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Cancerindia
Organ Wise Cancer Knowledge Bank

Anal Cancer

Finding anal cancer in the early stages and diagnosing it accurately can help improve your chances for successful therapy. We have the most advanced and accurate technology, as well as specialized experts to interpret results.

Anal Cancer Diagnosis

If you have symptoms that may signal anal cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family history.

One or more of the following tests may be used to find out if you have anal cancer and if it has spread. These tests also may be used to find out if treatment is working.

Imaging tests, which may include :

  • Anoscopy : A short tube with a camera is inserted into the anus and lower rectum. The doctor examines the anus and can biopsy tissue.
  • Proctoscopy: A short tube with a camera is inserted into the anus to the rectum. The doctor examines the anus and can biopsy tissue.
  • Double contrast barium enema (DCBE): Barium is a chemical that allows the bowel lining to show up on an X-ray. You will be given an enema with a barium solution, and then X-rays will be taken.
  • Colonoscopy
  • Virtual colonoscopy or CT (computed tomography) colonoscopy
  • CT or CAT (computed tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET/CT (positron emission tomography) scans
  • Endo-anal or endorectal ultrasound: An endoscope is inserted into the anus. A probe at the end of the endoscope bounces high-energy sound waves (ultrasound) off organs to make an image (sonogram). Also called endosonography.
  • Chest X-Ray

Fine-needle aspiration (FNA) biopsy : Anal cancer may spread through the lymph system, and sometimes it is found in lymph nodes. A tiny needle is placed into a lymph node, and cells are removed and looked at with a microscope. A positive lymph node biopsy may help the doctor decide what areas to treat with radiation therapy.

Anal Cancer Staging

If you are diagnosed with anal caner, your doctor will determine the stage of the disease. Staging is a way of talking about how much disease is in the body and where it has spread. This information helps the doctor treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Anal Cancer Stages :

  • Stage I : Cancer has formed. The tumor is 2 centimeters or smaller
  • Stage II : Tumor is larger than 2 centimeters but not greater than or equal to 5 centimeters
  • Stage IIIA : Tumor is 5 centimeters or greater and/or has spread to either :
    • Lymph nodes near the rectum
    • Nearby organs, such as the vagina, urethra or bladder
  • Stage IIIB : Tumor is 5 centimeters or greater and/or may be any size and has spread to :
    • Nearby organs and lymph nodes near the rectum
    • Lymph nodes on one side of the pelvis and/or groin and may have spread to nearby organs
    • Lymph nodes near the rectum and in the groin and/or lymph nodes on both sides of the pelvis and/or groin and may have spread to nearby organs
  • Stage IV : Tumor may be any size and may have spread to lymph nodes or nearby organs and has spread to distant parts of the body

Anal Cancer Facts

According to the American Cancer Society, more than 5,000 people are diagnosed with anal cancer in the United States each year. Unfortunately, this figure is increasing. The average age of people diagnosed with anal cancer is the early 60s. It occurs slightly more often in women than men because more women have human papilloma virus (HPV), which is a risk factor for anal cancer. Anal cancer often can be treated successfully if it is found early.

The anus, which is about 1-1/2 inches long, connects the rectum (lower part of the large intestine) to the outside of the body. It allows solid waste (also called stool or feces) to pass from the body. The sphincter is two muscles that open and close the anus to let waste pass. The anus is lined with squamous cells, which also are found in the bladder, cervix, vagina, urethra and other places in the body.

Anal Cancer Types

Several types of tumors may be found in the anus. While some of them are malignant (cancer), others are benign (not cancer) or precancerous (may develop into cancer). The main types of anal cancer are :

Carcinoma in situ is early cancer or precancerous cells. They are only on the surface cells of the anal canal. This also may be called Bowen’s disease.

Squamous cell cancer (carcinoma) forms in the cells that line the anus. This is the most common type of anal cancer.

Adenocarcinomas develop in the glands around the anus.

Skin cancers, including basal cell and melanoma, often are found when they are in advanced stages.

Our Approach :

This depth of experience and expertise sets us apart, enabling us to offer you the most accurate diagnosis methods and the very latest treatments for anal cancer.

Your care plan is customized by a team of renowned anal cancer specialists. They work together to ensure the most-advanced therapies with the fewest possible side effects. During treatment and beyond, they are supported by specially trained nurses, social workers, nutritionists and others.

Our high level of experience in minimally invasive and sphincter-sparing surgeries and other innovative techniques can help many people with anal cancer. We offer the most advanced therapies for every type of anal cancer, including in people with HIV and AIDS. Because we know quality of life is important, we make every effort to preserve the sphincter, without affecting control of bowel movements.

Anal Cancer Screening

Cancer screening exams are important medical tests done when you’re healthy and don’t have symptoms. They help find cancer at its earliest stage, when the chances for treating it are best.

The chances for successful treatment are much higher when anal cancer is found early. While anal cancer often does not have symptoms, a digital rectal exam (DRE) can diagnose some cases early.

Men over 50 years old should have annual rectal exams. Once they are sexually active, women should have annual pelvic exams that include rectal exams.

If you have risk factors for anal cancer, talk to your doctor about other tests, including an anal Pap test. In this test, much like the Pap test for cervical cancer, cells from the anus are removed and looked at under a microscope.

Anal Cancer Risk Factors

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

  • Age: Squamous cell carcinoma of the anus most often is found in people older than 50
  • Human papillomavirus (HPV) infection
  • Human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
  • Having more than 10 sexual partners
  • Anal intercourse
  • Frequent anal redness, swelling and soreness
  • Tobacco use
  • Immunosuppression, including taking immune-suppressing drugs after an organ transplant

Not everyone with risk factors gets anal cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Anal Cancer Prevention :

Certain lifestyle choices can help prevent anal cancer. One of the most important is to avoid HPV infection. Some ways you can lower your chances of getting HPV include :

  • Wait until you are older to have sex and limit your number of sexual partners
  • Use condoms during sex
  • Don’t smoke or use other types of tobacco
  • Avoid sex with people with sexually transmitted diseases (STD) or who have had multiple sexual partners
  • Get an HPV vaccine. Gardasil® and Cervarix® help protect against certain types of HPV. But if you have HPV, they do not cure it.

Anal cancer often does not have symptoms. When it does have symptoms, they vary from person to person. If you have anal cancer symptoms, they may include :

  • Anal or rectal bleeding
  • Pain or pressure around the anus
  • Change in bowel habits
  • Narrower stool than usual
  • A lump close to the anus
  • Swollen lymph nodes in the anal or groin area
  • Anal discharge

These symptoms do not always mean you have anal cancer. However, it is important to discuss any symptoms that last more than two weeks with your doctor, since they may signal other health problems.

Our Treatment Approach

As one of the nation's largest cancer centers, we care for more patients with anal cancer than most other hospitals. A team of experts personalizes your comprehensive care plan to be sure you receive the most effective treatment with the fewest possible side effects.

A team of anal cancer specialists, including oncologists, radiation oncologists, surgeons and others as needed, focus on your treatment. They are supported by a group of specially trained nurses, nutritionists and social workers.

Most Advanced Therapies

We make every effort to preserve the sphincter without affecting control of bowel movements, and we use all means possible to decrease the risk of a colostomy. However, if a colostomy is needed, highly qualified nurses help you make the transition and maintain your quality of life.

If you have anal cancer that has spread (metastasized) and/or have HIV or AIDS, we offer the most advanced treatments for them.

Bone Cancer

Accurate diagnosis is essential to successful treatment of bone cancer. The wrong kind of biopsy may make it more difficult later for the surgeon to remove all of the cancer without having to also remove all or part of the arm or leg with the tumor. A biopsy that is not done correctly may cause the cancer to spread.

If your doctor thinks you may have bone cancer, it’s important to go to a cancer center with a specialized bone cancer program. You should look for a program that does as many diagnostic procedures as possible. Also, if possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer.

Bone Cancer Diagnosis

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

Biopsy : A biopsy, which removes a tiny piece of bone, is used to confirm the presence of cancer cells. This is the only way to find out for certain if the tumor is cancer or another bone disease. It is very important for the biopsy procedure to be done by a surgeon with experience in diagnosing and treating bone tumors.

There are two types of bone biopsy :

  • Needle biopsy : A long, hollow needle is inserted through the skin to the area of bone to be tested. The needle removes a cylindrical sample of bone to look at under a microscope.
  • Open or surgical biopsy : An incision (cut) is made, and the surgeon removes a tiny piece of bone for examination under a microscope.

Your doctor will decide which type of biopsy is best for you based on several factors, including the type and location of the tumor. If possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer.

Imaging tests, which may include :

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

Bone Cancer Facts

Bone cancer is a sarcoma (type of cancerous tumor) that starts in the bone. Other cancers may affect the bones, including :

  • Secondary cancers that metastasize, or spread, from other parts of the body
  • Other types of cancer including non-Hodgkin’s lymphoma and multiple myeloma

This information is about primary bone cancers.

Bones support and give structure to the body. They usually are hollow. The main parts of the bones are :

Matrix is the outer part of bones. It is made of fiber-like tissue and is covered with a layer of tissue called the periosteaum.

Bone marrow is the soft tissue in the space in hollow bones called the medullary cavity. Cells inside bone marrow include :

  • Fat cells
  • Red blood cells, white blood cells and platelets
  • Fibroblasts, a type of cell that helps build connective tissue
  • Plasma, in which blood cells are suspended
  • Cartilage is at the end of most bones. It is softer than bone, but it is firmer than soft tissue. Cartilage and other tissues, including ligaments, make up joints, which connect some bones.
  • Bone constantly changes as new bone forms and old bone dissolves. To make new bone, the body deposits calcium into the cartilage. Some of the cartilage stays at the ends of bones to make joints.

Bone Cancer Types

There are several types of bone tumors. They are named according to the area of bone or tissue where they start and the type of cells they contain. Some bone tumors are benign (not cancer), and some are malignant (cancer). Bone cancer also is called sarcoma.

The most commonly found types of primary bone cancer are :

Osteosarcoma or osteogenic sarcoma is the main type of bone cancer. It occurs most often in children and adolescents, and it accounts for about one-fourth of bone cancer in adults. More males than females get this cancer. About 1,000 people in the United States are diagnosed with osteosarcoma each year. It begins in bone cells, usually in the pelvis, arms or legs, especially the area around the knee.

Chondrosarcoma is cancer of cartilage cells. More than 40% of adult bone cancer is chondrosarcoma, making it the most prevalent bone cancer in adults. The average age of diagnosis is 51, and 70% of cases are in patients over 40. Chondrosarcoma tends to be diagnosed at an early stage and often is low grade. Many chondrosarcoma tumors are benign (not cancer). Tumors can develop anywhere in the body where there is cartilage, especially the pelvis, leg or arm.

