Know Your Cancer

Risk factors for bladder cancer may include:

• Using tobacco, especially smoking cigarettes
• Being a male (Men are four times more likely than women to develop the disease.)
• Being over 40 years of age
• A personal history of chronic urinary tract infections or bladder infections
• Exposure to certain chemotherapy drugs or radiation treatments
• Exposure to certain chemicals or occupations that deal with certain chemicals: this includes those who work in the rubber, leather or chemical industry, hairdressers, printers, painters, machinists, metal workers, textile workers, truck drivers, and those who work at dry cleaners.
• Use of urinary catheters for a prolonged time
• Having a kidney transplant
• Having a history of kidney or bladder stones
• Drinking water with high levels of arsenic
• Prolonged use of the bacteria A. fang chi, found in a Chinese herb
• Certain genetic conditions, including hereditary nonpolyposis colon cancer (HNPCC), otherwise known as Lynch syndrome

What are the symptoms of Bladder Cancer?

How is Bladder Cancer diagnosed?

Risk factors for cervical cancer can include:

• Human papillomavirus (HPV) infection with certain high-risk subtypes
• Smoking cigarettes
• Many sexual partners
• First sexual intercourse at a young age
• Weakened immune system, such as for those with AIDS

What are the symptoms of Cervical Cancer?

How is Cervical Cancer diagnosed?

Anything that increases your chance of getting esophageal cancer is a risk factor. Long-term heartburn or reflux is a factor in half of esophageal cancers. Other esophageal cancer causes and risks include:

• Long-term history of smoking: Half of squamous cell esophageal cancers involve smoking. Smoking also increases the risk of adenocarcinoma.
• Drinking too much alcohol, especially if you smoke
• Barrett’s esophagus, a condition in which chronic acid reflux causes changes in the cells lining the lower esophagus
• Age: Most cases of esophageal cancer are in people over 55.
• Gender: Men are three times more likely than women to develop esophageal cancer.
• Achalasia, a disease in which the sphincter, or muscle, at the bottom of the esophagus fails to open and move food into the stomach
• Tylosis, a rare, inherited disorder that causes excess skin to grow on the soles of the feet and palms. It has a near 100% chance of developing into esophageal cancer.
• Esophageal webs: These flaps of tissue protruding into the esophagus, making swallowing difficult
• Lye ingestion or being around dry-cleaning chemicals
• Diet and weight: Risk is higher if you are overweight, tend to overeat or do not eat a healthy diet
• History of other squamous cell cancers related to tobacco use

Not everyone with risk factors gets esophageal cancer. However, if you have risk factors, you should discuss them with your doctor.

What are the symptoms of Esophageal Cancer?

How is Esophageal Cancer diagnosed?

Factors that can increase the risk of Hodgkin’s lymphoma include:

• Your age. Hodgkin’s lymphoma is most often diagnosed in people between 15 and 30 years old and those over 55.
• A family history of lymphoma. Having a blood relative with Hodgkin’s lymphoma or non-Hodgkin’s lymphoma increases your risk of developing Hodgkin’s lymphoma.
• Being male. Males are slightly more likely to develop Hodgkin’s lymphoma than are females.
• Past Epstein-Barr infection. People who have had illnesses caused by the Epstein-Barr virus, such as infectious mononucleosis, are more likely to develop Hodgkin’s lymphoma than are people who haven’t had Epstein-Barr infections.

What are the symptoms of Hodgkin’s lymphoma?

How is Hodgkin’s lymphoma diagnosed?

A risk factor is anything that increases the chance that a person will develop a particular disease. The main risk factors for lung cancer are:

• A history of or current tobacco use
• Exposure to second-hand smoke
• Exposure to asbestos, arsenic, chromium or other chemicals
• Radiation exposure, including radiation therapy to the breast or chest and radon exposure.
• Living in an area with air pollution
• A family history of lung cancer
• Infection with the human immunodeficiency virus.

Lung cancer symptoms vary from person to person. Sometimes people with lung cancer don’t have any symptoms. Often, symptoms are easily confused with common respiratory illnesses such as bronchitis or pneumonia, delaying an accurate diagnosis.

If you have symptoms of lung cancer, they may include:

• A cough that does not go away and gets worse over time
• Constant chest pain, often made worse by deep breathing, coughing or laughing
• Arm or shoulder pain
• Coughing up blood or rust-colored phlegm
• Shortness of breath, wheezing or hoarseness
• Repeated episodes of pneumonia or bronchitis
• Swelling of the neck and face. This occurs when the tumor compresses a large vein, the superior vena cava, that moves blood to the heart from the head and arms
• Loss of appetite and/or weight loss
• Feeling weak or tired
• Widening of the fingertips and nailbed also known as “clubbing.” This symptom is common in non-small cell lung cancer cases, but rare for small cell lung cancer
• If lung cancer spreads to other parts of the body, it may cause:
• Bone pain
• Arm or leg weakness or numbness
• Headache, dizziness or seizure
• Balance problems or an unsteady gait
• Jaundice (yellow coloring) of skin and eyes
• Swollen lymph nodes in the neck or shoulder

These symptoms do not always mean you have lung cancer. However, it is important to discuss any lung cancer symptoms with your doctor, since they may also signal other health problems.In rare cases, lung cancer can be passed down from one generation to the next. Genetic counseling may be right for you. 

Early-stage lung cancer often does not have symptoms. In addition, when symptoms appear they can easily be mistaken for common respiratory illnesses like bronchitis or pneumonia. Because of this, many cases are diagnosed at an advanced stage.

Patients at high risk for lung cancer, especially those with a history of smoking, should undergo regular screenings to catch the disease at its early stages when there is a better chance of cure.

If you have symptoms that signal lung cancer, your doctor will ask you questions about your medical, smoking, and family history and whether you have been around certain chemicals or substances.

You will then undergo an imaging exam, typically a chest X-ray. If the image shows an area of concern, the doctor may order other scans, including a CT scan or PET scan, for additional details regarding the area of concern.

If the findings on the imaging scans indicate cancer, the doctor will request that tissue or fluid be removed from the lung and examined by microscope. The act of obtaining a tissue or fluid sample is called a biopsy. There are several ways doctors can perform biopsies of lung tumors:

• Bronchoscopy: A thin flexible tube with a tiny camera is inserted through the nose or mouth and down into the lungs to obtain a small tissue sample (biopsy). This is usually performed under mild sedation.
• Minimally invasive surgery: A CT-guided biopsy where a needle is inserted through the skin under local anesthesia to acquire a tumor sample.
• Fine needle aspiration (FNA): A very small needle is placed into the tumor. Suction is used to remove a small amount of tissue.
• Thoracentesis: Fluid from around the lungs is drawn out with a needle and tested for cancer cells.
• Endobronchial Ultrasound (EBUS): a bronchoscope with an attached ultrasound device is used to check for lung cancer inside nearby chest lymph nodes. EBUS is often performed at the same time as a bronchoscopy and requires general anesthesia.
• Video-assisted thoracoscopic surgery (VATS): This minimally invasive surgical procedure uses a small camera to help retrieve tumor samples that are otherwise difficult to access. VATS requires a general anesthetic and is performed in the operating room by a thoracic surgeon.

To complete an assessment of how advanced the cancer is, which is called staging, the patient will undergo a PET-CT scan and, in most cases, an MRI of the brain to check for signs of cancer spread to other organs. This will guide the treatment decisions for each patient’s lung cancer.

Your treatment for lung cancer will be customized to your particular needs. It may include one or more of the following therapies to treat the cancer and help relieve symptoms.

Lung Cancer Surgery

Statistically speaking, the more experienced the surgeon, the better the outcomes for lung cancer patients. They operate only on cancers involving the chest and use the most advanced surgical techniques to treat a wide variety of lung cancers, including highly complex cases.

All patients with lung cancer who undergo surgery at the Thoracic Center enroll in a program of enhanced recovery, which aims to minimize pain, surgical stress, and downtime. This leads to faster recovery, fewer side effects, and better quality of life following surgery.

The most common types of surgery for lung cancer, in order of the amount of lung tissue removed, are:

Wedge resection: Removal of the tumor and a pie- or wedge-shaped piece of the lung around the tumor. This procedure is typically used to perform a biopsy of a lung nodule.

Segmentectomy or segmental resection: Removal of a segment, or part, of the lobe where the cancer is located. Both the segmentectomy and wedge resection are typically performed on patients who have limited lung capacity and can’t tolerate the removal of a larger section of the lung. They are also a good option for patients with small early-stage tumors generally measuring less than two centimeters. Both preserve lung capacity and the patient’s quality of life.

Lobectomy: Removal of the lung lobe where the cancer is located. This is considered the “standard of care” for most lung cancer patients who undergo surgery.

Sleeve lobectomy: A more complex form of lobectomy that is typically used for centrally located tumors. Though not always possible, sleeve lobectomies are preferable to pneumonectomy (complete removal of the lung) to preserve more functioning lung tissue.

