Cancer Care

SPECIFIC CANCERS - Body Areas

• BLADDER CANCER
• BREAST CANCER
• CERVICAL CANCER
• HEAD AND NECK CANCER
• LUNG CANCER
• PROSTATE CANCER
• UTERUS CANCER

BLADDER CANCER

The wall of the bladder has several layers. The urinary bladder consists of three layers that are the epithelium and the subepithelial connective tissue, the muscularis, and perivesical fat. From the three main types of bladder cancers, Transitional cell carcinoma (TCC), accounts for nearly 90 percent of cases. Less common bladder cancers types include squamous cell carcinomas. Different types of bladder cancers are treated differently and treatment process may vary from patient to patient.

Epidemiology

• Bladder cancer is one of the most common malignancies and it occurs more commonly in males.
• Approximately 54,000 Americans will be diagnosed with bladder cancer this year. <TOP>

Risk Factors

• The most common factors include smoking, exposure to chemicals and schistosomiasis.
• Smokers face twice the risk of having cancer compared to nonsmokers. <TOP>

Symptoms

• Most common symptom of bladder cancer is blood in the urine. It is usually a painless symptom.
• Others include an increased frequency of urination, urgency to urinate, and feeling the need to urinate but not being able to, and painful urination. <TOP>

Diagnosis

• It is often diagnosed by examining cells in the urine under a microscope and by inspecting the bladder with a cystoscope—a slender tube fitted with lens and a light that is inserted into the bladder through the urethra.
• If diagnosed with cancer then a tissue sample is removed during the cystoscopic procedure and examined under a microscope. Also a computed tomography (CT) may be needed to determine the stage of the cancer. <TOP>

Treatment

• Treatment for bladder cancer varies greatly depending on the state of the disease at the time of diagnosis. <TOP>

BREAST CANCER

Cancer is a group of diseases that can appear in any part of the body and take many forms. Breast cancer is a disease in which malignant (cancerous) cells are found in breast tissues. Most cancers form initially in the terminal duct lobular units of the breast. Glandular tissue is more abundant in the upper outer portion of the breast; as a result, half of all breast cancers occur in this area. The glandular tissue consists of lobules that group together into 15-25 lobes arranged approximately in a spoke-like pattern. <TOP>

Anatomy

• The mammary gland lies over the pectoralis major muscle and extends from the second to the sixth rib in the vertical plane and from the sternum to the anterior or midaxillary line.
• The mamma consists of glandular tissue arranged in multiple lobes composed of lobules connected in ducts, areolar tissue, and blood vessels.
• A network of lymphatics is formed over the entire surface of the chest, neck, and abdomen and becomes dense under the areola.
• The following lymphatic pathways originate mostly in the base of the breast: The axillary or principal pathway passes form the upper and lower halves of the breast to the chain of nodes situated between the second and third intercostal space; the transpectoral pathway passes through the pectoralis major muscle to the supraclavicular lymph nodes; and the internal mammary pathway passes through the midline, through the pectoralis major and intercostals muscles (usually close to the sternum) to the nodes of the internal mammary chain. <TOP>

Natural History

• As breast cancer grows, it travels along the ducts, eventually breaking through the basement membrane of the duct to invade adjacent lobules, ducts, fascial strands, mammary fat, and skin. It then spreads through the breast lymphatics and into the peripheral lymphatics; tumor can invade blood vessels.
• About 20 to 40 percent of newly diagnosed stage T1 and T2 breast cancers, respectively, have pathologic evidence of axillary nodal metastases; the incidence is correlated with tumor size.
• Metastases to the internal mammary nodes are more frequent from inner quadrant and central lesions; they occur more often when there is axillary node involvement. Supraclavicular nodes occasionally are involved.
• Vascular invasion by tumor and hematogenous metastases to the lungs, pleura, bone, brain, eyes, liver, ovaries, and adrenal and pituitary glands occurs, even with small tumors.
• Metachronous bilateral carcinoma of the breast occurs in 5 to 8 percent of patients and is simultaneous in approximately 1 percent. <TOP>