Ewing's sarcoma is the second most prevalent blood cancer in children and adolescents, and the third most often found in adults. It accounts for about 8% of bone cancers in adults. Ewing’s sarcoma can start in bones, tissues or organs, especially the pelvis, chest wall, legs or arms.

Less - commonly found types of bone cancer include :

  • Chordoma, which is found in 10% of adult bone cancer cases, usually in the spine and base of the skull
  • Malignant fibrous histiocytoma/fibrosarcoma, which usually starts in connective tissue
  • Fibrosarcoma, which often is benign and found in soft tissue in the leg, arm or jaw
  • Secondary (or metastatic) bone cancer is cancer that spreads to the bone from another part of the body. This type of bone cancer is more prevalent than primary bone cancer. For more information about this type of cancer, see the type of primary cancer (where the cancer started).

Our Approach

Our experience and expertise help us produce outstanding outcomes, and our patients have an 80% five-year event-free survival rate.

We bring together a team of experts that includes specialists from many areas to give you personal, customized care. They focus their full attention on you, communicating and collaborating with each other and you to ensure carefully coordinated care. We use specialized therapies and technologies to be sure you receive the most advanced treatment with the least impact on your body.

If possible, it is best to have a biopsy to diagnose bone cancer at the same place you expect to receive treatment. It is essential to go to a specialized cancer center that has experience in osteosarcoma biopsy. If the biopsy is done incorrectly, it may make it more difficult later for the surgeon to remove all of the cancer without having to also remove all or part of the arm or leg with the tumor. A biopsy that is not done correctly may cause the cancer to spread.

As one of the world's leading cancer centers, we constantly work to discover new treatments and innovations. We helped pioneer :

  • Embolization for localized unresectable giant cell tumor of bone
  • Limb-sparing surgery to help save arms and legs
  • Targeting a cell receptor known to play a part in the spread of cancer to the bones may enable chemotherapy drugs to be delivered directly to the cells

Bone Cancer Screening

Screening tests are important ways to find cancer if you are at risk but do not have symptoms. Unfortunately, no standardized screening tests have been shown to improve bone cancer outcomes.

Bone Cancer Risk Factors

Anything that increases your chance of getting bone cancer is a risk factor. However, having risk factors does not mean you will get bone cancer. In fact, most people who develop bone cancer do not have any risk factors. If you have risk factors, it’s a good idea to discuss them with your health care provider.

Teenagers and young adults are at greatest risk of developing osteosarcoma, a type of bone cancer, because it often is associated with growth spurts. Some diseases that run in families can slightly increase the risk of bone cancer. These include :

  • Li-Fraumeni syndrome
  • Rothmund-Thompson syndrome
  • Retinoblastoma (an eye cancer of children)
  • Multiple osteochondromas

Other risk factors for bone cancer include :

  • Paget's disease
  • Prior radiation therapy for cancer, especially treatment at a young age or with high doses of radiation
  • Bone marrow transplant

Bone Cancer Staging

If you are diagnosed with bone cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

AJCC Staging System

One system that is used to stage all bone cancer is the American Joint Commission on Cancer (AJCC) system.

  • T stands for features of tumor (its size)
  • N stands for spread to lymph nodes
  • M is for metastasis (spread) to distant organs
  • G is for the grade of the tumor

This information about the tumor, lymph nodes, metastasis and grade is combined in a process called stage grouping. The stage is then described in Roman numerals from I to IV (1-4).

T stages of bone cancer

  • TX: Primary tumor can't be measured
  • T0: No evidence of the tumor
  • T1: Tumor is 8 centimeters (around 3 inches) or less
  • T2: Tumor is larger than 8 centimeters
  • T3: Tumor is in more than one place on the same bone

N stages of bone cancer

  • N0: The cancer has not spread to the lymph nodes near the tumor
  • N1: The cancer has spread to nearby lymph nodes

M stages of bone cancer

  • M0: The cancer has not spread anywhere outside of the bone or nearby lymph nodes
  • M1: Distant metastasis (the cancer has spread)
    • M1a: The cancer has spread only to the lung
    • M1b: The cancer has spread to other sites (like the brain, the liver, etc)

Grades of bone cancer

  • G1-G2: Low grade
  • G3-G4: High grade

TNM stage grouping

After the T, N and M stages and the grade of the bone cancer have been determined, the information is combined and expressed as an overall stage. The process of assigning a stage number is called stage grouping. To determine the grouped stage of a cancer using the AJCC system, find the stage number below that contains the T, N and M stages, and the proper grade.

Stage I: All stage I tumors are low grade and have not yet spread outside of the bone.

  • Stage IA: T1, N0, M0, G1-G2: The tumor is 8 centimeters or less.
  • Stage IB: T2 or T3, N0, M0, G1-G2: The tumor is either larger than 8 centimeters or it is in more than one place on the same bone.

Stage II: Stage II tumors have not spread outside the bone (like stage I) but are high grade.

  • Stage IIA: T1, N0, M0, G3-G4: The tumor is 8 centimeters or less.
  • Stage IIB: T2, N0, M0, G3-G4: The tumor is larger than 8 centimeters.

Stage III: T3, N0, M0, G3-G4: Stage III tumors have not spread outside the bone but are in more than one place on the same bone. They are high grade.

Stage IV: Stage IV tumors have spread outside of the bone they started in. They can be any grade.

  • Stage IVA: Any T, N0, M1a, G1-G4: The tumor has spread to the lung.
  • Stage IVB: Any T, N1, any M, G1-G4 OR Any T, any N, M1b, G1-G4: The tumor has spread to nearby lymph nodes or to distant sites other than the lung (or both).

Even though the AJCC staging system is widely accepted and used for most cancers, bone cancer specialists tend to simplify the stages into localized and metastatic. Localized includes stages I, II and III, while metastatic is stage IV.

Bone cancer symptoms vary from person to person. They also depend on the size and location of the cancer.

If you have symptoms, they may include :

  • Pain
  • Swelling or tenderness in or near a joint
  • Difficulty with normal movement
  • Fatigue
  • Fever
  • Weight loss
  • Anemia (low red blood cell count)
  • Fractures

Having one or more of these symptoms does not mean you have bone cancer. However, it is important to discuss any symptoms with your doctor, since they may indicate other health problems.

Surgery

Surgery is the main treatment for most bone cancers. Both the biopsy and surgery should be done by a surgeon with extensive experience in these procedures. A biopsy in the wrong location can cause surgical problems and lower your chances of successful treatment.

If at all possible, the same surgeon should perform both the biopsy and surgery. The biopsy will help the surgeon locate the tumor more precisely.

The goal of surgery is to remove as much of the cancer as possible. If any cancer cells remain, they may grow and spread. To get as much of the cancer as possible, the surgeon performs a wide-excision surgery. This involves removing the cancer, as well as a margin of healthy tissue around it.

If the tumor is in an arm or leg, the surgeon almost always is able to perform limb-sparing surgery, which removes the cancer cells but allows you to keep full use of your leg or arm. To replace bone that is removed during surgery, a bone graft may be done or an internal device called an endoprosthesis may be implanted.

If this is not possible, an amputation, or removal of the limb, may be performed. Reconstructive surgery and/or prosthesis will be needed. Rehabilitation is necessary after either procedure.

Chemotherapy

Chemotherapy may be recommended to treat osteosarcoma or Ewing’s sarcoma. In osteosarcoma, it is often given before surgery to shrink the tumor and make it easier to remove, and after surgery to destroy remaining cancer cells. Chemotherapy is also used for bone cancer that has metastasized (spread) to the lungs or other organs.

Radiation Therapy

Bone cancer is not highly sensitive to radiation, so radiation usually is not a treatment. It sometimes may be given if the tumor cannot be operated on or if cancer cells remain after surgery. Radiation may help relieve symptoms if bone cancer returns.

New radiation therapy techniques and remarkable skill allow doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

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

Targeted Therapy

These newer agents are used to help fight some types of bone cancer, including chordoma. Targeted therapies attack cancer cells by using small molecules to block pathways that cells use to survive and multiply.

Brain Tumour

If you have a brain tumor, it is important to get the most accurate diagnosis possible. This will help your doctor pinpoint the tumor to give you the most-advanced treatment with the least impact on your body.

We have the most modern and accurate equipment available to home in on brain tumors and find out exactly how far they may have spread.

Our specialized staff truly sets us apart. They are an essential part of our team, and their expertise and experience can make a big difference in brain tumor treatment success.

Brain Tumor Diagnostic Tests

If you have symptoms that may signal a brain tumor, your doctor will examine you and ask you questions about your health, your lifestyle and your family history.

One or more of the following tests may be used to find out if you have a brain tumor and if it has spread. These tests also may be used to find out if treatment is working.

  • Biopsy: While imaging tests may show an area that may be a brain tumor, a biopsy is almost always needed to diagnose a brain tumor. A biopsy may be done by either of two methods.
  • Surgery: A biopsy may be done during surgery in which all or part of the brain tumor is removed. The operation also is called a craniotomy. If a tumor is difficult to reach, a CT (computed tomography) scan may be used for three-dimensional needle placement (stereotactic biopsy). This helps doctors precisely locate the tumor.
  • Sterotactic (needle) biopsy: This method may be used if the suspicious area is in a place that makes surgery too risky or difficult.

Imaging tests, which may include :

  • CT (computed tomography) scans
  • MRI (magnetic resonance imaging)
  • PET (positive emission tomography) scan

Lumbar puncture: A small amount of cerebrospinal fluid (clear liquid in and around the brain and spine) is removed with a needle and looked at with a microscope. This test may be done if :

  • Doctors suspect tumor has invaded the layers of tissue that cover the brain (meninges)
  • When the diagnosis or type of tumor is not clear

Our Approach

Each patient who comes to us for brain tumor treatment receives customized care from some of the nation’s top experts. From diagnosis through treatment and follow-up, you are the focus of a team of specialists who personalize your therapy for your unique situation.

Specialized, Comprehensive Care

Successful brain tumor care depends on accurate diagnosis. This sets us apart from many other cancer centers and helps us target each tumor for optimal outcomes.

Neurosurgeons perform a large number of brain tumor surgeries each year, using the least-invasive and most-advanced techniques.

