CANCER LIBRARY

+ Bladder Cancer

Overview

Bladder cancer begins when cells in the urinary bladder start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body.

The bladder is an organ which stores urine before it leaves the body and has flexible, muscular walls. The muscular walls of the bladder are made up of many different layers and types of cells. Most bladder cancers starts in the innermost layer. As it grows and spreads, the cancer becomes more advanced.

Types of bladder cancer include:

• Urothelial carcinoma, also known as transitional cell carcinoma (TCC)
• This is by far the most common type of bladder cancer.
• Squamous cell carcinoma
• Adenocarcinoma
• Small cell carcinoma
• Sarcoma

Symptoms

Often the early stages of bladder cancer cause bleeding, but little or no pain or other symptoms. Blood in the urine is the most common symptom for bladder cancer. This symptom may be present, then absent for a period of time. It is important to note blood in the urine can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional with this symptom.

Other symptoms may include:

• Changes in frequency of urination
• Pain or burning during urination
• Difficulty urinating or weak urine stream
• Lower back pain on one side
• Loss of appetite and weight loss
• Feel lethargic or tired
• Feet swelling
• Bone pain

Risk Factors

People who smoke are three times as likely to get bladder cancer as nonsmokers. Smoking is the cause of about half of all bladder cancers in men and women. Some chemicals have been linked with this cancer, called aromatic amines. Other workplace exposures to chemicals and dyes include makers of rubber, leather, textiles, paint products and printing companies.

There is a possible link between prolonged use of the diabetes medication pioglitazone (Actos) and bladder cancers. Also, dietary supplements containing aristolochic acid have been known to cause an increased risk for bladder cancers. People who drink a lot of fluids, especially water, tend to have lower rates of bladder cancer.

People of white ethnicity are twice as likely to get bladder cancer, compared to African Americans and Hispanics. Risk for this cancer also increases with age – 90% of those diagnosed with this cancer are over the age of 55. Bladder cancer is more common in men than in women.

Other risk factors include: chronic bladder infections, personal history with bladder cancer, bladder birth defects, family genetics, pelvic exposure to radiation and prior chemotherapy Cytoxan.

Prevention

While some risk factors, such as age, gender, and race cannot be controlled, there may be some things you can do to lower your risk of bladder cancer:

• Stop smoking. Smoking is thought to cause about half of all bladder cancers.
• Limit exposure to chemicals in the workplace
• Drink plenty of fluids, especially water
• Eat lots of fruits and vegetables

Diagnosis

A detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam may include both rectal and pelvic exams. Some lab tests may be ordered, including: urinalysis, urine cytology, urine culture, and urine tumor marker tests.

Cytoscopy may be used for the doctor to look at the lining of the bladder. If an abnormal area is seen, the area may be biopsied. This biopsy is needed to confirm the diagnosis. Two important features of the biopsy results include: invasiveness and grade (low or high).

Other imaging tests may be used in addition to the diagnostic tools discussed above. These may include x-rays, MRI, CT, Ultrasound, and Bone Scans.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Intravesical therapy
• Chemotherapy
• Radiation therapy
• Immunotherapy

Your doctor may decide more than one of these treatment options will be in your best interest. Surgery is the most common treatment option and can often remove early-stage bladder tumors. Close follow up will be required for bladder cancer patients.

+ Brain Cancer

Overview

Brain tumors are masses of abnormal cells that have grown out of control. These tumors rarely spread to other parts of the body, but they can spread throughout other areas of the brain. In many types of cancer and other parts of the body, distinguishing between malignant and benign is very important. In the case of brain tumors, even benign tumors can grow and harm other areas of the brain. Initial concerns of these tumors are how quickly it could spread to other areas of the brain or spinal cord and if it can be removed and not come back.

Brain tumors often behave very differently in children versus adults. They many times show up in different areas, have varying cell types, and outlook/treatment is often different.

There are three main parts of the brain portion of the Central Nervous System (CNS): cerebrum, cerebellum and the brain stem. The cerebrum is the largest part and is the outer portion of the brain – there two halves known as hemispheres and it controls many functions of the body including: thought, emotion, language, voluntary muscle movement, and interpreting physical stimuli. The cerebellum is located under the cerebrum and it helps coordinate movement. The brain stem is the lowest part of the brain and it connects to the spinal cord. This area controls signals between the cerebrum and the rest of the body. There are specific areas of the brain stem that control vital functions like breathing and heart rhythm. Cranial nerves originate in the brain stem.

Symptoms

Symptoms of a brain tumor in the cerebrum can include:

• Seizures
• Nausea or vomiting
• Difficulty with speech
• Abrupt change in mood
• Personality changes
• Weakness or paralysis
• Changes in vision or other senses

Symptoms of a brain tumor in the cerebellum may include:

• Difficulty walking
• Fine movement challenges with limbs
• Problems swallowing
• Changes in speech rhythm

Symptoms of a brain tumor in the brain stem can include:

• Weakness
• Rigid muscles
• Difficulty feeling sensation, facial movement, hearing or swallowing
• Double vision is often reported as an early symptom
• Risk Factors

Research has shown most brain tumors are not associated with specific risk factors or no known cause. A few factors known to raise concern include: radiation exposure, family history in rare cases, and a weakened immune system.

Prevention

Due to the fact that most brain tumors are not associated with a specific risk factor or behavior, there is not much one can to do protect against them.

Diagnosis

Most brain tumors are found when a patient presents with concerning signs or symptoms that could be caused by a brain tumor. Your doctor will perform a comprehensive physical exam and obtain a medical history. If any of their findings are abnormal, they may refer you to a neurologist or neurosurgeon for further testing. Common tests include imaging, such as an MRI, CT, PET Scan, or X-Rays. If abnormal areas show upon those images, a biopsy is often the next step to help identify what type of tumor it may be. A spinal tap, blood tests, and urine samples may also be conducted.

Treatment

The treatment plan will determine on a number of factors including your age and overall health, the type of tumor, where the tumor is located, likelihood the treatment will work and the patient’s wishes as it relates to possible side effects. Typically, a team of doctors work together to develop a personalized treatment plan to give the best chance of success in treating the tumor and minimizing side effects. Treatment plans can include a singular option, or combination of:

• Surgery
• Radiation Therapy
• Chemotherapy
• Targeted Therapy
• Other drug treatments

+ Breast Cancer

Overview

Outside of skin cancers, breast cancer is the most common cancer in American woman. Women have approximately a 12% chance of developing this cancer sometime in her life. There are more than 3 million breast cancer survivors in the U.S.

When cells in the breast begin to grow out of control due to changes in DNA, breast cancer can begin. Often from a tumor, these cells may be visible on imaging or felt as a lump in the breast. If the cells invade other tissues or spread to distant parts of the body, the tumor would be considered malignant. While men can get this cancer, it is most commonly found in women.

Breast cancer can originate in any part of the breast but is commonly found in the ducts and glands. It is important to note that not all breast cancers can be felt as a lump in the breast, which is why screening mammograms are so important. Any lump or change should be discussed with your healthcare provider.

Breast cancers can spread to other areas of the body through the lymphatic system or through the blood system. If cancer cells are found in lymph nodes, there is an increased risk the cancer may have spread to other organs and can affect the treatment plan. This is not a sure fact, as some women with cancer in their lymph nodes do not have metastases.

Symptoms

Finding breast cancer early can help improve the prognosis of the disease and allow for more successful treatment. Self exams are an important part of overall health, but should not replace screening mammograms or other screening tests. These tests may help identify cancer before any symptoms show up.

A new lump is the most common symptom of breast cancer. Any new lump should be checked by a healthcare professional knowledgeable in breast diseases.

Other symptoms may include:

• Swelling of the breast
• Dimples of breast tissue
• Pain
• Nipple turning inward
• Changes in the skin on the breast or nipple
• Nipple discharge (other than breast milk)
• Discomfort or swelling around lymph nodes around the collar bone or under the arm

Risk Factors

Some risk factors include those within your control, or behavioral, such as diet and exercise. Some of the more common risk factors in this category include:

• Drinking alcohol
• Being overweight or obese
• Sedentary lifestyle
• Not having children
• Not breastfeeding
• Taking birth control
• Hormone therapy after menopause

Other risk factors you have no control over, such as your age, being a woman, or certain genetic predispositions. Breast cancer is 100 more common in women than men. Most of these cancers are found in women over the age of 55, so your risk goes up with your age.

5-10% of breast cancers are attributed to hereditary causes. The most common mutations are those of BRCA1 and BRCA2, in which women have about a 7 in 10 chance of getting the cancer by age 80.

Having a family or personal history of breast cancer also increases your risk of developing it again in the future. White women are slightly more likely to have this cancer than African American women. Having dense breast tissue and other benign breast conditions can also increase your risk for developing the cancer.

Other risk factors may include:

• Starting menstruation early, especially before age 12
• Go through menopause after age 55
• Having radiation to your chest

There are several risk factors for breast cancer in which research has not shown a correlation including: antiperspirants, wearing of bras, abortion or miscarriages, and breast implants. There is no research to support any of these would increase a woman’s likelihood of developing breast cancer in the future.

Prevention

While there is no way to guarantee you will not develop breast cancer, as some risk factors are out of your control, there are a few things you can do to help lead a healthy lifestyle and reduce your likelihood.

• Maintain a healthy body weight
• Stay physically active, at least 150 minutes of activity each week
• Limit or avoid alcohol
• Eat a healthy diet
• Choose to breastfeed for at least several months

There are some medications for patients to take who are at a known risk for developing breast cancer. A small subset of patients may also consider removal of the breasts or ovaries when they are at a very high risk for developing breast cancer. These options should be discussed with your healthcare provider to determine how helpful they would be and how it may lower your risk of developing breast cancer.

Diagnosis

While some breast cancers are found after a lump, or other symptoms appear, many women are diagnosed with no symptoms at all. For this reason, regular screenings are important for early detection. Imaging commonly used include: mammograms, breast ultrasounds, and breast MRI scans.

If a change in breast tissue is noted with these images, a biopsy will likely be taken to see whether or not it is in fact cancerous. Additional tests may be needed if your doctor suspects the cancer may have spread to other areas of the body.

To see the suggested mammogram guidelines from the American Cancer Society, please click here.

Treatment

Every patient is unique and there are many factors that go into developing a customized treatment plan, including the type of stage of the cancer.