Pneumonectomy: Removal of the entire lung. This surgery is occasionally required due to the location of the tumor. In people with lungs that are otherwise healthy and function normally, pneumonectomy is well tolerated.

During most of these procedures, the surgeon will also remove lymph nodes from the chest. Since cancer often spreads through these nodes, doctors will examine them under a microscope to find out if the lung cancer has moved outside the lungs. This will help doctors decide if you need further treatment after surgery, such as chemotherapy, radiation therapy, or targeted therapy. Treatment following surgery is called adjuvant therapy.

Occasionally, patients may receive chemotherapy or radiation before surgery to shrink the tumor. This is called neoadjuvant therapy.

Surgical approaches

For some lung cancer surgeries, there are different ways to perform the same procedure. Your surgeon will work with you to choose the best option. These methods include:

• Open surgery: The traditional surgical method. Surgeons perform the procedure through a four- to eight-inch incision between the ribs.
• Minimally invasive surgery: These procedures require several smaller incisions, typically between ¼ and ½ inch, and usually have a shorter recovery time and less pain for the patient. There are two primary methods of minimally invasive surgery for lung cancer patients.
  • Video-assisted thoracic surgery (VATS) or thoracoscopy: This technique uses a small camera and instruments that are inserted into the chest allowing the surgeon to perform the surgery through small incisions. It is typically performed on patients with small, early-stage lung cancers.
  • Robotic-assisted Surgery: This newer method of minimally invasive surgery uses robotic arms remotely controlled by the surgeon. Better images of the surgical site and greater instrument dexterity allow the surgeon to perform more complex surgery than is possible with VATS.

Lung Cancer Radiation Therapy

At most hospitals, radiation oncologists are expected to treat several different types of cancer.  Thoracic Center has radiation oncologists dedicated exclusively to caring for patients with lung cancer. This gives them incredibly deep experience in designing treatment plans.

Working with these radiation oncologists is a team of radiation therapy specialists, including dosimetrists and medical physicists, that helps deliver the maximum amount of radiation with the least damage to healthy cells. The radiation therapy treatments used for lung cancer patients include:

• 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor. This is primarily used as a palliative treatment and not to cure the disease.
• Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor. Brachytherapy is primarily used to treat metastatic growths in the airway. Since most of these growths can be treated with external beam radiation, brachytherapy is rarely used on lung cancer patients.
• Intensity-modulate radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor. This type of radiation is commonly used to treat cancers that have invaded nearby lymph nodes.
• Volumetric-modulate Arc therapy (VMAT): A type of IMRT, in VMAT therapy, the part of the machine that shoots out the beam of radiation rotates around the patient in an arc. This can irradiate the tumor more precisely and shorten procedure times.
• Stereotactic body radiation therapy (SBRT): High doses of radiation delivered with several beams at various intensities and angles to precisely target the tumor. Learn more about SBRT.

Lung cancer proton therapy

A type of radiation therapy, proton therapy delivers a high dose of radiation directly to the tumor, sparing nearby healthy tissue and organs. 

Systemic Therapy for Lung Cancer

There have been significant advances in the treatment of lung cancer through the last decades.

Targeted therapy for lung cancer

Cancer cells use specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules. Currently, there are targeted therapies for many subtypes of adenocarcinoma.

Immunotherapy for lung cancer

Immunotherapies recruit the body’s immune system in the fight against cancer. The current standard of care for non-small cell lung cancer includes the use of checkpoint inhibitor immunotherapies, which take the natural “brakes” off the immune system, allowing it to attack cancer cells. This treatment can lead to durable responses and has revolutionized care for lung cancer patients.

Chemotherapy for lung cancer

Chemotherapy uses drugs to directly kill cancer cells by stopping their growth. This form of treatment is commonly combined with immunotherapy. In combination, both drugs become more effective.

Common signs and symptoms

• Headaches
• Seizures
• Weakness in the arms or legs
• Loss of balance
• Memory loss
• Speech disturbance

Other symptoms

• Behaviour and personality changes
• Blurred vision/vision disturbance
• Numbness
• Hearing loss

Metastatic brain and spine tumors are not usually diagnosed until symptoms appear. Here are some ways doctors may diagnose a metastatic brain tumor:

• Physical exam: After gathering information about your symptoms and personal and family health history, the doctor proceeds with a physical exam and vision and reflex tests.
• Neurological exam
• Computed tomography (CT or CAT scan)
• Magnetic resonance imaging (MRI)
• Diffusion tensor imaging (DTI): This scan allows the surgeon and treating team to visualize the circuitry (or wiring) of the brain to guide the surgery. These images can then be loaded into navigation systems that are used in the operating room to serve as a kind of GPS and map for the surgeon.
• Biopsy

It is important to know that metastatic brain tumors are often treatable and can be well controlled.

Optimal treatment for metastatic brain or spine tumors is tailored to each patient. The neurosurgeon determines the most appropriate treatment approach, considering these factors:

• The type of primary cancer the patient has, response to treatment and current status
• The location and number of metastatic tumors within the brain or spine
• The patient’s general health and preferences regarding potential treatment options
• The patient’s current symptoms

Surgery

Surgery provides fast relief of the “mass effect” — the pressure inside the skull resulting from a growing tumor and swelling of the brain. Patients can experience improvement within hours of surgery if the mass effect is what is causing their symptoms.

The goal of surgery is to minimize the amount of space the tumor takes up by debulking, and removing as much of the tumor as possible while maintaining the patient’s neurological function.

In general, doctors recommend surgery when:

• There is a clear correlation of neurologic deficits with the tumor’s location
• The patient’s primary cancer is treatable and under control
• A patient has one or two metastatic brain tumors, or a few tumors that are close to each other that can be safely removed

The most common type of surgery to remove metastatic brain tumors is called a craniotomy, which can be performed through a variety of approaches, including the keyhole craniotomy.

The surgeon may choose a microsurgery procedure, and use newer tools — such as image-guided surgery and minimally invasive endoscopy — to ensure the best chance for a good outcome.

Radiation

Radiation therapy is the treatment of tumors using X-rays and other forms of radiation (light energy) to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.

These painless treatments involve passing beams of radiation through the body, which can treat cancers in areas of the brain that are difficult to reach through surgery. Procedures may include any one or combination of the following:

• Whole-brain radiation
• External beam radiation therapy
• Stereotactic radiosurgery (e.g., fractionated radiosurgery)
• Liquid radiation

These procedures may also be performed after surgery to prevent tumors from growing near the site of the tumor removal and into other brain tissue.

Choosing radiation therapy is complex and often involves a team approach. Some patients receive a form of radiation therapy called stereotactic radiosurgery instead of surgery. Other patients will receive whole-brain radiation or a combination of both therapies, depending on what the treatment team determines is best.

The Radiation Team

Treatment planning for radiation therapy includes mapping to pinpoint the exact location of the tumor using X-rays or other images.

A radiation oncologist uses these images to create a three-dimensional picture of the patient’s brain. For some types of radiation therapy, a custom-fitted mask is created to increase the precision of the treatment. Fiducials — small markers temporarily attached to the scalp — may also be used.

A radiation oncologist then designs the patient’s treatment, determining the most appropriate radiation dose (the level of radiation energy to be used) and delivery method.

A dosimetrist or medical physicist (professionals who specialize in using radiation therapy equipment and calculating and measuring radiation) will calculate the dose, the angle of the treatment beam, and the amount of time for each beam. After they work with the radiation oncologist to review the calculations, the treatments can be scheduled.

Chemotherapy

Because traditional chemotherapy cannot cross the blood-brain barrier, a new treatment called targeted therapy is used as the primary type of chemotherapy for treating metastatic brain tumors.

These drugs identify and attack cancer cells (the target) with minimal harm to normal cells while preventing the growth and spread of cancer cells. Targeted therapy can be administered after surgery or in conjunction with radiation therapy to destroy remaining cancer cells. Targeted therapies used to treat metastatic brain tumors include:

• Trastuzumab for breast cancer that has metastasized to the brain
• Erlotinib for the most common type of lung cancer (non-small cell lung cancer) that has metastasized to the brain

Immunotherapy

Cancer immunotherapy is a fast-growing field of research that seeks to develop drugs, vaccines, and other therapies that trigger the immune system’s natural abilities to fight cancer.

