Wednesday, September 30, 2009

Cancer .. Causes; prevention; and treatment.

What Is Cancer?

Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells.

How a normal cell becomes cancer
Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.
Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, cancer cells outlive normal cells and keep forming new abnormal cells. Another difference between cancer cells and normal cells is that cancer cells can invade (grow into) other tissues. Being able to grow out of control and to invade other tissues makes a cell a cancer cell.

Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its actions. Most of the time, when DNA gets damaged the cell can fix it. If the cell can’t repair the damage, the cell dies. In cancer cells the damaged DNA is not repaired, but the cell doesn’t die like it should. Instead, this cell goes on making new cells even though the body does not need them. These new cells will all have the same DNA damage as the first cell does.
People can inherit damaged DNA, but most of the time DNA damage is caused by something we are exposed to in our environment. Sometimes the cause of the DNA damage is something obvious, like cigarette smoking. But many times no clear cause is found.
A cancer cell has many mistakes in its DNA -- having damage in just one spot does not cause cancer. Even when someone inherits damaged DNA, more mistakes in their DNA are needed before a cancer will develop. Staying away from things that are known to damage DNA (like smoking) as a part of a healthy life style lowers the chance that more DNA damage will take place. This can reduce the risk of cancer -- even in people who have an inherited tendency to get cancer.

How cancers grow and spread
In most cases the cancer cells form a tumor. Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow. But sometimes the extra cells in these blood cancers may also form a mass of tissue called a tumor.
Cancer cells often travel to other parts of the body, where they begin to grow and replace normal tissue. This process is called metastasis. It happens when the cancer cells get into the bloodstream or lymph vessels of our body.
But no matter where a cancer may spread, it is always named for the place where it started. For example, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer.

Not all tumors are cancerous. Tumors that aren't cancer are called benign. Benign tumors can cause problems -- they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can't invade, they also can't spread to other parts of the body (metastasize). These tumors are almost never life threatening.
How cancers differ
Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer.

How common is cancer
Cancer is the second leading cause of death in the United States. Nearly half of all men and a little over one third of all women in the United States will develop cancer during their lifetimes.
Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. Often, the sooner a cancer is found and treatment begins, the better are the chances for living for many years.

Who Gets Cancer?
Over one million people get cancer each year. About 1 out of every 2 American men and 1 out of every 3 American women will have some type of cancer at some point during their lifetime. Anyone can get cancer at any age; but about 77% of all cancers are diagnosed in people age of 55 and older. Cancer can be found in Americans of all racial and ethnic groups, but the rate of cancer occurrence (called the incidence rate) varies from group to group.
Today, millions of people are living with cancer or have been cured of the disease. The sooner a cancer is found and the sooner treatment begins, the better a patient's chances are of a cure. That's why early detection of cancer is such an important weapon in the fight against cancer.

What Are the Risk Factors for Cancer?
Smoking and drinking alcohol cause some people to get certaintypes of cancer. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. The best thing is to never use tobacco at all. Cigarettes, cigars, pipes and smokeless tobacco all cause cancer and should not be used. People who already smoke should try to quit -- we know that former smokers have less risk of cancer than do people who continue to smoke.

Many of the more than 1 million skin cancers that are diagnosed every year could have been prevented by protecting the skin from the sun's rays and avoiding indoor tanning. The chances of getting skin cancer can be lowered by staying in the shade as much as you can, wearing a hat and shirt when you are in the sun, and using sunscreen.
About one third of the cancer deaths expected every year are related to nutrition, overweight or obesity, and physical inactivity, and thus could also be prevented. We know that our diet, (what we eat) is linked to some types of cancer, but the exact reasons are not yet clear. The best advice is to eat a lot of fresh fruits and vegetables, whole grains like pasta and bread, and limit foods high in saturated fat, like high-fat dairy products, processed meats (like bacon, hot dogs, and luncheon meats), and red meats. It is also important to get to and stay at a healthy weight and get at least 30 to 45 minutes of physical activity on at least 5 days per week. You can get more information on this in our document.

Certain cancers are related to infectious diseases, such as hepatitis B virus (HBV), human papilloma virus (HPV), human immunodeficiency virus (HIV), Helicobacter pylori (H. pylori), and others. Many of these could be prevented through behavioral changes, vaccines, or antibiotics.
There is no way to prevent most cancers, but the best plan is to avoid risk factors you can control and make healthy lifestyle choices.

Can Cancer Be Prevented?

Smoking and drinking alcohol cause some people to get certain types of cancer. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. The best thing is to never use tobacco at all. Cigarettes, cigars, pipes and smokeless tobacco all cause cancer and should not be used. People who already smoke should try to quit -- we know that former smokers have less risk of cancer than do people who continue to smoke.
Many of the more than 1 million skin cancers that are diagnosed every year could have been prevented by protecting the skin from the sun’s rays and avoiding indoor tanning. The chances of getting skin cancer can be lowered by staying in the shade as much as you can, wearing a hat and shirt when you are in the sun, and using sunscreen.
About one third of the cancer deaths expected every year are related to nutrition, overweight or obesity, and physical inactivity, and thus could also be prevented. We know that our diet, (what we eat) is linked to some types of cancer, but the exact reasons are not yet clear. The best advice is to eat a lot of fresh fruits and vegetables, whole grains like pasta and bread, and limit foods high in saturated fat, like high-fat dairy products, processed meats (like bacon, hot dogs, and luncheon meats), and red meats. It is also important to get to and stay at a healthy weight and get at least 30 to 45 minutes of physical activity on at least 5 days per week. You can get more information on this in our document.
Certain cancers are related to infectious diseases, such as hepatitis B virus (HBV), human papilloma virus (HPV), human immunodeficiency virus (HIV), Helicobacter pylori (H. pylori), and others. Many of these could be prevented through behavioral changes, vaccines, or antibiotics.
There is no way to prevent most cancers, but the best plan is to avoid risk factors you can control and make healthy lifestyle choices.
What Causes Cancer?