Local treatments for breast cancer, where only the tumor is affected, include surgery and radiation therapy. Most women will have some type of surgery to remove the tumor, then may need additional treatment depending on the diagnosis.

Systemic treatments are medications administered either orally or via IV. These include chemotherapy, hormone therapy, and targeted therapy.

You may have a team of doctor to help walk you through your cancer diagnosis. These could include: a breast surgeon, radiation oncologist, medical oncologist, and a plastic surgeon for cosmetic repairs. The team of doctors here at Highlands Oncology Group work closely with other specialists in our area to ensure you the best care possible.

+ Cervical Cancer

Overview

Cervical cancer begins when cells in the cervix start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced.

The cervix is the lower part of the uterus which connects the uterus to the vagina. Nearly all cervical cancers start in the transformation zone, the area between the endocervix (the part of the cervix closest to the body of the uterus) and exocervix (the part of the cervix closest to the vagina). Cervical cancers commonly start as pre-cancers which can be detected by a Pap test.

Types of cervical cancer include:

• Squamous cell carcinomas (About 9 out of 10 cervical cancers are of this type)
• Adenocarcinomas
• Adenosquamous carcinomas or mixed carcinomas
• Rarely, other types of cancer can start in the cervix, including melanoma, sarcoma, and lymphoma

Symptoms

Early cervical cancers and pre-cancers often do not cause symptoms. When cervical cancer becomes malignant and begins to spread, it can cause:

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pain during intercourse

It is important to note that the symptoms above can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional to improve the chances of effective treatment.

Risk Factors

The most important risk factor for cervical cancer is infection with human papillomavirus (HPV). HPV is common, but in some cases, the body is unable to clear the infection and develops a chronic infection, which can eventually cause cancer by producing proteins which deactivate the tumor suppressor genes that normally regulate cell growth.

Smokers are twice as likely as non-smokers to develop cervical cancer. Tobacco by-products have been found in cervical mucus, and may be damaging to cervical cells; the immune system may also be weakened by smoking and therefore become less effective in combating cancer-causing HPV infections.

Suppression of the immune system, which can be caused by human immunodeficiency virus (HIV) or certain treatments for autoimmune diseases, may increase the risk of HPV infection or allow cervical cancer to develop and spread more quickly.

Long-term use of oral contraceptives increases the risk of cervical cancer, increasing the longer use persists and decreasing after it is stopped, with risk level returning to normal after about 10 years after stopping oral contraceptives. It is important to discuss the benefits and risks of oral contraceptives with your doctor.

The use of intrauterine devices (IUDs) may decrease the risk of developing cervical cancer, and the risk reduction has been observed even after the IUD is removed, and with less than a year of use.

Women who have a full-term pregnancy before the age of 17 are nearly twice as likely to develop cervical cancer than those who do not become pregnant until after 25.

Other risk factors include: current or past chlamydia infection, a diet which does not include sufficient fruits and vegetables, being overweight, having had three or more full-term pregnancies, lacking access to adequate health care and screening services (often due to economic status), fetal exposure to the hormonal drug diethylstilbestrol (DES) (learn more here), and having a family history of cervical cancer.

Prevention

Many cases of cervical cancer can be prevented by detecting and treating pre-cancers. Screening methods include regular Pap tests and HPV tests. Pap tests involve collecting and examining cervical cells, and are often performed during a routine pelvic exam.

There are other recommendations to prevent or lower your risk of cervical cancers and pre-cancers, which include:

• Use condoms, which protect against HIV, chlamydia, and other sexually transmitted infections, and offer incomplete protection against HPV infection (which can be contracted by skin-to-skin contact not necessarily including intercourse).
• Refrain from or stop smoking.
• Receive HPV vaccination if recommended by your doctor.

Learn more about the American Cancer Society recommendations for HPV vaccination here.

Diagnosis

While some cervical cancers are found after symptoms like abnormal vaginal bleeding appear, many women are diagnosed with no symptoms at all. For this reason, regular screenings are important for early detection, and regular Pap tests are recommended as part of a regular examination by your gynecologist.

If there is a suspicion of cervical cancer, you should be examined by a gynecologist. A detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include a pelvic exam and Pap screening.

An abnormal Pap test result is not a diagnostic test for cancer, and additional testing will be required to confirm a diagnosis of cancer or pre-cancer. This testing may include a colposcopy, in which your physician examines the cervix using a speculum and external magnifying scope, and which is no more invasive or uncomfortable than a regular speculum exam. A biopsy — the removal and testing of possibly abnormal tissue — may also be required. Biopsy procedures can be performed under local anesthetic in your doctor’s office, but may cause some discomfort, cramping, or bleeding.

Other tests may be used in addition to the diagnostic tools discussed above.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy

Your doctor may decide more than one of these treatment options will be in your best interest. Surgery is a common treatment option.

+ Colorectal Cancer

Overview

Colon or rectal cancer begins when cells in the colon or the rectum start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced. Colon and rectal cancers share many features in common, and are sometimes grouped under the general label “colorectal cancer.”

The colon is the part of the digestive system which absorbs water and salt from food matter that has passed through the stomach and small intestine. The rectum is the last part of the digestive system, which stores waste matter until it is passed in a bowel movement. Colorectal cancers commonly start as growths on the inner lining of the colon or rectum, called polyps; not all polyps are likely to develop into cancers, but it is important to discuss abnormalities with your doctor.

Types of colorectal cancer include:

• Adenocarcinomas (About 96% of colorectal cancers are of this type)
• Carcinoid tumors
• Gastrointestinal stromal tumors
• Lymphomas
• Sarcomas

Symptoms

Early colorectal cancers may not cause symptoms, but symptoms may include:

• Persistent change in bowel habits (diarrhea, constipation, or narrowing of stool, lasting more than a few days)
• Feeling of bowel movement urgency not relieved by having a bowel movement
• Rectal bleeding (bright red blood)
• Bloody stools
• Cramping or abdominal pain
• Weakness or fatigue
• Unintentional weight loss
• Anemia (low red blood cell count) caused by blood loss into the digestive tract

It is important to note that the symptoms above can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional to improve the chances of effective treatment.

Risk Factors

The links between lifestyle factors (factors that can be modified to reduce risk) and the risk of colorectal cancers are among the strongest for any type of cancer. Modifiable risk factors which increase your risk of colorectal cancer include:

• Overweight or obesity
• Physical inactivity
• Diets high in red meat and processed meats
• Smoking
• Heavy alcohol use

Older people (over 50) are more likely to be diagnosed with colon cancer than young people. African-Americans and Jews of Eastern European descent are also at increased risk of colorectal cancer.

Certain conditions can increase the risk of developing colorectal cancer (for more detailed information about these conditions and gene mutations, visit the American Cancer Society website):

• Previous colorectal cancer or polyps
• Inflammatory bowel disease
• Family history of colorectal cancer or adenomatous polyps
• Lynch syndrome or hereditary non-polyposis colorectal cancer (HNPCC)
• Familial adenomatous polyposis (FAP)
• Peutz-Jeghers syndrome (PJS)
• MYH-associated polyposis (MAH)
• Type 2 diabetes

Prevention

Many cases of colorectal cancer can be prevented by detecting and removing pre-cancerous polyps. If you are over the age of 45, it’s important to discuss screening options with your doctor.

Other recommendations to prevent or lower your risk of colorectal cancers include:

• Stay at a healthy weight, and particularly avoid weight gain in the midsection.
• Engage in regular physical activity; moderate activity (brisk walking) lowers risk, and more vigorous activity may reduce risk even further.
• Limit red meats and processed meats, and eat plenty of vegetables and fruits. Ongoing research suggests that diets higher in fiber may be beneficial.
• Avoid excessive alcohol consumption.
• Refrain from or stop smoking.

Diagnosis

While some colorectal cancers are found after symptoms appear, many people are diagnosed with no symptoms at all. For this reason, regular screenings are important for early detection, and regular stool-based or visual tests (including colonoscopy) are recommended for those at average risk over the age of 45. Find more information about screening recommendations from the American Cancer Society website.

If there is a suspicion of colorectal cancer, a detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include an examination of your abdomen and may include a digital rectal exam.

Diagnostic colonoscopy or proctoscopy is often used to confirm a diagnosis of colorectal cancer, and may be combined with biopsy and blood tests. Imaging tests including CT, Ultrasound, MRI, PET, and X-ray (including angiography) may be used throughout diagnosis and treatment.

Other tests may be used in addition to the diagnostic tools discussed above.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy

Your doctor may decide more than one of these treatment options will be in your best interest. Surgery and radiation therapies are common treatment options for early-stage cancers.

+ Kidney Cancer

Overview

Kidney cancer begins when cells in the kidney start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced.

The kidneys are a pair of organs at the back of the abdomen on either side of the spine which filter the blood to remove waste and excess water and salt. These filtered waste products form urine and pass through the ureters to the urinary bladder. The kidneys also manufacture hormones which regulate blood pressure and red blood cell formation, and they are connected to the adrenal glands which create adrenaline, cortisol, and other substances which regulate body function.

Types of kidney cancer include:

• Renal cell carcinoma (About 9 of 10 kidney cancers are of this type)
  • Clear cell renal cell carcinoma
  • Papillary renal cell carcinoma
  • Chromophobe renal cell carcinoma
  • Rare renal cell carcinomas: renal cell carcinomas, multilocular cystic renal cell carcinoma, medullary carcinoma, mucinous tubular and spindle cell carcinoma, neuroblastoma-associated renal cell carcinoma
  • Unclassified renal cell carcinoma
• Transitional cell carcinoma or urothelial carcinoma
• Wilms tumor or nephroblastoma
• Renal sarcoma

Symptoms

Early kidney cancers may not cause symptoms, but symptoms may include:

• Blood in urine or hematuria
• Lower back pain on one side not caused by injury
• A mass on the lower back or side
• Fatigue
• Loss of appetite
• Unintended weight loss
• Persistent fever not caused by infection
• Anemia or low red blood cell count

It is important to note that the symptoms above can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional to improve the chances of effective treatment.

Risk Factors

The risk of developing kidney cancer is increased for those who smoke, and may be further elevated based on how much one smokes. Kidney cancer risk eventually falls back towards the normal/non-smoker level over many years after quitting smoking. Smoking is a factor in many cases of kidney cancer, so avoiding or quitting smoking may be an important way to lower your risk.

