor may collect tissue or cells for closer examination.

Laboratory tests

Although no single test can be used to diagnose cancer, laboratory tests such as blood and urine tests give the doctor important information. If cancer is present, the lab work can show the effects of the disease on the body. In some cases, special tests are used to measure the amount of certain substances in the blood, urine, and other body fluids, or tumor tissue. The levels of these substances may become abnormal when certain kinds of cancer are present.

Biopsy

The physical exam, imaging, endoscopy, and lab tests can show that something abnormal is present, but a biopsy is the only sure way to know whether the problem is cancer. In a biopsy, the doctor removes a sample of tissue from the abnormal area or may remove the whole tumor. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually tell what kind of cancer it is and may be able to judge whether the cells are likely to grow slowly or quickly.

Staging

When cancer is found, the patient's doctor needs to know the stage, or extent, of the disease to plan the best treatment. The doctor may order various tests and exams to find out whether the cancer has spread and, if so, what parts of the body are affected. In some cases, lymph nodes near the tumor are removed and checked for cancer cells. If cancer cells are found in the lymph nodes, it may mean that the cancer has spread to other organs.

How is cancer treated?

Cancer is treated with surgery, radiation therapy, chemotherapy, hormone therapy, or biological therapy. Patients with cancer are often treated by a team of specialists, which may include a medical oncologist (specialist in cancer treatment), a surgeon, a radiation oncologist (specialist in radiation therapy), and others. The doctors may decide to use one treatment method or a combination of methods. The choice of treatment depends on the type and location of the cancer, the stage of the disease, the patient's age and general health, and other factors.

Some cancer patients take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.

Getting a second opinion

Before starting treatment, the patient may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion; others may pay for a second opinion if the patient requests it. There are a number of ways to find specialists to consult for a second opinion.

  • The patient's doctor may suggest a specialist for a second opinion.
  • The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs in their area supported by the National Cancer Institute.
  • Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.

Preparing for treatment

Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. Often, it helps to make a list of questions to ask the doctor. Patients may take notes or, with the doctor's consent, tape record the discussion. Some patients also find it helps to have a family member or friend with them when they talk with the doctor, to take part in the discussion, to take notes, or just to listen.

When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult to think of every question to ask the doctor. Patients may find it hard to remember everything the doctor says. The should not feel they need to ask all their questions or remember all the answers at one time. They will have other chances for the doctor to explain things that are not clear and to ask for more information.

Methods of treatment

Surgery - Surgery is local treatment to remove the tumor. Tissue around the tumor and nearby lymph nodes may also be removed during the operation.

Radiation Therapy - In radiation therapy (also called radiotherapy), high-energy rays are used to damage cancer cells and stop them from growing and dividing. Like surgery, radiation therapy is a local treatment; it affects cancer cells only in the treated area. Radiation can come from a machine (external radiation). It can also come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation). Some patients receive both kinds of radiation therapy.

External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. Patients are not radioactive during or after the treatment.

For internal radiation therapy, the patient stays in the hospital for a few days. The implant may be temporary or permanent. Because the level of radiation is highest during the hospital stay, patients may not be able to have visitors or may have visitors only for a short time. Once an implant is removed, there is no radioactivity in the body. The amount of radiation in a permanent implant goes down to a safe level before the patient leaves the hospital.

Chemotherapy - Treatment with drugs to kill cancer cells is called chemotherapy. Most anticancer drugs are injected into a vein (IV) or a muscle. Some are given by mouth. Chemotherapy is systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body.

Chemotherapy is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on. Usually a patient has chemotherapy as an outpatient at the hospital, at the doctor's office, or at home. However, depending on which drugs are given and the patient's general health, the patient may need to stay in the hospital for a short time.

Hormone Therapy - Some types of cancer, including most breast and prostate cancers, depend on hormones to grow. For this reason, doctors may recommend therapy that prevents cancer cells from getting or using the hormones they need. Sometimes, the patient has surgery to remove organs (such as the ovaries or testicles) that make the hormones. In other cases, the doctor uses drugs to stop hormone production or change the way hormones work. Like chemotherapy, hormone therapy is a systemic treatment; it affects cells throughout the body.

Biological Therapy - Biological therapy (also called immunotherapy) is a form of treatment that uses the body's natural ability (immune system) to fight infection and disease or to protect the body from some of the side effects of treatment. Monoclonal antibodies, interferon, interleukin-2 (IL-2), and several types of colony-stimulating factors (CSF, GM-CSF, G-CSF) are forms of biological therapy.

What are the side effects of cancer treatment?

It is hard to limit the effects of treatment so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unpleasant side effects.

The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently. Attempts are made to plan the patient's therapy to keep side effects to a minimum. Patients are monitored during therapy so that any problems which occur can be addressed.

Radiation Therapy - With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. The most common side effects are tiredness, skin reactions (such as a rash or redness) in the treated area, and loss of appetite. Radiation therapy can also cause a decrease in the number of white blood cells, cells that help protect the body against infection. Although the side effects of radiation therapy can be unpleasant, they can usually be treated or controlled. It also helps to know that, in most cases, they are not permanent.