Some kinds of cancer are caused by things people do. For example, smoking causes cancers of the lungs, mouth, throat, bladder, kidneys and some other organs, as well as heart disease and stroke. While not everyone who smokes will get cancer, smoking increases a person's chance of getting the disease. Drinking a lot of alcohol has also been shown to increase a person's chance of getting cancer of the mouth, throat, and some other organs. This is especially true if the person drinks and smokes.

Radiation (x-rays) can cause cancer. But the x-rays used by the doctor or dentist are safe. Too much exposure to sunlight without any protection can cause skin cancer.
Certain inherited DNA changes can increase the risk for developing some cancers and are responsible for the cancers that run in some families. For example, the BRCA genes (BRCA1 and BRCA2) are tumor suppressor genes -- they keep tumors from growing. Changes (mutations) in these genes can be passed on (inherited) from parents. When they are mutated, they no longer suppress abnormal growth, and cancer is more likely to develop.

But in most cases, the exact cause of cancer remains a mystery. We know that certain changes in our cells can cause cancer to start, but we don't yet know exactly how this happens. Many scientists are studying this problem.
Cancer Screening and Early Detection

There are tests, called screening tests, which adults should have in order to find cancers at an early stage when they are most treatable. Screening can prevent cancers of the cervix, colon, and rectum by allowing doctors to take out pre-cancerous tissue before it becomes cancer. Screening can also detect cancers of the breast, colon, rectum, cervix, prostate, oral cavity, and skin at early stages. For most of these cancers, early detection has been shown to reduce the number of deaths caused by cancer.
Cancers that can be prevented or detected earlier by screening account for at least half of all new cancer cases. For complete information on cancer screening and early detection.

Signs and Symptoms of Cancer

What are signs and symptoms?
A symptom is a signal of disease, illness, injury, or that something is not right in the body. Symptoms are felt or noticed by the person who has them, but may not be easily seen by anyone else. For example, chills, weakness, aches, and feeling short of breath may be symptoms of pneumonia.
A sign is also a signal that something is not right in the body. But signs are signals that can be seen by a doctor, nurse, or other health care professional. Fever, fast breathing, and abnormal breathing sounds heard through a stethoscope may be signs of pneumonia.
Having one symptom or sign may not be enough to figure out what's causing it. For example, a rash in a child could be a sign of a number of things, such as poison ivy, an infectious disease like measles, a skin infection, or a food allergy. But if the child has the rash along with other signs and symptoms like a high fever, chills, achiness, and a sore throat, then a doctor can get a better picture of the illness. In many cases, a patient's signs and symptoms alone do not give the doctor enough clues to figure out the cause of an illness. Then medical tests, such as x-rays, blood tests, or a biopsy may be needed.
How does cancer cause signs and symptoms?
Cancer is a group of diseases that may cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, how big it is, and how much it affects nearby organs or tissues. If a cancer has spread (metastasized), symptoms may appear in different parts of the body.
As a cancer grows, it can begin to push on nearby organs, blood vessels, and nerves. This pressure creates some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can cause early symptoms.

But sometimes cancer starts in places where it will not cause any symptoms until it has grown quite large. Pancreas cancers, for example, do not usually grow large enough to be felt from the outside of the body. Some pancreatic cancers do not cause symptoms until they begin to grow around nearby nerves (this causes a backache). Others grow around the bile duct and block the flow of bile. This causes a yellowing of the eyes and skin called jaundice. By the time a pancreatic cancer causes these signs or symptoms, it is usually in an advanced stage. This means it has grown and spread beyond the place it started – the pancreas.

Patrick Swayze dies from pancreatic cancer

A cancer may also cause symptoms like fever, extreme tiredness (fatigue), or weight loss. This may be because cancer cells use up much of the body’s energy supply, or they may release substances that change the way the body makes energy from food. Or the cancer may cause the immune system to react in ways that produce these symptoms.
Sometimes, cancer cells release substances into the bloodstream that cause symptoms which are not usually linked to cancer. For example, some cancers of the pancreas can release substances which cause blood clots in veins of the legs. Some lung cancers make hormone-like substances that raise blood calcium levels. This affects nerves and muscles, making the person feel weak and dizzy.
How are signs and symptoms helpful?
Treatment is most successful when cancer is found as early as possible. Finding cancer early usually means it can be treated; while it is still small and is less likely to have spread to other parts of the body. This often means a better chance for a cure, especially if the cancer can be removed with surgery.
A good example of the importance of finding cancer early is melanoma skin cancer. Skin cancer can be easy to remove if it has not grown deep into the skin. The 5-year survival rate (percentage of people living at least 5 years after diagnosis) at this stage is nearly 100%. Once melanoma has spread to other parts of the body, the 5-year survival rate drops below 20%.