Obesity increases the risk of kidney cancer. This effect is thought to be due to hormonal changes which occur in very overweight people and may lead to the development of kidney cancer. Those with high blood pressure are also at increased risk of developing kidney cancer.

Exposure to certain chemicals in the workplace, including cadmium and certain herbicides and solvents, increases the risk of kidney cancer. The medicines phenacetin (no longer available in the US) and diuretics have been linked to higher rates of kidney cancer. In the case of diuretics, it is not known whether the increase is due to the medication itself or the high blood pressure they treat. It is important to follow your doctor’s instructions for the use of diuretics if needed.

Men are about twice as likely as women to develop kidney cancer. Increased smoking rates and increased rates of exposure to carcinogenic chemicals in the workplace may partially explain this difference. African-Americans and Native Americans have a slightly higher risk of kidney cancer than those from other racial/ethnic backgrounds.

Certain conditions can increase the risk of developing kidney cancer (for more detailed information about these conditions and gene mutations, visit the American Cancer Society website):

• Advanced kidney disease, especially requiring dialysis
• Family history of kidney cancer
• High blood pressure
• von Hippel-Lindau disease
• Hereditary papillary renal cell carcinoma
• Hereditary leiomyoma-renal cell carcinoma
• Birt-Hogg-Dube (BHD) syndrome
• Familial renal cancer
• Cowden syndrome
• Tuberous sclerosis
• Hereditary renal oncocytoma

Prevention

While some risk factors, such as gender, hereditary conditions, and race cannot be controlled, there may be some things you can do to lower your risk of kidney cancer:

• Refrain from or stop smoking.
• Maintain a healthy weight with exercise and a healthy diet.
• Treat high blood pressure.
• Avoid exposure to cadmium, organic solvents, and other harmful chemicals at work.

Diagnosis

While some kidney cancers are found after symptoms appear, many people are diagnosed with no symptoms at all. If there is a suspicion of kidney cancer, a detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include an examination of your abdomen and may include additional lab testing.

Imaging tests, including CT, MRI, Ultrasound, PET, and X-ray (including intravenous pyelogram and angiography) are often used to confirm a diagnosis of kidney cancer, but some cases may require biopsy. Blood tests and urinalysis may be used throughout diagnosis and treatment to assess kidney function and overall health.

Other tests may be used in addition to the diagnostic tools discussed above.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Ablation or other local therapy
• Active surveillance
• Radiation therapy
• Targeted therapy
• Immunotherapy
• Chemotherapy

Your doctor may decide more than one of these treatment options will be in your best interest. Surgery is recommended for most cases of kidney cancer.

+ Leukemias

Overview

Leukemia is a cancer of the early-forming blood cells in the body. Early blood-forming tissue can include bone marrow, the sponge like material inside most bones. Often, leukemia is a cancer of the white blood cells, but some types of leukemia can start in other blood cell types. Leukemia can be fast growing or slow growing. There are different types of leukemia that have different treatment options and outlooks.

Types of Leukemia

• Acute Lymphocytic Leukemia (ALL): most prevalent during childhood and early adulthood, but can be found in adults.
• Acute Myeloid Leukemia (AML): occurs most often in adults
• Chronic Lymphocytic Leukemia (CLL): most commonly found in people between the ages of 40 and 70.
• Chronic Myeloid Leukemia (CML): most commonly found in people between the ages of 40 and 70.

In acute leukemia, the bone marrow cells cannot mature properly. The leukemia cells continue to reproduce and build in the body. Without treatment, most people with acute leukemia would only live a few months. Some types of acute leukemia respond well to treatment, and many patients can be cured.

In chronic leukemia, cells mature partly but not 100%. These cells can look close to normal, but generally do not fight infection as well as normal white blood cells can. These cells can also live longer, and crowd out healthy cells. Chronic leukemias progress over a longer period of time, most people can live many years with it. Chronic leukemias are generally harder to cure than acute leukemias.

According the the American Cancer Society, roughly 43,000 people in the US are diagnosed with cancer each year. This includes 15000 cases of CLL, 13500 cases of AML, 6000 cases of ALL, and 5000 cases of CML.

The different types of leukemia are grouped by the type of cell affected in the body and the rate of that call growth.

Symptoms

Quite often, leukemia does not have symptoms early on. Symptoms of leukemia vary depending on type of leukemia and person. Symptoms of leukemia may include:

• Constant feeling of fatigue
• Loss of appetite, unintentional weight loss
• Easy bruising or bleeding
• Unexplained nosebleeds
• Shortness of breath
• Petechiae (small spots of red under the skin caused by bleeding)
• Swollen lymph glands
• Anemia
• Night sweats
• Bone or joint pain
• Persistent infections
• Unexplained fever

It is important to note that these symptoms may not always mean you have leukemia. Discuss these symptoms with your doctor.

Risk Factors

For each type of leukemia, there are many different risk factors. To learn more about specific risk factors for leukemia, visit the links below.

ALL Risk Factors

• Radiation Exposure
• Certain Chemical Exposures
• Certain Viral Infections
• Inherited syndromes
• Down syndrome
• Klinefelter syndrome
• Fanconi anemia
• Bloom syndrome
• Ataxia-telangiectasia
• Neurofibromatosis
• Race/Ethnicity
• Gender

AML Risk Factors

• Smoking
• Chemical Exposure
• Chemotherapy Drugs
• Radiation Exposure
• Blood disorders such as polycythemia vera, essential thrombocythemia, and idiopathic myelofibrosis.
• Genetic syndromes
• Fanconi anemia
• Bloom syndrome
• Diamond-Blackfan anemia
• Schwachman-Diamond syndrome
• Li-Fraumeni syndrome
• Neurofibromatosis type 1
• Severe congenital neutropenia
• Trisomy 8
• Down Syndrome
• Older Age
• Male Gender

CLL Risk Factors

• Age
• Exposure to certain chemicals
• Family history
• Gender
• Race/Ethnicity

CML Risk Factors

• Radiation Exposure
• Age
• Gender
• Prevention

At the time, ways to prevent leukemia are not known.

Diagnosis

Precise diagnosis of leukemia is essential to effective treatment. Certain signs and symptoms can suggest that someone may have leukemia, but tests are needed to confirm the diagnosis. Results of blood and bone marrow tests, including bone marrow aspiration and biopsy are required to successfully diagnose leukemia.

Treatment

There are different treatment options for each different types of leukemia. Treatment options include

• Chemotherapy
• Targeted therapy
• Stem cell transplants
• Surgery

+ Liver Cancer

Overview

Liver cancer begins when cells in the liver start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced.

The liver is situated below the right lung under the ribs. The liver metabolizes and stores nutrients, creates clotting factors to prevent excess bleeding, secretes bile for the intestines to break down certain nutrients, and processes toxins (including alcohol and other intoxicants) into waste products excreted via urine and stool.

Types of liver cancer include:

• Hepatocellular carcinoma or hepatocellular cancer
• Intrahepatic cholangiocarcinoma or bile duct cancer
• Angiosarcoma and hemangiosarcoma
• Hepatoblastoma

Metastatic or secondary liver cancer, originating elsewhere in the body and spread to the liver (secondary liver cancers are more common in the United States than primary liver cancers)

Symptoms

Early liver cancers may not cause symptoms, but symptoms may include:

• Loss of appetite
• Unintended weight loss
• Feeling of fullness after small meals
• Nausea or vomiting
• A mass under the ribs on the right or left side, caused by an enlarged liver or spleen
• Abdominal pain or pain near the right shoulder blade
• Abdominal swelling or fluid build-up
• Itching
• Jaundice (yellowing of the skin and eyes)

It is important to note that the symptoms above can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional to improve the chances of effective treatment.

Risk Factors

The risk factor most commonly associated with liver cancer is chronic hepatitis B or C infection (also known as Hep-B and Hep-C or HBV and HCV). HBV/HCV is bloodborne, which means it can be spread via contaminated needles, unprotected intercourse, blood transfusions (very rarely in the US), and childbirth. Hepatitis B is more likely to cause symptoms but is usually successfully treated within months; hepatitis C is less likely to cause symptoms and, without detection and treatment, may lead to chronic infection. Chronic HBV/HCV infection can lead to cirrhosis, in which damaged liver cells are replaced by scar tissue.

Most cases of liver cancer co-occur with evidence of cirrhosis, and other causes of cirrhosis also increase a person’s risk of liver cancer, including alcohol abuse, non-alcoholic fatty liver disease, primary biliary cirrhosis, and inherited metabolic diseases. Obesity increases the risk of liver cancer, which is likely because it may result in fatty liver disease. Type 2 diabetes also increases the risk of liver cancer, particularly in patients with co-occurring risk factors like alcohol abuse, chronic hepatitis, or obesity.

Long-term exposure to aflatoxins from fungal contamination of certain foods increases the risk of developing liver cancer, though exposure is rare in developed countries like the US in which the aflatoxin content of food is tested and regulated. Vinyl chloride and thorium dioxide/Thorotrast exposure and schistosomiasis parasite infection are similarly rare risk factors. The long-term use of anabolic steroids (not cortisone steroids like prednisone or hydrocortisone) may slightly increase the liver cancer risk. Persistent exposure to arsenic, often via contaminated drinking water, may be a risk factor of concern in certain areas of the US.

Men are more likely than women to develop liver cancer. Increased smoking rates and other secondary factors may partially explain this difference. Asian-Americans and Pacific Islanders have higher rates of liver cancer than those from other racial/ethnic backgrounds in the United States.

Smoking increases the risk of liver cancer; quitting can reduce risk, but people who have never smoked are at lowest risk.

Certain conditions can increase the risk of developing liver cancer:

• Tyrosinemia
• Alpha1-antitrypsin deficiency
• Porphyria cutanea tarda
• Glycogen storage diseases
• Wilson disease

Prevention

While some risk factors, such as gender, hereditary conditions, and race cannot be controlled, many cases of liver cancer can be prevented by following the guidelines below to reduce risk:

• Avoid or treat hepatitis infection.
• Limit alcohol consumption.
• Refrain from or stop smoking.
• Maintain a healthy weight.
• Limit exposure to carcinogenic substances including aflatoxins and arsenic.
• Treat inherited diseases associated with a higher risk of liver cancer as early as possible.

Diagnosis

If there is a suspicion of liver cancer, a detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include an examination of your abdomen, skin, and eyes (to check for jaundice), and may include additional lab testing.