Although its exact cause is unknown, multiple myeloma can be controlled in most patients, sometimes for many years. However, certain things appear to make you more likely to develop multiple myeloma:

• Age: Over 65
• Gender: Men are slightly more likely to develop multiple myeloma.
• Race: African Americans are twice as likely as white Americans to develop multiple myeloma.
• Radiation exposure
• Family history: If a parent, brother, or sister has the disease, your risk is four times higher. However, this is rare.
• Working in oil-related industry: While some studies suggest this, it has not been proven.
• Obesity
• Other plasma cell diseases: If you have had one of the following you are at higher risk:
  • A precancerous condition called monoclonal gammopathy of undetermined significance (MGUS)
  • A single tumor of plasma cells (solitary plasmacytoma)

Multiple myeloma often doesn’t have symptoms at first. This can make it difficult to diagnose in the early stages. Symptoms of multiple myeloma may include:

• Fractures: Myeloma cells produce substances called cytokines, which can trigger bone cells (osteoclasts) to destroy surrounding bone. When more than 30% of the bone has been destroyed, X-rays show a thinning of the bone (osteoporosis) or dark holes (lytic lesions). The weakened area of bone is more likely to break. This is called a pathological fracture. Bone pain, especially in the middle and/or lower back, rib cage or hips. The pain can be mild or severe depending on the extent of the multiple myeloma, the speed with which it has developed, and whether fracture or nerve compression has occurred. Typically, movement makes the pain much worse.
• Fatigue and/or shortness of breath: Myeloma can cause anemia for some patients which can lead to feeling short of breath with exertion or tiredness more than usual.
• Confusion: For some patients, bone involvement of myeloma can lead to high calcium levels in the blood and/or kidney failure. This can lead to confusion.
• Appetite changes: High calcium levels in the blood and/or kidney failure can also cause a decrease in appetite, weight loss, and nausea.
• Infection: Because myeloma cells crowd out normal white blood cells, which fight infection, there is a risk of infection. Common myeloma infections include pneumonia, bladder or kidney infections, sinusitis, and skin infections.

In addition to a complete medical history and physical examination, diagnostic procedures for multiple myeloma may include the following:

• X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Bone scans are used to evaluate bone involvement with most cancers, but they are unreliable in multiple myeloma.
• Blood and urine tests. These tests are used to look for proteins or other substances that are more likely to be seen in the blood or urine of people with myeloma. 
• Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.
• Skeletal survey. A series of plain X-rays of all of the major bones in the body.
• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays (but often not quite as detailed as MRI scans). 
• Positron emission tomography (PET) scan. Radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use glucose more than normal tissues (such as tumors) can be detected by a scanning machine. PET scans can be used to find small tumors throughout the body

Specific treatment for multiple myeloma will be determined by your doctor based on:

• Your age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatments for myeloma

Standard treatment options include:

• Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade), carfilzomib (Kyprolis) and ixazomib (Ninlaro) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Targeted therapy drugs may be administered through a vein in your arm or in pill form.

  Other targeted therapy treatments include monoclonal antibody drugs that bind to the specific proteins present in myeloma cells, causing them to die.

• Biological therapy. Biological therapy drugs use your body’s immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid), and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are commonly taken in pill form.
• Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a bone marrow transplant.
• Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They are also active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.
• Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.

  Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.

• Radiation therapy. This treatment uses beams of energy, such as X-rays and protons, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells forms a tumor (plasmacytoma) that’s causing pain or destroying a bone.

A risk factor is anything that increases a person’s chance of developing a tumor. Although risk factors often influence the development of a neuroendocrine tumor, most do not directly cause it. Some people with several risk factors never develop a tumor, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person’s risk of developing a neuroendocrine tumor:

• Age. Pheochromocytoma is most common in people between the ages of 40 and 60. Merkel cell cancer is most common in people older than 70.
• Gender. Men are more likely to develop pheochromocytoma than women. For every 2 women who develop pheochromocytoma, 3 men will develop the disease. Men are also more likely to develop Merkel cell cancer than women.
• Race/ethnicity. White people are most likely to develop Merkel cell cancer; however, some black people and people of Polynesian descent develop the disease.
• Family history. Ten percent (10%) of pheochromocytomas are linked to hereditary, or genetic, causes. Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition that increases the risk of developing a tumor in the pituitary gland, parathyroid gland, and pancreas. Multiple endocrine neoplasia type 2 (MEN2) is a hereditary condition associated with medullary thyroid cancer and other types of cancer, including pheochromocytoma.
• Immune system suppression. People with human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS), and people whose immune systems are suppressed because of an organ transplant have a higher risk of developing a neuroendocrine tumor.
• Merkel cell polyomavirus (MCV). Research indicates that there is a link between this virus and Merkel cell cancer. MCV is present in up to an estimated 80% of Merkel cell cancers. However, scientists believe MCV is common, while Merkel cell cancer is not. More research is needed to learn the role of MCV.
• Arsenic exposure. Exposure to the poison arsenic may increase the risk of Merkel cell cancer.
• Sun exposure. Because Merkel cell cancer often occurs on the sun-exposed areas of the head and neck, many doctors think that sun exposure may be a risk factor for this type of cancer. Learn more about protecting your skin from the sun.

• Hyperglycemia, which is a high level of glucose in the blood. Glucose is a sugar that is converted into energy by the body.
• Hyperglycemia causes frequent urination, increased thirst, and increased hunger.
• Hypoglycemia, which is a low level of glucose in the blood. It causes fatigue, nervousness and shakiness, dizziness or light-headedness, sweating, seizures, and fainting.
• Diarrhea
• Persistent pain in a specific area
• Loss of appetite or weight loss
• A cough or hoarseness that does not go away
• Thickening or lump in any part of the body
• Changes in bowel or bladder habits
• Unexplained weight gain or loss
• Jaundice, which is the yellowing of the skin and whites of the eyes
• Unusual bleeding or discharge
• Persistent fever or night sweats
• Headaches
• Anxiety
• Gastric ulcer disease
• Skin rash
• Some people also experience nutritional deficiencies before a diagnosis, such as niacin and protein deficiency. Others develop this symptom later.

Symptoms of pheochromocytoma

Multiple myeloma often doesn’t have symptoms at first. This can make it difficult to diagnose in the early stages. Symptoms of multiple myeloma may include:

• High blood pressure
• Anxiety attacks
• Fever
• Headaches
• Sweating
• Nausea
• Vomiting
• Clammy skin
• Rapid pulse
• Heart palpitations

Symptoms of Merkel cell cancer

• Painless, firm, shiny lumps on the skin that can be red, pink, or blue

In addition to a physical examination, the following tests may be used to diagnose a neuroendocrine tumor:

• Blood/urine tests. The doctor may collect blood and urine samples to check for abnormal levels of hormones and other substances. Urine tests check for increased levels of adrenaline in the body. Large amounts of adrenaline can be a sign of pheochromocytoma.

The glucagon stimulation test and clonidine (Catapres) suppression test are blood tests that measure adrenaline levels for people who sometimes have symptoms of pheochromocytoma. During the glucagon stimulation test, glucagon is injected into a vein. Glucagon is a hormone produced by the pancreas that helps the body process carbohydrates. Blood samples are then drawn at specific times to measure adrenaline levels.

During the clonidine suppression test, a tablet of the drug clonidine is swallowed, and blood samples are taken at regular intervals over the next 3 hours. Clonidine is used to lower adrenaline levels in the blood, so if these levels do not decrease during testing, it may be a sign of a tumor. Blood pressure and heart rate are also carefully monitored during these tests.

• X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation.
• Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumor. A CT scan can also be used to measure a tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow.
• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure a tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.
• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s) removed during the biopsy. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. Other tests can suggest that a tumor is present, but only a biopsy can make a definite diagnosis.
• Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy. See the Treatment Options section for more information.
• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan, called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Some centers are researching the role of PET or PET-CT scans regarding Merkel cell cancer, for both staging and ongoing monitoring of patients during treatment.

Treatment for NETs varies, depending largely on the type and stage of the disease. Common treatment options for neuroendocrine tumors include:

Surgery

Removing the primary tumor with surgery is often the first approach recommended for patients with localized NETs. The goal of surgery is to fully remove a neuroendocrine tumor or reduce the tumor burden. Surgery may also be an option for those with advanced disease, to help relieve symptoms. Some surgical procedures for NETs include debulking or cytoreductive surgery, minimally invasive laparoscopic resections and liver transplantation.

Medical oncology

Depending on the type of NET and treatment goals, chemotherapy, hormone therapy and/or targeted therapy may be used to manage certain types of NETs, including advanced tumors. Some targeted therapies for pancreatic NETs include everolimus and sunitinib. Chemoembolization, in which chemotherapy drugs are administered directly into the tumor, may be an option if the disease has metastasized to the liver.

Radiation therapy

Radiation therapy is generally used when a neuroendocrine tumor has spread or is in a location that makes surgery difficult. CyberKnife® may be a non-invasive option for some patients and enables our radiation oncologists to deliver high, targeted doses of radiation to NETs. For metastatic disease to the liver, TheraSphere® and SIR-Spheres® offer innovative options that deliver radiation directly to tumors in the liver.

Interventional radiology

Radiofrequency ablation may be used for NETs that have spread to the liver. This type of interventional radiology uses high-energy radio waves to heat and destroy cancerous cells. NanoKnife® may be a minimally invasive option for patients with inoperable or difficult-to-reach tumors. Instead of using extreme heat or cold, which may damage normal adjacent tissues, the NanoKnife system uses electrical currents to destroy NETs. For NETs that have spread to the liver, embolization procedures may help reduce or cut off the supply of blood to the tumor.

