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2	CANCER UNCONTROLLED CELL DIVISION SAME BASIC CAUSE MANY DIFFERENT DISEASES AS EACH TISSUE/CELL TYPE IS DIFFERENT WITH REGARD TO WHICH GENES ARE EXPRESSED
3	CANCER TERMS MUTATION = A CHANGE IN THE NUCLEOTIDE SEQUENCE OF DNA MUTAGEN = A CHEMICAL OR PHYSICAL AGENT THAT CAUSES CELLS TO MUTATE CARCINOGEN = A CHEMICAL OR PHYSICAL AGENT THAT CAUSES CELLS TO BECOME CANCEROUS
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6	CANCER TERMS MALIGNANT TUMOR = AN ABNORMAL TISSUE MASS THAT CAN SPREAD INTO NEIGHBORING TISSUE AND TO OTHER PARTS OF THE BODY USUALLY VIA THE LYMPH OR BLOOD; A CANCEROUS TUMOR
7	METASTASIS & MALIGNANCY
8	CANCER TERMS BENIGN TUMOR = AN ABNORMAL MASS OF CELLS THAT REMAINS AT ITS ORGINIAL SITE IN THE BODY
9	CANCER TERMS CELL DIFFERENTIATION = SPECIALIZATION IN THE STRUCTURE AND FUNCTION OF CELLS. DIFFERENT CELL TYPES EXPRESS DIFFERENT GENES AND THUS HAVE DIFFERENT STRUCTURES AND FUNCTIONS
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14	CANCER TERMS TUMOR SUPPRESSOR GENE = A GENE WHOSE PRODUCT INHIBITS CELL DIVISION, THEREBY PREVENTING UNCONTROLLED CELL GROWTH ONCOGENE = A CANCER-CAUSING GENE; USUALLY CONTRIBUTES TO MALIGNANCY BY ABNORMALLY ENHANCING THE AMOUNT OR ACTIVITY OF A GROWTH FACTOR MADE BY THE CELL
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18	MRI – LUNG CANCER
19	METASTATIC LUNG CANCER
20	PROSTATE CANCER
21	BREAST CANCER Risk About 207,000 new cases each year, 50,000 deaths About 1 in 9 women on average At age 20 = 1 in 2500 At age 60 = 1 in 28
22	BREAST CANCER Inherited Breast Cancer About 10% of cases are caused by inheritance of a faulty gene If mother had it, risk is 1.8 times higher, 2.3 times if sister, 2.5 times if both BRCA1 (chromosome 17) codes for tumor suppressor protein protects against ovarian and breast cancer BRCA2 (chromosome 13) associated with breast, not ovarian cancer One good copy could become flawed due to environmental mutagen May develop breast cancer even if both genes are normal
23	BREAST CANCER Noninherited Breast Cancer Complex and difficult to determine relationship between all factors involved Sum of lifetime exposure to estrogen appears to increase risk ½ of breast cancers are estrogen dependent More cycles = greater risk (“Western women”) Women who have child before 30 are at lower risk than nulliparous women Some plant alkaloids are protective (broccoli), beta carotene (vitamin A), olive oil
24	BREAST CANCER Detection Changes in breast that persist: lump, swelling, thickening, skin irritation, nipple discharge or pain Should perform breast self exams once a month after age 20 Mammogram = x-ray of breasts to pick up small lumps Clinical exam and baseline mammogram every 3 years for women aged 20 to 40 Clinical exam and baseline mammogram every 1 to 2 years for women aged 35 to 40 Clinical exam and baseline mammogram once per year for women aged 50 or older New computerized and electrical conduction tests may increase accuracy of detection
25	MAMMOGRAM
26	BREAST CANCER - MAMMOGRAM
27	BREAST CANCER Surgical Treatments Simple Mastectomy = surgical removal of breast Modified Radical Mastectomy = surgical removal of breast and surrounding lymph nodes Radical Mastectomy = surgical removal of breast, axillary lymph nodes and underlying pectoralis major muscle. Partial Mastectomy (lumpectomy) = removal of a portion of the breast when combined with radiation or chemotherapy may be as effective as the more radical surgical techniques
28	COLORECTAL POLYPS & ENDOSCOPY
29	MELANOMA - SKIN CANCER
30	Skin Cancer - ABCs Look for any changes or abnormalities in pigmented skin regions or moles A = Asymmetrical or uneven B = Border; irregular C = Color; mottled or showing dark red patches of color D = Diameter; larger than pencil eraser could potentially be cancerous
31	Tumors Tumors can be benign or malignant: Benign tumors are not cancer: Benign tumors are rarely life-threatening. Generally, benign tumors can be removed. They usually do not grow back. Benign tumors do not invade the tissues around them. Cells from benign tumors do not spread to other parts of the body. Malignant tumors are cancer: Malignant tumors are generally more serious than benign tumors. They may be life-threatening. Malignant tumors often can be removed. But sometimes they grow back. Malignant tumors can invade and damage nearby tissues and organs. Cells from malignant tumors can spread to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the lymphatic system or bloodstream. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
32	Breast Cancer Stats Definition of breast cancer: Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare. Estimated new cases and deaths from breast cancer in the United States in 2007: New cases: 178,480 (female); 2,030 (male) Deaths: 40,460 (female); 450 (male)