Imaging tests including Ultrasound, CT, MRI, and X-ray angiography may be used for diagnosis and throughout treatment. Laparoscopy or biopsy are sometimes used to confirm a diagnosis of liver cancer, but may not be necessary based on the results of imaging tests.

Other tests, including blood tests, may be used in addition to the diagnostic tools discussed above.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Ablation
• Embolization
• Radiation therapy
• Targeted therapy
• Immunotherapy
• Chemotherapy

Your doctor may decide more than one of these treatment options will be in your best interest. Surgery is necessary for most cases of liver cancer.

+ Melanoma

Melanoma is a certain type of skin cancer that typically originates in specific skin cells called melanocytes, which are responsible for pigmented coloring of your skin. Most melanoma tumors are brown or black because they still produce melanin, but some can appear pink, tan, or sometimes white in color. Melanoma can develop anywhere, but is commonly found on the chest and back in men and legs in women.

While melanoma is less common than other types of skin cancer, it is more dangerous because it is more likely to spread to other areas of the body if not detected early.

Risk Factors

Exposure to UV rays, including those from the sun and tanning beds, is one of the biggest risk factors for melanoma. Patients who have moles are more likely to develop melanoma than those who do not have any moles. Melanoma is much more common in white people with fair skin, red or blonde hair, blue or green eyes, and those with freckling. Risk of melanoma is also higher if you have a first degree relative who has had melanoma. Other risk factors include having a weakened immune system, being older in age, and being male.

Detection and Diagnosis

Through a self skin exam, or a skin exam by a medical professional, any changes in spots or moles on the skin should be noted, especially when moles change in size, shape, or color. Using the ABCDE tool for changes in moles can be helpful:

A – assymetry, one side of the mole is different from the other

B- border, edges are irregular

C- color, varying colors on the mole

D- diameter, larger than 6mm

E – evolving, or changing often

A skin exam by a dermatologist is the best way to detect skin cancer early. The dermatologist will inspect the site in concern and determine whether or not a biopsy is needed. There are a variety of biopsy types and your dermatologist will recommend the best option. The biopsy sample will be reviewed by a pathologist and any findings will be shared with the care team. Additional imaging may be necessary, such as xays, CT scan, MRI, or PET scans.

Treatment

Treatment options can vary widely, depending on the specific type and staging of melanoma. Often times, surgery is used to completely remove the skin cancer and find clear margins. For some cases, a specialized skin cancer removal surgery called Mohs may be indicated. Removal of lymph nodes near the melanoma site may also be part of the surgical plan.

Other types of treatments commonly used for melanoma include:

• immunotherapy
• targeted therapy
• chemotherapy
• radiation
• Prevention

While there is no sure way to prevent melanoma, there are a few things you can do to reduce your risk:

– reduce exposure to UV rays by staying in the shade, avoiding the sun during peak hours, wearing a wide brimmed hat, and using proper sunscreen

– avoid using tanning beds

– watch for abnormal moles and perform regular skin exams

+ Multiple Myeloma

Overview

Multiple Myeloma is a type of cancer affecting plasma cells, which are found in the bone marrow and make up an important part of the body’s immune system. These specialized cells make antibodies vital to help attack germs in the body. It is important to note there are a few other conditions affecting the plasma cells that do not meet criteria to be considered myeloma.

Signs and Symptoms

Patients with multiple myeloma often have low blood counts because the cancerous plasma cells growing out of control can crowd out other normal types of blood cells. Low counts of red blood cells, otherwise known as anemia, may occur. Patients may also have low platelet counts (thrombocytopenia), which can cause easy bruising, or leukopenia (low white blood cell counts), which can affect the body’s ability to fight off infections.

Patients with multiple myeloma may also have difficulty keeping their bones strong and experience fractured bones due to dissolving of the bones at a higher than normal rate. Some patients also experience kidney problems due to an antibody created by the myeloma that is harmful to kidney cells.

Risk Factors

Most people diagnosed with multiple myeloma are over the age of 65, and this type of cancer has been shown to affect men more often than women. Myeloma is twice as common in African Americans. Being overweight and having other plasma cell conditions can increase one’s risk of developing multiple myeloma.

Diagnosis and Treatment

Early detection of multiple myeloma is difficult, as the early symptoms can be vague and resemble other conditions. There are a few common symptoms for multiple myeloma:

• bone issues (fractures, bone pain)
• low blood counts
• high levels of calcium in the blood
• nervous system changes (numbness, tingling)
• infections that are slow to respond to treatment (pneumonia is common)
• kidney concerns

Confirmation of multiple myeloma may require a number of tests and images, including: blood tests, bone marrow biopsy, x-rays, MRI, CT scan, etc.

Surgery is not commonly used to treat multiple myeloma, but may need to be used to help with bone issues as a result of this cancer. Chemotherapy, radiation, and stem cell transplants may all be used to help treat multiple myeloma. There are a number of factors that go into determining the correct treatment plan, and your doctors will work together to ensure the best personalized plan is in place for you.

Prevention

There are few known risk factors that can be avoided to prevent the development of multiple myeloma.

+ Myelodysplastic syndromes

Overview

Myelodysplastic syndromes (MDS) begin when blood-forming cells in the bone marrow start to behave abnormally, leading to defective functioning and low counts of certain blood cells. MDS is considered a form of cancer, and about 1 in 3 MDS patients develop acute myeloid [leukemia] (AML), a type of cancer of the bone marrow. [Myeloproliferative disorders] are a related group of conditions.

Bone marrow, the tissue found in the center of large bones, contains blood-forming cells including stem cells. These blood-forming cells manufacture red blood cells, white blood cells, and platelets.

Types of myelodysplastic syndromes include:

• MDS with multilineage dysplasia (MDS-MLD): this is the most common type
• MDS with single lineage dysplasia (MDS-SLD)
• MDS with ring sideroblasts (MDS-RS)
• MDS with excess blasts (MDS-EB)
• MDS with isolated del(5q)
• MDS, unclassifiable (MDS-U)

MDS can also be divided into primary MDS, in which the underlying cause is not known, or secondary MDS, in which prior cancer treatment, existing bone marrow disease, or another factor may be identified as the cause. Primary MDS is more common.

Symptoms

The main symptom of MDS is low blood cell counts, which can be detected by blood tests with or without associated symptoms. MDS symptoms may include:

• Anemia, or too few red blood cells
  • Fatigue
  • Dizziness
  • Weakness
  • Shortness of breath
  • Pale skin
• Leukopenia, or too few normal white blood cells
  • Frequent or more severe infection
• Thrombocytopenia, or too few blood platelets
  • Easy bruising or bleeding
  • Frequent or more severe nosebleeds or gum bleeding
• Other symptoms
  • Unintended weight loss
  • Fever
  • Pain in the bones
  • Loss of appetite

It is important to note that the symptoms above can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional to improve the chances of effective treatment.

Risk Factors

The risk of MDS increases with advanced age: most cases occur in people older than 70, and MDS is uncommon in people younger than 50. MDS is more common in men than in women, which may be partially explained by associated differences in other risk factors like higher rates of smoking among men.

People who have undergone prior cancer treatment may be at higher risk for developing secondary MDS. Certain chemotherapy medications, including mechlorethamine, procarbazine, chlorambucil, cyclophosphamide, ifosfamide, etoposide, teniposide, and doxorubicin, may increase the risk of MDS, though this risk varies based on dosages and types of drugs used in treatment. Chemotherapy combined with radiation treatment increases MDS risk further, and stem cell transplants including high chemotherapy doses may also be at elevated risk. It is important to note, however, that only a small percentage of people who receive these cancer treatments develop MDS.

Smoking increases the risk of MDS as well as many other types of cancer. Exposure to high-dose radiation or certain chemicals including benzene and certain substances used in petroleum and rubber manufacturing are also associated with increased rates of MDS.

Certain conditions can increase the risk of developing MDS, including:

• A family history of MDS
• Fanconi anemia
• Shwachman-Diamond syndrome
• Diamond Blackfan anemia
• Familial platelet disorder with a propensity to myeloid malignancy
• Severe congenital neutropenia
• Dyskeratosis congenita

Prevention

While some risk factors, such as gender, hereditary conditions, and age cannot be controlled, there may be some things you can do to lower your risk of MDS:

• Refrain from or stop smoking.
• Avoid exposure to benzene and other known carcinogenic chemicals.
• Thoroughly discuss the benefits and risks of proposed chemotherapy medications with your doctor. Usually, these treatments’ life-saving benefits outweigh the minor risk of secondary MDS, but research on how to limit risk associated with these treatments is ongoing.

Diagnosis

While some myelodysplastic syndromes are found after symptoms appear, many people are diagnosed based on the results of blood tests performed for other reasons. If there is a suspicion of MDS, additional lab testing will be performed. This will include a complete blood count (CBC), and may include other blood tests to rule out alternative diagnoses like iron deficiency anemia.

A bone marrow aspiration and biopsy is usually required to confirm a diagnosis of MDS. In the aspiration procedure, a sample of bone marrow is removed from the hip bone under local anesthetic via a thin needle. The biopsy procedure involves removal of a small piece of bone as well as the marrow, with a slightly larger needle; it often follows a bone marrow aspiration. A pathologist or hematologist will then examine the samples for abnormalities to determine diagnosis.

Other tests, including flow cytometry, immunocytochemistry, and chromosome testing, may be used in addition to the diagnostic tools discussed above.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Supportive therapy
• Growth factors
• Chemotherapy
• Stem cell transplant

Your doctor may decide more than one of these treatment options will be in your best interest. Stem cell transplant is often the best option for those who are good candidates. Supportive care such as blood transfusions are important to treatment and often used in combination with other methods.

+ Myeloproliferative disorders

Overview

Myeloproliferative disorders (MPD) are diseases of the blood which disrupt the process of blood cell production and development, leading to abnormally high counts of certain blood cells. Some MPD patients develop acute myeloid [leukemia][7] (AML), a type of cancer of the bone marrow. [Myelodysplastic syndromes][8] are a related group of disorders.

Bone marrow, the tissue found in the center of large bones, contains blood-forming cells which manufacture red blood cells, white blood cells, and platelets. Different types of MPD affect this process of blood cell production and development in different ways.