Gastroenterology

A wide range of treatment options for gastrointestinal NETs are available . Gastroenterologist uses various technologies to look at the GI tract in different and minimally invasive ways. He may recommend innovative techniques and ablative treatments to help remove obstructions in the GI tract and relieve pain or breathing problems.

Molecular targeted therapy

Peptide receptor radionuclide therapy (PRRT) is a molecular-targeted therapy that may be used to treat certain NETs. Molecular targeted therapies use drugs or other substances to identify and attack cancer cells while reducing harm to healthy tissue.

In most cases, people diagnosed with non-Hodgkin’s lymphoma don’t have any obvious risk factors. And many people who have risk factors for the disease never develop it.

Some factors that may increase the risk of non-Hodgkin’s lymphoma include:

• Medications that suppress your immune system. If you’ve had an organ transplant, you’re more susceptible because immunosuppressive therapy has reduced your body’s ability to fight new illnesses.
• Infection with certain viruses and bacteria. Certain viral and bacterial infections appear to increase the risk of non-Hodgkin’s lymphoma. Viruses linked to increased non-Hodgkin’s lymphoma risk include HIV and Epstein-Barr infection. Bacteria linked to an increased risk of non-Hodgkin’s lymphoma include the ulcer-causing Helicobacter pylori.
• Chemicals. Certain chemicals, such as those used to kill insects and weeds, may increase your risk of developing non-Hodgkin’s lymphoma. More research is needed to understand the possible link between pesticides and the development of non-Hodgkin’s lymphoma.
• Older age. Non-Hodgkin’s lymphoma can occur at any age, but the risk increases with age. It’s most common in people 60 or over.

Non-Hodgkin’s lymphoma symptoms vary from person to person. They may include:

• Painless swelling of lymph nodes in the neck, groin, or underarm
• Fevers
• Heavy night sweats
• Tiredness
• Weight loss without a known reason
• Severe itchiness
• Reddened patches on the skin
• Nausea, vomiting or abdominal pain
• Coughing or shortness of breath
• Headaches, concentration problems, personality changes

Symptoms of non-Hodgkin’s lymphoma also often differ by the type of disease. Low-grade (indolent) non-Hodgkin’s lymphoma develops slowly. Patients may have painless swelling of lymph nodes (usually in the neck or over the collarbone) but appear healthy otherwise. The swelling may go away for a while and then return. If low-grade non-Hodgkin’s lymphoma spreads outside the lymph nodes, there may be discomfort in the affected area.

Aggressive non-Hodgkin’s lymphoma grows quicker and tends to have more symptoms than low-grade non-Hodgkin’s lymphoma. Symptoms may include:

• Pain in neck, arms or abdomen
• Fever and/or night sweats
• Unexplained weight loss
• Fatigue
• Shortness of breath
• Weakness in arms and/or legs
• Confusion

Non-Hodgkin’s Lymphoma Diagnostic Tests

If you have symptoms that may signal non-Hodgkin’s lymphoma, your doctor will examine you and ask you questions about your health and your medical history. One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.

• Lymph node biopsy: A small piece of tissue is removed from a lymph node and looked at under a microscope. Sometimes the entire node is removed.
• Imaging tests, which may include:
  • X-rays
  • CT or CAT (computed axial tomography) scans
  • PET (positron emission tomography) scans
  • MRI (magnetic resonance imaging) scans
• Blood tests: To determine if blood cells are normal in number and appearance and if blood chemistry is normal. If you have been diagnosed with non-Hodgkin’s lymphoma, certain blood tests may help doctors determine your outlook.
• Bone marrow aspiration and biopsy
• Liver and kidney function tests
• Echocardiogram: To evaluate the size and function of the heart.
• Immunophenotyping: Cells from a lymph node, blood or bone marrow are examined with a microscope to determine what type of non-Hodgkin’s lymphoma cells are present.
• Pulmonary function test: Finds out how well the lungs function.

If you are diagnosed with non-Hodgkin’s lymphoma, your doctor will discuss the best options to treat it. This depends on several factors, including:

• Type of lymphoma
• Stage and category of disease
• Symptoms
• Your age and general health

Your treatment for non-Hodgkin’s lymphoma cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Chemotherapy

This is the treatment most often used for non-Hodgkin’s lymphoma. And since chemotherapy may lower certain types of blood cells, a transfusion of a type of drug called blood cell growth factors may be needed. Liposomal drug delivery is an advanced way of giving chemotherapy that may help it be more effective.

Radiation Therapy

Radiation therapy may be used in early-stage lymphoma or to help symptoms such as pain. It is seldom the only treatment given.

Proton Therapy

Proton therapy delivers high radiation doses directly to the tumor site, with no damage to nearby healthy tissue. For some patients, this therapy results in better cancer control with fewer side effects.

Immunotherapy

Immunotherapy for Non-Hodgkin’s lymphoma may include:

• Monoclonal antibodies, including Rituximab
• Biological therapies that develop antibodies to help the body fight the cancer
• Proteasome inhibitors, such as Velcade
• Immune modulators, such as thalidomide and lenalidomide, that modify the environment of the tumor cell and allow it to die
• Targeted therapies that attack cancer cells by using small molecules to block pathways cells used to survive and multiply
• Small molecule treatments such as panobinostat
• Cytokine therapies
• Interferon is made by the body to help fight infection. Sometimes interferon that has been made in the laboratory is given to patients with non-Hodgkin’s lymphoma.

Stem cell transplantation: If non-Hodgkin’s lymphoma does not respond to chemotherapy or if it returns, your doctor may recommend a stem cell transplant. Also, since chemotherapy often destroys healthy cells in the blood and bone marrow, patients who have certain types of chemotherapy may need stem cell transplants.

Radioimmunotherapy pairs a monoclonal antibody to a radioactive substance to target cancer cells.

Mouth cancers form when cells on the lips or in the mouth develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The mutation changes tell the cells to continue growing and dividing when healthy cells die. The accumulating abnormal mouth cancer cells can form a tumor. With time they may spread inside the mouth and onto other areas of the head and neck or other parts of the body.

Mouth cancers most commonly begin in the flat, thin cells (squamous cells) that line your lips and the inside of your mouth. Most oral cancers are squamous cell carcinomas.

It’s not clear what causes the mutations in squamous cells that lead to mouth cancer. However doctors have identified factors that may increase the risk of mouth cancer.

Risk factors

Factors that can increase your risk of mouth cancer include:

• Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco, and snuff, among others
• Heavy alcohol use
• Excessive sun exposure to your lips
• A sexually transmitted virus called human papillomavirus (HPV)
• A weakened immune system

Signs and symptoms of mouth cancer may include:

• A lip or mouth sore that doesn’t heal
• A white or reddish patch on the inside of your mouth
• Loose teeth
• A growth or lump inside your mouth
• Mouth pain
• Ear pain
• Difficult or painful swallowing

Diagnosis

Tests and procedures used to diagnose mouth cancer include:

• Physical exam. Your doctor or dentist will examine your lips and mouth to look for abnormalities — areas of irritation, such as sores and white patches (leukoplakia).
• Removal of tissue for testing (biopsy). If a suspicious area is found, your doctor or dentist may remove a sample of cells for laboratory testing in a procedure called a biopsy. The doctor might use a cutting tool to cut away a sample of tissue or use a needle to remove a sample. In the laboratory, the cells are analyzed for cancer or precancerous changes that indicate a risk of future cancer.

Determining the extent of the cancer

Once mouth cancer is diagnosed, your doctor works to determine the extent (stage) of your cancer. Mouth cancer staging tests may include:

• Using a small camera to inspect your throat. During a procedure called endoscopy, your doctor may pass a small, flexible camera equipped with a light down your throat to look for signs that cancer has spread beyond your mouth.
• Imaging tests. A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-ray, CT, MRI, and positron emission tomography (PET) scans, among others. Not everyone needs each test. Your doctor will determine which tests are appropriate based on your condition.

Mouth cancer stages are indicated using the Roman numerals I through IV. A lower stage, such as stage I, indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger cancer, or that cancer has spread to other areas of the head or neck or to other areas of the body. Your cancer’s stage helps your doctor determine your treatment options.

Your treatment for oral cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Surgery is the most frequent first treatment for oral cancer. The type of surgery depends on the type, extent, and stage of the cancer. Surgical techniques are designed to remove all of the cancer in the mouth, and if needed, lymph nodes confirmed or suspected to have cancer cells.

During oral cancer surgery, surgeons work closely with pathologists who use special techniques to examine the tissues and make sure the cancer is removed completely. If needed, plastic surgeons reconstruct the surgical site and help restore function.

Radiation Therapy

Radiation therapy may be used after surgery, either alone or with chemotherapy for more advanced tumors. In rare cases, radiation therapy is used instead of surgery or as a first step in treatment. The method of radiation treatment used depends on the type and stage of cancer.

