Cancer, Detection & Treatment
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.
Often, patients who need many doses of IV chemotherapy receive the drugs through
a catheter (a thin flexible tube). One end of the catheter is placed in a large
vein in the chest. The other end is outside the body or attached to a small device
just under the skin. Anticancer drugs are given through the catheter. This can
make chemotherapy more comfortable for the patient. Patients and their families
are shown how to care for the catheter and keep it clean. For some types of cancer,
doctors are studying whether it helps to put anticancer drugs directly into the
affected area.
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.
Surgery - The side effects of surgery depend on the location of the tumor, the
type of operation, the patient's general health, and other factors. Although patients
are often uncomfortable during the first few days after surgery, this pain can
be controlled with medicine. Patients should feel free to discuss pain relief
with the doctor or nurse. It is also common for patients to feel tired or weak
for a while. The length of time it takes to recover from an operation varies for
each patient.
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.
In some cases, bone marrow transplantation and peripheral stem cell support are
used to replace tissue that forms blood cells when that tissue has been destroyed
by the effects of chemotherapy or radiation therapy.
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.
What are clinical trials?
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.
What other support is there for cancer patients?
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.
What does the future hold for cancer patients?
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.
What resources are available to patients with cancer
and their families?
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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