MOD 2

Cancer

Having cancer is a life-changing event. Knowing what to expect — from

diagnosis to recovery — can empower you and help you take control of your
health. This is a general overview of what cancer is, what causes it, how
healthcare providers treat it and how you can take care of yourself throughout
your journey.

Overview
Cancer happens when normal cells become cancerous cells that multiply and
spread. Cancer is the second most common cause of death in the U.S.

What is cancer?

Cancer is a large group of diseases with one thing in common: They happen
when normal cells become cancerous cells that multiply and spread.
Your genes send instructions to your cells — like when to start and stop
growing, for example. Normal cells follow these instructions, but cancer cells
ignore them.

Cancer is the second most common cause of death in the U.S. But fewer
people are dying of cancer now than 20 years ago. Early detection and
innovative treatments are curing cancer and helping people with cancer live
longer.

Types of cancer

There are over 100 types of cancer. Healthcare providers categorize them
according to where they start in your body and the type of tissue they affect.
There are three broad cancer classifications:

• Solid cancers: This is the most common type of cancer, making up

about 80% to 90% of all cases. This includes carcinoma that forms in
epithelial tissue (like your skin, breast, colon and lungs) and sarcoma that
forms in bone and connective tissues.

• Blood cancers: These are cancers that start in your blood cells or
lymphatic system. Examples include leukemia, lymphoma and multiple
myeloma.

• Mixed: Cancers that involve two classifications or subtypes. Examples

include carcinosarcoma and adenosquamous carcinoma.

How common is cancer?

Cancer is the second most common cause of death worldwide. Researchers

estimate that in 2024, over 2 million people living in the U.S. will receive a
cancer diagnosis, and over 611,000 people will die from the disease.

About 1 in 4 people will develop cancer at some point during their lifetime.
The most common cancers in the U.S. are:

• Breast cancer.

• Lung cancer.

• Prostate cancer.

• Colorectal cancer.

• Blood cancers.

Anyone can develop cancer, but cases vary based on race and sex. According to
the 2022 Annual Report on Cancer, the disease:

• Affects slightly more people assigned male at birth (AMAB) than people
assigned female at birth (AFAB).

• Affects people over 60 more than any other age group.

• Affects more Black men (AMAB) than people in other racial groups.

• Affects more women (AFAB) who are American Indian or Alaska

Natives than people in other racial groups.

Symptoms and Causes

What are the symptoms of cancer?

Symptoms of cancer vary from person to person. They depend on what type of
cancer you have and how advanced it is.

General cancer symptoms may include:

• Fatigue.

• Fever that occurs mostly at night.

• Loss of appetite.

• Night sweats.
 • Persistent pain.

• Skin changes, particularly moles that change shape and size or new
moles.

• Unexplained weight loss.

In some cases, cancer may cause organ-specific additional symptoms. This may
include:

• Blood in your pee or stool.

• Change in the shape, color or size of skin mole.

• Coughing up blood.

• New lumps or bumps.

This isn’t an exhaustive list. And having these symptoms doesn’t necessarily
mean you have cancer.

Cancer is a complicated disease. Different types cause different symptoms. It’s

also possible to have cancer for years without knowing it. Other times, it can
cause obvious symptoms that get worse very quickly.

A good rule of thumb is to let a healthcare provider know any time there’s a
change in your body that lasts for more than two weeks.

What causes cancer?

Cancer is a genetic disorder. But that doesn’t necessarily mean it’s inherited. It
happens when genes that manage cell activity mutate (change). They create
abnormal cells that divide and multiply, eventually disrupting how your body
works.
These cells create cancer clusters, or tumors. Cancerous cells may break away
from tumors and travel to other areas of your body through your lymphatic
system or bloodstream. (Healthcare providers call this metastasis.)

For example, a tumor in your breast may spread to your lungs, making it hard
for you to breathe. In some types of blood cancer, your bone marrow makes
abnormal blood cells that multiply uncontrollably. Eventually, the abnormal
cells crowd out normal blood cells.

According to medical researchers, inherited genetic mutations (changes you

can’t control) cause about 5% to 10% of all cancers. More often, cancer occurs
as an acquired genetic mutation (change). That means it happens over the course
of your life. Medical researchers have identified several risk factors that
increase your chance of developing cancer.

Risk factors

There isn’t one single cause for cancer. Rather, certain things can increase your
chance of developing it, like:

• Family history. If you have close biological family members (parents,

siblings, grandparents) who have cancer, you have a higher risk of
developing it.

• Smoking. Smoking tobacco or using e-cigarettes increases your chance

of developing lung, esophageal, pancreatic and oral cancer.

• Environmental factors. Exposure to toxins in your environment, like

asbestos, pesticides and radon, can eventually lead to cancer.

• Malnutrition. High-fat or high-sugar foods can increase your risk for

many types of cancer. You’re also more vulnerable to disease if you don’t
get enough physical activity.
 • Hormone therapy. Women and people assigned female at birth (AFAB)
taking hormone replacement therapy may have an increased risk for
breast cancer and uterine cancer.

• Radiation exposure. Ultraviolet (UV) radiation from the sun

significantly increases your risk of developing skin cancer. Over-
exposure to radiation therapy can also be a risk factor.

Diagnosis and Tests

How is cancer diagnosed?