Clinical Presentation

• Patients with carcinoma in situ, T1, or T2 breast cancers present with a painless or slightly tender breast mass or have an abnormal screening mammorgram.
• Mammography used to detect about 40 to 50 percent of these lesions; about 35 percent of tumors detected by mammography and physical examination are invasive carcinomas smaller than 1 cm. <TOP>

Epidemiology

• Breast cancer is one of the deadliest cancer in women in the U.S. According to the American Cancer Society (ACS), approximately 211, 300 new cases are expected to occur in the year 2003.
• The lifetime risk of any particular woman getting breast cancer is about 1 in 8. <TOP>

Risk Factors

• Since there are many factors contributed to breast cancer recurrence, every women’s risk is different. Women who are childless, or had her first child at the age after 30 has increased the risk for breast cancer.
• The most important risk factor is age - woman who are older has a greater chance of getting breast cancer (having a mother, sister, or daughter with breast cancer doubles your risk).
• About 5-20 percent of women with breast cancer have several relatives who have had breast cancer and/or ovarian cancer.
• Patients with previous cancer are at a higher risk to spread to the lymph nodes and whose tumor was large in size.
• Family history of this disease.
• Having had radiation therapy to the chest region.
• Being Caucasian.
• Having your menopause late (after 50 years old).
• Getting your periods young (before your 12 years of age).
• Risk factor increases by having genetic mutation. <TOP>

Symptoms

The early stages of breast cancer may not have any symptoms. It is important to follow screening recommendations by your doctor. As a tumor grows, it can produce a variety of symptoms including:
• Lump or thickening in the breast or underarm.
• Change in size or shape of the breast.
• Nipple discharge or nipple turning inward.
• Redness or scaling of the skin or nipple.
• Ridges or pitting of the breast skin.
• Diagnosis/Stages.
• The method used to detect breast cancer is a mammogram. A diagnostic mammogram is another set of x-rays; however, it is more complete with close ups on the suspicious areas.
• Ultrasound is another method, uses high-frequency sound waves to outline the suspicious areas of the breast.
• When breast cancer is suspected, a doctor will perform a biopsy. A biopsy may be performed with surgery. There are different types of biopsies; they differ on how the much tissue is removed. To performs biopsy some use a very fine needle, while others use thicker needles or even a small surgical procedure to remove more tissue. Your doctor will decide which type of biopsy is needed depending on your particular breast mass.

Doctors diagnose and classify breast cancer according to stages. In order to determine the stage of breast cancer, the oncologist considers three important factors: tumor size, nodal status, and metastasis. This staging is narrow to a simple version:

• Stage 0 (called carcinoma in situ)
• Lobular or ductal carcinoma in situ: Lobular carcinoma (LCIS) refers to abnormal cells lining a gland in the breast. Ductal carcinoma (DCIS) refers to abnormal cells lining a duct.
• Stage I early stage breast cancer where the tumor is less that 2 cm across and hasn't spread beyond the duct or lobule.
• Stage II - early stage breast cancer where the tumor is either less than 2 cm across and has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm but still confined to the breast; or the tumor is larger than 5 cm and hasn't spread outside the breast
• Stage III locally advanced breast cancer where the tumor is greater than 5 cm across and has spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast.
• Stage IV metastatic breast cancer where the cancer has spread outside the breast to other organs in the body, most often the bones, lungs, liver, or brain. Depending on the stage of your cancer, your doctor may want additional tests to see if you have metastatic disease. <TOP>

Treatment

• Surgery is usually the first choice of treatment for breast cancer. Nearly all women with breast cancer will have some type of surgery. The surgery is to remove as much of the cancer as possible, and there are many different ways that the surgery can be carried out.
• In breast conservation therapy (BCT) surgeons perform a lumpectomy which means they remove the tumor with a little bit of breast tissue around it but do not remove the entire breast.
• In advanced-stage treatment when cancer spreads, or metastasizes, from the initial site in the breast, it often does so through the lymph system. If the lymph nodes contain cancer, she may need chemotherapy which is an aggressive treatment. To prevent cancer cells from establishing themselves elsewhere in the body, the lymph nodes that drain the breast area are often removed during surgery.
• In order to decrease a patient’s risk of recurrence, many breast cancer patients are offered chemotherapy. Chemotherapy is the use of anti-cancer drugs that go throughout the entire body.
• Radiation therapy is offered to breast cancer patients who received breast conservation therapy (BCT). Radiation therapy is offered to breast cancer patients to rid the body of any microscopic cancer cells that may remain near the area where the cancer was originally found. Your radiation oncologist can answer questions about the utility, process, and side effects of radiation therapy in your particular case. <TOP>