External-beam radiation therapy is the most frequently used method to deliver radiation therapy to the mouth. Intensity-modulated radiotherapy (IMRT) and proton therapy are aimed at treating the tumor while minimizing damage to surrounding normal tissue.

Internal radiation or brachytherapy delivers radiation with tiny seeds, needles or tubes that are implanted into the tumor. It is used sometimes for treating small tumors or with surgery for advanced tumors.

Proton Therapy

Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in a higher chance for successful treatment with less impact on the body.

Chemotherapy

Chemotherapy may be used to shrink the cancer before surgery or radiation, or it may be combined with radiation to increase the effectiveness of both treatments. It also may be used to shrink tumors that cannot be surgically removed.

Targeted Therapy

Cancer cells need specific molecules to survive, multiply, and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies, such as epidermal growth factor (EGF) receptor inhibitors, are designed to interfere with those molecules or the cancer-causing genes that create them.

Immunotherapy

Cancer cells need to evade the immune system to survive, multiply and spread. A new class of cancer medicines, immunotherapies, work to unmask the cancer to the immune system. These drugs are not currently a standard treatment option for oral cancer outside of a clinical trial, except for patients with unresectable or metastatic cancer.

Risk factors for ovarian cancer can include:

• A family history of ovarian cancer: genetic risk can be transmitted between generations, either through maternal or paternal genetic inheritance. Known gene mutations that confer an increased risk of ovarian cancer and other cancers include BRCA gene mutations, Lynch syndrome genes, and other less common gene mutations.
• Hormone replacement therapy
• Late onset of menopause
• Infertility
• Nulliparity, or a woman who has had no children

What are the symptoms of Ovarian Cancer?

How is Ovarian Cancer diagnosed?

Risk factors for pancreatic cancer include:

• Pancreatic cysts
• Smoking
• Long-standing diabetes
• Chronic pancreatitis (inflammation of the pancreas, especially in people who smoke)
• Age (55+ years)
• Obesity
• Race (African-Americans are more likely to develop pancreatic cancer than white, Hispanic, or Asian Americans)
• Family history of pancreatic cancer
• Genetic factors; one or more inherited genetic mutations, including as part of the following familial cancer syndromes:
• Hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary breast-ovarian cancer (HBOC), hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndromes (FAMMM).

What are the symptoms of Pancreatic Cancer?

How is Pancreatic Cancer diagnosed?

Anything that increases your chance of getting prostate cancer is a risk factor. These include:

• Age: This is the most important risk factor. Most men who develop prostate cancer are older than 50. About two of every three prostate cancers are diagnosed in men older than 65.
• Family history: Risk is higher when other members of your family (especially father, brother, son) have or have prostate cancer, especially if they were young when they developed it.
• Race: African-American men have nearly double the risk of prostate cancer as white men. It is found less often in Asian American, Hispanic, and American Indian men.
• Diet: A high-fat diet, particularly a diet high in animal fats, may increase risk; diets high in fruits and vegetables may decrease risk.
• Nationality: Prostate cancer is more prevalent in North America and northwestern Europe than in other parts of the world.
• Some research suggests that inflammation of the prostate (prostatitis) may play a role in prostate cancer. Sexually transmitted diseases (STDs) are being investigated as possible risk factors as well.

Symptoms may not appear during the early stages of prostate cancer, and most symptoms of prostate cancer vary from person to person. Having these symptoms does not mean you have prostate cancer.

Common prostate cancer signs and symptoms may include:

• Weak or interrupted (“stop-and-go”) urine flow
• Sudden or frequent urge to urinate
• Trouble urinating or starting the flow of urine
• Trouble emptying the bladder completely
• Trouble holding back urination
• Pain or burning urination
• Blood in the urine or semen
• Pain in the back, hips, or pelvis that doesn’t go away
• Shortness of breath, feeling very tired, an accelerated heartbeat, dizziness, or pale skin caused by anemia
• Difficulty having an erection

Some of the symptoms listed above may occur with a condition called benign prostatic hyperplasia (BPH). BPH occurs when the prostate enlarges and interferes with urine flow or sexual function. BPH is not cancer, but surgery may be needed to correct it. The symptoms of BPH or other problems in the prostate mimic the symptoms of prostate cancer.

To diagnose prostate cancer, or to see if the cancer has spread, these tests may be performed:

• Digital rectal exam (DRE)
• A prostate-specific antigen (PSA) test that measures the level of PSA in the blood
• Rectal ultrasound
• Biopsy
• MRI
• Transrectal Ultrasound

The main types of treatment for pancreatic cancer include:

• Treatment for low-risk prostate cancer is often active surveillance. Surgery may be performed to remove a portion of the prostate. Radiation may be suggested for early-stage patients, as surgery and radiation produce similar outcomes.
• Treatment for intermediate-risk prostate cancer generally includes hormone therapy (androgen deprivation) combined with surgery to remove a portion of or the entire prostate, and possibly radiation.
• Treatment for high-risk prostate cancer often includes an emphasis on clinical trials. Hormone therapy and radiation will likely be introduced to the plan, as well. A prostatectomy may be performed, along with removal of affected tissue or lymph nodes.
• Metastatic prostate cancer treatment often includes immunotherapy and hormone therapies.
• Chemotherapy may be introduced if these therapies aren’t successful. Radiation may be suggested at this stage of the disease to ease pain or symptoms.
• For prostate cancer patients with recurrent prostate cancer, surgery will include prostatectomy and radiation. Hormone therapy is occasionally suggested for recurrent cases, as well.

Radiation Therapy

Radiation often is used to treat prostate cancer that is contained within the prostate or the surrounding area. For early-stage disease, patients often have a choice between surgery and radiation with similar outcomes. For larger or more aggressive tumors, radiation therapy may be used in combination with hormone therapy. Radiation also may be used to treat prostate cancer tumors that are not completely removed or that come back after surgery.

Proton therapy delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in better cancer control with fewer side effects.

Hormone Therapy

The majority of prostate cancers are hormone-sensitive, which means male hormones (androgens) such as testosterone fuel the growth of the cancer. About one-third of prostate cancer patients require hormone therapy (also called androgen deprivation), which blocks testosterone production or blocks testosterone from interacting with the tumor cells. This reduces the tumor size or makes it grow more slowly. While hormone therapy may help control prostate cancer, it does not cure it.

Gene Therapy

It is important to examine each prostate cancer tumor carefully to determine gene-expression profiles. Ongoing research will help us determine the most effective and least invasive treatment targeted to specific cancers. This personalized medicine approach sets us above and beyond most cancer centers and allows us to attack the specific causes of each cancer for the best outcome.

Cryotherapy

The tumor is frozen with a long, thin probe inserted into the tumor. Intensive follow-up with X-rays or other imaging procedures is required to ensure that the tumor has been destroyed.

Targeted Therapies

Chemotherapy

• Taxotere® (docetaxel) is one of the standard chemotherapy agents for adenocarcinoma of the prostate.
• Cisplatin-based chemotherapy is used to treat the small-cell variant of prostate cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for basal cell carcinoma and squamous cell carcinoma of the skin include the following:

• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
• Having a fair complexion, which includes the following:
  • Fair skin that freckles and burns easily, does not tan, or tans poorly.
  • Blue, green, or other light-colored eyes.
  • Red or blond hair.

Although having a fair complexion is a risk factor for skin cancer, people of all skin colors can get skin cancer.

• Having a history of sunburns.
• Having a personal or family history of basal cell carcinoma, squamous cell carcinoma of the skin, actinic keratosis, familial dysplastic nevus syndrome, or unusual moles.
• Having certain changes in the genes or hereditary syndromes, such as basal cell nevus syndrome, that are linked to skin cancer.
• Having skin inflammation that has lasted for long periods of time.
• Having a weakened immune system.
• Being exposed to arsenic.
• Past treatment with radiation.

Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

Not all changes in the skin are a sign of basal cell carcinoma, squamous cell carcinoma of the skin, or actinic keratosis. Check with your doctor if you notice any changes in your skin.

Signs of basal cell carcinoma and squamous cell carcinoma of the skin include the following:

• A sore that does not heal.
• Areas of the skin that are:
  • Raised, smooth, shiny, and look pearly.
  • Firm and look like a scar, and may be white, yellow, or waxy.
  • Raised and red or reddish-brown.
  • Scaly, bleeding, or crusty.

Basal cell carcinoma and squamous cell carcinoma of the skin occur most often in areas of the skin exposed to the sun, such as the nose, ears, lower lip, or top of the hands.

Signs of actinic keratosis include the following:

• A rough, red, pink, or brown, scaly patch on the skin that may be flat or raised.
• Cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.

Actinic keratosis occurs most commonly on the face or the top of the hands.

Non-melanoma skin cancer usually starts as an abnormal area or change on any part of the skin. How non-melanoma skin cancer looks often depends on the type of cancer. Other health conditions can also look like non-melanoma skin cancer. See your doctor if you have any changes on your skin.

The following are common signs and symptoms of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the most common types of non-melanoma skin cancer.