Healthcare providers begin a cancer diagnosis by doing a complete physical

examination. They’ll ask you to describe your symptoms and your family
medical history. They may also need to do:

• Blood tests for cancer, which may include complete blood count (CBC),
blood protein tests and tumor marker tests.

• Imaging tests like CT scans, MRI, ultrasound or iodine

metaiodobenzylguanidine (MIGB).

• Biopsies, which could be surgical (with an incision) or nonsurgical (with

a needle).

• Genetic testing for cancer to diagnose and plan treatment for inherited
forms of cancer.

How is cancer stage determined?

Healthcare providers use cancer staging systems to plan treatment and develop a
prognosis or expected outcome.

Most cancers have four stages. The specific stage is determined by a few
different factors, including the tumor’s size and location.
Stage I-III (1-3) (early-stage or locally advanced) usually describes cancer when
it has grown directly into surrounding tissue or has spread to nearby lymph
nodes.

Stage IV (4) (or metastatic) means that cancer cells have spread to distant areas
of your body through your bloodstream or lymphatic system.

Management and Treatment

How is cancer treated?

Healthcare providers may use several different treatments, sometimes

combining treatments based on your situation. Common cancer treatments
include:

• Surgery: Can remove cancerous tumors that haven’t spread.

• Chemotherapy: Destroys cancer cells with powerful drugs in pill form

or intravenously (through a needle into a vein).

• Radiation therapy: Kills cancer cells with high dosages of radiation.

• Immunotherapy: Engages your immune system to fight the disease.

• Targeted therapy: Targets the genetic mutations (changes) that turn

healthy cells into cancer cells.

• Hormone therapy: Blocks cancer-causing hormones. For example,

people assigned male at birth who have prostate cancer might receive
hormones to lower testosterone, which can contribute to prostate cancer.

• Bone marrow transplant: Replaces damaged blood stem cells with

healthy ones.

Cancer treatments can cause several side effects. These side effects vary
depending on which treatment you have and how your body tolerates it. If you
develop side effects during your cancer treatment, let your healthcare provider
know. They may be able to give you recommendations or medications that can
help.

Prevention

Can cancer be prevented?

You can’t always prevent cancer, especially when unavoidable risk factors cause
it. But there are things you can do to lower your risk:

• If you smoke or use tobacco, try to stop. Ask a healthcare provider about
smoking cessation programs that can help you quit tobacco.

• Follow a nutrition plan that’s healthy for you.

• Include physical activity in your daily routine.

• Avoid environmental toxins like asbestos and pesticides.

• Protect yourself against sun damage.

• Have regular cancer screenings.

Outlook / Prognosis

What is the outlook for cancer?

You are unique, and so is your prognosis. Your healthcare providers will base
your outlook on factors like:

• Your overall health.

• The type of cancer you have.

• The stage of your cancer.

• How you respond to treatment.

While there’s no single cure for cancer, some cancers respond well to treatment.
Many people notice a reduction in their signs and symptoms. When this
happens, healthcare providers call it remission. Partial remission is when you
have fewer signs and symptoms. Complete remission is when you no longer
experience symptoms at all.

Different cancers require different treatments, so outcomes vary. In general,

people who receive their diagnosis and begin treatment before cancer spreads
have a more positive outlook. But even if your cancer has spread beyond where
it started, treatment can slow its growth, ease your symptoms, help you live
longer and improve your quality of life.

What are cancer survival rates?

Survival rates are estimates based on the experiences of large groups of people
with different kinds of cancer. Like prognoses, survival rates vary based on
cancer type, stage and treatment.

It’s important to remember that survival rates are only estimates. They can’t tell
you how long you’ll live or how your body will respond to certain treatments.
Your healthcare provider can tell you more about survival rates and what they
mean for you.

Living With

How do I take care of myself?

Self-care is an important part of living with cancer, and it looks different for
everyone. Giving yourself some TLC when you need it can reduce stress and
enrich your mental, emotional and spiritual well-being. The following are some
self-care ideas:

• Explore art or music therapy.

• Find a support group so you can talk with others who are having similar
experiences.
 • Get a massage (but get the “OK” from your healthcare provider first).

• Meet with a nutritionist to develop a personalized plan.

• Practice yoga, meditation or other forms of mindfulness.

• Read a cherished book or watch a favorite movie.

• Rest whenever you need to, not just when you can.

• Set your own “visiting hours” so you can spend time with your loved
ones and still protect your downtime.

• Talk with a therapist or counselor about the emotional impact of your

illness.

• Write your thoughts in a journal.

Some of these things might not be your cup of tea, and that’s OK. The bottom
line? Do things that bring you joy and satisfaction. Find meaningful ways to
spend your time.

When should I see my healthcare provider?

Tell your healthcare provider about any issues you have while you’re
undergoing cancer treatment, including any treatment side effects. In many
cases, your oncologist can find ways to keep you more comfortable. Don’t
hesitate to reach out if you’re not feeling well.

What questions should I ask my doctor?

Knowledge is power. If you have cancer, you’ll want to gather as much

information as you can. Here are some questions to ask your healthcare
provider:

• What type of cancer do I have?

• Has the cancer spread to other areas of my body?

 • What are my chances of survival?

• Which treatments do you recommend?

• What are the risks and benefits of my treatment?

• How long will treatment take?

• Will I be able to work during cancer treatment?

• Will cancer treatment affect my fertility?

• Will I need to stay in the hospital for my treatment?

• Would a clinical trial be a good option for me?