33	Breast Cancer Risk Factors Studies have found the following risk factors for breast cancer: Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause. Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast. Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk. Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer. Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. NCI offers publications on gene testing. Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
34	Breast Cancer Risk Factors Reproductive and menstrual history: The older a woman is when she has her first child, the greater her chance of breast cancer. Women who had their first menstrual period before age 12 are at an increased risk of breast cancer. Women who went through menopause after age 55 are at an increased risk of breast cancer. Women who never had children are at an increased risk of breast cancer. Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer. Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
35	Breast Cancer Risk Factors Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life. Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer. Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study. Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese. Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity. Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer. Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.
36	Breast Cancer Screening -Mammograms Screening Mammogram To find breast cancer early, NCI recommends that: Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays. Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them. Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present. If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. (The "Diagnosis" section has more information on biopsy.) Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect: A mammogram may miss some cancers. (The result is called a "false negative.") A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.") Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them. Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.
37	Clinical Breast Exam Clinical Breast Exam During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips. Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid. Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged. A thorough clinical breast exam may take about 10 minutes.
38	Breast Self-Exam Breast Self-Exam You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period. You should contact your health care provider if you notice any unusual changes in your breasts. Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.
39	Symptoms of Breast Cancer Common symptoms of breast cancer include: A change in how the breast or nipple feels A lump or thickening in or near the breast or in the underarm area Nipple tenderness A change in how the breast or nipple looks A change in the size or shape of the breast A nipple turned inward into the breast The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange. Nipple discharge (fluid) Early breast cancer usually does not cause pain. Still, a woman should see her health care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not due to cancer. Other health problems may also cause them. Any woman with these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.
40	Breast Cancer - Diagnosis Diagnosis If you have a symptom or screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order a mammogram or other imaging procedure. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells. Clinical Breast Exam Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture. Your doctor will also check to see if it moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer. Diagnostic Mammogram
41	Breast Cancer - Diagnosis Diagnostic mammograms are x-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram. Doctors use them to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms. Ultrasound An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues. A computer uses the echoes to create a picture. Your doctor can view these pictures on a monitor. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram. Magnetic Resonance Imaging Magnetic resonance imaging (MRI) uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram. Biopsy Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. Fluid or tissue is removed from your breast to help find out if there is cancer. Some suspicious areas can be seen on a mammogram but cannot be felt during a clinical breast exam. Doctors can use imaging procedures to help see the area and remove tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy.