We have the most-modern technology and techniques available to treat brain tumors, including :

  • Gamma Knife
  • Cyber Knife

Brain Tumor Facts

About 17,000 people are diagnosed with cancer that began in or next to the brain every year in the United States. These are called primary brain cancers. Another 100,000 people are diagnosed with cancer in the brain or spinal cord that spread (metastasized) from another place in the body. These are called secondary brain cancers.

Most types of brain tumors are slightly more common in men than women. Meningiomas are more common in women.

Growth Causes Problems

Some brain tumors grow slowly and may become quite large before causing symptoms. Others may grow quickly and cause a sudden onset of symptoms. While most types of brain cancer may spread within the brain, few spread beyond the brain. Because the skull is rigid, providing no room for the tumor to expand, brain tumors may press on parts of the brain that control movement, speech, sight or other vital functions.

Even when brain tumors are benign (not cancer), they can cause serious problems. Although non-cancerous brain tumors usually grow slower than cancerous brain tumors, they may damage and press against normal brain tissue or the spine as they grow.

Brain Has Crucial Roles

Emotions, thought, speech, vision, hearing, movement and many more important parts of everyday life begin in the brain. The brain sends messages throughout the body via the spinal cord and cranial nerves in the head. The network of the brain and spinal cord is called the central nervous system (CNS). Tumors can develop in the spinal cord and cranial nerves.

The hard, bony skull protects the brain, and the bones (vertebrae)of the spine protect the spinal cord. A liquid called cerebrospinal fluid surrounds both the brain and the spinal cord.

The brain has four main parts :

Cerebrum: The outer and largest part of the brain. The cerebrum has two halves that are called hemispheres. It is responsible for :

  • Emotions
  • Reasoning
  • Language
  • Movement of muscles
  • Senses of seeing, hearing, smelling, touch
  • Perception of pain

Basal ganglia: These are found deeper inside the brain. They play a part in muscle movement.

Cerebellum: This section is at the back of the brain. It helps control and coordinate movement, such as walking and swallowing.

Brain stem: The brain stem is at the base of the brain. Its nerve fibers carry messages between the cerebrum and the rest of the body. This small area is very important and even plays a part in breathing and heartbeat.

Brain Tumor Types

Brain tumors are classified by the types of cells within the tumor. Each type of brain tumor grows and is treated in a different way.

The main types of brain tumors are as follows. The type of cells where they begin are in parentheses.

  • Adenoma (pituitary gland)
  • Chordoma (skull and spine)
  • Craniopharyngioma (pituitary gland)
  • Dermoid cysts and epidermoid tumors
  • Germ cell tumors, including germinomas (near the pineal gland)
  • Gliomas: This is the main group of brain tumors, occurring in 65% of cases. It includes :
    • Glioblastoma multiforme (glial cells and oligodendrocytes). This is the type of brain cancer found most often in adults.
    • Astrocytoma (glial cells of tissue that supports nerve cells)
    • Oligodendroglioma (oligodendrocytes in the myelin sheath around nerve fibers in the brain)
    • Ependymoma (the ventricles in tissue lining the spaces within the brain)
  • Hemangioblastoma (cells that develop into blood vessels)
  • Medulloblastoma (cerebellum)
  • Meningioma (meninges, the layers of tissue covering the brain)
  • Osteoma and osteosarcoma (bones of the skull)
  • Pinealoma (pineal gland)
  • Pituitary adenoma (pituitary gland)
  • Sarcoma (connective tissue)

Brain Metastases

Cancers that metastasize (spread) to the brain are called metastases. They may grow in one or several parts of the brain. Many types of cancer can spread to the brain. The main types are breast cancer, lung cancer, gastrointestinal cancers, malignant melanoma, leukemia and lymphoma.

Lymphomas of the brain often are found in people who have AIDS. For unknown reasons, they are increasingly being found in people with normal immune systems.

Brain Tumor Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Unfortunately, no standardized screening tests have been shown to improve brain tumor outcomes.

Brain Tumor Risk Factors

Anything that increases your chance of getting a brain tumor is a risk factor. While no definite risk factors have been found for brain tumors, some factors may put you at increased risk, including :

  • Radiation exposure
  • Family history of certain conditions including :
    • Neurofibromatosis type 1 and type 2
    • Tuberous sclerosis
    • Von Hippel-Lindau disease
    • Li-Fraumeni syndrome
  • Immune system disorders, including AIDS and lymphoma

Research is ongoing into the causes and risk factors of brain tumors. Many possibilities are being studied, including genetics and environmental exposure to certain chemicals.

Brain tumor symptoms depend on the area of the brain affected. Brain tumors can :

  • Invade and destroy brain tissue
  • Put pressure on nearby tissue
  • Take up space and increase pressure within the skull (intracranial pressure)
  • Cause fluids to accumulate in the brain
  • Block normal circulation of cerebrospinal fluid through the spaces within the brain
  • Cause bleeding

Brain tumor symptoms vary from person to person. They may include :

  • Headaches, which are often the first symptom. A headache due to a brain tumor usually becomes more frequent as time passes. It is often worse when you lie down or first awaken.
  • Seizures
  • Changes in mental function, mood or personality. You may become withdrawn, moody or inefficient at work. You may feel drowsy, confused and unable to think. Depression and anxiety, especially if either develops suddenly, may be an early symptom of a brain tumor. You may become uninhibited or behave in ways you never have before.
  • Changes in speech (trouble finding words, talking incoherently, inability to express or understand language)
  • Changes in the ability to hear, smell or see, including double or blurred vision
  • Loss of balance or coordination
  • Change in the ability to feel heat, cold, pressure, a light touch or sharp objects
  • Changes in pulse and breathing rates if brain tumor compresses the brain stem

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

Our Treatment Approach

Some of the nation’s top experts customize your brain tumor care here. They take a team approach to deliver the most-advanced therapies with the fewest possible side effects, keeping a constant eye on your quality of life.

These highly trained physicians work together to give individualized care for malignant (cancer) and benign (non-cancer) brain tumors, collaborating and communicating frequently. Your personal team of experts may include renowned neurosurgeons, radiation oncologists and neuro-oncologists, supported by a specially trained staff.

Surgical Expertise

Like all surgeries, brain tumor surgery is most successful when it is performed by a specialist with a great deal of experience in the particular experience. This is especially true with brain tumors, because it is crucial to remove as much of the tumor as possible while leaving intact as much brain function as possible.

We have the most-modern technology available to treat brain tumors, including :

  • Gamma Knife
  • Cyber Knife

Our Brain Tumor Treatments

If you are diagnosed with a brain tumor, your doctor will discuss the best options to treat it. This depends on several factors, including the location and type of the cancer and your general health.

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

Surgery

Surgery usually is the first treatment for brain tumors. Even when complete removal is not possible surgery may be able to :

  • Help reduce the tumor’s size
  • Relieve symptoms
  • Help doctors decide what other treatments are needed

The most common surgery for brain tumors is craniotomy, which involves opening the skull. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make them difficult or impossible to remove without destroying important parts of the brain.

Radiation Therapy

Radiation therapy may be able to stop or slow the growth of brain tumors that cannot be removed with surgery. It may be used :

  • Alone
  • With chemotherapy to help the radiation work better or lessen effect on normal parts of the brain
  • With targeted therapies to destroy remaining cancer cells

New radiation therapy techniques and remarkable skill allow our doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

We use the most advanced radiation treatment methods, including :

  • Gamma Knife radiosurgery, which is not really surgery. It delivers a pinpoint dose of radiation from hundreds of angles
  • Focused radiation therapy, which is aimed directly at the tumor and immediately surrounding area
  • Whole-brain radiation therapy, which may be needed if you have two or more brain tumors in different locations
  • Intensity-modulated radiotherapy (IMRT), which shapes the radiation bean to the shape of the brain tumor and lessens exposure to the rest of the brain

Chemotherapy

We offer the most up-to-date and advanced chemotherapy options for brain tumors. These drugs may be taken orally or by injection. They may be given alone or with other treatments.

Chemotherapy often is not as effective for brain cancer as some other types of cancer. This is because of the blood-brain barrier, small blood vessels in the brain and spinal cord that protect the brain from harmful substances. They also may act as a shield against chemotherapy drugs.

Targeted Therapies

These new drugs target the specific gene changes that cause cancer.

Breast Cancer

Breast Cancer Diagnostic Tests

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

Biopsy: A small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies for breast cancer may be done in one of the following ways :

  • Surgical biopsy: An incision (small cut) is made in the breast. Surgeons find the tumor by touch or with a CT (or CAT, computed axial tomography) scan, ultrasound or mammogram. In an excisional biopsy, the entire mass is removed. In an incisional biopsy, part of the tumor is removed.
  • Fine needle aspiration (FNA): A thin, hollow needle is inserted into the breast. Fluid and cells are removed from the tumor and looked at with a microscope. While this test can help to determine if breast cancer is present, it cannot determine if the cancer is invasive. Additional biopsies may be needed if breast cancer is found.
  • Core biopsy: A thicker needle is used to remove one or more small cylinder-shaped tissue samples from the tumor.
  • Sentinel lymph node biopsy: Lymph nodes are olive-sized glands that are part of the lymphatic system that circulates lymph fluid throughout the body. The lymphatic system also can carry cancer cells from the tumor site to other areas of the body. In breast cancer, the first nodes to be affected are under the arms.

In a sentinel lymph node biopsy, a radioactive blue dye is injected into the area before surgery. The dye shows up in cancerous lymph nodes. The node with the highest amount of blue dye is the “sentinel” node. The surgeon removes all nodes with blue dye.

Sentinel node biopsy can spare healthy lymph nodes, which results in fewer side effects such as lymph edema. We have special expertise in this type of biopsy for breast cancer, which often helps preserve function and health.

Imaging tests, which may include :

  • CT or CAT (computed tomography) scan
  • Mammogram
  • MRI (magnetic resonance imaging) scan
  • Ultrasound
  • PET scan

When you are treated for breast cancer us, you can rest assured we are doing everything possible to help you recover and get back to a healthy life. You benefit from the expertise available at one of the most comprehensive and complete breast cancer centers in the India.

A team of top physicians, including oncologists, surgeons, plastic surgeons and radiation oncologists, customizes your breast cancer treatment to be sure it is the most-advanced and least-invasive possible. Our skilled plastic surgeons offer multiple reconstruction options, using innovative procedures that focus on your quality of life. And a specially trained support team, including nurses, dietitians and therapists, helps make sure you receive personalized, coordinated breast cancer care.

Advanced Techniques, Personal Care

We treat every type of breast cancer with the latest treatments, including personalized therapies based on the cancer’s specific genetic makeup. We have the expertise to examine each breast cancer tumor carefully to determine gene-expression profiles, which then guide us toward the most effective, gentlest treatment targeted specifically to the cancer. This approach sets us above and beyond most cancer centers.