A note from Cleveland Clinic

“You have cancer” may be one of the scariest things you’ll ever hear. Suddenly,
everything seems so uncertain. You might feel sad, alone, frustrated or angry.
Maybe you’re all these things at once. Or maybe you’re totally numb. Whatever
you’re feeling is valid and OK.

How will this diagnosis change me? What will my life look like now? How long
do I have to spend with my loved ones? If these are the questions running
through your mind, you’re not alone. The day of your diagnosis, you became
a cancer survivor — a member of a global community. You’ll meet many people
on this journey. Lean on them and your loved ones for support. Your healthcare
providers understand the gravity of this life-changing event — and they’re here
to help in whatever ways you need.

The basics of cancer

Cells and cancer

To begin to understand Cancer of Unknown Primary (CUP) one needs to
understand first a bit about how cancer starts, and that involves our cells: the
human body is composed of billions of cells. Cells are the clever little building
blocks that make up the organs and tissues of our bodies.

Our cells are genetically programmed to do various things throughout our

lifetime. We need new cells to replace worn out cells that die in a regular cycle.
If (the DNA in) a cell becomes faulty, cells can start growing uncontrollably and
form a tumour – a ‘swelling’ but in the cancer context the word is used to
denote abnormal growth of tissue.

If the tumour is abnormal it is known as ‘malignant’; if it is not cancerous it is

known as ‘benign’. The word ‘lesion’ is sometimes used. Lesions are caused by
any process that damages tissues. A cancerous tumour is an example of a lesion.
A benign tumour does not spread within the body; but an untreated, malignant
tumour is likely to spread (metastasise).

Early diagnosis is important. However, a tumour may not be apparent and the
symptoms may not be recognised by the patient or the doctor.

Causes of cancer

Cancer is a genetic disease. It is caused by a number of changes (mutations) in

the genes in our body that control cell growth or regulate the detection and
repair of DNA damage. Often there is more than one gene involved in cancer
development.

Cancer is the result of accumulated mutations to a person’s DNA. The mutations

that can lead to cancer may be inherited or acquired. Multiple events have to
occur to cells before cancer occurs (which is why few children get cancer,
unless it is through inherited damage, and why those over 60 are more likely to
get cancer).
Mutations may result through a loss of activity in Tumour Suppressor Genes
(the brakes), or enhanced activity by Oncogenes (accelerators), that regulate the
way our cells work. So, whilst we may have a genetic predisposition to a
particular cancer it needs further ‘hits’ to turn this into cancer. The damage, or
additional damage, can be caused by a wide variety of factors such as: lifestyle
(diet, drink, smoking, sunbathing etc.), radiation exposure, stress, viral
infection, chemicals.

The primary

The point of origin in the body, where the genes have caused cells to grow
uncontrollably and form a tumour, is known as the primary site. In most cases
the primary site is obvious and quickly diagnosed. Conventional medical
wisdom suggests the importance of finding the primary; but as diagnosis and
medicines get increasingly personalised (e.g. through genomic profiling for
CUP) it will become a case of: what is the pattern of this disease we need to
define a treatment for, rather than where is the primary site?

Strictly speaking CUP exists from the point someone presents with metastatic
cancer without an obvious primary site until they know for certain the site of the
primary. Following the NICE Guideline for CUP (2010) when the initial
diagnosis is uncertain this is described as MUO or metastatic malignancy of
unknown primary origin. It becomes CUP when it remains impossible to tell,
from increasingly sophisticated tests (X-rays, blood tests, scans etc.), where the
cancer began in the body.

Metastasis

Metastasis means the spread of cancer. This spread is common to many cancer
patients by the time they see their doctor and, although it means that surgery is
unlikely to be the main treatment, the cancer remains treatable.
Cancer cells that break away from a primary tumour are carried around the body
by the bloodstream or the lymphatic system. The cells that escape from a
primary site and form a secondary site or sites are known as secondary cancers
or metastases. Metastasis is the process and this is easy to understand if one
goes back to the Greek origins of the word. Literally it means going beyond
(meta) standing still (stasis).

Metastatic cancer is sometimes evident in visible lumps (lesions) and in images

captured by X-ray, PET-CT and similar techniques.

Every tumour is different and every ‘host’, i.e. the patient, is different. The
genetic make-up of people probably has something to do with their vulnerability
to the cancer spread. Using specialized diagnostic tests and microscopes, a
pathologist tries to tell where the cancer cells came from. Usually, cancer cells
look like abnormal versions of cells in the tissue where the cancer began but the
visible and chemical clues are not always apparent with CUP; CUP seems to
behave differently to other cancers in a way that is not yet understood.

Where these loose cancer cells choose to lodge is random, but these cells form a
new, or secondary, tumour. There is a ‘seed and soil’ theory that the metastatic
cells (cancer seed) from an identified primary colonise particular organs (the
soil). This does not seem to be the case with CUP where metastasis is unusual
(atypical); making it more difficult to work backwards in terms of the diagnosis
from the secondary sites with any confidence.

The cells in the metastatic tumour are genetically those of the original tumour.
This means, for example, that if breast cancer spreads to the lungs, the
metastatic tumour in the lung is made up of cancerous breast cells (not lung
cells) and this is then described as metastatic breast cancer (not lung cancer).
Chemotherapy drugs are designed to target the primary, or ancestral, cancer
cells which is why finding the origin of the cancer is important for treatment.