CERVICAL CANCER

Cervical cancer is a disease in which cancer cells are found in the tissues of the cervix. The cervix is the opening of the uterus, extending into the upper end of the vagina. Almost all cases of cervical cancer can be linked to the human papilloma virus (HPV), a sexually transmitted virus. <TOP>

Epidemiology

• Cervical cancers can be detected and can be cured with effective screening.
• Cancer of the cervix is the second most common type of cancer found in women, it affects an estimated 500,000 worldwide each year.
• Women of all ages are at risk of cervical cancer, but the majority of those diagnosed are between ages 30 and 55. <TOP>

Risk Factors

The one risk factor is papilloma viruses, which have been known to cause cervical dysplasia, or precancers, for more than two decades. Women increase their likelihood of developing cervical cancer and HPV infection by:
• Early age at first sexual intercourse.
• Having many sexual partners.
• Smoking, which exposes the body to cancer-causing chemicals that can damage cervical cells, making them more vulnerable to infection.
• Infection with the Chlamydia bacteria, which is spread by sexual contact.
• Infection with HIV.
• A family history of cervical cancer.
• A diet low in fruits and vegetables. <TOP>

Symptoms

• Family history of the disease.
• Pain or bleeding during or after intercourse.
• Unusual discharge from the vagina.
• Signs of spread to other areas of the body include lymph gland enlargement in the groin or collarbone area or left armpit. Advanced spread may give bone, liver, lung, bowel and brain abnormalities. <TOP>

Diagnosis

• Pap test is used to screen women for cancer of the cervix to detect early abnormal cell changes that could lead to cervical cancer.
• First Pap test should be at a age of 21. Continue to have regular Pap tests until you are 65 to 70 years of age and have had 3 normal Pap tests within the last 10 years.
• Biopsy is performed after a Pap test shows an abnormality. Biopsy is removing a sample of cervical tissue for microscopic examination. <TOP>

Treatment

• Treating cervical cancer depends chiefly on the stage of the disease – the size of the cancer, the depth of invasion, and whether the cancer has spread to other parts of the body
• The primary forms of treatment are surgery and combined radiation therapy and chemotheraphy.
• Colposcopy exams the cervix with a special lens that magnifies the surface 40 times.
• Cone Biopsy means cutting out a thin “cone” of the cervical canal for evaluation. <TOP>

HEAD AND NECK CANCER

Head and neck cancer are of the squamous cell variety.  Squamous cells are the thin flat cells that line the surface of the oral cavity, aerodigestive tact and other organs.  These cells may then become pre-cancerous.  Cancers that arise from these cells are called squamous cell carcinomas.  Tumors can occur in several areas of the head and neck region, some are the nasal passages, inuses, mouth, throat, larynx, swallowing passages, salivary glands, and the thyroid gland. 

There are many different types of head and neck cancers.  Some are oral, laryngeal, nasal cavity and paranasal sinus, nasopharyngeal, oropharyngeal, hypopharyngeal, salivary gland, and thyroid.

People who use tobacco or drink alcohol execessively are much more likely than others to develop the disease. <TOP>

Epidemiology

About 2,000 people seek treatment for head and neck cancer.  Head and neck Are of the squamous cell variety. 

Risk Factors
• Risk factors for head and neck cancers include the use of tobacco products, second hand smoke, alcohol, a history of pre-cancerous lesions, and exposure to the cancer-causing agents in the environment.
• People who smoke tobacco and drink alcohol are at a greater risk for the disease.
• A combination of tobacco and alcohol use increases the risk for oral cancer by 6–15 times more than for users of either substance alone
• Smoking raises the risk of cancer of the larynx or hypopharynx much greater than nonsmokers.
• People who have had extensive exposure to the sun are at a higher risk for skin cancers in the areas of head and neck.
• Poor oral hygiene, exposure to occupational inhalants, poor nutrition, gastroesophageal reflux (heartburn), and human papilloma virus infection.
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Symptoms