Types of myeloproliferative disorders include:

• Primary myelofibrosis (PMF): red blood cells and certain white blood cells mature abnormally and fibers inside bone marrow thicken and scar, leading to anemia (decreased red blood cell production).
• Polycythemia vera (PV): red blood cells are overproduced and build up in the blood, and the spleen may swell.
• Essential thrombocythemia (ET): platelets are overproduced, slowing down blood flow.
• Chronic eosinophilic leukemia or hypereosinophilic syndrome (HES): eosinophils (a type of white blood cell) are overproduced, causing itching and swelling.
• Systemic mastocytosis (SM): mast cells (a type of white blood cell) accumulate in the body, affecting the spleen, bone marrow, liver, or small intestine.

Symptoms

Early-stage MPD may not cause symptoms, and symptoms may vary based on the type of disorder, but these may include:

• Headache
• Fatigue
• Shortness of breath
• Easy bruising or bleeding
• Red spots under the skin called petechiae
• Unintended weight loss
• Night sweats
• Fever
• Pressure or swelling of the spleen (below the ribs on the left side)
• Chest pain
• Unexplained itching all over the body
• Swelling of the extremities

It is important to note that the symptoms above can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional to improve the chances of effective treatment.

Risk Factors

Research has not found strong links to specific risk factors or discovered the causes of MPD. A few factors of concern include: radiation exposure, exposure to toxic chemicals including benzene and certain pesticides, and family history in rare cases.

Acquired (meaning not inherited) gene mutations may be a factor in many cases of MPD, but the causes and significance of these mutations are not known.

Prevention

The causes of myeloproliferative disorders are not known, so it is difficult to determine what can be done to avoid MPD. There may be some things you can do to lower your risk of MPD:

Avoid exposure to benzene and other known carcinogenic chemicals. Avoid exposure to high levels of radiation. Diagnosis

While some myeloproliferative disorders are found after symptoms appear, many people are diagnosed based on the results of blood tests performed for other reasons. If there is a suspicion of MPD, additional lab testing will be performed. This will include a complete blood count (CBC), and may include other blood tests to rule out alternative diagnoses.

A bone marrow aspiration and biopsy is usually required to confirm a diagnosis of MPD. In the aspiration procedure, a sample of bone marrow is removed from the hip bone under local anesthetic via a thin needle. The biopsy procedure involves removal of a small piece of bone as well as the marrow, with a slightly larger needle; it often follows a bone marrow aspiration. A pathologist or hematologist will then examine the samples for abnormalities to determine diagnosis.

Other tests may be used in addition to the diagnostic tools discussed above.

Treatment

The treatment plan will depend on the stage of the disorder, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Medications
• Blood transfusions
• Growth factors
• Radiation therapy
• Phlebotomy (drawing blood)

Your doctor may decide more than one of these treatment options will be in your best interest.

+ Non-Hodgkin’s Lymphoma

Overview

Non-Hodgkin’s lymphoma is the seventh most common cancer in men and women in the United States. According to the American Cancer Society, 74000 new cases of non-Hodgkin’s lymphoma are diagnosed each year in the US. Non-Hodgkin’s lymphoma originates in the lymphatic system of the body. The lymphatic system fights diseases throughout the body. In non-Hodgkin’s lymphoma, tumors develop from white blood cells called lymphocytes. Lymph tissue is found in many places throughout the body, so lymphomas can start almost anywhere. Non-Hodgkin’s lymphoma is more common than the other type of general lymphoma, Hodgkin lymphoma.

The major sites of lymph tissue are:

• Lymph Nodes
• Spleen
• Bone Marrow
• Thymus
• Adenoids and Tonsils
• Digestive Tract

Noting how many different areas of the body major lymph tissue sites are located is important. Each site can cause different symptoms for people.

There are many types of non-Hodgkin lymphoma, which can make classifying difficult for physicians. To read about the specific types of NHL, visit The American Cancer Society website.

Symptoms

• Painless, swollen lymph nodes in your neck, armpits, or groin.
• Abdominal pain or swelling
• Chest pain
• Coughing or trouble breathing
• Fatigue
• Fever
• Night sweats
• Unexplained weight loss

It is important to note that if you are experiencing these symptoms it does not necessarily mean you have non-Hodgkin’s lymphoma. It is important to discuss these symptoms with your physician.

Risk Factors

• Medications that suppress your immune system. If you’ve had an organ transplant, you are more susceptible because immunosuppressive therapy has reduced your body’s ability to fight new illness.
• Infection with certain viruses and bacteria. Viruses linked to increased Non-Hodgkin’s lymphoma risk include HIV and Epstein-Barr infection.
• Chemicals. Certain chemicals such as chemicals used to kill weeds and insects, may possibly increase your risk.
• Autoimmune diseases. Diseases such as rheumatoid arthritis, systemic lupus, celiac disease, and others have been linked with increase risk of NHL.
• Older age. Non-Hodgkin’s lymphoma can occur at any age but is most commonly found in people over 60.
• Gender. Non-Hodgkin’s lymphoma is slightly more common in men.
• Race. Non-Hodgkin’s lymphoma is slightly more common in caucasians.

Prevention

There is no current way to prevent NHL. Most people diagnosed with NHL have no risk factors that can be changed.

Diagnosis

Precise and accurate diagnosis helps doctor choose the best treatment plan for you. If you have symptoms that may signal for this disease, your physician will examine you. One or more of the following tests may be used to find out if you have cancer.

• Lymph node biopsy. A small piece of tissue will be removed from a lymph node and looked at under a microscope. Sometimes physicians will remove the entire lymph node.
• Imaging Tests. Imaging tests can include X-Rays, CT scans, PET scans, and MRI scans.
• Blood Tests. If blood cells are normal in number in appearance and if blood chemistry is normal.
• Bone marrow aspiration and biopsy.
• Liver and kidney function tests.

Treatment

Doctors who treat NHL consist of hematologists, medical oncologists, and radiation oncologists.

Treatment options for NHL depend on type and stage of the lymphoma and other factors. Treatment options can include:

• Chemotherapy
• Radiation Therapy
• Bone Marrow Transplant
• Drug Therapy
• Proton Therapy
• Immunotherapy
• Stem Cell Transplant

+ Non-Hodgkin’s Lymphoma

Overview

Non-Hodgkin’s lymphoma is the seventh most common cancer in men and women in the United States. According to the American Cancer Society, 74000 new cases of non-Hodgkin’s lymphoma are diagnosed each year in the US. Non-Hodgkin’s lymphoma originates in the lymphatic system of the body. The lymphatic system fights diseases throughout the body. In non-Hodgkin’s lymphoma, tumors develop from white blood cells called lymphocytes. Lymph tissue is found in many places throughout the body, so lymphomas can start almost anywhere. Non-Hodgkin’s lymphoma is more common than the other type of general lymphoma, Hodgkin lymphoma.

The major sites of lymph tissue are:

• Lymph Nodes
• Spleen
• Bone Marrow
• Thymus
• Adenoids and Tonsils
• Digestive Tract

Noting how many different areas of the body major lymph tissue sites are located is important. Each site can cause different symptoms for people.

There are many types of non-Hodgkin lymphoma, which can make classifying difficult for physicians. To read about the specific types of NHL, visit The American Cancer Society website.

Symptoms

• Painless, swollen lymph nodes in your neck, armpits, or groin.
• Abdominal pain or swelling
• Chest pain
• Coughing or trouble breathing
• Fatigue
• Fever
• Night sweats
• Unexplained weight loss

It is important to note that if you are experiencing these symptoms it does not necessarily mean you have non-Hodgkin’s lymphoma. It is important to discuss these symptoms with your physician.

Risk Factors

• Medications that suppress your immune system. If you’ve had an organ transplant, you are more susceptible because immunosuppressive therapy has reduced your body’s ability to fight new illness.
• Infection with certain viruses and bacteria. Viruses linked to increased Non-Hodgkin’s lymphoma risk include HIV and Epstein-Barr infection.
• Chemicals. Certain chemicals such as chemicals used to kill weeds and insects, may possibly increase your risk.
• Autoimmune diseases. Diseases such as rheumatoid arthritis, systemic lupus, celiac disease, and others have been linked with increase risk of NHL.
• Older age. Non-Hodgkin’s lymphoma can occur at any age but is most commonly found in people over 60.
• Gender. Non-Hodgkin’s lymphoma is slightly more common in men.
• Race. Non-Hodgkin’s lymphoma is slightly more common in caucasians.

Prevention

There is no current way to prevent NHL. Most people diagnosed with NHL have no risk factors that can be changed.

Diagnosis

Precise and accurate diagnosis helps doctor choose the best treatment plan for you. If you have symptoms that may signal for this disease, your physician will examine you. One or more of the following tests may be used to find out if you have cancer.

• Lymph node biopsy. A small piece of tissue will be removed from a lymph node and looked at under a microscope. Sometimes physicians will remove the entire lymph node.
• Imaging Tests. Imaging tests can include X-Rays, CT scans, PET scans, and MRI scans.
• Blood Tests. If blood cells are normal in number in appearance and if blood chemistry is normal.
• Bone marrow aspiration and biopsy.
• Liver and kidney function tests.

Treatment

Doctors who treat NHL consist of hematologists, medical oncologists, and radiation oncologists.

Treatment options for NHL depend on type and stage of the lymphoma and other factors. Treatment options can include:

• Chemotherapy
• Radiation Therapy
• Bone Marrow Transplant
• Drug Therapy
• Proton Therapy
• Immunotherapy
• Stem Cell Transplant

+ Ovarian Cancer

Overview

Ovarian cancer begins when cells in the ovaries or fallopian tubes start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced.

The ovaries are female reproductive glands located on either side of the uterus. They produce the ova (eggs), which move to the uterus via the fallopian tubes and are fertilized during the reproductive process, and the female hormones responsible for regulating the menstrual cycle and other processes of the reproductive system.

Some abnormal growths in the ovaries are not cancerous (benign), or have a low potential to spread (borderline or low malignant potential).

Types of ovarian tumors include:

• Epithelial ovarian tumors
  • Benign epithelial ovarian tumors
  • Borderline epithelial ovarian tumors
  • Malignant epithelial ovarian tumors
    • Serous carcinomas
    • Clear cell carcinomas
    • Mucinous carcinomas
    • Endometrioid carcinomas
• Ovarian germ cell tumors
• Ovarian stromal tumors
• Ovarian cysts

Symptoms

It is important to note that the symptoms below can be caused by a number of other non-cancerous causes, and many occur just as frequently in women without ovarian cancer, but it is important to be checked by a medical professional with these symptoms. When these symptoms are caused by ovarian cancer, they usually occur persistently and are abnormal for the patient (more severe, more frequent, etc.).