Symptoms

The signs and symptoms of (metastatic) cancer are different for everyone – for
some there may be no symptoms; for others there may be general physical
deterioration. Some of the symptoms can include: breathlessness, discomfort in
the chest, or a collection of fluid around the lungs, bone pain, back pain,
swelling and discomfort in the tummy (abdomen), swollen lymph glands such
as those in the neck, underarm, chest or groin (they may feel hard and swollen
or cause pain through pressure on tissue or nerves nearby). Additional,
generalised symptoms such as: weight loss, headaches, no appetite, feeling
extremely tired are all things that your GP will want to know about.

Types of Cancer

How Is Each Cancer Type Named?

Cancer is named after the part of the body where it originated. When cancer
spreads, it keeps this same name. For example, if kidney cancer spreads to the
lungs, it is still kidney cancer, not lung cancer. Lung cancer would be an
example of a secondary tumor.

Staging is the process of determining whether cancer has spread and, if so, how
far. There is more than one system used for staging cancer.
What Are the Different Types of Cancer?

Cancer is not just one disease but rather a group of diseases, all of which cause
cells in the body to change and grow out of control. Cancers are classified either
according to the kind of fluid or tissue from which they originate, or according
to the location in the body where they first developed. In addition, some cancers
are of mixed types.

The following five broad categories indicate the tissue and blood classifications
of cancer:

Carcinoma

A carcinoma is a cancer found in body tissue known as epithelial tissue that

covers or lines surfaces of organs, glands, or body structures. For example, a
cancer of the lining of the stomach is called a carcinoma. Many carcinomas
affect organs or glands that are involved with secretion, such as breasts that
produce milk. Carcinomas account for 80-90% of all cancer cases.

Types of carcinoma include:

• Melanoma

• Basal cell carcinoma

• Squamous cell skin cancer

• Merkel cell carcinoma

Sarcoma

A sarcoma is a malignant tumor growing from connective tissues, such as

cartilage, fat, muscle, tendons, and bones. The most common sarcoma, a tumor
on the bone, usually occurs in young adults. Examples of sarcoma include
osteosarcoma (bone) and chondrosarcoma (cartilage).

Types of sarcoma include:

 • Soft tissue sarcoma

• Osteosarcoma

• Ewing's sarcoma

• Chrondrosarcoma

Lymphoma

Lymphoma refers to a cancer that originates in the nodes or glands of the

lymphatic system, whose job it is to produce white blood cells and clean body
fluids, or in organs such as the brain and breast. Lymphomas are classified into
two categories: Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Types of lymphoma include:

• Hodgkin's lymphoma

• Non-Hodgkin's lymphoma

• Cutaneous lymphoma

Leukemia

Leukemia, also known as blood cancer, is a cancer of the bone marrow that
keeps the marrow from producing normal red and white blood cells and
platelets. White blood cells are needed to resist infection. Red blood cells are
needed to prevent anemia. Platelets keep the body from easily bruising and
bleeding.

Examples of leukemia include acute myelogenous leukemia, chronic

myelogenous leukemia, acute lymphocytic leukemia, and chronic lymphocytic
leukemia. The terms myelogenous and lymphocytic indicate the type of cells
that are involved.

Types of leukemia include:

 • Acute lymphocytic leukemia

• Acute myeloid leukemia

• Agnogenic myeloid leukemia

• Chronic lymphocytic leukemia

• Chronic myeloid leukemia

• Essential thrombocythemia (ET)

• Hairy cell leukemia

• Myelodysplastic syndromes (MDS)

Myeloma

Myeloma grows in the plasma cells of bone marrow. In some cases, the
myeloma cells collect in one bone and form a single tumor, called a
plasmacytoma. However, in other cases, the myeloma cells collect in many
bones, forming many bone tumors. This is called multiple myeloma.

How Is Cancer Diagnosed?

There is no single test that can accurately diagnose cancer. The complete
evaluation of a patient usually requires a thorough history and physical
examination along with diagnostic testing. Many tests are needed to determine
whether a person has cancer, or if another condition (such as an infection) is
mimicking the symptoms of cancer.

Effective diagnostic testing is used to confirm or eliminate the presence of

disease, monitor the disease process, and to plan for and evaluate the
effectiveness of treatment. In some cases, it is necessary to repeat testing when a
person's condition has changed, if a sample collected was not of good quality, or
an abnormal test result needs to be confirmed.
Diagnostic procedures for cancer may include imaging, laboratory tests
(including tests for tumor markers), tumor biopsy, endoscopic examination,
surgery, or genetic testing.

Cancer diagnosis methods:

• Lab tests

• Diagnostic imaging

• Endoscopic exams

• Genetic tests

• Tumor biopsies

What are the different types of lab tests used to diagnose cancer?

Clinical chemistry uses chemical processes to measure levels of chemical

components in body fluids and tissues. The most common specimens used in
clinical chemistry are blood and urine.

Many different tests exist to detect and measure almost any type of chemical
component in blood or urine. Components may include blood glucose,
electrolytes, enzymes, hormones, lipids (fats), other metabolic substances, and
proteins.

The following are some of the more common laboratory tests:

• Blood tests

• Complete blood count (CBC)

• Urinalysis

• Tumor markers

Learn more about laboratory tests.