Sometimes people ignore symptoms. They may not know that symptoms could mean something is wrong. Or they may be frightened by what the symptoms might mean and don't want to get medical help. Some symptoms, such as tiredness, are more likely to have a cause other than cancer and can seem unimportant, especially if there is an obvious cause or the problem only lasts a short time. In the same way, a person may reason that a symptom like a breast lump is probably a cyst that will go away by itself. But no symptom should be ignored or overlooked, especially if it has been there for a long time or is getting worse.
Most likely, any symptoms you may have will not be caused by cancer, but it’s important to have them checked out by a doctor, just in case. If cancer is not the cause, a doctor can help figure out what is and treat it, if needed.
Sometimes, it is possible to find cancer before you have symptoms. The American Cancer Society and other health groups recommend cancer-related check-ups and certain tests for people even though they have no symptoms. This helps find certain cancers early, before symptoms occur.
General cancer signs and symptoms
You should know some of the general (non-specific) signs and symptoms of cancer. But remember , having any of these does not mean that you have cancer – many other things cause these signs and symptoms, too.
Unexplained weight loss
Most people with cancer will lose weight at some point. An unexplained weight loss of 10 pounds or more (when you're not trying to lose weight) may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus, or lung.
Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all patients with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. This can make it harder for the body to fight infection. Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

Fatigue is extreme tiredness that does not get better with rest. It may be an important symptom as cancer grows. It may happen early, though, in cancers like leukemia, or if the cancer is causing blood loss, which can happen with some colon or stomach cancers.
Pain may be an early symptom with some cancers such as bone cancers or testicular cancer. A headache that does not go away or respond to treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain that is linked to cancer is a symptom of cancer that has already metastasized (spread from where it started).
Skin changes
Along with cancers of the skin (see the next section), some other cancers can cause skin symptoms or signs that can be seen. These signs and symptoms include:
darker looking skin (hyperpigmentation)
yellowish skin and eyes (jaundice)
reddened skin (erythema)
Excessive hair growth

Signs and symptoms of certain cancers
Along with the general symptoms, you should watch for certain other common symptoms and signs which could suggest cancer. Again, there may be other causes for each of these, but it is important to see a doctor about them as soon as possible.
Change in bowel habits or bladder function
Long-term constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Any changes in bladder or bowel function should be reported to a doctor.

Sores that do not heal
Skin cancers may bleed and look like sores that do not heal. A long-lasting sore in the mouth could be an oral cancer and should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should not be ignored.

White patches inside the mouth or white spots on the tongue
White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that is caused by ongoing irritation. It is often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for developing leukoplakia. If it is not treated, leukoplakia can become oral cancer. Any long-lasting mouth changes should be checked by a doctor or dentist right away.
Unusual bleeding or discharge
Unusual bleeding can happen in early or advanced cancer. Blood in the sputum (phlegm) may be a sign of lung cancer. Blood in the stool (or a dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause unusual vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.
Thickening or lump in the breast or other parts of the body
Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if you’ve just found it or notice it has grown in size.

Indigestion or trouble swallowing
While they most often are caused by other things, indigestion or swallowing problems may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat).
Recent change in a wart or mole or any new skin change
Any wart, mole, or freckle that changes color, size, or shape, or loses its definite borders should be reported to a doctor right away. Any new skin changes should be reported as well. A skin change may be a melanoma which, if found early, can be treated successfully.

Nagging cough or hoarseness
A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx (voice box) or thyroid.
Although the signs and symptoms listed are the ones more commonly seen with cancer, there are many others that are less common and are not listed here. If you notice any major changes in the way your body works or the way you feel, especially if it lasts for a long time or gets worse, let a doctor know. If it has nothing to do with cancer, the doctor can find out more about what's going on and treat it, if needed. If it is cancer, you'll give yourself the best chance to have it treated early, when treatment is most likely to be effective.
How Is Cancer Diagnosed?

A patient's signs and symptoms are not enough to know whether or not cancer is present. If your doctor suspects cancer you will probably need to have more tests done, such as x-rays, blood tests, or a biopsy. In most cases a biopsy is the only way to tell for sure whether or not cancer is present.
To do a biopsy a piece of the lump or abnormal area is taken out and sent to the lab. There a pathologist (a doctor who specializes in diagnosing diseases) looks at the tissue under a microscope to see if it contains cancer cells. If there are cancer cells the doctor tries to figure out exactly what type of cancer it is and whether it is likely to grow slowly or more quickly.
Scans can measure the size of the cancer and whether it has spread to nearby tissues. Blood tests can tell doctors about your overall health and can show how well your organs are working.

What Are Imaging Tests?
Imaging tests are studies that make pictures of what's going on inside your body. These tests use different forms of energy (x-rays, sound waves, radioactive particles, or magnetic fields) that are passed through the body. The changes in energy patterns caused by different body tissues can be detected by special devices, which change them into pictures. These pictures can show normal body structure and function as well as abnormalities caused by diseases such as cancer.
Imaging tests are different from endoscopic tests (for example, colonoscopy or bronchoscopy), which use a flexible, lighted tube connected to a viewing lens or a video camera. Endoscopic tests allow doctors to look inside parts of the body as if they were looking with the "naked eye."
What Are Imaging Tests Used For?

Imaging tests are used for cancer in many ways:
They are sometimes used in screening – looking for cancer in its early stages, even though a person has no symptoms. A mammogram is an example of an imaging test used for cancer screening.

They sometimes help predict whether a tumor is likely to be cancer and help doctors decide if you need to have a biopsy (taking a tissue sample to be looked at under the microscope) . A biopsy is almost always needed to know for sure that a tumor is cancer.
. They sometimes help predict whether a tumor is likely to be cancer and help doctors decide if a biopsy (removal of a tissue sample for viewing under the microscope) is needed. However, a biopsy is almost always needed to say for sure that a tumor is cancer.
. They show exactly where the tumor is, even deep within the body, so that a sample of it can be taken for further study.
. They help stage cancer (determining how far the cancer has spread).
. They can be used to plan treatment, such as when determining where the beams should be focused in radiation therapy.
. They can give a doctor an idea of how well treatment is working (that is, if a tumor has shrunken, stayed the same, or grown after treatment).
. They can help find out if a cancer has recurred (come back) after treatment.
Imaging tests are only part of the process of cancer diagnosis and management. A complete initial workup for your cancer also includes a careful medical history (interview about symptoms and risk factors) and physical exam, and possibly blood or other lab tests.
Imaging tests may give important evidence that a lump or mass is present, but they usually cannot tell for sure if the lump is a cancer. For the doctor to make a diagnosis, a biopsy is almost always needed. In many cases, imaging tests make it possible to get a biopsy without the need for major surgery.
Many doctors request x-rays or other images before treatment begins so that a record is available showing how things change over time. These studies are called baseline studies because they provide a basis of information that helps doctors evaluate the results of treatment or progression of the disease.
Who Performs and Interprets Imaging Tests?