42	Breast Biopsy Doctors can remove tissue from the breast in different ways: Fine-needle aspiration: Your doctor uses a thin needle to remove fluid from a breast lump. If the fluid appears to contain cells, a pathologist at a lab checks them for cancer with a microscope. If the fluid is clear, it may not need to be checked by a lab. Core biopsy: Your doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy. Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells. An incisional biopsy takes a sample of a lump or abnormal area. An excisional biopsy takes the entire lump or area. If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. Abnormal cells are found in the lining of the ducts. Lobular carcinoma is another type. Abnormal cells are found in the lobules. If you are diagnosed with cancer, your doctor may order special lab tests on the breast tissue that was removed. These tests help your doctor learn more about the cancer and plan treatment: Hormone receptor test: This test shows whether the tissue has certain hormone receptors. Tissue with these receptors needs hormones (estrogen or progesterone) to grow. HER2 test: This test shows whether the tissue has a protein called human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. Having too much protein or too many copies of the gene in the tissue may increase the chance that the breast cancer will come back after treatment.
43	Stages of Breast Cancer – 0 & I These are the stages of breast cancer: Stage 0 is carcinoma in situ. Lobular carcinoma in situ (LCIS): Abnormal cells are in the lining of a lobule. (See picture of lobule on page 3.) LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer for both breasts. Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated. Stage I is an early stage of invasive breast cancer. The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have not spread beyond the breast.
44	Stage II Breast Cancer Stage II is one of the following: The tumor is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm. The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has not spread to the lymph nodes under the arm. The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer has spread to the lymph nodes under the arm The tumor is larger than 5 centimeters (2 inches). The cancer has not spread to the lymph nodes under the arm.
45	Stage III Breast Cancer Stage III is locally advanced cancer. It is divided into Stage IIIA, IIIB, and IIIC. Stage IIIA is one of the following: The tumor is no more than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone. The tumor is more than 5 centimeters across. The cancer has spread to underarm lymph nodes that are either alone or attached to each other or to other structures. Or the cancer may have spread to lymph nodes behind the breastbone. Stage IIIB is a tumor of any size that has grown into the chest wall or the skin of the breast. It may be associated with swelling of the breast or with nodules (lumps) in the breast skin. The cancer may have spread to lymph nodes under the arm. The cancer may have spread to underarm lymph nodes that are attached to each other or other structures. Or the cancer may have spread to lymph nodes behind the breastbone. Inflammatory breast cancer is a rare type of breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast. When a doctor diagnoses inflammatory breast cancer, it is at least Stage IIIB, but it could be more advanced. Stage IIIC is a tumor of any size. It has spread in one of the following ways: The cancer has spread to the lymph nodes behind the breastbone and under the arm. The cancer has spread to the lymph nodes above or below the collarbone.
46	Stage IV Breast Cancer Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body. Recurrent cancer is cancer that has come back (recurred) after a period of time when it could not be detected. It may recur locally in the breast or chest wall. Or it may recur in any other part of the body, such as the bone, liver, or lungs.
47	Cervical Cancer Stats Definition of cervical cancer: Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Estimated new cases and deaths from cervical (uterine cervix) cancer in the United States in 2007: New cases: 11,150 Deaths: 3,670
48	Cervical Cancer & HPV Studies have found a number of factors that may increase the risk of cervical cancer. These factors may act together to increase the risk even more: Human papillomaviruses (HPVs): HPV infection is the main risk factor for cervical cancer. HPV is a group of viruses that can infect the cervix. HPV infections are very common. These viruses can be passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives. Some types of HPV can cause changes to cells in the cervix. These changes can lead to genital warts, cancer, and other problems. Doctors may check for HPV even if there are no warts or other symptoms. If a woman has an HPV infection, her doctor can discuss ways to avoid infecting other people. The Pap test can detect cell changes in the cervix caused by HPV. (See the "Screening" section to learn more about the Pap test.) Treatment of these cell changes can prevent cervical cancer. There are several treatment methods, including freezing or burning the infected tissue. Sometimes medicine also helps.