Diagnostic imaging

Diagnostic radiology has greatly advanced in recent years with the development
of new instruments and techniques that can better detect cancer and also help
patients avoid surgery.

The diagnostic radiology staff and physicians at the Stanford Cancer Center are
leaders in their field and have access to the most advanced technology available
today for imaging of cancer.

In fact, the expertise of our doctors is so well recognized that we proudly serve
as a reference center, meaning that outside physicians can send our staff
complex or borderline images and receive expert interpretation for their
patients.

In addition to advanced instruments and experienced staff, the Cancer Center

was designed to improve the delivery of diagnostic radiology. For example, we
have consolidated imaging workstations for mammograms, ultrasounds, and
magnetic resonance images in one room, allowing physicians to directly
compare images from multiple sources.

This unprecedented cross-platform, simultaneous access ensures that all of the

relevant data is at your doctor's fingertips when s/he is making important
decisions about your care.

What are the different types of diagnostic imaging?

Imaging is the process of producing valuable pictures of body structures and

organs. It is used to detect tumors and other abnormalities, to determine the
extent of disease, and to evaluate the effectiveness of treatment. Imaging may
also be used when performing biopsies and other surgical procedures. There are
three types of imaging used for diagnosing cancer: transmission imaging,
reflection imaging, and emission imaging. Each uses a different process.
Transmission imaging

X-rays, computed tomography scans (CT scans), and fluoroscopy are

radiological examinations whose images are produced by transmission. In
transmission imaging, a beam of high-energy photons is produced and passed
through the body structure being examined. The beam passes very quickly
through less dense types of tissue such as watery secretions, blood, and fat,
leaving a darkened area on the X-ray film. Muscle and connective tissues
(ligaments, tendons, and cartilage) appear gray. Bones will appear white.

• X-ray

• Computed tomography scan (also called a CT scan or computed axial

tomography or CAT scan)

• Bone scan

• Lymphangiogram (LAG)

• Mammogram

Reflection imaging

Reflection imaging refers to the type of imaging produced by sending high-

frequency sounds to the body part or organ being studied. These sound waves
"bounce" off of the various types of body tissues and structures at varying
speeds, depending on the density of the tissues present. The bounced sound
waves are sent to a computer that analyzes the sound waves and produces a
visual image of the body part or structure.

• Ultrasound

Emission imaging

Emission imaging occurs when tiny nuclear particles or magnetic energy are
detected by a scanner and analyzed by computer to produce an image of the
body structure or organ being examined. Nuclear medicine uses emission of
nuclear particles from nuclear substances introduced into the body specifically
for the examination. Magnetic resonance imaging (MRI) uses radio waves with
a machine that creates a strong magnetic field that in turn causes cells to emit
their own radio frequencies.

• Magnetic resonance imaging (MRI)

What are the different types of endoscopic examinations used to diagnose

cancer?

Types of endoscopies include:

• Cystoscopy (also called cystourethroscopy)

• Colonoscopy

• Endoscopic retrograde cholangiopancreatography (ERCP)

• Esophagogastroduodenoscopy (also called EGD or upper endoscopy)

• Sigmoidoscopy

What are the different types of genetic testing used to diagnose cancer?

Testing for mutations in genes that give an increased risk for cancer is
complicated. The concepts are important to understand when considering cancer
susceptibility gene testing.

What are the different types of tumor biopsies used to diagnose cancer?

A biopsy is a procedure performed to remove tissue or cells from the body for
examination under a microscope. Some biopsies can be performed in a
physician's office, while others need to be done in a hospital setting. In addition,
some biopsies require use of an anesthetic to numb the area, while others do not
require any sedation.
Biopsies are usually performed to determine whether a tumor is malignant
(cancerous) or to determine the cause of an unexplained infection or
inflammation.

The following are the most common types of biopsies:

• Endoscopic biopsy

• Bone marrow biopsy

• Excisional or incisional biopsy

• Fine needle aspiration biopsy

• Punch biopsy

• Shave biopsy

• Skin biopsy

Cancer Treatment

Cancer is treated in several ways, depending on each person's medical condition

and type of cancer. Common treatments involve chemotherapy and radiation
therapy. Other treatments include surgery and biological therapies.

For many people with cancer, treatment is a process that is designed to meet
their needs. Doctors plan treatments based on several key factors, such as the
type and stage of the cancer, as well as the person's age, health, and lifestyle.

If you have been diagnosed with cancer, it is important for you to know that you
play an important role in the treatment process. Offering input, asking
questions, and expressing your concerns about treatment can help make
treatment a better experience.

Cancer treatment terms you should know

Combined modality therapy: A term used to describe when doctors choose
more than one therapy in treating a patient, such as a combination of radiation
therapy and chemotherapy.

Adjuvant therapy: A term used to describe when doctors choose more than
one therapy in treating a patient. However, the term adjuvant therapy is more
specifically used to describe treatment given after the primary cancer treatment
is completed to improve the chance of a cure. For example, if the doctor wants
to treat cancer cells that may be present, he/she may prescribe one or more
additional treatments.

Neoadjuvant therapy: A term used to describe when doctors choose to use

more than one therapy in treating a patient. However, the term neoadjuvant
therapy is more specifically used to describe cancer treatment given before the
primary therapy—both to kill any cancer cells and contribute to the
effectiveness of the primary therapy.

Preparing a patient for treatment

How can patients prepare for treatment?