Breast Cancer Facts

Breast cancer is the most common cancer in women and is second only to lung cancer as the leading cause of cancer deaths among women in the India. It affects one of every eight Indian women.

The National Cancer Registry estimates that more than 192,370 women are diagnosed with breast cancer each year, and the number of new cases has declined over the past decade. More than 40,000 women lose their lives to this disease annually.

Men can develop breast cancer, but it happens much less often than in women. Nearly 2,000 men are diagnosed with breast cancer each year.

Breast Cancer Types

There are two main types of breast cancer. Breast tumors may have a single type of cancer, a combination of types, or a mixture of invasive and noninvasive (in situ) cancer.

  • Ductal carcinoma (cancer) is the most common form of breast cancer. Tumors form in the cells of the milk ducts, which carry milk to the nipples. Ductal carcinoma can be invasive with the potential to spread or non-invasive (also called ductal carcinoma in situ or DCIS). About one in five new breast cancer cases are DCIS. The chance for successful treatment of DCIS usually is very high.
  • Lobular carcinoma (cancer) occurs in the lobules, which are the milk-producing glands. Lobular breast cancer can be non-invasive (in situ or LCIS, also called lobular neoplasia) or invasive (have a tendency to spread). About one in 10 breast cancer cases are invasive lobular cancer.

Less common types of breast cancer

Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer that affects the dermal lymphatic system. Rather than forming a lump, IBC tumors grow in flat sheets that cannot be felt in a breast exam.

Triple-negative breast cancer is usually an invasive ductal carcinoma with cells that lack estrogen and progesterone receptors and do not have an excess of HER2 protein on their surfaces. These types of breast cancers tend to spread more quickly and do not respond to hormone therapy or drugs that target HER2.

Recurrent breast cancer is cancer that has returned after being undetected for a time. It can occur in the remaining breast tissue or at other sites such as the lungs, liver, bones or brain. Even though these tumors are in new locations, they still are called breast cancer.

Breast Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don't have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best. We recommends the following screening tests for breast cancer :

Starting at age 20: Women at all risk levels for breast cancer should practice breast self-awareness. Be familiar with how your breasts look and feel and immediately report any changes to your doctor.

Starting at age 40: Women at average risk for breast cancer should begin getting annual mammograms and breast exams.

Breast Cancer Risk Factors

If you have any of the risk factors listed below, talk to your doctor about getting these tests more often and adding more tests, including breast MRI (magnetic resonance imaging) and genetic testing. If you are concerned about inherited family syndromes that may cause breast cancer. Anything that increases your chance of getting breast cancer is a risk factor. These include :

  • Age: While most cases occur in women 50 or older, breast cancer sometimes develops in women in their 20s. Age is the main risk factor.
  • Family history (especially mother, sister, daughter) of ovarian and/or breast cancer
  • Hormones/childbirth: Your risk of breast cancer is higher if you :
    • Had your first period before age 12
    • Began menopause after age 55
    • Never had children
    • Had your first child after age 30
    • Used hormone therapy after menopause
  • History of radiation to the chest area
  • Previous abnormal breast biopsy results
  • Breast diseases such as atypical hyperplasia, or lobular or ductal carcinoma
  • Obesity or weight gain after menopause
  • Inherited susceptibility genes BRCA1 and BRCA2 account for about 5% to 10% of breast cancer cases. Tell your doctor if other women in your family have had breast cancer.

Other breast cancer risk factors include :

  • Oral contraceptive use (birth control pills)
  • Diet high in saturated fats
  • Not getting enough exercise
  • Drinking more than one alcoholic drink a day

Not everyone with risk factors gets breast cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Breast Cancer Stages

Stage 0 (carcinoma in situ): Cancer has not spread from the site of origin. There are two types of breast carcinoma in situ :

  • Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive breast cancer and spread to other tissues.
  • Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast (where milk is made). This condition seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of developing breast cancer in either breast.

Stage I: Cancer has formed. The tumor is 2 centimeters or smaller and has not spread outside the breast.

Stage IIA: No tumor is found in the breast. Breast cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or

  • The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
  • The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB

  • The breast cancer tumor is larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
  • The tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA: No tumor is found in the breast. Breast cancer is found in axillary lymph nodes that are attached to each other or to other structures. Cancer may be found in lymph nodes near the breastbone; or

  • The tumor is 2 centimeters or smaller. Breast cancer has spread to axillary lymph nodes that are attached to each other or to other structures. Cancer may have spread to lymph nodes near the breastbone; or
  • The tumor is larger than 2 centimeters but not larger than 5 centimeters. Breast cancer has spread to axillary lymph nodes that are attached to each other or to other structures. Cancer may have spread to lymph nodes near the breastbone; or
  • The tumor is larger than 5 centimeters. Breast cancer has spread to axillary lymph nodes that may be attached to each other or to other structures. Cancer may have spread to lymph nodes near the breastbone.

Stage IIIB: The tumor may be any size and breast cancer:

  • Has spread to the chest wall and/or the skin of the breast
  • May have spread to axillary lymph nodes that may be attached to each other or to other structures
  • May have spread to lymph nodes near the breastbone

Stage IIIC: There may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Breast cancer :

  • Has spread to lymph nodes above or below the collarbone
  • May have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IIIC breast cancer is divided into operable and inoperable stages. In operable stage IIIC, the cancer is found in:

  • Ten or more axillary lymph nodes; or
  • Lymph nodes below the collarbone; or
  • Axillary lymph nodes and in lymph nodes near the breastbone

In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone.

Stage IV: The cancer has spread to other organs of the body, most often the bones, lungs, liver or brain.

Breast cancer symptoms vary from person to person. The best thing to do is to be familiar with your breasts so you know how "normal" feels and looks. If you notice any changes, tell your doctor. However, many breast cancers are found by mammograms before any symptoms appear.

Breast cancer symptoms may include :

  • Lump or mass in your breast
  • Enlarged lymph nodes in the armpit
  • Changes in breast size, shape, skin texture or color
  • Skin redness
  • Dimpling or puckering
  • Nipple changes or discharge
  • Scaliness on the breast
  • Nipple pulling to one side or a change in direction

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

Our Treatment Approach

We customize your breast cancer care so you receive the most-advanced, least-invasive treatments with the fewest side effects. In addition to treatments you might find at most breast cancer centers, we offer specialized therapies available at only a few centers in the nation.

We’re able to provide a wide range of therapies, including :

  • Oncoplastic surgery
  • Breast conservative surgery
  • Sentinel lymph node biopsy
  • Modified radical mastectomy
  • Immediate or delayed breast reconstruction
  • Novel therapies, including targeted biologic agents
  • Accelerated partial breast irradiation
  • Bone-directed treatment for breast cancer that has spread to the bones
  • Intensity-modulated radiotherapy (IMRT), brachytherapy and stereotactic radiosurgery

We have the expertise to examine each breast cancer tumor carefully to determine gene-expression profiles, which then guide us toward the most effective, gentlest treatment targeted specifically to the cancer. This personalized medicine approach sets us above and beyond most cancer centers and allows us to attack the specific causes of each breast cancer for the optimal outcome.

Our Breast Cancer Treatments

If you are diagnosed with breast cancer, your doctor will talk to you about the best options for treating it. Your treatment will be customized especially for you, and it may include one or more of the following therapies.

Surgery

Like all surgeries, breast cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. We perform a large number of surgeries for breast cancer each year, using the least-invasive and most-effective techniques. If reconstructive surgery is needed, our experts use the most advanced procedures with extraordinary skill.

Surgery is the most common treatment for breast cancer. Procedures may include :

  • Mastectomy: This surgery removes one or both breasts. The entire breast is removed, along with any affected lymph nodes. In about 80% of mastectomies, breast reconstruction or implant surgery is done during the same procedure, after the breast is removed.
  • Breast - sparing surgery is an attempt to save as much healthy breast tissue as possible. These procedures are best for treating early stage (I and II) breast cancer. Breast - sparing techniques include :
    • Lumpectomy: The tumor and a small margin of healthy breast tissue are removed.
    • Partial mastectomy: The tumor is removed, along with a margin of healthy breast tissue. The lining of the chest muscles and any affected lymph nodes under the arm are removed also.
    • Breast reconstruction: using either breast implants or tissue from your abdomen or other parts of your body, the surgeon can recreate a breast either during the cancer surgery (immediate reconstruction) or after surgery (delayed reconstruction).

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy beams to destroy cancer cells. New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Two main types of radiation treatment are used for breast cancer :

  • External beam radiation: The beams are aimed at the tumor from outside the body.
  • Internal radiation: Tiny plastic tubes filled with radioactive material are implanted in the breast at the tumor site. They are removed after several days. This procedure requires a hospital stay.

Intensity-modulated radiation therapy (IMRT): We pioneered the use of this type of radiotherapy for breast cancer. Only a few institutions in the country offer it. IMRT may lead to improved outcomes and less impact on your body than other types of radiotherapy.

Accelerated partial breast irradiation (APBI)

Stereotactic Radiosurgery

Women who have breast-sparing surgery and/or mastectomy may receive radiation afterward to destroy any lingering breast cancer cells. Radiation also can be used before surgery to shrink large tumors or to treat tumors in a difficult location.

Chemotherapy

In breast cancer, chemotherapy most often is given before or after surgery. It also may be the main treatment for cancer that has spread outside the breast.

We offers the most up-to-date and effective chemotherapy options for breast cancer. Our experts helped develop many drugs now used as standard care at other centers, as well as novel approaches to administer them.

We also use chemotherapy before surgery to shrink breast cancer tumors, reducing damage to surrounding tissue.

Hormone Therapy

Hormone therapy sometimes helps prevent female hormones (estrogen, progesterone and estradiol) from fueling the growth of breast cancer. Hormone therapy can involve taking drugs by mouth or through an IV.

Targeted Therapy

Targeted therapies are drug treatments that help the body’s immune system fight cancer. Herceptin® (Trastazumab) is a type of biologic therapy that targets cells that produce too much of a protein called HER2. This protein is present in some breast cancer patients. Herceptin binds to the cells, shutting off HER2 production.

Cervical Cancer

It’s important to diagnose cervical cancer early and accurately and find out if it has spread. This helps your doctors choose the best treatment for you. Here specialized experts use the most modern and accurate equipment to diagnose cervical cancer. With pinpoint attention to detail, our pathologists, diagnostic radiologists and specially trained technicians find out the exact extent of disease. This helps increase the likelihood your treatment will be successful.