49	Cervical Cancer Risk Factors The NCI offers a fact sheet called "Human Papillomaviruses and Cancer: Questions and Answers." Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells. Treating precancerous cervical changes often prevents cancer. Weakened immune system (the body's natural defense system): Women with HIV (the virus that causes AIDS) infection or who take drugs that suppress the immune system have a higher-than-average risk of developing cervical cancer. For these women, doctors suggest regular screening for cervical cancer. Age: Cancer of the cervix occurs most often in women over the age of 40. Sexual history: Women who have had many sexual partners have a higher-than-average risk of developing cervical cancer. Also, a woman who has had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher-than-average risk of HPV infection. Smoking cigarettes: Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke. Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with HPV infection. Having many children: Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection. Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer and certain other cancers of the reproductive system in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)
50	PAP Smear/Test Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. For most women, the test is not painful. A Pap test is done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix, and then smears the cells on a glass slide. In a new type of Pap test (liquid-based Pap test), the cells are rinsed into a small container of liquid. A special machine puts the cells onto slides. For both types of Pap test, a lab checks the cells on the slides under a microscope for abnormalities. Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer. Doctors generally recommend that: Women should begin having Pap tests 3 years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first). Most women should have a Pap test at least once every 3 years. Women aged 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening. Women who have had a hysterectomy (surgery) to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening. However, if the surgery was treatment for precancerous cells or cancer, the woman should continue with screening. Women should talk with their doctor about when they should begin having Pap tests, how often to have them, and when they can stop having them. This is especially important for women at higher-than-average risk of cervical cancer.
51	PAP Smear/Test Some activities can hide abnormal cells and affect Pap test results. Doctors suggest the following tips: Do not douche for 48 hours before the test. Do not have sexual intercourse for 48 hours before the test. Do not use vaginal medicines (except as directed by a doctor) or birth control foams, creams, or jellies for 48 hours before the test. Doctors also suggest that a woman schedule her Pap test for a time that is 10 to 20 days after the first day of her menstrual period. Most often, abnormal cells found by a Pap test are not cancerous. However, some abnormal conditions may become cancer over time: LSIL (low-grade squamous intraepithelial lesion): LSILs are mild cell changes on the surface of the cervix. Such changes often are caused by HPV infections. LSILs are common, especially in young women. LSILs are not cancer. Even without treatment, most LSILs stay the same or go away. However, some turn into high-grade lesions, which may lead to cancer. HSIL (high-grade squamous intraepithelial lesion): HSILs are not cancer, but without treatment they may lead to cancer. The precancerous cells are only on the surface of the cervix. They look very different from normal cells.
52	Cervical Cancer Symptoms When the disease gets worse, women may notice one or more of these symptoms: Abnormal vaginal bleeding Bleeding that occurs between regular menstrual periods Bleeding after sexual intercourse, douching, or a pelvic exam Menstrual periods that last longer and are heavier than before Bleeding after menopause Increased vaginal discharge Pelvic pain Pain during sexual intercourse Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.
53	Cervical Cancer Diagnosis If a woman has a symptom or Pap test results that suggest precancerous cells or cancer of the cervix, her doctor will suggest other procedures to make a diagnosis. These may include: Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic. Biopsy : The doctor removes tissue to look for precancerous cells or cancer cells. Most women have their biopsy in the doctor's office with local anesthesia. A pathologist checks the tissue with a microscope. Punch biopsy: The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue. LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of tissue. Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette. Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia. Conization also may be used to remove a precancerous area. Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Women may also feel some pain similar to menstrual cramps. Medicine can relieve this discomfort.
54	Cervical Cancer Stages These are the stages of cervical cancer: Stage 0: The cancer is found only in the top layer of cells in the tissue that lines the cervix. Stage 0 is also called carcinoma in situ. Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix. Stage II: The cancer extends beyond the cervix into nearby tissues. It extends to the upper part of the vagina. The cancer does not invade the lower third of the vagina or the pelvic wall (the lining of the part of the body between the hips). Stage III: The cancer extends to the lower part of the vagina. It also may have spread to the pelvic wall and nearby lymph nodes. Stage IV: The cancer has spread to the bladder, rectum, or other parts of the body. Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.