Some of the symptoms of head and neck cancer are:

• A sore that does not heal over a period of time or that a gums bleed easily.
• Persistent sore throat and hoarseness pain in the neck, throat, or ears that doesn’t go away.
• Difficulty in swallowing or chewing.
• A lump or swelling in the neck.
• Loosening of teeth or numbness in the tongue or other areas.
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Diagnosis

• Physical examination and a complete medical history will be taken and noting all symptoms and risk factors.  There will be a thorough examination of the head and neck areas and the inside of the mouth and oral cavity.  The tongue and the back of the throat are examined as well. 
• Imaging tests are performed such as a CT or computed tomographic scan and MRI or magnetic resonance image scan or an ultrasound exam. 
• Other tests include a panorex, a barium swallow, dental x-rays, chest x-rays, and radionuclide bone scan.
• Biopsy is performed to avoid any possibilities of cancer when a sore does not heal or a suspicious patch or lump is seen in the mouth, larynx, nasopharynx, or throat. <TOP>

Treatment

• Treatment of head and neck cancer depends on the size of the tumor and location. 
• Other treatments are surgery which is the primary treatment method, radiation therapy and chemotherapy.
• Some patients may need a surgical examination of the lymph nodes in the neck to see if any cancer cells have spread beyond the site of origin <TOP>

LUNG CANCER

Lung cancer refers to malignant tumors that originate in the lung itself. There are two major types of lung cancers: non-small cell and small cell. Each type of lung cancer grows and spreads in different ways and is treated differently.

Small cell lung cancer is usually caused by smoking. It is not common for someone who has never smoked to develop it. Non-small cell lung cancer, the most common type of lung cancer is usually caused by smoking. There are three types of non-small cell lung cancer: squamous cell carcinoma (also called epidermoid carcinoma); adenocarcinoma; and large cell carcinoma.

Mesothelioma is a very rare form of lung cancer of the chest and abdominal lining. The mesothelium is made up of parietal and visceral membranes, thin layers of tissue, which surround organs and body cavities, such as the lungs or abdomen. The mesothelioma is referred by different names, depending on what part of the body it is found. The abdomem is called the peritoneum, in the lungs, the pleura, and in the heart it is called the pericardium. <TOP>

Epidemiology

There are two major types of lung cancers, non-small cell and small cell. - More than 90,000 men and 79,000 women are diagnosed each year with cancer of the lungs and bronchi (the air tubes leading to the lungs). - Studies show that female smokers may be more likely to develop lung cancer than male smokers. <TOP>

Risk Factors

Smoking tobacco - Secondhand smoke increases risk for lung cancer. - Other risk factors are radon which is an odorless radioactive gas produced naturally in rocks and soil. Asbestos – if inhaled, asbestos particles can cause lung damage that leads to lung cancer and mesothelioma which is a rare cancer of the chest and abdominal lining. <TOP>

Symptoms / Diagnosis

Chest pain
Coughing up blood
A cough that doesn't go away and gets worse
Shortness of breath, wheezing, or hoarseness
Fatigue
Swelling of the neck and face
Loss of appetite and weight
Repeated problems with pneumonia or bronchitis

Several techniques used to diagnose lung cancers are the following:
•Imaging tests that include a chest x-rays. Computed tomography (CT) scans, and magnetic resonance imaging (MRI) helps locate abnormal areas in the lung.
•Low-dose helical CT-diagnoses cancer by exposing the patient to less radiation than a conventional chest CT scan while allowing the doctor to see areas of the chest normally obscured in a standard x-ray.
• Combined PET/CT scans is particularly important in imaging lung cancer, which can be difficult to identify on a regular CT scan. PET stands for positron emission tomography scan, which picks up the metabolic signal of actively growing cancer cells in the body, is run simultaneously with the CT scan. o Bronchoscopy & Biopsies- doctors may perform a bronchoscopy, which allows them to examine the bronchial passages using an instrument called a bronchosocope. This is a small tube that is inserted through the nose or mouth, down the throat and into the bronchi. For analysis physicians may remove some tissue during this procedure. A modified form of bronchoscopy is called atuofluorescence bronchoscopy. Physicians may perform a needle biopsy (“fine needle aspiration” or FNA) to remove a smalol sample of tissue for analysis. <TOP>

Treatment

Lung cancer treatment depends the type of lung cancer (non-small cell or small cell), the size, location, and extent of the tumor, and the general health of the lung cancer patient.