Basal cell carcinoma usually develops on areas of skin exposed to the sun, especially the head, face and neck. It can also develop on the central part of the body (trunk). BCC may appear on the skin as:

Basal cell carcinoma usually develops on areas of skin exposed to the sun, especially the head, face and neck. It can also develop on the central part of the body (trunk). BCC may appear on the skin as:

• a sore that doesn’t heal or comes back after healing
• pale white or yellow flat areas that look like scars
• raised and scaly red patches
• small, smooth and shiny lumps that are pearly white, pink or red
• a pink growth with raised edges and indents in the centre
• a growth that has small blood vessels on the surface
• a sore that bleeds
• a growth or area that is itchy

Squamous cell carcinoma usually develops on areas of skin exposed to the sun, but it can also be found on the skin around the genitals and anus. It can occur on the skin of scars, sores, ulcers and burns. SCC may appear on the skin as:

• a sore that doesn’t heal or comes back after healing
• rough or scaly red patches with irregular borders
• raised lumps that indent in the centre
• a growth that looks like a wart
• a sore that is crusty or bleeds easily
• a growth or area that is itchy, irritated or sore

The following procedures may be used:

• Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Skin exam: An exam of the skin for bumps or spots that look abnormal in color, size, shape, or texture.
• Skin biopsy : All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are four main types of skin biopsies:
  • Shave biopsy : A sterile razor blade is used to “shave-off” the abnormal-looking growth.
  • Punch biopsy : A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth.
• Punch biopsy. A hollow, circular scalpel is used to cut into a lesion on the skin. The instrument is turned clockwise and counterclockwise to cut down about 4 millimeters (mm) to the layer of fatty tissue below the dermis. A small sample of tissue is removed to be checked under a microscope. Skin thickness is different on different parts of the body.
• Incisional biopsy : A scalpel is used to remove part of a growth.
• Excisional biopsy : A scalpel is used to remove the entire growth.

The following tests and procedures may be used in the staging process for squamous cell carcinoma of the skin:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the head, neck, and chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Sometimes a PET scan and CT scan are done at the same time.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues, such as lymph nodes, or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. An ultrasound exam of the regional lymph nodes may be done for basal cell carcinoma and squamous cell carcinoma of the skin.
• Eye exam with dilated pupil : An exam of the eye in which the pupil is dilated (opened wider) with medicated eye drops to allow the doctor to look through the lens and pupil to the retina and optic nerve. The inside of the eye, including the retina and the optic nerve, is examined with a light.
• Lymph node biopsy : The removal of all or part of a lymph node. A pathologist views the lymph node tissue under a microscope to check for cancer cells. A lymph node biopsy may be done for squamous cell carcinoma of the skin.

There are different types of treatment for patients with basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis.

Eight types of standard treatment are used:

1. Surgery – One or more of the following surgical procedures may be used to treat basal cell carcinoma, squamous cell carcinoma of the skin, or actinic keratosis .Simple excision: The tumor, along with some of the normal tissue around it, is cut from the skin.

2. Radiation therapy – Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type of cancer being treated. External radiation therapy is used to treat basal cell carcinoma and squamous cell carcinoma of the skin.

3. Chemotherapy – Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemotherapy for basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis is usually topical (applied to the skin in a cream or lotion). The way the chemotherapy is given depends on the condition being treated. Topical fluorouracil (5-FU) is used to treat basal cell carcinoma.

4. Photodynamic therapy – Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein or put on the skin. The drug collects more in cancer cells than in normal cells. For skin cancer, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Photodynamic therapy causes little damage to healthy tissue.

5. Immunotherapy – Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy. Interferon and imiquimod are immunotherapy drugs used to treat skin cancer. Interferon (by injection) may be used to treat squamous cell carcinoma of the skin. Topical imiquimod therapy (a cream applied to the skin) may be used to treat some basal cell carcinomas.

6. Targeted therapy – Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Targeted therapy with a signal transduction inhibitor is used to treat basal cell carcinoma. Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Vismodegib and sonidegib are signal transduction inhibitors used to treat basal cell carcinoma.

7. Chemical peel – A chemical peel is a procedure used to improve the way certain skin conditions look. A chemical solution is put on the skin to dissolve the top layers of skin cells. Chemical peels may be used to treat actinic keratosis. This type of treatment is also called chemabrasion and chemexfoliation.

Other drug therapy – Retinoids (drugs related to vitamin A) are sometimes used to treat squamous cell carcinoma of the skin. Diclofenac and ingenol are topical drugs used to treat actinic keratosis.

No one knows the exact causes of stomach cancer, but risk factors can include: Having any of the following medical conditions:

• Helicobacter pylori (H. pylori) infection of the stomach
• Atrophic gastritis (chronic inflammation of the stomach)
• Pernicious anemia
• Intestinal metaplasia (a condition in which the normal stomach lining is replaced with the cells that line the intestines)
• Familial adenomatous polyposis (FAP) or gastric polyps
• Eating a diet high in salted, smoked foods, and low in fruits and vegetables
• Eating foods that have not been prepared or stored properly
• Being older or male
• Smoking
• Having a mother, father, sister, or brother who has had stomach cancer

Stomach cancer often does not have symptoms in the early stages. When signs do appear, they may be mistaken for less serious problems such as indigestion or heartburn. This means stomach cancer often is not found until it spreads.

Stomach cancer symptoms may include:

• Abdominal pain or discomfort
• Loss of appetite
• Heartburn, indigestion or ulcer-type symptoms
• Nausea and vomiting
• Bloating or swelling in the abdomen
• Diarrhea or constipation
• Feeling of fullness after eating small amounts of food
• Bloody or black stools
• Fatigue
• Unintentional weight loss

If you have any of the following problems, talk to your doctor:

• A new lump or a lump that is growing anywhere on your body
• Abdominal pain that is getting worse
• Blood in your stool or vomit
• Black, tarry stools (this may mean there is internal bleeding)

These symptoms do not always mean you have stomach cancer. However, if you notice any of them for over two weeks, talk to your doctor. Even if they are not signs of cancer, they may signal other health problems.

Initial diagnosis

Your doctor will likely conduct or review these tests:

Physical exam and history: Your doctor examines your body to check general signs of health, including checking for signs of disease, such as lumps and swollen lymph nodes.

Blood chemistry studies: Your doctor takes a blood sample to check the amounts of certain substances released into the blood by organs and tissues in the body.

Complete blood count (CBC): Your doctor takes a sample of blood to check for:

• The number of red blood cells, white blood cells, and platelets.
• The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
• The portion of the sample is made up of red blood cells.

Fecal occult blood test: This test checks your stool for blood that can be seen only with a microscope.

Barium swallow: For this series of X-rays of the stomach, you drink a liquid that contains barium (a silver-white metallic compound). The liquid coats your stomach, and X-rays of it. This procedure is also called an upper GI series.

Endoscopy: Your doctor uses an endoscope (a thin tube) to look inside your stomach. You may receive medications to help you relax during the procedure.

Biopsy: Using an endoscope with a tool for removing cells or tissues, your doctor takes a small sample that your pathologist will later view under a microscope.

CT scan (CAT scan): Your doctor takes detailed pictures of areas inside your body from different angles. The pictures are made by a computer linked to an X-ray machine. You may have dye injected into a vein or you may swallow it to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Stomach Cancer Surgery

Surgery is the most common treatment for stomach cancer, many times with chemotherapy and radiation. If all three therapies are needed,  the standard approach is to give chemotherapy and radiation before surgery. This method usually is more successful and better tolerated.

Surgical techniques for stomach cancer may include:

Endoscopic mucosal resection: An endoscope is inserted down the throat and into the stomach, allowing doctors to remove certain types of early, non-invasive stomach cancers.

Subtotal (partial) gastrectomy: The cancerous part of the stomach, nearby lymph nodes (tissues that filter infection and disease), and parts of other organs near the tumor are surgically removed.

Total gastrectomy: The entire stomach, nearby lymph nodes and sometimes the spleen, parts of the esophagus, intestines, pancreas, and other organs where the cancer has spread, are removed. The esophagus is reconnected to the small intestine you can continue to eat and swallow.

During the surgery, the surgeon forms a new “stomach” from part of the intestine. After surgery, you may:

• Have a feeding tube that goes directly into your small intestine to be sure you receive needed nutrients
• Need to eat smaller, more frequent meals and avoid sugar
• Have abdominal discomfort and diarrhea
• Need to take vitamin supplements as pills or shots (injections)

If a stomach cancer tumor is blocking the stomach but cannot be removed completely, surgery may be done to help you eat normally. Procedures include:

• Endoluminal stent placement: A thin, expandable tube is placed between the stomach and esophagus or small intestine to keep the passageway open.
• Endoluminal laser therapy: An endoscope with a laser is inserted into the body. The laser cuts the tumor.

Stomach cancer chemotherapy

chemotherapy for stomach cancer often is given before surgery to shrink the tumor

Stomach cancer radiation therapy

The most precise methods of radiation therapy, target the stomach cancer while limiting damage to surrounding areas.