Most common symptoms of ovarian cancer may include:

• Bloating
• Abdominal or pelvic pain
• Trouble eating, or feeling full quickly
• Urinary urgency or frequency

Other symptoms may include fatigue, upset stomach, back pain, pain during intercourse, constipation, changes in the menstrual cycle (heavier bleeding, irregular bleeding, etc.), or abdominal swelling with weight loss.

Risk Factors

Older women are at a higher risk of developing ovarian cancer. Most cases develop after menopause, and half are found in women 63 or older.

Ovarian cancer risk for women with a mother, sister, or daughter who has a history of ovarian cancer is increased, and is even higher for those with multiple relatives affected by the disease. A personal history of breast cancer may also increase a woman’s risk of developing ovarian cancer, thought to be due in part to shared reproductive-system and genetic risk factors.

Estrogen (hormone replacement) therapy after menopause, especially for at least five years, increases ovarian cancer risk, but this increase may not be as significant if progesterone is administered during the same course of treatment (which is known as combination hormone therapy).

Women who have never had a full-term pregnancy or have done so only after the age of 35 are at a higher risk of developing ovarian cancer. Ovarian cancer risk decreases for every full-term pregnancy, and breastfeeding may lower risk even further. Fertility treatments (IVF) may increase the risk of borderline tumors, but research has not demonstrated a link between fertility treatments and more invasive types of ovarian cancer.

Certain methods of birth control may lower the risk of ovarian cancer. Oral contraceptives lower risk significantly, drive risk lower the longer they are used, and protect against ovarian cancer for many years after they are discontinued. Tubal ligation and the intrauterine devices (IUDs) also seem to reduce risk. Hysterectomy may reduce risk by as much as one-third.

Some gene mutations may increase the risk of ovarian cancer, including the BRCA1 or BRCA2 genes (also associated with a higher risk of breast cancer). For more information about genetic risk factors, visit the American Cancer Society website or discuss genetic counseling with your doctor.

Prevention

Most known modifiable risk factors only slightly increase a woman’s risk of developing ovarian cancer, so it is not possible to prevent most cases. Of these modifiable factors, most involve major medical interventions or decisions, and should be discussed with your doctor to determine alternative options and risks:

• Maintain a healthy weight.
• Avoid estrogen therapy. If hormone replacement therapy is indicated for you, discuss your options and risks thoroughly with your doctor.
• Use oral contraceptives. Discuss benefits and risks with your doctor.
• Consider surgical interventions as medically appropriate: tubal ligation, hysterectomy, bilateral salpingo-oophorectomy (ovary and fallopian tube removal), or bilateral salpingectomy (fallopian tube removal). These operations may reduce ovarian cancer risk but are generally recommended for other medical reasons. However, ovarian cancer risk factors (especially age and family history) should be considered when discussing and choosing what surgery may be right for your case.
• For those at high risk of ovarian cancer due to family history, consider genetic counseling and discuss the prevention strategies above.

Diagnosis

Early detection of ovarian cancer is associated with very positive outcomes in treatment, so it is important to receive regular women’s health exams, report symptoms, and discuss risk factors and the possibility of screening with your doctor. Currently available screening tests include transvaginal ultrasound and the CA-125 blood test, but these are not considered reliable enough to recommend to women at average risk for ovarian cancer. Other screening methods are being actively researched.

If there is a suspicion of ovarian cancer, you should be examined by a doctor. A detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include a pelvic exam.

Consultation with a gynecologic oncologist and imaging tests including ultrasound, CT, x-ray, MRI, and PET will help diagnose and determine the course of treatment for an ovarian tumor.

A surgical biopsy is often used to confirm the diagnosis of other types of cancer, but in suspected cases of ovarian cancer, doctors will usually recommend complete removal of the tumor rather than biopsy. In rare cases, biopsy may be recommended instead.

Other tests may be used in addition to the diagnostic tools discussed above. These may include blood tests, scoping procedures, and genetic testing.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Radiation therapy
• Chemotherapy
• Hormone therapy
• Targeted therapy

Your doctor may decide more than one of these treatment options will be in your best interest. Treatment commonly includes surgery and often combines multiple therapies.

+ Pancreatic Cancer

Overview

Pancreatic cancer begins when cells in the pancreas start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced. Some abnormal growths of the pancreas are benign, or not cancerous, and others are pre-cancers, meaning they might develop into cancer if untreated.

The pancreas is an organ located behind the stomach. It produces digestive enzymes and hormones important to metabolic regulation, including the blood sugar regulators insulin and glucagon.

Types of pancreatic cancer include:

• Exocrine pancreatic cancers
  • Pancreatic adenocarcinoma
    • Exocrine pancreatic cancers are most common, and 95% of those are adenocarcinomas
  • Adenosquamous carcinoma
  • Squamous cell carcinoma
  • Signet ring cell carcinoma
  • Undifferentiated carcinoma
• Pancreatic endocrine tumors or pancreatic neuroendocrine tumors (NETs), which may be benign or malignant (cancerous), and are rare (less than 5% of pancreatic cancer cases)
  • Functioning NETs
  • Non-functioning NETs
  • Carcinoid tumors

Ampullary cancer, which occurs in the part of the body where the bile duct and pancreatic duct meet the small intestine, is not technically a pancreatic cancer, but is treated similarly.

Symptoms

It is important to note that the symptoms listed below can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional with these symptoms.

Symptoms of exocrine pancreatic cancer may include:

• Jaundice, which may cause dark urine, light-colored or greasy stool, or itchy skin
• Abdominal or back pain
• Unintentional weight loss, poor appetite
• Nausea and vomiting
• Enlargement of the gallbladder or liver
• Blood clots, often in the leg
• Fatty tissue abnormalities (such as uneven texture)
• Diabetes

Pancreatic neuroendocrine tumors may cause many different symptoms based on the hormones produced in excess by the tumor. You can learn more about the different types of pancreatic NETs and their associated signs and symptoms by visiting the American Cancer Society website.

Risk Factors

Pancreatic cancer risk for smokers is double that of non-smokers, and 20-30% of pancreatic cancer cases are thought to be associated with smoking. Other types of tobacco use (cigars, pipes, and smokeless products) also increase risk.

Obesity is also a significant risk factor: obese people are about 20% more likely to develop pancreatic cancer than those at a healthy weight. Extra weight around the waist (abdominal fat) may increase risk even for those whose body weight is closer to the normal range.

Occupations in the dry cleaning and metal working industries may involve significant exposure to chemicals which may increase pancreatic cancer risk.

Pancreatic cancer risk increases with age, with about two-thirds of cases occurring in patients over 65. Men are more likely than women to develop the disease, but this is thought to be due in part to higher rates of tobacco use by men, as a recent decrease in the difference in risk correlates with a decrease in the difference in tobacco use by men and women. African-Americans are at slightly higher risk of pancreatic cancer, but this, too, may be explained by a difference in other risk factors (rates of diabetes and obesity, etc.).

Certain conditions can increase the risk of developing pancreatic cancer, including:

• Diabetes, especially type 2
• Chronic pancreatitis
• Cirrhosis of the liver
• Stomach infections (with H. pylori)

A family history of pancreatic cancer as well as certain other genetic factors may contribute to pancreatic cancer. These genetic factors may include:

• BRCA1 or BRCA2 gene mutation
• Familial atypical multiple mole melanoma (FAMMM) syndrome (p16/CDKN2A gene mutation)
• Familial pancreatitis (often associated with a PRSS1 gene mutation)
• Lynch syndrome or hereditary non-polyposis colorectal cancer (HNPCC)
• Peutz-Jeghers syndrome
• Von Hippel-Lindau syndrome
• Neurofibromatosis, type 1
• Multiple endocrine neoplasia, type I (MEN1)

Prevention

While some risk factors, such as age, gender, and race cannot be controlled, there may be some things you can do to lower your risk of pancreatic cancer:

• Refrain from or stop smoking
• Maintain a healthy weight
• Limit alcohol use. While a direct link between alcohol and pancreatic cancer has not been confirmed by research, secondary conditions of heavy alcohol use, including pancreatitis and cirrhosis, are known risk factors.
• Limit exposure to known carcinogenic chemicals in the workplace (find a list and more information at the American Cancer Society’s website)

Diagnosis

If pancreatic cancer is suspected, a detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include a close examination of the abdomen.

A biopsy of pancreatic tissue is usually needed to confirm a diagnosis of pancreatic cancer, and may be done surgically, endoscopically, or through the skin via a fine needle aspiration. Imaging tests including CT, MRI, ultrasound, cholangiopancreatography, somatostatin receptor scintigraphy (SRS), PET, and angiography may be used throughout diagnosis and treatment.

Other tests may be used in addition to the diagnostic tools discussed above. These include a variety of blood tests used to determine the level of functioning of the pancreas and other organs, look for tumor markers, and evaluate other symptoms.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Ablation or embolization treatments
• Radiation therapy
• Chemotherapy

Your doctor may decide more than one of these treatment options will be in your best interest.

+ Prostate Cancer

Overview

Prostate cancer begins when cells in the prostate gland start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced.

The prostate is a male reproductive organ located near the rectum and below the urinary bladder. This gland creates part of the fluid component of semen.

Types of prostate cancer include:

• Adenocarcinoma
  • Almost all prostate cancers are of this type
• Sarcoma
• Small cell carcinoma
• Neuroendocrine tumors
• Transitional cell carcinoma

Prostate cancer is the second most common form of cancer in American men, after skin cancer, and 1 in 9 men will be diagnosed in their lifetime. It is the second leading cause of cancer death in American men, after lung cancer. It is important to note, however, that most diagnoses of prostate cancer are not fatal, and the general survival rate (averaging all stages) is very high.

Symptoms

Prostate cancer in its early stages rarely causes symptoms. It is important to note that the symptoms listed below can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional with these symptoms.

Symptoms of prostate cancer may include:

• Problems urinating
• Slow/weak urination
• More frequent urinary urges, especially at night
• Blood in urine or semen
• Erectile dysfunction (ED)
• Pain in hips, spine, ribs, or other bony areas
• Weakness or numbness of legs or feet
• Loss of bladder or bowel control

Risk Factors

Prostate cancer risk rises with age, and the majority of cases occur in men over 65. African-American men are more likely to develop prostate cancer than those in other racial/ethnic groups, and Asian-American and Hispanic/Latino men are less likely than white men to develop the disease.