Cervical Cancer Diagnostic Tests

If you have symptoms or Pap test results that suggest precancerous cells or cervical cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have cervical cancer and if it has spread. These tests also may be used to find out if treatment is working.

Colposcopy: This test uses an instrument called a colposcope to look more closely at an area of abnormal tissue on the cervix, vagina or vulva. A colposcope is a microscope designed to examine the cervix. It looks like a pair of binoculars on a stand.

Biopsy: In a biopsy to look for cervical cancer, the doctor removes a small amount of tissue from the cervix to look at under a microscope. Types of cervical biopsies include :

Punch biopsy: The tissue sample is removed from the cervix using biopsy forceps, an instrument used to grasp tissue firmly and remove it.

Endocervical curettage (ECC): A tissue sample is scraped from an area just past the opening of the cervix using a curette (small, spoon-shaped instrument) or a thin, soft brush.

LEEP (Loop electro-surgical excision procedure): This test uses a small wire that is heated with low-voltage, high-frequency radio waves to remove cells from the cervix.

Cone biopsy: A cone-shaped sample of tissue is removed so the pathologist can see if abnormal cells are in the tissue beneath the surface of the cervix. The amount of tissue removed is larger than that removed with other types of biopsy. This type of biopsy can be done by one of the following methods :

  • LEEP cone biopsy: The LEEP device is used, and the biopsy can be done in the doctor's office under local anesthesia.
  • Knife cone biopsy: A scalpel (small sharp knife) is used in an operating room with local or general anesthesia.
  • Laser: A carbon dioxide laser is used to remove tissue.

Cystoscopy or proctoscopy: If you are diagnosed with cervical cancer and your doctor thinks it may have spread, you may have a cytoscopy or proctoscopy or both. These tests use lighted tubes to view the inside of the bladder (cystoscopy) or the anus, rectum and lower colon (proctoscopy).

Imaging tests, which may include :

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

Our Approach

Working together closely, a team of some of the nation’s top experts works together to plan your cervical cancer carefully when you come to us. We customize your plan of action to be sure it delivers the most-advanced cervical cancer treatment with the least impact on your body.

Your personal group of experts, which includes highly specialized medical, surgical, radiology and gynecological oncologists, is supported by a thoroughly trained staff. They communicate and collaborate at every step to increase your chances for successful treatment for cervical cancer.

We also offer treatment for pre-cancerous changes of the cervix and perform cervical biopsies to investigate abnormal Pap tests.

Surgical Expertise

Surgery often is an integral part of cervical cancer treatment, and the surgeon’s skill can make a crucial difference in the success of these delicate operations. MD Anderson’s surgeons are among the most experienced in the nation in surgery for cervical cancer, giving them a higher level of expertise. Procedures available may include :

  • Minimally invasive procedures including laparoscopic hysterectomy
  • Radical hysterectomy
  • Fertility-sparing techniques, including radical trachelectomy, a highly specialized surgery that may help some women keep the ability to have children

Cervical Cancer Facts

This most common cancer in rural India. It is one of the main cancers of the female reproductive organs.

The cervix is in the bottom part of the uterus (or womb, where a baby grows). It joins the uterus to the vagina (birth canal).

Most women who develop cervical cancer are between 20 and 50 years old. Cervical cancer often can be treated successfully when it is caught and treated early.

Before cervical cancer appears, the cells of the cervix go through precancerous changes, known as dysplasia. Usually this is a slow process that develops over many years.

An annual Pap test looks for these changes. If precancerous cells are found, they often can be removed.

Most cases of cervical cancer are caused by infection with human papillomavirus (HPV), which usually is passed from person to person by sexual contact. Data says about 75- 90% of men and women who have had sex will be exposed to HPV at some point.

In most people, the immune system clears the virus before it is detected or causes cells to change. However, in a small percentage of people the virus will remain and cause cell changes that may develop into cancer.

Cervical Cancer Types

Cervical cancer is usually one of the following types, which are named for the type of cell where they develop. The main types of cervical cancer are :

  • Squamous cell carcinoma (cancer): This is the main type of cervical cancer and is found in 80% to 90% of cases. It develops in the lining of the cervix.
  • Adenocarcinoma develops in gland cells that produce cervical mucus. About 10% to 20% of cervical cancers are adenocarcinomas.
  • Mixed carcinoma (cancer): Occasionally, cervical cancer has features of squamous cell carcinoma and adenocarcinoma.

In rare instances, other types of cancer, such as melanoma, sarcoma and lymphoma, are found in the cervix.

Cervical Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

One of the best ways to find cervical cancer in the early stages is to have annual Pap tests. This test’s full name is Papanicolau test, and it also may be called a Pap smear, cervical smear or smear tests. This test finds abnormal cells in and around the cervix.

Discuss your specific need for Pap tests with your gynecologist. It may be important to have regular Pap tests even if you :

  • Have had a hysterectomy
  • Are older than 50 or have gone through menopause
  • Are not sexually active
  • Have finished having children

Cervical Cancer Risk Factors

Anything that increases your chance of getting cervical cancer is a risk factor.

HPV, which is spread by sexual contact, is the cause of almost all cases of cervical cancer. HPV may cause the cells in the cervix to change. If abnormal cells are not found and treated, they may become cancer. HPV causes almost all cervical cancers, as well as many vaginal and vulvar cancers.

As many as 75% of men and women who have had sex have HPV. Usually the body’s immune system handles the virus, and most people never know they have it. While most women with HPV will not get cervical cancer, you should be aware of the risk and have regular Pap tests.

Other cervical cancer risk factors include :

  • Age: The risk of cervical cancer increases with age. It is found most often in women over the age of 40. However, younger women often have precancerous lesions that require treatment to prevent cancer.
  • Smoking: Cigarette smoke contains chemicals that damage the body's cells. It increases the risk of precancerous changes in the cervix, especially in women with HPV. Read more about MD Anderson’s smoking cessation clinical trials.
  • Sexual behavior: Certain types of sexual activity may increase the risk of getting HPV infection. These include :
    • Multiple sexual partners
    • High-risk male partners
    • First intercourse at an early age
    • Not using condoms during sex
  • Lack of regular Pap tests
  • Having a sexually transmitted disease (STD), including chlamydia
  • Diethylstilbestrol (DES) exposure before birth: This drug was used between 1940 and 1971 to help women not have miscarriages. Women whose mothers took DES during pregnancy have a high risk of vaginal and cervical cancers.
  • HIV infection

Not everyone with risk factors get cervical cancer. However, if you have risk factors it’s a good idea to discuss them with your health care provider.

Cervical Cancer Prevention

Certain lifestyle choices may lower your risk of developing cervical cancer. These include :

  • Have regular Pap tests to find and treat precancerous changes
  • Take steps to help prevent HPV infection, including the following :
    • Wait until you are older to have sex and limit your number of sexual partners
    • Use condoms during sex
    • Don’t smoke.
    • Avoid sex with people with a sexually transmitted disease (STD) or who have had multiple sexual partners
    • Get an HPV vaccine: Gardasil® and Cervarix® help protect against certain types of HPV. But if you have HPV, they do not cure it. You should continue to have regular Pap tests after you have receive the vaccine

Cervical Cancer Staging

If you are diagnosed with cervical cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps your doctor plan the best way to treat the cancer.

Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Cervical Cancer Stages

Stage 0: Abnormal cells are found in the inner lining of the cervix. These abnormal cells may become cancer and spread to nearby normal tissue. Stage 0 also is called carcinoma in situ.

Stage I: Cancer has formed and is in the cervix only.

  • Stage IA: A small amount of cancer that can be seen only with a microscope is in the tissues of the cervix.
  • Stage IA1: The cancer is not more than 3 millimeters deep and not more than 7 millimeters wide.
  • Stage IA2: The cancer is more than 3 but not more than 5 millimeters deep and not more than 7 millimeters wide.
  • Stage IB: Cancer can be seen only with a microscope. It is more than 5 millimeters deep or 7 millimeters wide, or it can be seen without a microscope.
  • Stage IB1: The cancer can be seen without a microscope and is not larger than 4 centimeters.
  • Stage IB2: The cancer can be seen without a microscope and is larger than 4 centimeters.

Stage II: Cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina.

  • Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus.
  • Stage IIB: Cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus.

Stage III: Cancer has spread to the lower third of the vagina, may have spread to the pelvic wall, and/or has caused the kidney to stop working.

  • Stage IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall.
  • Stage IIIB: Cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis.

Stage IV: Cancer has spread to the bladder, rectum or other parts of the body.

  • Stage IVA: Cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.
  • Stage IVB: Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver, intestinal tract or lungs

In its earliest stages, cervical cancer usually does not have symptoms. This is why regular Pap tests are so important, particularly if you are sexually active.

When cervical cancer does have symptoms, they vary from person to person. Tell your doctor if you have any of the following :

  • Vaginal discharge tinged with blood
  • Vaginal bleeding after sexual intercourse
  • Abnormal vaginal bleeding: after menopause, between menstrual periods or excessively heavy periods
  • Urinating more often
  • Pain during sex
  • Swollen leg
  • History of untreated dysplasia (precancerous cell changes) of the cervix

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

Our Treatment Approach

We use the extraordinary expertise to give you personalized care for cervical cancer. We also offer treatment for pre-cancerous changes of the cervix.

Your therapy is customized to fit your unique situation, taking into account a number of factors. The cervical cancer therapies available to you may include :

  • Fertility-sparing techniques, including radical trachelectomy, a highly specialized procedure that may help some women keep the ability to have children
  • Laparoscopic radical hysterectomy
  • Radical hysterectomy, TAH, BSO,omentectomy
  • Specialized advanced radiation techniques

Remarkable Skill, Experience

Surgery is part of treatment for many cases of cervical cancer. Like all surgeries, it is most successful when performed by a specialist with a great deal of experience in the particular procedure.

Colon Cancer

Colon Cancer Diagnostic Tests

The following tests may be used to diagnose colon cancer or find out if it has spread. Tests also may be used to find out if surrounding tissues or organs have been damaged by treatment.

Digital rectal exam (DRE): The doctor inserts a gloved finger into the rectum to feel for polyps or other problems.

Fecal occult blood test (FOBT): This take-home test finds blood in stool.

Fecal immunochemical test (FIT): This take-home test finds blood proteins in stool.

Endoscopic tests, which may include :

  • Sigmoidoscopy: A tiny camera on flexible plastic tubing (sigmoidoscope) is inserted into the rectum. This gives the doctor a view of the rectum and lower colon. Tissue or polyps can be biopsied (removed) and looked at under a microscope.
  • Colonoscopy: A longer version of a sigmoidoscope, a colonscope can look at the entire colon.
  • Endoscopic ultrasound (EUS): An endoscope is inserted into the rectum. A probe at the end bounces high-energy sound waves (ultrasound) off internal organs to make a picture (sonogram). Also called endosonography.