A doctor, a certified technologist, or other health professional may perform an imaging test. Depending on the technology involved, the test may be done in a hospital, a special clinic or imaging center, or a doctor's office. In larger medical centers, imaging tests are usually done in the radiology department (even though some types of tests do not involve high-energy radiation).
A radiologist, a doctor who specializes in imaging techniques, usually reads (interprets) the imaging test. The radiologist writes a report on the findings and sends the report to your doctor. A copy of the report will become part of your patient records. Your other doctors (oncologists, surgeons, etc.) may look at the images as well.
Types of Imaging Tests
The rest of this document explains some of the more common types of imaging tests, how they are done, and when they may be needed.
Computed Tomography (CT) Scan
Other Names
CT scan, CAT scan, spiral CT, helical CT

What Does It Show?
Computed tomography or CT (also called CAT) scans show a slice, or cross-section, of the body. The image shows your organs and soft tissues more clearly than standard x-rays. Because the image is created by a computer, it can be enlarged to make it easier to read and interpret.
Since the late 1970s, CT scans have been a very valuable technology in detecting cancer. CT scans can show a tumor's shape, size, volume, and location and can reveal the blood vessels that feed the tumor.
Doctors often use CT scans to help them guide a needle to remove a tissue sample (called a CT-guided biopsy). They can also be used to guide needles into tumors for some types of cancer treatments, such as radiofrequency ablation (destroying a tumor using heat and ionic agitation).
CT scans are especially effective in detecting and evaluating cancer in the liver, pancreas, adrenal glands, lungs, and bones. They are also used to provide information about cancer in the large and small intestines, esophagus, stomach, brain, prostate, or other organs.
By comparing CT scans done over time, doctors can see how a tumor is responding to therapy or detect a possible recurrence after treatment.

Magnetic Resonance Imaging (MRI)
Other Names
magnetic resonance (MR), nuclear magnetic resonance (NMR) imaging
What Does It Show?
Like computed tomography (CT) scans, MRI displays a cross-section of your body. However, MRI uses powerful magnetic fields instead of radiation to create the images. An MRI scan can present cross-sectional slices (views) from several angles, as if someone were looking at a slice of your body from the front (frontal view), from the side (sagittal view), or from above your head (axial view). The procedure creates images of soft tissue parts of the body that would sometimes be hard to see using other imaging tests.
MRI is especially valuable in detecting and localizing cancer in the brain and spinal cord, head, neck, and bones and muscles. Used with contrast agents, it is the best way to see brain tumors. Using MRI, doctors can sometimes tell a benign tumor from a malignant (cancerous) tumor.

In recent years, MRI has become the main way to thoroughly evaluate the female reproductive system, and it is helpful in determining the stage of endometrial cancer before surgery. Another important use for MRI is looking for signs that cancer may have metastasized (spread) to the liver from another site in the body.
MRI images can also help doctors plan treatment such as surgery or radiation therapy.
Unlike x-rays or CT scans, MRI cannot detect calcifications (tiny mineral deposits that may suggest the presence of cancer) in tissues such as the breast. However, special MRI machines, now available in a few hospitals, are designed specifically for examining the breast. MRI is sometimes used along with mammograms or breast ultrasound to look for breast cancer, particularly in younger women or those with very dense breasts. At this time MRI is not recommended by itself for the early detection of breast cancer.

Radiographic Studies (Regular X-rays and Contrast Studies)
Other Names
Radiographs, roentgenograms.

What Do They Show?
Radiographs, commonly known as x-rays, produce shadow-like images of certain organs or tissues. An abdominal x-ray may reveal tumors or other diseases in organs of the abdomen, including the intestines, stomach, liver, spleen, and kidneys. A chest x-ray is used to detect lung diseases, including cancer. These tests, which produce a single image or series of still images, are sometimes referred to as standard radiographic studies. Mammography (a breast x-ray) is another form of radiographic study (for more information, see the section Mammography).
Special types of x-ray tests may use dyes called contrast materials. For example, a lower gastrointestinal (GI) series, often called a barium enema exam, takes x-ray images after the bowel is filled with barium sulfate (a contrast material). Another contrast study, intravenous pyelography (IVP), examines the structure and function of the kidneys.
With advances in technology, many contrast studies once commonly used for diagnosis are being replaced by other methods, such as CT or MRI scans
Other Names
mammogram, digital mammography