Prostate cancer risk for men with a father or brother who has a history of prostate cancer is more than doubled, and is even higher for those with multiple relatives affected by the disease. However, most diagnoses of prostate cancer are not associated with a family history of the disease.

Some gene mutations may increase the risk of prostate cancer, including the BRCA1 or BRCA2 genes (associated with a higher risk of breast cancer in women) and Lynch syndrome (also associated with a higher risk of several other cancers). For more information about genetic risk factors, visit the American Cancer Society website or discuss genetic counseling with your doctor.

Several risk factors for prostate cancer are still being investigated by researchers but may have some effect on the chances of being diagnosed with prostate cancer or on the course of the disease:

• Diets high in red meat and dairy and lower in fruits and vegetables, and those particularly high in calcium, seem to be associated with a slightly higher risk of developing prostate cancer, but it is not clear which factor(s) may contribute to this increased risk.
• Obesity may not affect the overall risk of developing prostate cancer, but some (not all) studies have found that it may increase the risk of developing a more aggressive form of the disease.
• Smoking is similarly not associated with an increased risk of developing prostate cancer but early research suggests that it may slightly increase the risk of death for those who do develop the disease.
• Inflammation of the prostate, and sexually transmitted infections (STIs) which may cause inflammation, are being investigated as a risk factor, but research results are not yet clear.
• Vasectomy is similarly a possible risk factor being investigated with mixed research results.
• Firefighters may be exposed to chemicals which, some evidence suggests, might increase prostate cancer risk.
• Studies investigating a possible link between prostate cancer and exposure to the herbicide Agent Orange have found mixed results.

Prevention

While some risk factors, such as age, genetics, and race cannot be controlled, there may be some things you can do to lower your risk of prostate cancer:

• Eat a variety of fruits and vegetables
• Engage in regular physical activity
• Maintain a healthy weight
• Certain drugs and supplements, including aspirin, may lower your risk, but research is not yet conclusive, and all options should be discussed with your doctor to determine whether they are appropriate for you.

Diagnosis

Prostate cancer may be detected by a blood test, but the benefits of screening may not outweigh the risk of a false positive or the side effects of treating a prostate cancer that may never have developed dangerous symptoms. Some prostate cancers develop so slowly that they do not become a problem for the patient. It is important to educate yourself about the benefits and risks of screening at different stages of life and for those with certain risk factors, and to discuss the options with your doctor.

If cancer is suspected based on the results of a screening test, your doctor will confirm the diagnosis using additional diagnostic tests, which may include a transrectal ultrasound or a prostate biopsy.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Watchful waiting or active surveillance
• Surgery
• Radiation therapy
• Cryotherapy or cryosurgery
• Hormone therapy
• Chemotherapy
• Vaccine treatment
• Bone-directed treatment

Treatments for prostate cancer are most often used individually, but your doctor may decide more than one of these treatment options will be in your best interest.

+ Stomach Cancer

Overview

Stomach or gastric cancer begins when cells in the stomach start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced. These cancers often develop slowly, and pre-cancerous changes to the stomach which do not create symptoms are common.

The stomach is an organ which holds food and secretes enzymes and acids in order to complete the second step of digestion (after chewing). It is located just below the lungs and diaphragm in the upper abdomen. The stomach has several layers of tissue, including the inner lining, or mucosa, which creates the digestive enzymes and acids necessary for digestion, and a muscular layer which mixes the stomach’s contents and moves them to the next stage of the digestive process.

Types of stomach cancer include:

• Adenocarcinoma
• Over 90% of stomach cancers are of this type
• Lymphoma (see Non-Hodgkin’s Lymphoma)
• Gastrointestinal stromal tumor
• Carcinoid tumor
• Squamous cell carcinoma, small cell carcinoma, leiomyosarcoma (very rare)

Symptoms

Stomach cancer in its early stages rarely causes symptoms. It is important to note that the symptoms listed below can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional with these symptoms.

Symptoms of stomach cancer may include:

• Poor appetite
• Unintentional weight loss
• Abdominal pain
• Discomfort in the abdomen, particularly above the navel
• Fullness when eating small meals
• Heartburn or indigestion
• Nausea
• Vomiting
• Abdominal swelling or fluid build-up
• Blood in the stool
• Anemia (low red blood cell count)

Risk Factors

Infection with the bacterium Helicobacter pylori is a major risk factor for stomach cancer. While many people carrying the bacteria will not develop cancer, H. pylori infection can cause chronic inflammation leading to pre-cancerous changes in the stomach, and it is associated with some types of stomach lymphoma.

Smoking approximately doubles stomach cancer risk. Dietary choices can also modify the risk of stomach cancer: large amounts of smoked food, salted meat or fish, pickled vegetables, and cured meats can increase risk, while plenty of fresh fruits and vegetables seems to decrease risk. Research suggests that being overweight and obese may be associated with some types of stomach cancer.

Stomach cancer is more common in men than in women, and much more common in people older than 50. It is also more common in people with Type A blood. Hispanic Americans, African-Americans, Native Americans, and Asian Americans are at higher risk than whites. Stomach cancer occurs more frequently in Japan, China, Southern Europe, Eastern Europe, Central America, and South America than in North Africa, West Africa, South/Central Asia, and North America.

Occupations in the coal, metal, and rubber industries have been associated with a higher risk of stomach cancer.

Certain conditions can increase the risk of developing stomach cancer (for more detailed information about these conditions and gene mutations, visit the American Cancer Society website):

• Previous stomach lymphoma (which likely indicates infection with H. pylori)
• Previous stomach surgery removing part of the stomach
• Pernicious anemia
• Menetrier disease or hypertrophic gastropathy
• Hereditary diffuse gastric cancer: those inheriting the gene mutation associated with this syndrome are very likely to develop stomach cancer
• Lynch syndrome or hereditary non-polyposis colorectal cancer (HNPCC)
• Familial adenomatous polyposis (FAP)
• BRCA1/BRCA2, also a risk factor for breast cancer
• Li-Fraumeni syndrome
• Peutz-Jeghers syndrome (PJS)
• Family history of stomach cancer
• Adenomatous stomach polyps (most other types of polyps do not seem to increase stomach cancer risk)
• Epstein-Barr virus (EBV) infection, which causes mononucleosis (known as mono)
• Common variable immune deficiency (CVID)

Prevention

While some risk factors, such as age, gender, and race cannot be controlled, there may be some things you can do to lower your risk of stomach cancer:

• Treat H. pylori infection if you have it
• Refrain from or stop smoking
• Maintain a diet high in fresh fruits and vegetables
• Engage in regular physical activity
• Maintain a healthy weight
• Take aspirin or another NSAID, if your doctor thinks it is appropriate for you
• Those suspected of having hereditary diffuse gastric cancer syndrome or Lynch syndrome, which greatly increase stomach cancer risk, should discuss genetic testing and prevention with their doctor

Diagnosis

Stomach cancer is usually diagnosed after a patient visits the doctor with symptoms. If cancer is suspected, a detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include an examination of your abdomen. You may be referred to a gastroenterologist for further testing.

Upper endoscopy is usually used to confirm a diagnosis of stomach cancer, and may be combined with endoscopic ultrasound or a biopsy. Imaging tests including CT, MRI, PET, X-ray (including an upper gastrointestinal series) may be used throughout diagnosis and treatment.

Other tests may be used in addition to the diagnostic tools discussed above. These include laparoscopy, blood tests, and other lab tests.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Radiation therapy

Your doctor may decide more than one of these treatment options will be in your best interest.

+ Testicular Cancer

Overview

Testicular cancer begins when cells in the testicles start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced.

The testicles are male reproductive organs located in the scrotum, which produce sperm and androgens (male hormones) like testosterone.

Types of testicular cancer include:

• Germ cell tumors (Over 90% of testicular cancers are of this type)
  • Seminomas
    • Classical seminoma
    • Spermatocytic seminoma
  • Non-seminomas and mixed germ cell tumors
    • Embryonal carcinoma
    • Yolk sac carcinoma
    • Choriocarcinoma
    • Teratoma
• Carcinoma in situ or intratubular germ cell neoplasia
• Stromal tumors
  • Leydig cell tumor
  • Sertoli cell tumor

Cancers may also spread to the testicles and form a secondary testicular cancer. This is most common in lymphoma and can also occur in cases of leukemia, prostate cancer, lung cancer, melanoma, kidney cancer, and others.

Symptoms

Often testicular cancer causes a lump or swelling in the testicle. It is important to note that lumps in the testicle can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional with this symptom.

Other symptoms of testicular cancer may include:

• Pain, heaviness, or aching in the abdomen or scrotum
• Breast growth or soreness
• Signs of early puberty like deepening voice or facial hair growth

Advanced testicular cancer or the spread of testicular cancer may cause:

• Lower back pain
• Shortness of breath, chest pain, or cough
• Abdominal pain
• Headaches or confusion

Risk Factors

An undescended testicle, a condition also known as cryptorchidism, is one of the main risk factors for testicular cancer. Surgery to correct cryptorchidism may reduce the risk of the cancer, particularly if it is completed when the patient is young.

Pre-existing conditions including Kleinfelter’s syndrome, HIV infection (and especially AIDS), and a prior or family history of testicular cancer are associated with a higher risk of this cancer. (However, most cases of testicular cancer are not associated with a family history of the disease.)

White men’s risk of testicular cancer is 4 to 5 times higher than that of black and Asian-American men. Some studies have found a higher risk of testicular cancer in tall men. While testicular cancer can affect men at any age, about half of all cases occur in patients aged 20 to 34.

Testicular injury, strenuous physical exertion, and activities like horseback riding are popularly thought to be associated with an increased risk of testicular cancer, but there is no research to support the idea that any of these would increase a man’s likelihood of developing testicular cancer in the future.

Prevention

Most diagnoses of testicular cancer are not associated with a known risk factor or behavior, and most known risk factors are not modifiable (age, race, prior conditions, etc. cannot be changed), so it is not possible to prevent most cases.

Correcting an undescended testicle is recommended, but it is not known how much this procedure decreases testicular cancer risk.

Diagnosis

While some testicular cancers are found after a lump or other symptoms appear, many men are diagnosed with no symptoms at all. For this reason, regular screenings are important for early detection, and testicular examination is recommended as part of a regular physical examination by your family doctor.