As a patient, you play an important role in preparing for your cancer treatment.
The following are some of the most important things to consider before
treatment begins:

Find an oncologist and treatment center.

This step is important to everyone with cancer. Ask your general or primary
care doctor for a referral to an oncologist. You can also contact government and
professional medical organizations, such as your state's health department, the
National Cancer Institute (NCI), or the American Medical Association (AMA)
for information on cancer specialists and treatment centers in your area.

Get a second opinion.

It is common for people diagnosed with cancer to ask another cancer specialist
for their opinion. A second opinion can help you to be sure your diagnosis and
treatment plans are most appropriate for your individual medical history and
profile. Asking for a second opinion also provides more information to consider
when making choices about your treatment. Often, your oncologist can help you
locate another cancer specialist for a second opinion.

Find out about your cancer treatment.

Your cancer care team will help you understand your treatment and answer
questions. It also helps to learn about the type of cancer you have, as well as
your treatment options. Ask your doctor where you can find more information
about cancer. The Stanford Cancer Center contains information on many cancer
topics. Also, the National Cancer Institute (NCI), the American Cancer Society
(ACS), and other cancer- and health-related organizations provide helpful
information.

Find support when you need it.

Cancer treatment can be a long and tiring experience. Many people with cancer
need help throughout the process. Finding help from others can make your
experience more successful. Support groups for people with cancer are available
in many communities. Managing your emotional health, your diet, and your
finances are all things patients can do to reduce the stress involved in the
treatment process. Oncology nurses and social workers are excellent resources
for locating appropriate support groups.

Cancer treatment methods

Cancer is treated in several ways, depending on each person's medical condition

and type of cancer. Common treatments involve chemotherapy and radiation
therapy. Other treatments include surgery and biological therapies.
For many people with cancer, treatment is a process that is designed to meet
their needs. Doctors plan treatments based on several key factors, such as the
type and stage of the cancer, as well as the person's age, health, and lifestyle. If
you have been diagnosed with cancer, it is important for you to know that you
play an important role in the treatment process. Offering input, asking
questions, and expressing your concerns about treatment can help make
treatment a better experience.

There is a great deal of information to learn about the cancer treatment process,
including various cancer treatment options—their goals and side effects.

Surgery for cancer treatment

Radiation therapy

The use of high-energy radiation to kill or shrink cancer cells, tumors, and non-
cancerous diseases.

Chemotherapy

The use of anticancer drugs to shrink or kill cancerous cells and reduce cancer
spreading to other parts of the body.

Hormone therapy

Use of supplemental hormones to prevent or stop the growth or spread of

tumors. The type of hormone therapy you receive depends upon many factors,
such as the type and size of the tumor, your age, the presence of hormone
receptors on the tumor, and other factors.

Blood and bone marrow transplant

A specialized therapy to transfer healthy bone marrow cells into a patient after
their own unhealthy bone marrow has been eliminated.

Biologic therapy
Treatment with substances that are made naturally in the body or that can block
the growth of cancer cells.

Immunotherapy

Immunotherapy (also called biological therapy, biological response modifier

therapy, or biotherapy) is designed to boost the body's immune system in order
to fight cancer. The cells, antibodies, and organs of the immune system work to
protect and defend the body against foreign invaders, such as bacteria or
viruses. Doctors and researchers have found that the immune system might also
be able to both determine the difference between healthy cells and cancer cells
in the body, and to eliminate the cancer cells.

Angiogenesis inhibitors

A substance that may prevent the formation of blood vessels. In anticancer

therapy, an angiogenesis inhibitor may prevent the growth of new blood vessels
that tumors need to grow.

What Causes Cancer?

There is no one single cause for cancer. Scientists believe that it is the
interaction of many factors together that produces cancer. The factors involved
may be genetic, environmental, or constitutional characteristics of the
individual.

Diagnosis, treatment, and prognosis for childhood cancers are different than for
adult cancers. The main differences are the survival rate and the cause of the
cancer. The overall five-year survival rate for childhood cancer is about 80%,
while in adult cancers the survival rate is 68%. This difference is thought to be
because childhood cancer is more responsive to therapy and a child can tolerate
more aggressive therapy.
Childhood cancers often occur or begin in the stem cells, which are simple cells
capable of producing other types of specialized cells that the body needs. A
sporadic (occurs by chance) cell change or mutation is usually what causes
childhood cancer. In adults, the type of cell that becomes cancerous is usually
an epithelial cell. Epithelial cells line the body cavity and cover the body
surface. Cancer occurs from environmental exposures to these cells over time.
Adult cancers are sometimes referred to as acquired for this reason.

Cancer Risk Factors

As mentioned, some cancers, particularly in adults, have been associated with

repetitive exposures or risk factors. A risk factor is anything that may increase a
person's chance of developing a disease. A risk factor does not necessarily cause
the disease, but it may make the body less resistant to it. The following risk
factors and mechanisms have been proposed as contributing to cancer:

• Lifestyle factors. Smoking, a high-fat diet, and working with toxic

chemicals are examples of lifestyle choices that may be risk factors for
some adult cancers. Most children with cancer, however, are too young to
have been exposed to these lifestyle factors for any extended time.

• Family history, inheritance, and genetics may play an important role

in some childhood cancers. It is possible for cancer of varying forms to
be present more than once in a family. It is unknown in these
circumstances if the disease is caused by a genetic mutation, exposure to
chemicals near a family's residence, a combination of these factors, or
simply coincidence.