What Does It Show?
A mammogram is an x-ray exam of the breast. It can detect and diagnose many cases of breast cancer.
A mammogram is an effective screening tool. A screening mammogram is used to look for signs of breast disease when you do not have any breast symptoms. Many breast cancers take years to develop. A mammogram can detect cancer in its early stages, when treatment is most likely to be successful.
A diagnostic mammogram is the imaging test used when you have breast symptoms or when abnormalities appear on a screening mammogram. Diagnostic mammograms may include additional views (images) of the breast that are not usually done on screening mammograms.
Mammograms can't prove that an abnormal area is (or is not) cancer, but it can give information that shows whether further testing is needed. The 2 main types of breast abnormalities that can be found with a mammogram are calcifications and masses.
Calcifications are tiny mineral deposits within the breast tissue, which look like small white spots on the films. They may or may not be caused by cancer. There are 2 types of calcifications:
Macrocalcifications are coarse (larger) calcium deposits that are most likely changes in the breasts caused by aging of the breast arteries, old injuries, or inflammation. These deposits are related to non-cancerous conditions and do not require a biopsy (removing a sample of tissue for viewing under a microscope). Macrocalcifications are found in about half the women over 50, and in 1 of 10 women under 50.
Microcalcifications are tiny specks of calcium in the breast. They may appear alone or in clusters. Microcalcifications seen on a mammogram are of more concern, but still usually do not mean that cancer is present. The shape and layout of microcalcifications help the radiologist judge how likely it is that cancer is present. In most instances, the presence of microcalcifications does not mean a biopsy is needed. In other cases, the microcalcifications look more suspicious and a biopsy is needed.
A mass, which may occur with or without calcifications, is another important change seen on mammograms. Masses can be caused by many things, including cysts (non-cancerous, fluid-filled sacs) and non-cancerous solid tumors, but they could be cancer and usually should be biopsied if they are not cysts.
A cyst cannot be diagnosed by physical exam alone, nor can it be diagnosed by a mammogram alone. To confirm that a mass is really a cyst, either breast ultrasound or removal of fluid with a thin, hollow needle (aspiration) is needed.
If a mass is not a simple cyst (that is, if it is at least partly solid), then you may need to have more imaging tests. Some masses can be watched with periodic mammograms, while others may need a biopsy. The size, shape, and margins (edges) of the mass help the radiologist to determine whether cancer may be present.
Your prior mammograms may help show that a mass has not changed for many years, which would mean that the mass is likely a benign condition and a biopsy would not be needed. Having your prior mammograms available to the radiologist is very important.
A mammogram may show something suspicious, but by itself it cannot prove that an abnormal area is cancer. If a mammogram raises a suspicion of cancer, tissue must be removed and looked at under the microscope to tell if it is cancer. This can be done with a needle biopsy or an open surgical biopsy.
To get an accurate breast biopsy, enough cells or fluid must be removed from the suspicious area for the pathologist to study. It can be hard for a doctor to insert the needle precisely where the abnormality exists, especially if the lump cannot be felt. To improve accuracy, your doctor may use different imaging studies to guide the placement of the needle:
Stereotactic mammography uses mammograms taken from 2 angles (a "stereo" view). A computer calculates the precise location of the mass or calcification and then guides the placement of the biopsy needle.
Breast ultrasound can also be used to guide biopsy needles (see the section on Ultrasound).
A ductogram (galactogram) is a type of mammogram that is done after a contrast agent is inserted into a nipple duct with a thin tube. It is used to evaluate nipple discharge.
What Else Should I Know About This Test?
The American Cancer Society has developed guidelines for the early detection of breast cancer in women who are not having breast symptoms:
Women 40 years of age and older should have a mammogram every year and a clinical breast exam (CBE) performed by a health care professional every year. They also have the option of performing a breast self-exam (BSE) every month. The CBE should be conducted close to and preferably before the scheduled mammogram.
Women aged 20 to 39 should have a clinical breast exam by a health care professional every 3 years and have the option of performing breast self-exam every month.
Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram.
Mammography alone cannot detect all cases of breast cancer. For this reason, mammograms should be used in addition to a clinical breast exam by a health care professional. Knowing how your breasts normally look and feel, and reporting any changes to your doctor, is also very important.
To reduce the chance of discomfort during a mammogram, schedule the procedure for a week or so after your menstrual period, when your breasts are less likely to be tender.
A negative mammogram (no sign of calcifications or masses) does not necessarily mean that cancer is not present or that cancer will not develop later.
The need for a biopsy does not mean that you have cancer. About 70% to 80% of biopsies turn out to be benign (not cancer).
If you have breast implants, find a radiologist who is experienced in performing mammograms on augmented breasts and let the facility know this ahead of time. Additional views may be necessary, so it may take longer.
Nuclear Scans

Other Names

nuclear imaging, radionuclide imaging, nuclear medicine scans

What Do They Show?
Nuclear scans provide images based on the body’s chemistry rather than on anatomy (as is the case with other imaging tests). They use substances called radionuclides (also known as tracers or radiopharmaceuticals) that release low levels of radiation. The small amount of radioactivity used is harmless.
Inside the body, tissues affected by certain diseases such as cancer may absorb more or less of the tracer than normal tissues. Special cameras pick up the pattern of radioactivity to create images that show where the material has traveled and where it has accumulated. The scans show certain disorders of internal organs and tissues more accurately than standard x-ray images.
If cancer is present, the tumor may show up on the image as a "hot spot" – an area of increased uptake. Depending on the type of scan performed, the tumor may instead be a "cold spot" – a site of decreased uptake.
Nuclear scans are used to locate tumors, especially in the bones and thyroid gland. They are also used to study a cancer's stage (extent of its spread) and to decide if treatment is working. In the past, nuclear scans were often used to detect liver and brain tumors. Because of improvements in technology, a CT or MRI scan can now be done instead of a nuclear scan in many of these cases.
Nuclear scans may not detect very small tumors, nor do they always distinguish between benign and malignant (cancerous) tumors. They are often used along with other imaging tests to give a more complete picture of what is going on. For example, bone scans that show "hot spots" on the skeleton are usually followed by x-rays of the affected bones, which are better at showing details of the bone structure.
Nuclear scans have different names, depending on the organ involved. Some of the more commonly used nuclear scans (described in more detail below) include:
. bone scans
. gallium scans
. FDG PET scans
Ultrasound (US)