Regular testicular self-exams may be beneficial, particularly for men with known risk factors for developing testicular cancer, but there is no official recommendation at this time, and it is not yet known how self-exams affect cancer outcomes. For instructions on how to perform a testicular self-exam, visit the American Cancer Society website.

If testicular cancer is suspected, a doctor will perform a physical examination including close inspection of the testicles, abdomen, and other areas of the body. Imaging, especially ultrasound, may be used to determine whether a lump is likely to be cancer, and blood tests may be ordered to look for certain markers associated with testicular cancer.

A surgical biopsy is often used to confirm the diagnosis of other types of cancer, but in suspected cases of testicular cancer, doctors will usually recommend complete removal of the tumor rather than biopsy. In rare cases, biopsy may be recommended instead.

Other imaging tests may be used to examine whether and how testicular cancer may have spread, including: X-ray, CT, MRI, PET, and bone scan.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Radiation therapy
• Chemotherapy
• High-dose chemotherapy and stem cell transplant

Your doctor may decide more than one of these treatment options will be in your best interest. Surgery is the most common treatment option.

+ Thyroid Cancer

Overview

Thyroid cancer begins when cells in the thyroid start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body. As it grows and spreads, the cancer becomes more advanced. Many abnormal growths of the thyroid (nodules) are benign, or not cancerous.

The thyroid is a gland in the front of the neck, with lobes on either side of the trachea below the Adam’s apple. The thyroid gland produces thyroid hormone, which regulates metabolism, and calcitonin, which regulates the body’s use of calcium.

Types of thyroid cancer include:

• Differentiated
  • Papillary carcinoma or papillary adenocarcinoma
    • Most thyroid cancers are differentiated cancers, and 8 out of 10 are papillary cancers
  • Follicular carcinoma or follicular adenocarcinoma
  • Hṻrthle cell or oxyphil cell carcinoma
• Medullary
• Anaplastic (an aggressive undifferentiated tumor)
• Thyroid lymphomas
• Thyroid sarcomas

Parathyroid cancer, occurring in the parathyroid glands attached to the thyroid, can occur, but are very rare.

Symptoms

Often thyroid cancer causes a lump in the neck. It is important to note that lumps in the thyroid can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional with this symptom.

Other symptoms of thyroid cancer may include:

• Swelling in the neck
• Pain in the front of the neck
• Persistent hoarseness or other vocal changes
• Trouble swallowing or breathing
• Persistent cough, not due to a cold

Risk Factors

Thyroid cancers occur three times more often in women than in men, and risk is highest in middle age for women (ages 40-60) and later in life for men (ages 60-80).

While most cases of thyroid cancer are not associated with a family history of the disease, certain conditions can increase the risk of developing the cancer:

• An abnormal gene can cause familial medullary thyroid carcinoma. If this condition runs in your family, ask your doctor about monitoring blood-work or other diagnostic procedures, and about whether genetic testing would be appropriate.
• Familial adenomatous polyposis (FAP) is a condition of the colon which increases risk of colon cancer as well as other cancers, including thyroid cancer.
• Cowden disease increases the risk of thyroid problems including benign growths and thyroid cancer.
• Carney complex, type I may cause benign growths and hormone problems, and increases the risk of follicular thyroid cancer.
• Other kinds of thyroid carcinomas can occur more often in families and appear earlier in life. Certain gene mutations are associated with these cancers. Discuss genetic counseling with your doctor if your family history indicates any of these conditions.

Diets low in iodine, though rare in the United States, may increase the risk of thyroid cancer. Radiation exposure is a risk factor as well, particularly when exposure includes the head or neck, occurs earlier in life, or occurs in higher doses.

Prevention

Most diagnoses of thyroid cancer are not associated with a known risk factor or behavior, it is not possible to prevent most cases.

Radiation exposure is the most significant known risk factor, but high levels of exposure are rare, since changes in the practice of medicine have reduced or eliminated the practice of using radiation to treat less serious diseases and technology improvements have reduced the level of radiation exposure in diagnostic imaging procedures. It is not known how much low-dose radiation from imaging tests like X-rays increases the risk of thyroid cancer for children, so it is best to ensure that these tests are only performed when truly necessary and at the lowest effective dose, even though the increase in risk would likely be small.

Genetic testing is available for detection of familial medullary thyroid carcinoma, which can be prevented or treated early.

Diagnosis

Thyroid cancer may be diagnosed during a routine exam or after a patient visits the doctor with symptoms. A detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include a close examination of the thyroid and lymph nodes in the neck.

A biopsy of thyroid tissue is needed to confirm a diagnosis of thyroid cancer, and can be performed in the doctor’s office with minimal time and discomfort. Imaging tests including ultrasound, radioiodine scans, X-rays, CT scans, MRI scans, or PET scans may be used to examine the cancer’s spread, and blood tests may be used to determine the level of functioning of the thyroid.

Other tests may be used in addition to the diagnostic tools discussed above. These include additional blood tests and laryngoscopy.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Radioactive iodine treatment
• Thyroid hormone therapy
• External beam radiation therapy
• Chemotherapy
• Targeted therapy

Your doctor may decide more than one of these treatment options will be in your best interest. Most thyroid cancer patients can achieve full remission, especially if the cancer has not spread.

+ Uterine Cancer

Overview

Uterine cancer begins when cells in the uterus (womb) start to grow uncontrollably. A tumor can form when more cancer cells develop, and it can spread to other areas of the body.

The uterus is a hollow, muscular organ of the female body in which the fetus develops during pregnancy. The lining of the uterus (endometrium) changes throughout the menstrual cycle, thickening and shedding in a cycle governed by the hormones estrogen and progesterone. Nearly all uterine cancers start in the endometrial layer. As it grows and spreads, the cancer becomes more advanced.

Types of uterine cancer include:

• Endometrial carcinoma (Over 95% of uterine cancers are of this type)
  • Adenocarcinoma
    • This is the most common type of endometrial cancer
  • Carcinosarcoma
  • Squamous cell carcinoma
  • Undifferentiated carcinoma
  • Small cell carcinoma
  • Transitional carcinoma
• Uterine sarcoma
  • Uterine leiomyosarcoma (LMS)
  • Endometrial stromal sarcoma (ESS)
  • Undifferentiated sarcoma

Symptoms

Often uterine cancer causes abnormal vaginal bleeding (a change in menstrual cycle, bleeding between regular periods, or bleeding after menopause), the most common symptom of uterine cancer. It is important to note that abnormal vaginal bleeding can be caused by a number of other non-cancerous causes, but it is important to be checked by a medical professional with this symptom.

Other symptoms of uterine cancer may include:

• Other vaginal discharge (not bloody)
• Pelvic pain
• Unintentional weight loss
• Feeling a mass, or a feeling of fullness in the belly or pelvis

Risk Factors

Hormone-related factors are a major contributor to the development of many uterine cancers. Many of these risk factors affect estrogen and progesterone levels, which normally fluctuate throughout the menstrual cycle to produce periods and keep the endometrium healthy. Increased estrogen levels relative to progesterone can increase the risk of developing uterine cancer. Factors that can affect estrogen, and therefore uterine cancer risk, include:

• Estrogen (hormone replacement) therapy increases risk unless progesterone is administered during the same course of treatment (which is known as combination hormone therapy).
• The use of oral contraceptives lowers the risk of endometrial cancer, with protection increasing with longer use.
• A higher number of total menstrual cycles (starting menstruation early or menopause late) increases risk.
• Pregnancy increases relative levels of progesterone and therefore protects against uterine cancer.
• Carrying more fat tissue, which can convert certain other types of hormones into estrogen, increases uterine cancer risk. Endometrial cancer occurs twice more often in overweight women, and three times more often in obese women, than in healthy-weight women.
• The breast cancer treatment drug tamoxifen can increase risk of uterine cancer, but the risk is low, and should be weighed against the benefits of the drug in the treatment of breast cancer.
• Certain ovarian tumors produce estrogen, and this hormone production is not regulated by the body in the same way as normal hormone production from the ovaries. High estrogen levels resulting from this overproduction can lead to endometrial cancer.
• Polycystic ovarian syndrome (PCOS) results in abnormal hormone levels, including an increase in estrogen relative to progesterone, and thereby an increase in endometrial cancer risk.
• Intrauterine device (IUD) use reportedly lowers uterine cancer risk, though the research about non-hormonal and newer types of IUDs is limited.

Other (non-hormonal) risk factors include: advancing age, diet (especially diets high in fatty foods), low physical activity or more time sitting, diabetes, family history of endometrial cancer or a certain type of colon cancer, breast or ovarian cancer, endometrial hyperplasia (overgrowth of the endometrium), or pelvic radiation therapy. The abnormal gene associated with a type of eye cancer called retinoblastoma also increases the risk of uterine leiomyosarcoma (LMS), and uterine sarcomas are more common in African-American women than in white or Asian women.

Prevention

While some risk factors, such as age, race, co-occurring conditions, and total menstrual cycles cannot be controlled, there may be some things you can do to lower your risk of uterine cancer:

• Maintain a healthy weight with a healthy level of body fat
• Regular physical activity
• If hormone therapy is indicated for you, discuss your options and risks thoroughly with your doctor
• Be proactive in treating endometrial problems including hyperplasia and abnormal bleeding
• Talk to your doctor if you have hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome)

Diagnosis

If there is a suspicion of uterine cancer, you should be examined by a gynecologist. A detailed medical history and physical exam will be performed. Your doctor will ask questions about your risk factors and family history. The physical exam will include a pelvic exam.

Ultrasound may be used for the doctor to examine the uterus, ovaries, and fallopian tubes. The endometrium may be biopsied to determine whether an abnormality is hyperplasia or cancerous. This biopsy is needed to confirm the diagnosis, and can be performed in the doctor’s office with minimal time and discomfort. Other types of biopsy, including a hysteroscopy and dilation and curettage (D&C), may require anesthesia and a somewhat longer outpatient procedure.

Other imaging tests may be used in addition to the diagnostic tools discussed above. These may include x-rays, MRI, CT, PET, blood tests, and other scoping procedures.

Treatment

The treatment plan will depend on the stage of the cancer, as well as other factors. Our doctors will work closely with you and your family determine the best treatment plan for you. Options for treatment could include:

• Surgery
• Radiation therapy
• Hormonal therapy
• Chemotherapy

Your doctor may decide more than one of these treatment options will be in your best interest. Surgery is the most common treatment option.