Surgery is most often used for non-small cell lung cancers that have no spread beyond the lung.

Three surgical procedures commonly used are the following:
• wedge resection or segmental an operation to remove only a small part of the lung
• lobectomy when the surgeon removes an entire lobe of the lung
• pneumonectomy removal of an entire lung

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. In some cases, the cancer is completely eliminated with chemotheraphy before the patient has even had surgery. For small cell lung cancer the most common treatment, chemotherapy combined with radiation therapy.

Radiation therapy is not he best option, it involves the use of high-energy rays to kill cancer cells. Radiation therapy spares normal tissues and lessens damage to other organs in the chest. This method may also be used to relieve symptoms such as shortness of breath, to relieve pain and bleeding and alleviate problems with swallowing.

Photodynamic therapy (PDT), involves the use of a special chemical that is injected into the bloodstream and absorbed by the cells all over the body. A laser light aimed at the cancer activates the chemical, which then kills the cancer cells that have absorbed it. <TOP>

PROSTATE CANCER

Cancer of this type is most common amongst young men.  Prostate cancer is the growth of malignant class in the prostate.  The prostate is a size of a walnut and it is located below the bladder and in front of the rectum at the bottom of his pelvis.  Its purpose is to make and store seminal fluid, a milky liquid that nourishes sperm.  The gland helps regulate both bladder control and normal sexual functioning.  Nearly 230,000 new cases and 30,000 deaths are expected.  The American Society of Reproductive Medicine concludes that prostate cancer occurs in men 65 years of age or older. <TOP>

Risk Factors

• Men over the age of 50 can develop prostate cancer.  The disease can occur at any age, but it is often found in men that are older.  The risk of developing prostate cancer increases with age. 
• Race is another risk factor, according to the American Society of Reproductive Medicine, African-American men are twice as likely as white men to develop the disease. 
• Prostate cancer have first been seen in men in their twenties and in their ninietines.
• A family history of prostate cancer may also increase a man’s risk of developing the disease, especially if he has family members who are diagnosed with prostate tumors or if they are younger than the age of 60 at the time of diagnosis.
• Studies and Researcher also suggest that a high-fat diet may increase the risk of prostate cancer.  <TOP>

Symptoms

Some of the symptoms of prostate cancer are: • Need to urinate frequently
• Difficulty starting to urinate or hold back urine
• Inability to urinate
• Blood in urine or semen
• Painful or burning urination
• Frequent pain or stiffness in the lower back, hips or upper thighs <TOP>

Diagnosis

• A biopsy is suggested, this is a procedure in which tissue samples are removed from the prostate and then examined by a pathologist. Once the biopsy is completed and it indicates that you do have prostate cancer, your physician will gather more information to further characterize the cancer and help determine the most effective course of treatment.
• Physicians determine the aggressiveness of prostate cancer using the Gleason grading system.  Gleason grading system provides an estimate of the cancer’s potential to grow and spread to other parts of the body. Patients with high-grade cancers, are usually recommended for treatment.
• Diagnostic imaging tests are performed to determine the extent of the tumor in the prostate and whether cancer cells have spread to surrounding tissues or other parts of the body.  Some other tests may include:
• Ultrasound
• Microspectroscopy, a sophisticated chemical analysis, to better define the extent and location of a cancer
• Magnetic resonance imaging (MRI) using an endorectal or surface coil to help assess the extent of the tumor in the prostate and surrounding tissues
• Computed tomography (CT) scans or radionuclide bone scans to see if the disease has spread to lymph nodes, organs, or bones <TOP>