Other Names

ultrasonography, sonography, sonogram

What Does It Show?
An ultrasound machine produces images called sonograms by generating high-frequency sound waves that go through your body. As the sound waves bounce off your internal organs and tissues, they create echoes. Cysts (fluid-filled sacs) and solid tumors have different echo patterns than normal body tissues.
Ultrasound is especially good at giving pictures of some diseases of soft tissues that do not show up as well on x-rays. Ultrasound is an excellent way to tell fluid-filled cysts from solid tumors because the echo patterns produced by these disorders look very different. In diagnosing breast masses, for example, ultrasound is often used to tell cysts from solid tumors. Ultrasound can also be used to determine how deeply a tumor of the esophagus, rectum, or uterus has gone through the wall of the organ.
However, ultrasound images are not as detailed as those from CT or MRI scans. Ultrasound alone cannot distinguish a benign tumor from a cancerous one. Its use is also limited in some areas of the body because the sound waves cannot go through air (such as in the lungs) or through bone.
Doctors often use ultrasound to determine where to place a needle to obtain a biopsy (withdrawing fluid or tiny tissue fragments for viewing under a microscope). This procedure occurs in "real time" -- that is, the doctor can look at the ultrasound monitor while moving the needle and actually see the needle moving toward and into the tumor.
For some types of ultrasound exams, the transducer (the wand that produces the sound waves and detects echoes) is placed on the skin surface. The sound waves pass through the skin and reach the internal organs. In other cases, to get the best images, the doctor must use a transducer that is inserted into a body opening, such as the esophagus, rectum, or vagina.
Special ultrasound machines, known as Doppler flow machines, are able to show how blood is flowing through the vessels. This is important because blood flows differently through tumors than it does through normal tissue. Some of these machines make color images to increase the amount of information it contains. Unlike other forms of blood vessel imaging, color Doppler studies do not require contrast agents. Color Doppler has made it easier for doctors to determine if cancer
Screening tests refer to procedures used to find a disease, such as cancer, in people who do not have symptoms of that disease.
Detection refers to diagnostic procedures used if you have some indication (such as symptoms, abnormal physical exam results, or abnormal results from screening tests) that a disease such as cancer may be present. Imaging tests for detection can help find a mass or other abnormality of tissue and can often predict whether it is likely to be a cancer or some other type of disease. However, in almost all cases, a tissue sample (biopsy) must be viewed under the microscope to be sure if a cancer is present.

Image-guided biopsy refers to use of imaging tests to help guide a biopsy needle into the area of abnormal tissue. An image-guided biopsy can often provide tissue for study without the need for surgery.
Staging is the process of determining how far a cancer has grown and spread. Imaging tests are often used to estimate the size of a cancer; to find out how far it has spread in the organ in which it started; and to see whether it has spread to nearby tissues and organs, nearby lymph nodes, or distant organs. Most of the tests listed in this section are used to look for metastases in distant organs or tissues. For instance, men with prostate cancer often have bone scans to see if the cancer has spread to bones.
What Is Staging?

Staging is the process of finding out how much cancer there is in the body and where it is located. Staging the cancer is a key step in deciding on your best treatment choices. It also gives your health care team an idea of your outlook (prognosis).
Staging can take time, and people are usually anxious to begin treatment right away. Do not worry that the staging process is taking up treatment time. In most cases it is OK because by staging the cancer, you and your health care team will know which treatments are likely to work best.

Why is staging needed?
Doctors need to know the amount of cancer and where it is in the body to make sure a person gets the best possible treatment. For example, the treatment for early stage breast cancer may be surgery and radiation, while a more advanced stage of breast cancer may need to be treated with chemotherapy, too. Doctors also use the stage to help predict the course a cancer is likely to take.

What is the doctor looking for when staging cancer?
For most cancers, the stage is based on 3 main factors:
the original (primary) tumor's size and whether or not the tumor has grown into nearby areas
whether or not the cancer has spread to the nearby lymph nodes
whether or not the cancer has spread to distant areas of the body
Some cancers of the blood, such as leukemias, are not staged in this way because they are assumed to be in all parts of the body. Cancers in or around the brain are also not staged using the TNM system, since these cancers can disrupt vital brain and body functions before they even begin to spread.
What does staging involve?
Doctors gather different types of information about a cancer to figure out its stage. Depending on where the cancer is located, the physical exam may give some clue as to the extent of the cancer. Pictures taken during tests like x-rays, CT scans, and MRIs may also provide information about how much and where cancer is in the body. Taking out tumors or pieces of tumors and looking at them under the microscope (biopsy) is needed to confirm the diagnosis of cancer, but it can also help stage the cancer. Samples can be removed either during surgery or during less invasive biopsy procedures.

Types of staging
There are different types of staging.

Clinical staging is done at the time of diagnosis, before any treatment is given. It is an estimate how much cancer there is based on the physical exam, imaging tests (x-rays, CT scans, etc.), and sometimes biopsies of affected areas. For some cancers the results of other tests, such as blood tests, are also used in staging. The clinical stage is a key part of deciding the best treatment to use. It is also the baseline used for comparison when looking at the cancer's response to treatment.
Pathologic staging can only be done on patients who have had surgery to remove the cancer or to look at how much cancer is in the body. It combines the results of clinical staging with the results from the surgery. In some cases, the pathologic stage may be different from the clinical stage (for example, if the surgery shows the cancer has spread more than it was thought to have spread before surgery).
The pathological stage gives the health care team more precise information that can be used to predict treatment response and outcomes (prognosis).
Restaging is not common, but it may be done to find the extent of the cancer if it comes back (recurs) after treatment. This is done to help decide what the best treatment option would be at this time. Restaging is discussed further in the section "A cancer's stage does not change."
How Is Cancer Treated?