55	Uterine Cancer/Sarcoma Definition of uterine sarcoma: A rare type of uterine cancer that forms in muscle or other tissues of the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a baby grows). It usually occurs after menopause. The two main types are leiomyosarcoma (cancer that begins in smooth muscle cells) and endometrial stromal sarcoma (cancer that begins in connective tissue cells).
56	Endometrial/Uterine Cancer Stats Definition of endometrial cancer: Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a baby grows). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Estimated new cases and deaths from endometrial (uterine corpus) cancer in the United States in 2007: New cases: 39,080 Deaths: 7,400
57	Endometrial Cancer Risk Factors Studies have found the following risk factors: Age. Cancer of the uterus occurs mostly in women over age 50. Endometrial hyperplasia. The risk of uterine cancer is higher if a woman has endometrial hyperplasia. This condition and its treatment are described above. Hormone replacement therapy (HRT). HRT is used to control the symptoms of menopause, to prevent osteoporosis (thinning of the bones), and to reduce the risk of heart disease or stroke. Women who use estrogen without progesterone have an increased risk of uterine cancer. Long-term use and large doses of estrogen seem to increase this risk. Women who use a combination of estrogen and progesterone have a lower risk of uterine cancer than women who use estrogen alone. The progesterone protects the uterus. Women should discuss the benefits and risks of HRT with their doctor. Also, having regular checkups while taking HRT may improve the chance that the doctor will find uterine cancer at an early stage, if it does develop.
58	Endometrial Cancer Risk Factors Obesity and related conditions. The body makes some of its estrogen in fatty tissue. That's why obese women are more likely than thin women to have higher levels of estrogen in their bodies. High levels of estrogen may be the reason that obese women have an increased risk of developing uterine cancer. The risk of this disease is also higher in women with diabetes or high blood pressure (conditions that occur in many obese women). Tamoxifen. Women taking the drug tamoxifen to prevent or treat breast cancer have an increased risk of uterine cancer. This risk appears to be related to the estrogen-like effect of this drug on the uterus. Doctors monitor women taking tamoxifen for possible signs or symptoms of uterine cancer. The benefits of tamoxifen to treat breast cancer outweigh the risk of developing other cancers. Still, each woman is different. Any woman considering taking tamoxifen should discuss with the doctor her personal and family medical history and her concerns. Race. White women are more likely than African-American women to get uterine cancer. Colorectal cancer. Women who have had an inherited form of colorectal cancer have a higher risk of developing uterine cancer than other women
59	Endometrial Cancer Symptoms A woman should see her doctor if she has any of the following symptoms: Unusual vaginal bleeding or discharge Difficult or painful urination Pain during intercourse Pain in the pelvic area
60	Endometrial Cancer Diagnosis If a woman has symptoms that suggest uterine cancer, her doctor may check general signs of health and may order blood and urine tests. The doctor also may perform one or more of the exams or tests described on the next pages. Pelvic exam -- A woman has a pelvic exam to check the vagina, uterus, bladder, and rectum. The doctor feels these organs for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina. Pap test -- The doctor collects cells from the cervix and upper vagina. A medical laboratory checks for abnormal cells. Although the Pap test can detect cancer of the cervix, cells from inside the uterus usually do not show up on a Pap test. This is why the doctor collects samples of cells from inside the uterus in a procedure called a biopsy. Transvaginal ultrasound -- The doctor inserts an instrument into the vagina. The instrument aims high-frequency sound waves at the uterus. The pattern of the echoes they produce creates a picture. If the endometrium looks too thick, the doctor can do a biopsy. Biopsy -- The doctor removes a sample of tissue from the uterine lining. This usually can be done in the doctor's office. In some cases, however, a woman may need to have a dilation and curettage (D&C). A D&C is usually done as same-day surgery with anesthesia in a hospital. A pathologist examines the tissue to check for cancer cells, hyperplasia, and other conditions. For a short time after the biopsy, some women have cramps and vaginal bleeding.