Treatment

Early detection and proper treatment may eliminate prostate cancer or prevent it from progressing.
Surgery is performed to completely eliminate a patient’s cancer while
preserving normal urinary and sexual function, if possible.  According to recent research, surgeons with more experience are more likely to eliminate prostate cancer, and reduce the chance of recurrence of cancer.
While performing prostate cancer surgery, surgeons generally remove the prostate (a procedure called radical prostatectomy), as well as some tissue surrounding it.  Surgeons usually also remove a sample of the lymph nodes in a nearby tissue to determine whether the cancer has spread beyond the prostate.
Generally about 75 percent of men treated with surgery will not have a recurrence of their cancer.
Another treatment for prostate cancer is radiation therapy which uses high-energy rays delivered by external beam (similar to an x-ray) or brachytherapy (implanted radioactive sees).
Intensity modulated radiation therapy- a 3-D image of the prostate from multiple computed tomography (CT) scans and uses this image and moveable leaves similar to the lens on a camera to precisely shape the radiation beam to the contours of the prostate.  The beam delivers high doses of radiation specifically to prostate tissues while sparing surrounding tissues.
Systemic and hormonal therapies are for patients that have a form of the disease that is aggressive or has a high risk of spreading to other sites.   Treatment usually includes hormonal therapy and/or chemotherapy, often in combination with radiation or surgery.  Hormonal therapy is for patients whose prostate cancer has spread beyond the prostate or has recurred after treatment. <TOP>

UTERUS CANCER

Cancer is a group of many related diseases.  All cancers begin in cells, the body’s basic unit of life. There are two types of uterine cancers. Uterine cancers include endometrial cancer and uterine sarcomas, such as leiomyosarcoma.  Cancer of the uterus is cancer in the womb, the hollow, pear-shaped organ where a baby grows during a woman’s pregnancy. 

Endometerial cancer is a common cancer of the female reproductive system.  This cancer begins in the tissue lining (endometrium)  of the uterus.  Since this type of cancer is usually associated with the postmenopausal bleeding endometrial cancer is often found at an early stage.  Uterine sarcomas occur when cancer grows in the muscles or other supporting tissues in the uterus. <TOP>

Epidemiology

• The most common tumor of the female reproductive system
• Usually develops after menopause, between the ages of 50 and 60. 
• About 40,000 women are diagnosed with this disease each year in the United States. <TOP>

Risk Factors

• Age, mostly occurs in women over the age of 50.
• Obesity – the body makes some of its estrogen in fatty tissue.  Obese women with high levels of estrogen have increased the risk of developing uterine cancer.  The risk of this disease is also higher in women with diabetes or high blood pressure.
• Late menopause- after age 52
• Nulliparity (never having given birth) or a history of infertility ( an inability to become pregnant)
• Women who use estrogen alone without progesterone have an increased risk of uterine cancer. 
• Family history- Wite women are 70 percent more likely than African-American women to develop uterine cancer.
• Tamoxifen is a drug taken by women to treat and prevent breast cancer. Although antiestrogen effect on the breast, tamoxifen works like estrogen in some respects, such as countering osteoporosis—and promoting endometrial growth.
• Hormone replacement therapy (HRT) is used to control the symptoms of menopause, to prevent osteoporosis (thinning of the bones), and to reduce the risk of heart disease stroke. <TOP>

Symptoms

• Uterine cancer usually occurs after menopause.  Abnormal vaginal bleeding is the most common symptom or discharge.
• Difficult or painful urination
• Pain during intercourse
• Pain in the pelvic area <TOP>

Diagnosis

• Examination of the pelvic and transvaginal ultrasound are performed.  Transaginal ultrasound is an instrument inserted into the vagina, where high-fequency sound waves at the uterus. 
• Biopsy is performed to remove a sample of tissue from the uterine lining.  This endometrial biopsy may be done in the doctor’s office.  Some women may need to have a dilation and curettage (D&C).  Anesthesia is given to the patient during this procedure, where your doctor widens the cervix and gently scrapes tissue from the inside the uterus. 
• Other diagnostic test may be performed by your doctor if the cancer has spread beyond the uterus.
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Treatment

• Treatment options for endometrial cancer depend on chiefly on the type and   stage of your disease.
• Surgery is often done, hysterectomy (removal of the uterus) cures endometrial cancer.
• Radiation therapy (the use of x-rays or other high-energy waves to kill cancer cells and shrink tumors)
• Hormone therapy and/or chemotherapy (anticancer drugs administered intravenously or orally) after surgery, if some cancer cells remain undetected or if spread. <TOP>