The number of treatment choices you have will depend on the type of cancer, the stage of the cancer, and other factors such as your age, health status, and personal preferences. You are a key part of your cancer care team -- you should talk to them about which treatment choices are best for you. Don't be afraid to ask questions. Make sure you understand your options. A cancer diagnosis often makes people feel like they have to hurry to make choices about treatment and services. But take time to look at all the options available to you so you will be as well informed as possible.

The 3 major types of treatment for cancer are surgery, radiation, and chemotherapy. Depending on the type and stage of the cancer, 2 or more of these types of treatment may be combined at the same time or used after one another.

After the cancer is found and staged, your cancer care team will discuss your treatment options with you. It is important to take time and think about your possible choices. In choosing a treatment plan, one of the most important factors is the stage of the cancer. Other factors to consider include your overall health, the likely side effects of the treatment, and the probability of curing the disease, extending life, or relieving symptoms.

In considering your treatment options it is often a good idea to seek a second opinion, if possible. This may give you more information and help you feel more confident about the treatment plan you have chosen. It is also important to know that your chances for having the best possible outcome are highest in the hands of a medical team that is experienced in treating the type of cancer you have.
What treatment will be best for me?
Your cancer treatment will be based on your unique situation. Certain types of cancer respond very differently to different types of treatment, so figuring out the type of cancer is a key step toward knowing which treatments will work best. The cancer's stage (how widespread it is) will also determine the best course of treatment. This is because early-stage cancers respond better to different treatments than later-stage ones. Your overall health, your lifestyle, and your personal preferences will also play a part in deciding which treatment options are best for you.
Not all types of treatment will work well in your situation, so be sure that you understand your options. Don't be afraid to ask questions; it is your right to know what treatments are most likely to help you and what their side effects may be.
Before making treatment decisions, ask about and be sure you understand the goal of treatment in your situation. Is the purpose of the treatment to cure the cancer, keep it under control, or treat the problems it is causing? Know that the goal of treatment can change over time, so you may need to ask about this again at some point.

Complementary and Alternative Therapies

When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn't mentioned. Everyone from friends and family to Internet groups and Web sites offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

What exactly are complementary and alternative therapies?
Not everyone uses these terms the same way, and they are used to refer to many different methods, so it can be confusing. We use complementary to refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor's medical treatment.
Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some methods that are used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or peppermint tea to relieve nausea. Some complementary methods are known to help, while others have not been tested. Some have been proven not be helpful, and a few have even been found harmful.

Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may pose danger, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.

Finding out more
It is easy to see why people with cancer think about alternative methods. You want to do all you can to fight the cancer, and the idea of a treatment with no side effects sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no longer be working. But the truth is that most of these alternative methods have not been tested and proven to work in treating cancer.

Cancer Treatment Side Effects

Cancer treatment can cause many different side effects. The kinds of side effects depend mostly on the type of treatment used. Side effects vary from patient to patient. Some people have no side effects at all, while others have quite a few. This is because every person responds to treatment differently. There is no way to predict who might or might not have side effects.
Many side effects of treatment can be managed or treated. And most side effects go away over time. In the meantime, there are ways to reduce the discomfort they may cause. Tell your doctor or nurse about any side effects you notice so they can help you manage them.

What Is Remission?

Some people think that remission means the cancer has been cured, but this is not always the case. Remission is a period of time when the cancer is responding to treatment or is under control. In a complete remission, all the signs and symptoms of the disease go away and cancer cells cannot be detected by any of the tests available for that cancer. It is also possible for a patient to have a partial remission. This is when the cancer shrinks but does not completely disappear. Remissions can last anywhere from several weeks to many years. Complete remissions may go on for years and over time be considered cures. If the disease returns (recurs), another remission may be possible with further treatment.
Want to Help Prevent Cancer? Drink green Tea, and specific herbs.
Looking for advice on foods and herbs that help prevent cancer, one recommendation crops up over and over. Tea, especially green, and Strobilanthes crispus herb, is revered as being at the top of most lists of cancer prevention. Both are packed with antioxidants, flavonoids and other anti-cancer compounds.

"Clinical studies indicate that regular tea or herbal tea drinking is safe and may contribute to the prevention of . . . several kinds of cancer including cancer of the mouth, breast, bladder, skin, stomach, pancreas, lungs, prostate, and esophagus," among many other potential problems.
Other Foods and Herbs That Lower Cancer Risk
For preventing cancer before it even begins, in what is known as the initiation stage, recommends "Foods rich in carotenoids, such as dark-green leafy vegetables an yellow and orange fruits and vegetables; foods rich in sulphoraphanes, such as broccoli, cabbage, and Brussels sprouts; and food and herbs rich in flavonoids such as berries, green tea, and grapes."

Also mentioned specifically in several sources are:
· Evening Primrose
· Peppermint - high antioxidant content
· Purslane - highly packed with an amazing amount of nutrients, many of them potent cancer fighters
· Garlic - contains antioxidants and sulfides
· Tomatoes - contains lycopene
· Cat's Claw - helps prevent the formation of tumors
· Shiitake, Maitake, Reishi
· Milk Thistle - protects and helps to recover damage to the liver, and has shown some activity against breast and prostate cancer cells
· Grapeseed and Pinebark Extracts - studies have shown they help inhibit abnormal cell growth
· Red Clover - studies show it helps control the spread of cancerous cells
· Turmeric - prevents angiogenesis (formation of new blood supply to tumors, required to grow over 2 cm in size) and may have other anti-cancer properties as well
There are a variety of herbal programs that will assist the immune system and which are considered worthy in nutrition for cancer. However, the one particular formula that has stood the test of time is known to many as "Essiac". This is a formula which many use in the hope that they are preventing cancer and more especially, the impediment of cancer cells from metastasizing.