Chemotherapy - The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to develop infections, may bruise or bleed easily, and may have less energy. Cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients can have side effects, such as loss of appetite, nausea and vomiting, hair loss, or mouth sores. For some patients, medicines can be prescribed to help with side effects, especially with nausea and vomiting. Usually these side effects gradually go away during the recovery period or after treatment stops.

Hair loss, another side effect of chemotherapy, is a major concern for many patients. Some chemotherapy drugs only cause the hair to thin out, while others may result in the loss of all body hair. Patients may feel better if they decide how to handle hair loss before starting treatment.

In some men and women, chemotherapy drugs cause changes that may result in a loss of fertility (the ability to have children). Loss of fertility can be temporary or permanent depending on the drugs used and the patient's age. For men, sperm banking before treatment may be a choice. Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Periods are more likely to return in young women.

Hormone Therapy - Hormone therapy can cause a number of side effects. Patients can have nausea and vomiting, swelling or weight gain, and, in some cases, hot flashes. In women, hormone therapy can also cause interrupted menstrual periods, vaginal dryness, and, sometimes, loss of fertility. Hormone therapy in men can cause impotence, loss of sexual desire, or loss of fertility. These changes may be temporary, long-lasting, or permanent.

Biological Therapy - The side effects of biological therapy depend on the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients develop a rash, and some bleed or bruise easily. In addition, interleukin therapy can cause swelling. Depending on how severe these problems are, patients may need to stay in the hospital during treatment. These side effects are usually short-term and they gradually go away after treatment stops.

Doctors and nurses can explain the side effects of cancer treatment and help with any problems can occur.

How important is nutrition for cancer patients?

Some patients lose their appetite and find it hard to eat well. In addition, the common side effects of treatment, such as nausea, vomiting, or mouth sores, can make it difficult to eat. For some patients, foods taste different. Also, people may not feel like eating when they are uncomfortable or tired.

Patients who eat well during cancer treatment often feel better and have more energy. In addition, they may be better able to handle the side effects of treatment. Eating well means getting enough calories and protein to help prevent weight loss and regain strength.

Doctors, nurses, and dietitians can offer advice for healthy eating during cancer treatment. Patients and their families also may want to read the National Cancer Institute booklet Eating Hints: Recipes and Tips For Better Nutrition During Cancer Treatment, which contains many useful suggestions.

When laboratory research shows that a new treatment method has promise, cancer patients can receive the treatment in carefully controlled trials. These trials are designed to find out whether the new approach is both safe and effective and to answer scientific questions. Often, clinical trials compare a new treatment with a standard approach so that doctors can learn which is more effective.

Researchers also look for ways to reduce the side effects of treatment and improve the quality of patients' lives. Patients who take part in clinical trials make an important contribution to medical science. These patients take certain risks, but they also may have the first chance to benefit from improved treatment methods.

Clinical trials offer important options for many patients. Cancer patients who are interested in taking part in a clinical trial should talk with their doctor. They may want to read What Are Clinical Trials All About?, a booklet that explains treatment studies and outlines some of their possible benefits and risks.

One way to learn about clinical trials is through PDQ, a computerized resource developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials in progress all over the country. The Cancer Information Service can provide PDQ information to doctors, patients, and the public.

Living with a serious disease is difficult. Cancer patients and those who care about them face many problems and challenges. Coping with these difficulties is easier when people have helpful information and support services.

Cancer patients may worry about holding their job, caring for their family, or keeping up with daily activities. Worries about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a nurse, social worker, counselor, or a member of the clergy also can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.

Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. Also, it helps many patients to meet with others who are facing problems like theirs. Cancer patients often get together in support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another, even if they both have the same kind of cancer. It is a good idea to discuss the advice of friends and family members with the doctor.

Often, a social worker at the hospital or clinic can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care. The American Cancer Society has many services for patients and families. Local offices of the American Cancer Society are listed in the white pages of the telephone directory. The Cancer Information Service also has information on local services.

Researchers are finding better ways to detect and treat cancer, and the chance of recovery keeps improving. Still, it is natural for patients to be concerned about their future.

Sometimes patients use statistics to try to figure out their chance of being cured or how long they will live. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike. The doctor who takes care of the patient is in the best position to discuss the chance of recovery (prognosis). Patients should feel free to ask the doctor about their prognosis, but they should keep in mind that not even the doctor knows exactly what will happen. Doctors often talk about surviving cancer, or they may use the term remission rather than cure. Even though many cancer patients can be cured, doctors use these terms because the disease can recur.

Information about cancer is available from many sources, including the ones listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.

CANCER INFORMATION SERVICE (CIS)

1-800-4-CANCER

The Cancer Information Service, a program of the National Cancer Institute, is a nationwide telephone service for cancer patients, their families and friends, the public, and health care professionals. The staff can answer questions in English and Spanish and can send booklets about cancer. They also know about local resources and services. One toll-free number, 1-800-4- CANCER (1-800-422-6237), connects callers with the office that serves their area.

AMERICAN CANCER SOCIETY (ACS)

1599 Clifton Road, N.E.

Atlanta, GA 30329

1-800-ACS-2345

The American Cancer Society is a voluntary organization with a national office and local units all over the country. It supports research, conducts educational programs, and offers many services to patients and their families. To obtain free booklets about services and activities in local areas, call the Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the number listed under "American Cancer Society" in the white pages of the telephone book.

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