Stomach cancer targeted therapies

Targeted therapies are specially designed to treat stomach cancer’s specific genetic and molecular profile to help your body fight the disease.

Stomach cancer gene therapy

Gene therapy is a personalized medicine approach that sets us above and beyond most cancer centers and allows us to attack the specific causes of each stomach cancer.

Risk factors for testicular cancer include:

• Having family members with testicular cancer
• Abnormal development of the testicles
• History of undescended testicle
• Being white
• Exposure to certain chemicals in the environment, such as polyvinylchloride and phthalates

• A lump or enlargement in either testicle
• A feeling of heaviness in the scrotum
• A dull ache in the abdomen or groin
• A sudden collection of fluid in the scrotum
• Pain or discomfort in a testicle or the scrotum
• Enlargement or tenderness of the breasts
• Back pain

Urology

If your blood test is positive for testicular cancer tumor markers, or if your ultrasound reveals a cancerous-appearing lump in your testicle, you will be referred to a specialist called a urologist. Urologists are surgeons who focus on the urinary tracts of males and females, and on the reproductive system of males, including problems with the testicles. For patients with testicular cancer, a urologist will perform the surgery to remove the tumor.

Diagnostic surgery

Unlike other cancers for which a biopsy (the removal of a sample of cells for examination) is performed when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum. A biopsy through the scrotum for testicular cancer runs the risk of spreading the cancer and can complicate future treatment options. Removing the entire testicle out of the scrotum is the only safe way to diagnose testicular cancer. Only the cancer-containing testicle is removed, and it is important to do so promptly. The urology team will make this a priority for you. If there is any uncertainty, the urologists can examine the testicle by pulling the testicle out of the scrotum; if a condition other than testis cancer is found, the testicle is placed back into the scrotum.

This may sound frightening, but recovery is quick. And do not worry — the remaining testicle can do the work of two. Please understand that removal of the testicle will not make you sterile (unable to have children) and does not take away your ability to enjoy sexual activity or have an erection.

Pathology

The removed testicle will be sent to a pathology laboratory for a thorough examination under a microscope. A pathologist is a specially trained doctor who identifies cancerous cells and tumors. DF/BWCC pathologists are well-known for their expert evaluation of testicular cancer. They will diagnose and classify your cancer quickly and competently.

Most testicular cancers are classified as germ-cell tumors. This is not an infection. Instead, the term germ cell reflects the fact that testicles make sperm. Germ cell tumors are divided into two types: seminoma and nonseminoma.

• Seminoma tumors are the more common kind of testicular cancer. They are usually limited to the testicle but occasionally spread to other parts of the body. Seminomas tend to grow very slowly and are very curable.
• Nonseminoma tumors can grow more quickly and can be more likely to spread beyond the testicle to other parts of the body.
• While these tumors are curable, men with nonseminoma tumors are more likely to require chemotherapy at some point in their treatment.

Another test to expect if you are diagnosed with testicular cancer

To decide what treatment is best for you, it is important to know whether or not your testicular cancer has spread beyond the testicle. Another kind of scan can be used to look for cancer in other parts of the body:

• A CT scan (also known as a CAT scan) is a painless procedure that takes a series of detailed x-ray pictures inside the body from different angles. The CT scan is quick and painless and will look at your abdomen and chest. The results are usually ready in just a few hours.

Surgery

Surgical removal of the testicle (radical inguinal orchiectomy) is a highly effective treatment for testicular cancer and is performed immediately to determine the stage of your cancer. Our testicular cancer surgical team at DF/BWCC is one of the most experienced in the country and has been working together for more than a decade. Removing your testicle will not affect your ability to have children in the future or your ability to achieve and sustain an erection. After surgery and any other treatment, you will continue to meet with your team of doctors for regular scans and health check-ups.

Some men dislike the thought of being “unequal,” with a testicle on one side but not the other. A “fake” testicle, called a prosthesis, can be placed in the scrotum at the time of surgery for any man who wishes to have one. This is not a decision you need to make immediately. Our urologists will work closely with you to prepare you for surgery and help you feel comfortable with the changes in your body.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you’re positioned on a table and a large machine moves around you, aiming the energy beams at precise points on your body.

Radiation therapy is a treatment option that’s sometimes used in people who have the seminoma type of testicular cancer. Radiation therapy may be recommended after surgery to remove your testicle.

Side effects may include nausea and fatigue, as well as skin redness and irritation in your abdominal and groin areas. Radiation therapy is also likely to temporarily reduce sperm counts and may impact fertility in some men. Talk to your doctor about your options for preserving your sperm before beginning radiation therapy.

Chemotherapy

Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout your body to kill cancer cells that may have migrated from the original tumor.

Chemotherapy may be your only treatment, or it may be recommended before or after lymph node removal surgery.

Side effects of chemotherapy depend on the specific drugs being used. Ask your doctor what to expect. Common side effects include fatigue, nausea, hair loss and an increased risk of infection. There are medications and treatments available that reduce some of the side effects of chemotherapy.

Chemotherapy may also lead to infertility in some men, which can be permanent in some cases. Talk to your doctor about your options for preserving your sperm before beginning chemotherapy.

Factors that can increase your risk of throat cancer include:

• Tobacco use, including smoking and chewing tobacco
• Excessive alcohol use
• A sexually transmitted virus called human papillomavirus (HPV)
• A diet lacking in fruits and vegetables
• Gastroesophageal reflux disease (GERD)

These and other signs and symptoms may be caused by laryngeal cancer or by other conditions. Check with your doctor if you have any of the following:

• A sore throat or cough that does not go away.
• Trouble or pain when swallowing.
• Ear pain.
• A lump in the neck or throat.
• A change or hoarseness in the voice.

In order to diagnose throat cancer, your doctor may recommend:

• Using a scope to get a closer look at your throat. Your doctor may use a special lighted scope (endoscope) to get a close look at your throat during a procedure called endoscopy. A tiny camera at the end of the endoscope transmits images to a video screen that your doctor watches for signs of abnormalities in your throat.

  Another type of scope (laryngoscope) can be inserted in your voice box. It uses a magnifying lens to help your doctor examine your vocal cords. This procedure is called laryngoscopy.

• Removing a tissue sample for testing. If abnormalities are found during an endoscopy or laryngoscopy, your doctor can pass surgical instruments through the scope to collect a tissue sample (biopsy). The sample is sent to a laboratory for testing. Your doctor may also order a sample of a swollen lymph node using a technique called fine-needle aspiration.
• Imaging tests. Imaging tests, including X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), may help your doctor determine the extent of your cancer beyond the surface of your throat or voice box.

Three types of standard treatment are used:

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• External-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient’s head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat laryngeal cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. A blood test to check the thyroid hormone level in the body may be done before and after therapy to make sure the thyroid gland is working properly.

Hyperfractionated radiation therapy may be used to treat laryngeal cancer. Hyperfractionated radiation therapy is radiation treatment in which a smaller than usual total daily dose of radiation is divided into two doses and the treatments are given twice a day. Hyperfractionated radiation therapy is given over the same period of time (days or weeks) as standard radiation therapy. New types of radiation therapy are being studied in the treatment of laryngeal cancer.

Surgery

Surgery (removing the cancer in an operation) is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

• Cordectomy: Surgery to remove the vocal cords only.
• Supraglottic laryngectomy: Surgery to remove the supraglottis only.
• Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.
• Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient’s ability to talk.
• Total laryngectomy: Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. This is called a tracheostomy.
• Thyroidectomy: The removal of all or part of the thyroid gland.
• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor in the larynx.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Targeted drug therapy

Targeted drugs treat throat cancer by taking advantage of specific defects in cancer cells that fuel the cells’ growth.

As an example, the drug Cetuximab (Erbitux) is one targeted therapy approved for treating throat cancer in certain situations. Cetuximab stops the action of a protein that’s found in many types of healthy cells but is more prevalent in certain types of throat cancer cells.

Although the exact cause of thyroid cancer has not been identified, certain risk factors have been identified. They include:

• Age: Two-thirds of thyroid cancer cases occur between ages 20 and 55.
• Gender: Women are three times as likely as men to develop thyroid cancer. Papillary thyroid cancer is found most often in women of childbearing age.
• Exposure to radiation, including X-rays, especially during childhood
• Inherited disorders: Familial medullary thyroid cancer usually is caused by an inherited mutation in the RET gene. If your parent has the gene mutation, you have a 50% chance of having it too. If you inherit the gene, you are likely to develop the cancer. Other types of thyroid cancer also may be caused by diseases that run in families.
• Iodine deficiency: This is uncommon in the United States, where iodine often is added to table salt. In other areas of the world, especially inland regions without fish and shellfish in the diet, iodine levels are sometimes too low.

Successful treatment of thyroid cancer is more likely when diagnosed early. Unfortunately, it often has few signs or symptoms and they vary from person to person.