61	Endometrial Cancer Stages These are the main features of each stage of the disease: Stage I -- The cancer is only in the body of the uterus. It is not in the cervix. Stage II -- The cancer has spread from the body of the uterus to the cervix. Stage III -- The cancer has spread outside the uterus, but not outside the pelvis (and not to the bladder or rectum). Lymph nodes in the pelvis may contain cancer cells. Stage IV -- The cancer has spread into the bladder or rectum. Or it has spread beyond the pelvis to other body parts.
62	Ovarian Cancer Stats Definition of ovarian cancer: Cancer that forms in tissues of the ovary (one of a pair of female reproductive glands in which the ova, or eggs, are formed). Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells). Estimated new cases and deaths from ovarian cancer in the United States in 2007: New cases: 22,430 Deaths: 15,280
63	Ovarian Cancer Spread Ovarian cancer can invade, shed, or spread to other organs: Invade: A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus. Shed: Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants. Spread: Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen, and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs.
64	Ovarian Cancer Risk Factors Studies have found the following risk factors for ovarian cancer: Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer. If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer. Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer. Age over 55: Most women are over age 55 when diagnosed with ovarian cancer. Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer. Menopausal hormone therapy: Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.
65	Ovarian Cancer Symptoms Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include: Pressure or pain in the abdomen, pelvis, back, or legs A swollen or bloated abdomen Nausea, indigestion, gas, constipation, or diarrhea Feeling very tired all the time Less common symptoms include: Shortness of breath Feeling the need to urinate often Unusual vaginal bleeding (heavy periods, or bleeding after menopause) Most often these symptoms are not due to cancer, but only a doctor can tell for sure. Any woman with these symptoms should tell her doctor.
66	Ovarian Cancer Diagnosis You may have one or more of the following tests. Your doctor can explain more about each test: Physical exam: Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells. Pelvic exam: Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells. The Pap test detects cervical cancer. The Pap test is not used to diagnose ovarian cancer. Blood tests: Your doctor may order blood tests. The lab may check the level of several substances, including CA-125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman's response to ovarian cancer treatment and for detecting its return after treatment. Ultrasound: The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound). Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer. To learn more about surgery, see the "Treatment" section.
67	Ovarian Cancer Stages These are the stages of ovarian cancer: Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen. Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen. Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver. Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs.
68	Ovarian Cancer Treatment Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body: Local therapy: Surgery and radiation therapy are local therapies. They remove or destroy ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas. Intraperitoneal chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis. Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.
69	Vaginal Cancer Stats Definition of vaginal cancer: Cancer that forms in the tissues of the vagina (birth canal). The vagina leads from the cervix (the opening of the uterus) to the outside of the body. The most common type of vaginal cancer is squamous cell carcinoma, which starts in the thin, flat cells lining the vagina. Another type of vaginal cancer is adenocarcinoma, cancer that begins in glandular cells in the lining of the vagina. Estimated new cases and deaths from vaginal (and other female genital) cancer in the United States in 2007: New cases: 2,140 Deaths: 790
70	Penile Cancer Stats Definition of penile cancer: A rare cancer that forms in the penis (the external male reproductive organ). Most penile cancers are squamous cell carcinomas (cancer that begins in flat cells lining the penis). Estimated new cases and deaths from penile (and other male genital) cancer in the United States in 2007: New cases: 1,280 Deaths: 290
71	Prostate Cancer Stats Definition of prostate cancer: Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men. Estimated new cases and deaths from prostate cancer in the United States in 2007: New cases: 218,890 Deaths: 27,050
72	Prostate Cancer Risk Factors Studies have found the following risk factors for prostate cancer: Age: Age is the main risk factor for prostate cancer. This disease is rare in men younger than 45. The chance of getting it goes up sharply as a man gets older. In the United States, most men with prostate cancer are older than 65. Family history: A man's risk is higher if his father or brother had prostate cancer. Race: Prostate cancer is more common in African American men than in white men, including Hispanic white men. It is less common in Asian and American Indian men. Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk for prostate cancer. These prostate cells look abnormal under a microscope. Diet: Some studies suggest that men who eat a diet high in animal fat or meat may be at increased risk for prostate cancer. Men who eat a diet rich in fruits and vegetables may have a lower risk. (More about diet studies is in "The Promise of Cancer Research".)