• Some genetic disorders. For example, Wiskott-Aldrich and Beckwith-

Wiedemann syndrome are known to alter the immune system. The
immune system is a complex system that functions to protect our bodies
from infection and disease. The bone marrow produces cells that later
 mature and function as part of the immune system. One theory suggests
that the cells in the bone marrow, the stem cells, become damaged or
defective, so when they reproduce to make more cells, they make
abnormal cells or cancer cells. The cause of the defect in the stem cells
could be related to an inherited genetic defect or exposure to a virus or
toxin.

• Exposures to certain viruses. Epstein-Barr virus and HIV, the virus that
causes AIDS, have been linked to an increased risk of developing certain
childhood cancers, such as Hodgkin and non-Hodgkin lymphoma.
Possibly, the virus alters a cell in some way. That cell then reproduces an
altered cell and, eventually, these alterations become a cancer cell that
reproduces more cancer cells.

• Environmental exposures. Pesticides, fertilizers, and power lines have

been researched for a direct link to childhood cancers. There has been
evidence of cancer occurring among nonrelated children in certain
neighborhoods and/or cities. Whether prenatal or infant exposure to these
agents causes cancer, or whether it is a coincidence, is unknown.

• Some forms of high-dose chemotherapy and radiation. In some cases,

children who have been exposed to these agents may develop a second
malignancy later in life. These strong anticancer agents can alter cells
and/or the immune system. A second malignancy is a cancer that appears
as a result from treatment of a different cancer.

Cancer Genes

How do genes affect cancer growth?

The discovery of certain types of genes that contribute to cancer has been an
extremely important development for cancer research. Over 90% of cancers are
observed to have some type of genetic alteration. Some of these alterations are
inherited, while others are sporadic, which means they occur by chance or occur
from environmental exposures (usually over many years).

Types of cancer genes

There are three main types of genes that can affect cell growth and are altered
(mutated) in certain types of cancers, including the following:

• Oncogenes: These genes regulate the normal growth of cells. Scientists

commonly describe oncogenes as similar to a cancer "switch" that most
people have in their bodies. What "flips the switch" to make these
oncogenes suddenly become unable to control the normal growth of cells
and allowing abnormal cancer cells to begin to grow, is unknown.

• Tumor suppressor genes: These genes are able to recognize abnormal

growth and reproduction of damaged cells, or cancer cells, and can
interrupt their reproduction until the defect is corrected. If the tumor
suppressor genes are mutated, however, and they do not function
properly, tumor growth may occur.

• Mismatch-repair genes: These genes help recognize errors when DNA is

copied to make a new cell. If the DNA does not "match" perfectly, these
genes repair the mismatch and correct the error. If these genes are not
working properly, however, errors in DNA can be transmitted to new
cells, causing them to be damaged.

Usually the number of cells in any of our body tissues is tightly controlled so
that new cells are made for normal growth and development, as well as to
replace dying cells. Ultimately, cancer is a loss of this balance due to genetic
alterations that "tip the balance" in favor of excessive cell growth.

What is a tumor?

A tumor develops when cells reproduce too quickly.

The National Cancer InstituteTrusted Source defines a tumor as “an abnormal
mass of tissue that results when cells divide more than they should or do not die
when they should.”

Tumors can vary in size from a tiny nodule to a large mass, depending on the
type, and they can appear almost anywhere in the body.

Types

There are three main types of tumor:

• Benign: These tumors are not cancerous. They do not invade nearby
tissue or spread to other parts of the body. If a doctor removes them, they
do not generally return.

• Premalignant: In these tumors, the cells are not yet cancerous, but they
can potentially become malignant.

• Malignant: Malignant tumors are cancerous. The cells can grow and
spread to other parts of the body.

It is not always clear how a tumor will act in the future. Some benign tumors
can become premalignant and then malignant. For this reason, it is best to
monitor any growth.

Tumor vs. cyst

Tumors and cysts can look similar, and both can form on almost any part of the
body.

However, tumors are solid tissue masses, while cysts are sacs containing other
substances, such as fluid or air. Due to their content, cysts may appear softer to
the touch than tumors, which typically feel firm. However, some benign tumors
can also feel soft to the touch.

Learn more about the differences between tumors and cysts here.
Benign

Most benign tumors are not harmful, and are unlikely to affect other parts of the
body.

However, they can cause pain or other problems if they press against nerves or
blood vessels or trigger the overproduction of hormones, as in the endocrine
system.

Examples of benign tumors include:

Adenomas

Adenomas develop in glandular epithelial tissue, which is the thin membrane

that covers glands, organs, and other structures in the body.

Examples include:

• colon polyps

• fibroadenomas, a common form of benign breast tumor

• hepatic adenomas, which occur in the liver

Adenomas do not start as cancer. However, some can change and become
adenocarcinomas, which are cancerous.

Learn more about fibroadenomas of the breast here.

Fibroids

Fibroids, or fibromas, are benign tumors that can grow on the fibrous or
connective tissue of any organ.

Uterine fibroids are common and can cause:

• vaginal bleeding

• pelvic pain or discomfort

 • urinary incontinence

They can be “soft” or “hard,” depending on the proportion of fibers to cells.

There are many types of fibroma, including angiofibromasTrusted Source,

which can appear as small red bumps on the face, and dermatofibromas, which
appear on the skin, often on the lower legs.