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scan
  • MRI (magnetic resonance imaging) scan
  • PET/CT (positron emission tomography) scan
  • Virtual colonoscopy or CT (computed tomography) colonoscopy
  • Double contrast barium enema (DCBE): Barium is a chemical that allows the bowel lining to show up on an X-ray. A barium solution is given by enema, and then a series of X-rays are taken.

Blood test for carcinoembryonic antigen (CEA): CEA is a protein, or tumor marker, made by some cancerous tumors. This test also can be used to find out if the tumor is growing or has come back after treatment.

Colon Cancer Facts

Colon cancer and rectal cancer sometimes are grouped together and called colorectal cancer. Not counting skin cancers, colorectal cancers are the fifth most common type of cancer in India. When colon cancer is diagnosed early, it has nearly a 90% chance for cure.

Survival rate is on the rise

The colon is part of the digestive system, also called the gastrointestinal (GI) tract.

• The colon is the first six feet of the large intestine, also called the large bowel

• The rectum is the last six inches of the large intestine, which ends in the anus

Colorectal cancers grow slowly. They usually start as polyps, which are overgrowths of tissue in the lining of the colon. Colon cancer may start within a polyp, but not all polyps contain cancer.

The survival rate for colon cancers has been increasing for the past 15 years. Because of screening, polyps often are found and removed before they become cancer. Also, treatments have become more advanced and less invasive.

Colon Cancer Types

More than 95% of colorectal cancers are adenocarcinomas. Approximately 90% of colorectal adenocarcinomas began as adenomas, which are a type of polyp that may become cancer.

About 20% of colon cancers are inherited or are associated with a strong history of colon cancer in the family. The main types of colon cancer that are inherited include :

  • Hereditary nonpolyposis colorectal cancer syndrome or HNPCC (also called Lynch syndrome), accounts for 5% to 7% of colon cancers
  • Familial adenomatous polyposis (FAP) causes hundreds to thousands of polyps in the GI tract. FAP may begin during childhood.

Our Approach

Here, your treatment for colon cancer is personalized to provide the best outcomes, while focusing on your quality of life. An entire team of some of the nation’s leading physicians, supported by specially trained professionals, focuses it attention on giving you the most advanced care with the least impact on your body.

Our highly specialized surgeons focus only on the treatment of colorectal cancer, which translates into a remarkable depth of experience and skill. Minimally invasive laparoscopic and robotic surgeries often can be used, decreasing pain, helping you recover faster and shortening your hospital stay.

Because of this expertise, colostomies rarely are needed for colon cancer. However, if a colostomy is necessary, our team of specially trained nurses helps you make that transition. Nutritionists with expertise in colon cancer care work with you every step of the way.

Specialized Treatments

If chemotherapy is needed to treat colon cancer, we offer the newest options. Our internationally renowned team of physicians directs your therapy for the most benefit, while minimizing the impact on your body.

Sometimes radiation therapy is recommended as a part of treatment for colon cancer. Our colorectal radiation oncologists specialize in treating patients with colon cancer. They use the most advanced equipment and techniques including IMRT, to achieve maximum treatment benefit with the fewest side effects.

We have expertise in advanced colon cancer that has metastasized (spread) to other parts of the body. We offer novel chemotherapy and targeted therapy options, as well as a dedicated surgery program.

Leading-Edge Advancements

Our advanced knowledge in cancer genetics can help diagnose and treat inherited family syndromes that may increase risk of colon cancer. This expertise also helps us work with you to plan the most effective treatment for your specific condition.

Robotic colorectal surgery

Colon Cancer Screening

Cancer screening exams are medical tests done when you’re healthy with no signs of illness. They help find cancer at its earliest stage, when the chances for curing the disease are best. When it is found early, colon cancer has a good chance for successful treatment. That’s why it is important to get regular tests.

We recommends the following screening guidelines for people at average risk with no colorectal cancer symptoms. Beginning at age 50, men and women should follow ONE of these screening schedules :

  • Colonoscopy every 10 years (polyps can be removed during the test)
  • Virtual colonoscopy (also known as CT colonography) every five years. A colonoscopy will be performed if polyps are found. If you choose a virtual colonoscopy, check with your insurance provider before scheduling an exam. Not all insurance providers cover the cost of this exam.
  • Fecal occult blood test (FOBT) every year. This take-home test finds hidden blood in the stool, which may be a sign of cancer. A colonoscopy will be performed if blood is found.

Colon Cancer Risk Factors

Anything that increases your chance of getting colon cancer is a risk factor. Colon cancer risk factors include :

  • Age: Rectal cancer is much more common in people over 50 years old
  • Family history of colorectal cancer or polyps
  • Inherited disorders such as hereditary nonpolyposis colorectal cancer (HNPCC or Lynch) syndrome or familial adenomatous polyposis (FAP)
  • Inflammatory bowel disease (Crohn’s disease or chronic ulcerative colitis)
  • Colorectal cancer or polyps
  • Obesity
  • Lack of exercise
  • Diet: If you eat a lot of red meat, processed meats or meats cooked at very high heat, you may be at higher risk for colon cancer.
  • Diabetes Type 2
  • Cigarette smoking
  • Drinking too much alcohol

For patients who are concerned about inherited family syndromes that cause colon cancer, we offer advanced genetic testing to let you know your risk.

Colon Cancer Prevention

Certain lifestyle choices may decrease your chances of getting colon cancer. Try to :

  • Have regular screening tests
  • Stay at a healthy weight
  • Exercise regularly
  • Eat a healthy diet with lots of fruits and vegetables
  • Avoid cigarettes
  • Drink alcohol only in moderation

Colon Cancer Staging

If you are diagnosed with colon cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Colon Cancer Stages

  • Stage 0: Abnormal cells are found in the inner lining of the colon. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 also is called carcinoma in situ.
  • Stage I: Cancer has formed and spread into the first (submucosa) or second (muscle) layers of the rectal wall. It has not spread outside of the rectum.
  • Stage II: Cancer has spread outside of the rectal walls into the surrounding fat or nearby tissue. It has not gone into the lymph nodes (link to definition). It is divided into stages IIA, IIB or IIC depending on the extent of local tumor involvement.
  • Stage III: Cancer has spread to nearby lymph nodes. It has not spread to other parts of the body. It is divided into stages IIIA, IIIB or IIIC depending on the extent of local tumor involvement and the number of lymph nodes that contain cancer.
  • Stage IV: Cancer has spread to other parts of the body, such as the liver, lungs or ovaries. It is divided into stages IVA and IVB depending on the number of different other parts of the body to which the cancer has spread.
  • Stage IV: Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or lungs.

Colon cancer often does not have symptoms in the early stages. Most colon cancers begin as polyps, small non-cancerous growths on the colon wall that can grow larger and become cancerous. As polyps or cancers grow, they can bleed or block the intestines.

Symptoms of colon cancer may include :

  • Rectal bleeding
  • Blood in the stool or toilet after a bowel movement
  • Diarrhea or constipation that does not go away
  • A change in size or shape of stool
  • Discomfort or urge to have a bowel movement when there is no need
  • Abdominal pain or a cramping pain in your lower stomach
  • Bloating or full feeling
  • Change in appetite
  • Weight loss without dieting
  • Fatigue

These symptoms usually do not mean you have colon cancer. But if you notice one or more of them for more than two weeks, see your doctor.

Our Treatment Approach

A team of experts focuses incredible expertise and experience on each patient with colon cancer. Your comprehensive care is customized to provide the most-effective, least-invasive treatment, while helping you keep the best possible quality of life.

Your colon cancer treatment team may include :

  • Oncosurgeons
  • Oncologists
  • Radiation oncologists
  • Gastroenterologists
  • Genetics specialists
  • Diagnostic and interventional radiologists
  • Gynecologists

In addition, a specialized surgical team works with patients whose colon cancer has spread. Specially trained nurses, ostomy nurses, nutritionists and social workers support your treating physicians.

Advanced treatment options, including minimally invasive surgical techniques, targeted therapies and proton therapy are available to help many patients with colon cancer. A specialized surgical team treats patients with colon cancer that has spread.

Advanced genetic testing allows us to customize your treatment for the best possible results. Testing also helps find out if you or your family members may be at risk for other cancers.

Our experts have special expertise in treating rare hereditary types of colorectal cancer, as well as colon cancer that has metastasized (spread) to other parts of the body or has returned after treatment.

Kidney Cancer

If you have been diagnosed with a kidney tumor or kidney cancer, it’s important to be treated as early as possible. This helps improve your chances for successful treatment. Most tumors of the kidney are malignant (cancer), but some are benign (not cancer). There is no imaging test that can tell if a kidney tumor is benign or cancerous.

Kidney Cancer Diagnosis

If you have symptoms that may signal kidney cancer, your doctor will ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have kidney cancer and if it has spread. These tests also may be used to find out if treatment is working.

Blood and urine tests

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scans
  • PET scan
  • MRI (magnetic resonance imaging) scans
  • Ultrasound
  • Chest X-Ray
  • Bone Scan

Our Approach

Our method of delivering personalized care for kidney cancer can make a crucial difference in your outcome and recovery. In the Genitourinary Cancer Center, you are the focus of a team of experts who specialize in kidney cancer and strive to provide the most-advanced treatment with the least impact on your body.

Working together, this team of surgical and medical oncologists, as well as a specially trained support staff, utilizes the latest leading-edge technology and techniques from diagnosis through treatment. Your kidney cancer treatment options may include :

  • Kidney-sparing surgery
  • Laparoscopic nephrectomy
  • Targeted therapies including Sutent® (sunitinib) Nexavar® (sorafenib) Torisel® (temsirolimus) and Avastin® (bevacizumab)
  • Immunotherapy, including interferon and interleukin-2
  • Cryoablation, radiofrequency ablation and active surveillance

Kidney Cancer Facts

You have two kidneys, one on each side of the back above the waist. Kidneys filter blood, and the waste is carried in the urine, which is produced by microscopic tubules. Urine flows into the ureter tubes and down into the bladder. Cancer arises from the microscopic tubules inside the kidney. Although kidney cancer usually grows as a single mass within the kidney, a kidney may contain more than one tumor, or tumors may be found in both kidneys.

Surgery offers the highest chance for successful treatment when kidney cancer has not spread. Once the cancer has spread beyond the kidney, the chance for successful treatment becomes much lower. Since 2006, new-generation drugs called targeted therapies have become available to control the cancer more successfully than prior medications.