73	Prostate Cancer Screening Your doctor can explain more about these tests: Digital rectal exam: The doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall. The prostate is checked for hard or lumpy areas. Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in a man's blood sample. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. The digital rectal exam and PSA test can detect a problem in the prostate. They cannot show whether the problem is cancer or a less serious condition. Your doctor will use the results of these tests to help decide whether to check further for signs of cancer. Information about other tests is in the "Diagnosis" section.
74	Prostate Cancer Symptoms For men who have symptoms of prostate cancer, common symptoms include: Urinary problems Not being able to urinate Having a hard time starting or stopping the urine flow Needing to urinate often, especially at night Weak flow of urine Urine flow that starts and stops Pain or burning during urination Difficulty having an erection Blood in the urine or semen Frequent pain in the lower back, hips, or upper thighs Most often, these symptoms are not due to cancer. BPH, an infection, or another health problem may cause them. Any man with these symptoms should tell his doctor so that problems can be diagnosed and treated as early as possible. He may see his regular doctor or a urologist. A urologist is a doctor whose specialty is diseases of the urinary system.
75	Prostate Cancer Diagnosis You also may have other exams: Transrectal ultrasound: The doctor inserts a probe into the man's rectum to check for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram. Cystoscopy: The doctor uses a thin, lighted tube to look into the urethra and bladder. Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It is the only sure way to diagnose prostate cancer. The doctor inserts a needle through the rectum into the prostate. The doctor takes small tissue samples from many areas of the prostate. Ultrasound may be used to guide the needle. A pathologist checks for cancer cells in the tissue.
76	Prostate Cancer Stages These are the stages of prostate cancer: Stage I: The cancer cannot be felt during a digital rectal exam. It is found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate. Stage II: The cancer is more advanced, but it has not spread outside the prostate. Stage III: The cancer has spread outside the prostate. It may be in the seminal vesicles. It has not spread to the lymph nodes. Stage IV: The cancer may be in nearby muscles and organs (beyond the seminal vesicles). It may have spread to the lymph nodes. It may have spread to other parts of the body. Recurrent cancer is cancer that has come back (recurred) after a time when it could not be detected. It may recur in or near the prostate. Or it may recur in any other part of the body, such as the bones.
77	Pituitary Tumors/Cancer Definition of pituitary tumor: A tumor that forms in the pituitary gland. The pituitary is a pea-sized organ in the center of the brain above the back of the nose. It makes hormones that affect other glands and many body functions, especially growth. Most pituitary tumors are benign (not cancer).
78	Testicular Cancer Stats Definition of testicular cancer: Cancer that forms in tissues of the testis (one of two egg-shaped glands inside the scrotum that make sperm and male hormones). Testicular cancer usually occurs in young or middle-aged men. Two main types of testicular cancer are seminomas (cancers that grow slowly and are sensitive to radiation therapy) and nonseminomas (different cell types that grow more quickly than seminomas). Estimated new cases and deaths from testicular cancer in the United States in 2007: New cases: 7,920 Deaths: 380
79	Testicular Cancer General Info Nearly all testicular cancers are one of two general types: seminoma or nonseminoma. Other types are rare (see Question 1). This disease occurs most often in men between the ages of 20 and 39. It accounts for only 1 percent of all cancers in men (see Question 1). Risk factors include having an undescended testicle, previous testicular cancer, and a family history of testicular cancer (see Question 2). Symptoms include a lump, swelling, or enlargement in the testicle; pain or discomfort in a testicle or in the scrotum; and/or an ache in the lower abdomen, back, or groin (see Question 3). Diagnosis generally involves blood tests, ultrasound, and biopsy (see Question 4). Treatment can often cure testicular cancer (see Question 5), but regular follow-up exams are extremely important (see Question 6).