Some fibromas can cause symptoms and may need surgery. In rare cases,
fibroids can change and become fibrosarcomas. These are cancerous.

Learn more about dermatofibromas.

Hemangiomas

Hemangiomas are benign tumors that form when blood vessels grow
excessively.

They can appear as discolored marks on the skin or develop inside the body.
They are often present at birth and disappear during childhood.

Hemangiomas do not usually need treatment, but laser surgery and other options
are available if they do not go away.

Find out more here about internal hemangiomas.

Lipomas

Lipomas are a form of soft tissue tumor and consist of fat cells. They can appear
at any age but often affect people from 40–60 years old and are unlikely to
become cancerous.

Most lipomas are small, painless, rubbery, soft to the touch, and movable. They
often appear on the back, shoulders, arms, buttocks, and the tops of the legs.

Types of lipoma include fibrolipomas, which contain fat cells and fibrous
connective tissue, and angiolipomas, which appear under the skin.
Premalignant

This type of tumor is not cancerous, but doctors will monitor them closely for
changes.

Examples include:

Actinic keratosis

Also known as solar keratosis, this growth involves crusty, scaly, and thick skin
patches.

It is more likely to affect fair-skinned people, and sun exposure increases the
risk.

Sometimes, actinic keratosis will transform into squamous cell carcinoma, so

doctors usually recommendTrusted Source treating it.

Cervical dysplasia

In cervical dysplasia, a change occurs in the cells that line the cervix. A doctor
may find these cells during a Pap smear. Cervical dysplasia often stems from
the human papillomavirus (HPV), an infection common in young people.

The cells are not cancerous, but they may become malignant 10–30
yearsTrusted Source later, resulting in cervical cancer.

A surgeon may remove the cells using freezing techniques or taking a cone of
tissue from the cervix.

Metaplasia of the lung

These growths occurTrusted Source in the bronchi, the tubes that carry air into
the lungs.

The lining of the bronchi contains glandular cells. In some people, including
smokers, these can change and become squamous cells or cancer.
Leukoplakia

Leukoplakia causes thick white patches to form in the mouth.

These patches:

• are painless

• have an irregular shape

• have raised edges

• are not possible to scrape off

Anyone with this type of patch should see a doctor if it does not go away with
time.

They should also monitor the patches for changes and quit smoking or chewing
tobacco.

If a doctor believes the patches could become cancerous, they may use a laser or
surgical scalpel to remove them.

Learn more about leukoplakia here.

Malignant

Malignant tumors are cancerous. They develop when cells grow uncontrollably.
If the cells continue to grow and spread, the disease can become life
threatening.

Malignant tumors can grow quickly and spread to other parts of the body in a
process called metastasis. However, not all malignant tumors grow quickly;
some can grow much slower over time.

The cancer cells that move to other parts of the body are the same as the original
ones, but they can invade other organs. For example, if lung cancer spreads to
the liver, the cancer cells in the liver are still lung cancer cells.
Different types of malignant tumors originate in different types of cells.

Examples include:

• Carcinoma: These tumors form from epithelial cells, which are present
in the skin and the tissue that covers or lines the body’s
organs. Carcinomas can occur in the stomach, prostate, pancreas, lung,
liver, colon, or breast. They are a common type of malignant tumor.

• Sarcoma: Sarcomas start in connective tissue, such as cartilage, bones,

fat, and nerves. They originate in the cells outside the bone marrow.
Most sarcomas are malignant.

• Germ cell tumor: These tumors develop in the cells that produce sperm
and eggs. They usually occur in the ovaries or testicles but may also
appear in the brain, abdomen, or chest.

• Blastoma: These tumors form from embryonic tissue or developing cells.

Blastomas are much more common in children than in adults. They can
lead to tumors in the brain, eye, or nervous system.

• Meningiomas: These are among the most common types of brain tumors
and sometimes require excision or treatment if they are causing
symptoms.

Testicular cancer starts in the germ cells. Learn more here.

Causes

Tumors result from an overgrowth of cells.

In a healthy body, cells grow, divide, and replace each other in the body. As new
cells form, the old ones die. If too many new cells exist, a group of cells, or
tumor, can develop.
For example, when a person has cancer, new cells form when the body does not
need them.

Benign tumors may develop due to:

• injury

• environmental toxins

• infection

Risk factors

While the exact causes of tumor growth are often unclear, several factors can
increase a person’s risk.

Risk factors for malignant tumors includeTrusted Source:

• smoking

• alcohol use

• family history of cancer

• the type of tumor

• exposure to carcinogens

• genetics

• human papillomavirus (HPV)

• having obesity

• being overweight

The risk level of the above can vary across different people and different types
of cancer.

Risk factors for benign tumors include:

 • frequent exposure to toxins and radiation

• stress

• diet

• family history of tumors

• frequent infections

Diagnosis

A person can sometimes see or feel a tumor, but others will only show up on
imaging tests, such as mammograms or MRIs. Screening tests such as
colonoscopies and Pap smears can also pick up malignant and pre-cancerous
tumors.

A biopsy may be necessary to determine the type of lump. The doctor will take
a small tissue sample and send it to a laboratory where technicians will examine
it under a microscope.

The doctor may take the sample either in their office, using a needle, or during a
surgical procedure to remove the tumor.

They may decide that a person needs surgery first if they suspect that a tumor is
malignant.