Kidney Cancer Types

  • Renal cell carcinoma (cancer) (RCC) is the most prevalent form of kidney cancer. Types of RCC include clear cell, papillary, chromophobe and collecting duct carcinomas. Clear cell carcinoma accounts for 80% of all RCC cases, and most treatments are focused on this type.
  • Wilms’ tumor is a childhood cancer, responsible for 95% of pediatric kidney cancer cases. Learn more about Wilms' tumor.
  • Urothelial cancer of the kidney pelvis and ureter: Cancer of the urinary tract that occurs in the kidney or ureter is called urothelial carcinoma. It is not considered kidney cancer, although it is frequently called that in error.

Kidney Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best.

Unfortunately, no standardized screening tests have been shown to improve kidney cancer outcomes.

Kidney Cancer Risk Factors

Anything that increases your chance of getting kidney cancer is called a risk factor. The biggest risk for kidney cancer is smoking.

Other kidney cancer risk factors include :

  • Age: Most cases occur after age 50
  • Gender: Men are more than twice as likely to get kidney cancer as women
  • Obesity
  • High blood pressure
  • Exposure to asbestos, cadmium, and coke (used in making steel), benzene, herbicides and organic solvents
  • Advanced kidney disease and long-term kidney dialysis
  • Race: African-Americans have a slightly higher rate of kidney cancer
  • Rare inherited conditions including von Hippel-Lindau disease or hereditary papillary renal cell carcinoma
  • Family history of kidney disease

Not everyone with risk factors gets kidney cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Kidney Cancer Staging

If you are diagnosed with kidney cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.

After surgery for removal of the tumor, a grade or nuclear grade is assigned to kidney cancer. The cancer grade is a measure of how likely the cancer is to spread. The pathologist assigns the grade after looking at the tumor cells under the microscope.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Stages of Kidney Cancer

Stage I: The tumor is 7 centimeters or smaller and is only in the kidney

Stage II: The tumor is larger than 7 centimeters and is only in the kidney

Stage III: Cancer is found in one of the following :

  • The kidney and one nearby lymph node
  • An adrenal gland or the layer of fatty tissue around the kidney, also may be in one nearby lymph node
  • The main blood vessels of the kidney, also may be in one nearby lymph node

Stage IV: Cancer has spread to one of the following :

  • Beyond the layer of fatty tissue around the kidney and possibly to one nearby lymph node
  • To two or more nearby lymph nodes
  • To other organs, such as the bowel, pancreas or lungs and possibly to nearby lymph nodes.

Due to the location of the kidneys, many people with kidney cancer don't have symptoms until the tumor has grown quite large. If there are symptoms, they vary from person to person.

The most common kidney cancer symptom is blood in the urine (hematuria), but hematuria can be caused by a variety of conditions so it doesn't necessarily mean you have cancer.

Other kidney cancer symptoms may include :

  • A lump or mass on the side or lower back
  • Unexplained fever for a few weeks
  • Rapid weight loss
  • Lingering dull ache or pain in the side, abdomen or lower back
  • Feeling fatigued or in poor health
  • Swelling of ankles and legs

These symptoms do not always mean you have kidney cancer and may be caused by other conditions. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

Our Treatment Approach

Here, your kidney cancer treatment is personalized to include the most-advanced therapies with the fewest possible side effects. Our experts work together – and with you – to give you the highest chance for successful treatment and recovery.

Experience is Vital

This level of knowledge is especially important in kidney cancer surgery. Because it is important to save as much of the kidney as possible, the specialized skill of the surgeon can make a crucial difference. Our surgeons are among the most experienced in the country at kidney cancer surgical procedures.

We offer some of the most advanced therapies for kidney cancer, many of which are available at only a few centers in the country. These include minimally invasive surgeries that can mean less pain and quicker recovery.

Kidney Cancer Treatments

If you are diagnosed with kidney cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the stage of the cancer and your general health. Your treatment for kidney cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Tumors that are confined to the kidney or to the area around the kidney usually are surgically removed. It’s important for the surgeon to leave as much of the kidney as possible. When your surgeon has a high level of experience in this type of surgery, your outcomes are likely to be better.

These surgeries sometimes can be minimally invasive (done with a laparoscope).

You can usually live with one kidney, but if both kidneys are removed or not working you will need kidney dialysis (a way to clean the blood with a machine). A kidney transplant may be an option for some patients.

The main types of surgery for kidney cancer include :

Radical nephrectomy is removal of the entire kidney along with the surrounding fatty tissue. Sometimes the adrenal gland and nearby lymph nodes are removed too. One of the following methods will be used, depending on the size of the tumor and other factors that your surgeon will consider.

  • Standard or "open" surgery : A four- to eight-inch incision (cut) is made in the front of the abdomen. The surgeon removes the entire kidney through the incision.
  • Laparoscopic radical nephrectomy (LRN) : A small incision is made to insert a laparoscope. Other tiny incisions are made for miniature surgical instruments to remove the kidney. Benefits of this procedure include a shorter hospital stay (one to two days vs. five to seven days), shorter recovery time and less blood loss than with open surgery. Surgeon experience is important for this procedure.
  • Partial nephrectomy (or kidney-sparing surgery) : Only the cancerous portion of the kidney is removed, along with a margin of healthy tissue around it. High quality pre-treatment imaging is used to determine what will be removed, and ultrasound can be used to look for additional tumors during surgery.

Candidates for partial nephrectomy are chosen based on favorable tumor location, co-existing health problems that may affect the treatment outcome, the condition of the kidneys and the patient's desire to save the kidney. Partial nephrectomy is best for kidney cancer tumors that are 4 centimeters or less in size. They can be done for larger tumors when necessary. Recurrence rates for stage 1 cancers removed by either radical or partial nephrectomy are about 5%.

Partial nephrectomy can be done by traditional or laparoscopic robotic methods.

Energy Ablative Techniques

Other minimally invasive surgery techniques use either heat or cold to treat tumors in place, without having to remove the kidney. RFA and cryoablation are ideal for smaller kidney tumors in patients considered at high risk for surgery.

  • Cryoablation freezes the tumor to -140 degrees Centigrade with a long, thin probe inserted into the tumor. Intensive follow-up with X-rays or other imaging procedures is required to ensure that the tumor has been destroyed.
  • Radiofrequency ablation (RFA) is similar to cryoablation, but heat is used to destroy the tumor instead of cold.

Radiation Therapy

Radiation has a limited role in the treatment of kidney cancer. Kidney tumors are not very sensitive to radiation, but healthy kidneys are, so radiation as a frontline treatment is not advisable. In some cases, radiation may be used to help relieve pain and other symptoms when kidney cancer has spread to the bone, brain, or other parts of the body.

Targeted Therapies

Kidney tumors are very vascular, meaning they have a large number of blood vessels. The tumors use a process called angiogenesis to create their own network of blood vessels, enabling the cancer to thrive and grow.

These blood vessels are vulnerable to anti-angiogenic drugs, which are developed to take advantage of this process. This new generation of drugs targets the blood vessels leading to the tumor without harming normal blood vessels.

A number of agents have been developed, including Sutent® (sunitinib), Nexavar® (sorafenib), Votrient® (pazopanib) and Avastin® (bevacizumab). Another drug Torisel® (temsirolimus) has shown promise in patients with more aggressive kidney disease.

Immunotherapy

Renal cell carcinoma is occasionally responsive to immunotherapy, and is one option for kidney cancer that has metastasized (spread). These therapies have only a general, non-targeted effect on the immune system, and their side effects are not well tolerated by many patients.

Two types of immunotherapy are used to treat renal cell cancer :

  • Interferon-alpha (IFN) is a protein produced by white blood cells in response to a viral infection. It increases antigens on the surface of cancer cells, making them more susceptible to attack by the immune system. IFN is rarely used today.
  • Interleukin-2 (IL-2) is a protein that stimulates the growth of immune cells and activates them to destroy tumor cells. High-dose IL-2 therapy is given by IV, and treatment requires a five-day hospital stay. Side effects include hypotension (low blood pressure), flu-like symptoms (fever, muscle aches, headache and nasal congestion), decreased urine production, nausea and diarrhea. IL-2 can cause a complete shrinkage of disease in 5% to 10% of patients with clear cell tumors. For that reason, it is still offered as an option to patients with appropriate tumor characteristics who are in excellent overall physical condition.

Chemotherapy

Most traditional chemotherapy is generally ineffective against kidney tumors, with a few exceptions. A combination of gemcitabine and capecitabine is sometimes used to treat metastatic renal cell cancer.

Leukemia

Accurate and precise diagnosis of leukemia is essential to effective treatment. As many as 5% to 15% of leukemia patients have been misdiagnosed before they come to us.

We have the expertise and experience gained from being one of the most active programs in the world. Our hematopathologists (doctors who specialize in leukemia) are among the world’s most experienced and skilled experts.

Diagnosis of leukemia is based on the results of blood and bone marrow tests, including bone marrow aspiration and bone marrow biopsy.

Leukemia Facts

  • 15,000 cases of chronic lymphocytic leukemia (CLL), most in older adults
  • 13,500 cases of acute myeloid leukemia (AML), most in adults
  • 6,000 cases of acute lymphocytic leukemia (ALL), about one in three in adults
  • 5,000 cases of chronic myeloid leukemia (CML), most in older adults

Leukemia is cancer of blood-forming tissue such as the bone marrow, the sponge-like material inside some bones. In healthy bone marrow, blood cells form and mature, then move into the bloodstream. To understand what happens to your blood when you have leukemia, it helps to know what makes up normal blood and bone marrow.

Red Blood Cells (RBCs), the major part of your blood, carry oxygen and carbon dioxide throughout your body. The percentage of RBCs in the blood is called hematocrit. The part of the RBC that carries oxygen is a protein called hemoglobin. All body tissues need oxygen to work properly. When the bone marrow is working normally, the RBC count remains stable. Anemia occurs when there are too few RBCs in the body. Leukemia, or the chemotherapy used to treat it, can cause anemia. Symptoms of anemia include shortness of breath, headache, weakness and fatigue.

White Blood Cells (WBCs) include several different types. Each has its own role in protecting the body from germs. The three major types are neutrophils, monocytes and lymphocytes :

  • Neutrophils (also known as granulocytes or polys) destroy most bacteria
  • Monocytes destroy germs such as tuberculosis
  • Lymphocytes are responsible for destroying viruses and for overall management of the immune system. When lymphocytes see foreign material, they increase the body’s resistance to infection

WBCs play a major role in fighting infection. Infections are more likely to occur when there are too few normal WBCs in the body.