In the early 1920's a young Canadian nurse by the name of Rene Caisse was given this herbal formula by a patient. The patient said she had cured herself of breast cancer by using this combination prepared by a medicine man from the Ojibwa tribe. Caisse used the same formula on patients who were terminally ill. She claimed many cures and a staggering success rate. She obtained permission from the Canadian government to use this to treat people who were hopeless cases. Many attempts were made to legalize Essiac as a "cure for cancer", including the submission of a bill to parliament, which was defeated by only a few votes. The affect was quite detrimental and Essiac was outlawed, to be used only as an underground remedy.
The formula is quite simple and consists of four basic herbs: Sheep Sorrel (Rumex acetosella), the primary herb, Burdock (Arcticum lappa), Slippery Elm Bark (Ulmus fulva), and Turkey Rhubarb Root (Rheum palmarum). Other herbs can be added such as Pau de Arco and Red Clover Blossom.

Sheep Sorrel is the most important herb in the formula. It is known to be effective in breaking down and reducing (in some cases eradicating) tumors. It contains large amounts of vitamins A, B complex, C, D, E, K, P, and U. It has a high mineral content, including sodium, calcium, sulphur, iron, magnesium, chlorine, silicon, and trace amounts of copper, iodine, manganese and zinc. It also contains malic, oxalic, tannic, tartaric acids as well as a high amount of chlorophyll and carotenoids. Chlorophyll raises the amount of oxygen in the body. Some believe that cancer cannot live or thrive when oxygen levels are increased in the body.

Caretenoids include beta carotene which converts to vitamin A in the liver. This is a known antioxidant and is very high in oxalic acid which is a contributing factor to the anti-tumor and anti-cancer aspects of the herb. It has been said that this herb work, in formula, to stop cancer cells from metastasizing.
Burdock Root has been used for centuries for its amazing healing properties. It is an extremely powerful blood purifier. It is also rich in vitamins and has similar minerals to Sheep Sorrel. Burdock contains phosphorous, potassium, selenium.
The principle ingredient in Burdock is a polysaccharide called inulin. Inulin strengthens vital organs. It is a powerful immune modulator that can enhance white blood cell activity.
Turkey Rhubarb Root is a strong liver cleanser, which has also been used for many centuries. This herb is extremely high in its vitamin and mineral content, including B-Complex, C, P, calcium, phosphorous, potassium, iodine, copper, sulphur, zinc, silicon, magnesium, manganese. The acidic contents include gallic, malic, oxalic and tannic acids.
Slippery Elm Bark is well known for its highly nutritive qualities. It helps in revitalizing a debilitated system. It contains vitamins A, B-Complex, C, K, and P, and is high in minerals and gallic acids. It is a demulcent rich in mucilage and this quality reduces irritation and reduces sensitivity to acids.
There are many reports that "Essiac" has cured cancer. One can only take the word of those who have survived. The truth of the matter is that it is still difficult to tout any one formula as the absolute cure for this complicated disease. All cancers are different and all people are different. In addition, most people combine a variety of protocols.If you are looking to cure cancer, you well advised to embrace a fully holistic and nutritional program in addition to anything else you may choose to do. This Ojibwa formula may only be one part of this holistic and nutritional protocol. Many mainstream practitioners and scientists are now starting to realize the value of nutrition.

For those who are using this formula in the hope of preventing cancer, there are given no guarantees that this will work. However, it is something that I do every four months for two weeks to one month. In these cases the amount used should be half that of someone who has cancer, that is 4 oz per day. Also, one should take breaks between use.
During such breaks, there are many other herbs one can use, such as Pau De Arco, Watercress, Red Clover. If you have arthritis, you should exercise caution in using Essiac due to high oxalic acid content. also recommend a strong Immune system program for prevention, in between Essiac use, such as Blood Purifiers, (Red Clover, Echinacea, Burdock, Hyssop) Colon Liver cleansing (Milk Thistle, Dandelion, Gentian, Yellow Dock) and building formulas (Damiana, Ginsengs, Gotu-Kola, Ginkgo, Fo-Ti).
The key to good Essiac is using fresh, quality, organic herbs. When purchasing the essiac teas, do not simply choose any brand off a store shelf. Be sure it contains organic, recently harvested quality herbs. It is best to find the bulk herbs that have not been mass produced. Avoid capsulated essiac formulas as it should be only brewed as a tea, firstly for effectiveness and secondly to minimize the oxalic acid content.

Things You'll Need:
Supplied needed are:
· 4 gallon stainless steal pot with lid,
· 3 gallon stainless steal pot with lid,
· stainless steal fine-mesh double strainer,
· stainless steal funnel,
· stainless spatula or spoon,
· 12 or more 16-oz strainer
Herbs needed

. 6-1/2 cups Burdock root - cut
· 16 oz Sheep Sorrel herb - powdered
· 1 oz Turkey Rhubarb root - powdered
· 4 oz Slippery Elm Bark
· 2 gallons of sodium-free distilled water.

· Mix dry ingredients thoroughly.
· Bring distilled water to a rolling boil in 4 gallon pot with lid on.
· stir in 1 cup of dry ingredients, replaced lid and continue to boil for 10 minutes.
· Scrape down sides of pot and mix thoroughly, replace lid and let sit for 12 hours. After the 12 hours bring pot back to almost a boil.
· Strain into the 3 gallon pot, then restrain back into the cleaned 4 gallon pot. Use funnel to pour hot liquid into bottles and tighten caps.
· Refrigerate tea as it has no preservatives.
· measure out 1-2 oz of tea and mix with equal parts of bottled hot water and sip slowly 1 hour before eating or on an empty stomach before bed.

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