If you do have signs or symptoms of thyroid cancer, they may include:

• Lump or nodule in the front of the neck
• Enlargement of the thyroid or swelling in the neck
• Pain in the front of the neck that may stretch to the ears
• Change in voice or hoarseness
• Breathing problems, especially the feeling that you are breathing through a straw
• Cough that does not go away and is not caused by a cold
• Cough with blood
• Swallowing problems

These symptoms do not always mean you have cancer. However, it is important to discuss any signs or symptoms with your doctor, since they may signal other health problems.

Tests and procedures used to diagnose thyroid cancer include:

• Physical exam. Your doctor will look for physical changes in your thyroid and ask about your risk factors, such as excessive exposure to radiation and a family history of thyroid tumors.
• Blood tests. Blood tests help determine if the thyroid gland is functioning normally.
• Removing a sample of thyroid tissue. During a fine-needle biopsy, your doctor inserts a long, thin needle through your skin and into the thyroid nodule. Ultrasound imaging is typically used to precisely guide the needle into the nodule. Your doctor uses the needle to remove samples of suspicious thyroid tissue. The sample is analyzed in the laboratory to look for cancer cells.
• Imaging tests. You may have one or more imaging tests to help your doctor determine whether your cancer has spread beyond the thyroid. Imaging tests may include computerized tomography (CT) scans, positron emission tomography (PET) or ultrasound.
• Genetic testing. Some people with medullary thyroid cancer may have genetic changes that can be associated with other endocrine cancers. Your family history may prompt your doctor to recommend genetic testing to look for genes that increase your risk of cancer.

Surgery

Three types of standard treatment are used:

• Removing all or most of the thyroid (thyroidectomy). In most cases, doctors recommend removing the entire thyroid to treat thyroid cancer. Your surgeon makes an incision at the base of your neck to access your thyroid.

  In most cases, the surgeon leaves small rims of thyroid tissue around the parathyroid glands to reduce the risk of parathyroid damage. Sometimes surgeons refer to this as a near-total thyroidectomy.

• Removing lymph nodes in the neck. When removing your thyroid, the surgeon may also remove enlarged lymph nodes from your neck and test them for cancer cells.
• Removing a portion of the thyroid (thyroid lobectomy). In certain situations where the thyroid cancer is very small, your surgeon may recommend removing only one side (lobe) of your thyroid.

Thyroid surgery carries a risk of bleeding and infection. Damage can also occur to your parathyroid glands during surgery, which can lead to low calcium levels in your body. There’s also a risk of accidental damage to the nerves connected to your vocal cords, which can cause vocal cord paralysis, hoarseness, soft voice, or difficulty breathing.

Thyroid hormone therapy

After thyroidectomy, you’ll take the thyroid hormone medication levothyroxine (Levoxyl, Synthroid, others) for life. This medication has two benefits: It supplies the missing hormone your thyroid would normally produce, and it suppresses the production of thyroid-stimulating hormone (TSH) from your pituitary gland. High TSH levels could conceivably stimulate any remaining cancer cells to grow. You’ll likely have blood tests to check your thyroid hormone levels every few months until your doctor finds the proper dosage for you. Blood tests may continue annually.

Radioactive iodine

Radioactive iodine treatment uses large doses of a form of iodine that’s radioactive. Radioactive iodine treatment is often used after thyroidectomy to destroy any remaining healthy thyroid tissue, as well as microscopic areas of thyroid cancer that weren’t removed during surgery. Radioactive iodine treatment may also be used to treat thyroid cancer that recurs after treatment or that spreads to other areas of the body.

Radioactive iodine treatment comes as a capsule or liquid that you swallow. The radioactive iodine is taken up primarily by thyroid cells and thyroid cancer cells, so there’s a low risk of harming other cells in your body.

Side effects may include:

• Nausea
• Dry mouth
• Dry eyes
• Altered sense of taste or smell
• Fatigue

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is typically given as an infusion through a vein. The chemicals travel throughout your body, killing quickly growing cells, including cancer cells. Chemotherapy is not commonly used in the treatment of thyroid cancer, but it may benefit some people who don’t respond to other therapies. For people with anaplastic thyroid cancer, chemotherapy may be combined with radiation therapy.

Injecting alcohol into cancers

Alcohol ablation involves injecting small thyroid cancers with alcohol using imaging such as ultrasound to ensure precise placement of the injection. This treatment helps treat cancer that occurs in areas that aren’t easily accessible during surgery. Your doctor may recommend this treatment if you have recurrent thyroid cancer limited to small areas in your neck.

Targeted drug therapy

Targeted drug therapy uses medications that attack specific vulnerabilities in your cancer cells. Targeted drugs used to treat thyroid cancer include:

• Cabozantinib (Cometriq)
• Sorafenib (Nexavar)
• Vandetanib (Caprelsa)

These drugs target the signals that tell cancer cells to grow and divide. They’re used in people with advanced thyroid cancer.

Anything that increases your chance of getting vaginal cancer is a risk factor. These include:

• DES (diethylstilbestrol): This drug was given between 1940 and 1971 to some pregnant women to help them not have a miscarriage (lose the baby).
• Vaginal adenosis: In some women, especially those whose mothers took DES, the cells in the vagina change from squamous cells to endometrium (or glandular) cells.
• HPV (human papilloma virus)
• Cervical cancer or pre-cancer
• Smoking
• Drinking alcohol in excess
• HIV (Human immunodeficiency virus)

Early vaginal cancer may not cause any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:

• Unusual vaginal bleeding, for example, after intercourse or after menopause
• Watery vaginal discharge
• A lump or mass in your vagina
• Painful urination
• Frequent urination
• Constipation
• Pelvic pain

Vaginal cancer diagnostic tests

If you have symptoms that may signal vaginal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family history. One or more of the following tests may be used to find out if you have vaginal cancer and if it has spread. These tests also may be used to find out if treatment is working.

Biopsy

The only way to tell for sure if you have vaginal cancer is a biopsy. A small piece of tissue is removed, and then it is looked at under a microscope. Your doctor may use a colposcope to magnify the area and make it easier to remove the tissue. The doctor then looks at the area using colposcope, which is like binoculars with magnifying lenses, or a magnifying glass. A small piece of the suspicious area will be removed.

Imaging tests, which may include:

• CT or CAT (computed axial tomography) scans
• MRI (magnetic resonance imaging) scans
• PET (positron emission tomography) scans
• Chest X-ray

Endoscopic tests, which may include:

Proctosigmoidoscopy: An endoscope is inserted into the rectum to look at the rectum and colon. Biopsies can be done during the procedure.

Cystoscopy: An endoscope is inserted into the bladder through the urethra. Biopsies can be done during the procedure.

Surgery

Types of surgery that may be used to treat vaginal cancer include:

• Removal of small tumors or lesions. Cancer limited to the surface of your vagina may be cut away, along with a small margin of surrounding healthy tissue to ensure that all of the cancer cells have been removed.
• Removal of the vagina (vaginectomy). Removing part of your vagina (partial vaginectomy) or your entire vagina (radical vaginectomy) may be necessary to remove all of the cancer. Depending on the extent of your cancer, your surgeon may recommend surgery to remove your uterus and ovaries (hysterectomy) and nearby lymph nodes (lymphadenectomy) at the same time as your vaginectomy.
• Removal of the majority of the pelvic organs (pelvic exenteration). This extensive surgery may be an option if cancer has spread throughout your pelvic area or if your vaginal cancer has recurred.

During pelvic exenteration, the surgeon may remove many of the organs in your pelvic area, including your bladder, ovaries, uterus, vagina, rectum and the lower portion of your colon. Openings are created in your abdomen to allow urine (urostomy) and waste (colostomy) to exit your body and collect in ostomy bags.

If your vagina is completely removed, you may choose to undergo surgery to construct a new vagina. Surgeons use pieces of skin, sections of intestine or flaps of muscle from other areas of your body to form a new vagina.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation can be delivered two ways:

• External radiation. External beam radiation is directed at your entire abdomen or just your pelvis, depending on the extent of your cancer. During external beam radiation, you’re positioned on a table and a large radiation machine is maneuvered around you in order to target the treatment area. Most women with vaginal cancer receive external beam radiation.
• Internal radiation. During internal radiation (brachytherapy), radioactive devices — seeds, wires, cylinders or other materials — are placed in your vagina or the surrounding tissue. After a set amount of time, the devices may be removed. Those with very early-stage vaginal cancer may receive internal radiation only. Others may receive internal radiation after undergoing external radiation.

Radiation therapy kills quickly growing cancer cells, but it may also damage nearby healthy cells, causing side effects. Side effects of radiation depend on the radiation’s intensity and where it’s aimed.

If surgery and radiation can’t control your cancer, you may be offered other treatments, including:

• Chemotherapy. Chemotherapy uses chemicals to kill cancer cells. It isn’t clear whether chemotherapy is useful for treating vaginal cancer. For this reason, chemotherapy generally isn’t used on its own to treat vaginal cancer. Chemotherapy may be used during radiation therapy to enhance the effectiveness of radiation.