Absolute Neutrophil Count (ANC) is a measure of the number of WBCs you have to fight infections. You can figure out your ANC by multiplying the total number of WBCs by the percentage of neutrophils (“neuts”). The K in the report means thousands.

For example :

  • WBC = 1000 = 1.0K
  • Neuts = 50% (0.5)
  • 1000 X 0.5 = 500 neutrophils

While anyone can catch a cold or other infections, this is more likely to occur if your ANC falls below 500. Your WBC count generally will fall within the first week you start chemotherapy, but it should be back to normal between 21 to 28 days after starting chemotherapy.

Platelets are the cells that help control bleeding. When you cut yourself, the platelets collect at the site of the injury and form a plug to stop the bleeding.

Bone marrow is the soft tissue within the bones where blood cells are made. All blood cells begin in the bone marrow as stem cells.

The bone marrow is made up of blood cells at different stages of maturity. As each cell fully matures, it is released from the bone marrow to circulate in the bloodstream. The blood circulating outside of the bone marrow in the heart, veins and arteries is called peripheral blood.

Stem cells are very immature cells. When there is a need, the stem cells are signaled to develop into mature RBCs, WBCs or platelets. This signaling is done with “growth factors.”

In leukemia, the normal production of blood cells changes. The bone marrow starts making too many abnormal, immature cells, called blasts or lymphoblasts, which crowd out other blood cells in the blood marrow, blood stream and lymph system. They can travel to other places in the body, including lymph glands and the spleen.

Leukemia Types

Types of leukemia are grouped by the type of cell affected and by the rate of cell growth. Leukemia can be either acute or chronic.

Acute leukemia involves an overgrowth of very immature blood cells. This condition is life threatening because there are not enough mature blood cells to prevent anemia, infection and bleeding. A diagnosis of acute leukemia is made when there are 20% or more blasts or immature cells in the bone marrow.

There are two main types of acute leukemia :

  • Acute lymphocyte leukemia (ALL) is most prevalent during childhood and early adulthood, but it also is found in adults
  • Acute myeloid (or myelogenous) leukemia (AML) occurs more often in adults
  • Myelodysplastic Syndrome (MDS) is a condition in which the bone marrow does not produce enough normal blood cells. Some cases of MDS may, over time, progress to acute leukemia.
  • Myeloproliferative Disease (MPD), also known as myeloproliferative neoplasia (MPN), is a condition in which the bone marrow makes too many blood cells. Sometimes the disease progresses slowly and requires little treatment; other times it develops into acute myeloid leukemia (AML).

Chronic leukemia involves an overgrowth of mature blood cells. Usually, people with chronic leukemia have enough mature blood cells to prevent serious bleeding and infection. Chronic leukemia is found more often in people between ages 40 and 70.

The main types of chronic leukemia are :

  • Chronic lymphoblastic leukemia (CLL)
  • Chronic myeloid (or myelogenous) leukemia (CML)

To look for specific types of leukemia, your doctor will examine features on the bone marrow cell surface and the appearance of the bone marrow cells under a microscope, as well as analyze chromosome number and appearance.

Leukemia Screening

Cancer screening exams are important medical tests done when you're healthy and don't have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Unfortunately, no standardized screening tests have been shown to improve leukemia outcomes. However, here we're working to develop screening tests for those at risk. If you have risk factors, especially one of the inherited disorders listed below, talk to your doctor about the need for testing.

Leukemia Risk Factors

Anything that increases your chance of getting leukemia is a risk factor. Although the specific cause of leukemia is not known, scientists suspect that viral, genetic, environmental or immunologic factors may be involved. These include :

  • Viruses: Some viruses cause leukemia in animals, but in humans viruses cause only one rare type of leukemia. Even if a virus is involved, leukemia is not contagious. It cannot spread from one person to another. There is no increased occurrence of leukemia among people such as friends, family and caregivers who have close contact with leukemia patients.
  • Inherited disorders: Rarely, genetic changes that may increase chances of developing leukemia run in families.
  • Environmental factors: High-dose radiation and exposure to certain toxic chemicals have been directly related to leukemia. But this has been true only in extreme cases, such as atomic bomb survivors in Nagasaki and Hiroshima or industrial workers exposed to benzene. Exposure to ordinary X-rays, like chest X-rays, is not believed to be cause leukemia.
  • Immune-system deficiencies: These appear to put people at greater risk for cancer because of the body's decreased ability to resist foreign cells. There is evidence that patients treated for other types of cancer with some types of chemotherapy and/or high-dose radiation therapy may later develop leukemia.
  • Smoking tobacco may be a risk factor for acute myeloid leukemia (AML).

These factors may play a part in a small percentage of leukemia cases. But for most patients, the cause of leukemia is not known.

Not everyone with risk factors gets leukemia. However, if you have risk factors, it's a good idea to discuss them with your doctor.

Many times, leukemia does not have symptoms in the early stages. When it does have signs, they vary from person to person and according to the type of leukemia. If you do have symptoms, they may include :

  • Unexplained fever
  • Persistent fatigue or feeling of weakness
  • Unintentional weight loss, loss of appetite
  • Easy bruising or bleeding, unexplained nose bleeds
  • Shortness of breath
  • Petechiae (tiny red spots under the skin caused by bleeding)
  • Swollen lymph glands
  • Anemia (low red blood cell counts)
  • Night sweats
  • Bone or joint pain
  • Recurring infections

Symptoms of acute lymphoblastic leukemia may also include painless lumps under the skin in the groin, underarm or neck, and/or pain under the ribs.

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

Our Leukemia Treatments

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

Chemotherapy

Your treatment may consist of more than one chemotherapy drug or biological therapy. The short-term goal is a complete remission, which means the bone marrow has less than 5% blasts, the absolute neutrophil count is more than 1,000 and the platelet count is more than 100,000. The long-term goal is for an extended disease-free state and cure.

A course or cycle is the period of time from the start of chemotherapy until the blood and bone marrow cell counts are back to normal or you are able to receive further treatment. In some cases, leukemia cells are destroyed only in the blood and not in the bone marrow during the first course of chemotherapy. In these cases, a second course may be needed. If the leukemia does not respond to one or two courses of treatment, or if a relapse occurs, a different drug program may be used to attempt to bring about a remission.

A specific treatment plan is called a protocol. Each protocol is usually named by letters with each letter standing for a particular drug. A protocol may be considered standard or experimental therapy. Your doctor will discuss with you the advantages and disadvantages of a particular type of therapy.

Radiation Therapy

Radiation therapy is used with chemotherapy for some kinds of leukemia. Radiation therapy for leukemia patients may be directed to :

  • A specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles
  • The entire body. This is called total-body irradiation and usually is given before a stem cell transplant

Biological Therapy

Biological therapies help the immune system fight cancer, infections and other diseases. They include growth factors, interleukins and monoclonal antibodies. Biological therapies may be given alone or with chemotherapy.

Targeted Therapies

These agents are specially designed to treat each cancer's specific genetic/molecular profile to help your body fight the disease.

Surgery

Sometimes a splenectomy, or surgical removal of the spleen, is needed. The spleen is located on the left side of in the abdomen and acts as a filtration system for blood cells. In chronic leukemia, the spleen tends to collect leukemia cells, transfused platelets and red blood cells. Frequently, the spleen enlarges from storing these cells, making it difficult for chemotherapy to reduce diseased cells. If the spleen is not removed, it sometimes grows so large that it causes breathing difficulty and compresses other organs.

Stem Cell Transplantation

Stem cell transplantation (SCT), which used to be called bone marrow transplant, destroys leukemic bone marrow cells using high doses of chemotherapy and in some cases, radiation therapy. Because high-dose chemotherapy severely damages the bone marrow's ability to produce cells, healthy stem cells then are given intravenously to stimulate new bone marrow growth.

Like other leukemia treatments, SCT is highly individualized. Your care will be planned specifically for you, considering such factors as type of leukemia, past response to chemotherapy, availability of stem cells for replacement, your age and the status of the leukemia.

Liver cancer

Liver Cancer Diagnostic Tests

If you have symptoms of liver cancer, the first step is a physical exam. The doctor will :

  • Feel your abdomen to examine the liver, spleen and nearby organs
  • Check your abdomen for ascites, an abnormal accumulation of fluid
  • Examine your skin and eyes for signs of jaundice

If the doctor suspects liver cancer, you may have one or more of the following tests to diagnose it and find out if it has spread.

Blood tests: One common blood test detects alpha-fetoprotein (AFP), which can be a sign of liver cancer. Other blood tests may measure how well the liver is working.

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scans: This is usually the most reliable test for evaluating the extent of liver cancer. Our technology includes the precise triple-phase CT scan.
  • Ultrasound
  • Angiogram: The doctor injects dye into an artery. This allows the blood vessels in the liver to be seen on an X-ray.

Biopsy: A sample of tissue from the tumor or the healthy part of the liver is removed and looked at under a microscope. Healthy tissue may be tested to see how well the liver is working. A biopsy may be obtained by :

  • Fine needle aspiration (FNA): A thin needle is inserted into the liver to remove a small amount of tissue
  • Core biopsy: Similar to FNA, but a thicker needle is used to remove small cylinder-shaped samples (cores)
  • Laparoscopy: A small incision (cut) is made in the abdomen, and a thin, lighted tube (laparoscope) is inserted to view the tumor

Liver Cancer Facts

It is more prevalent in developing countries in sub-Saharan Africa and Southeast Asia than in the U.S.

Liver is Essential

The largest organ in the body, the liver is pyramid-shaped and located under your right ribs. It has two sections called lobes. It is different from most organs because it has two blood sources :

  • The hepatic artery brings in oxygen-rich blood
  • The portal vein supplies nutrient-rich blood from the intestines

The liver is vital; you can't live without it. Some of its important functions are to :

  • Break down and store nutrients from the intestine
  • Manufacture some of the clotting factors your body needs to stop bleeding
  • Make bile that helps the intestine absorb nutrients
  • Help get rid of waste

Liver Cancer Types

Liver cancer can begin in the liver or other parts of the body. Primary liver cancer begins in the liver. Metastatic liver cancer starts somewhere else in the body and metastasizes (spreads) to the liver.

The liver is a common place where cancer spreads. Its large size and high blood flow make it a prime target for tumor cells moving through the bloodstream. Colorectal, breast and lung cancers are the most common sources of metastatic liver cancer.

The information in this section is about primary liver cancer. For information about cancer that has spread to the liver, see the section on the primary cancer.

Some tumors in the liver are benign (non-cancerous) but grow large and cause problems. Usually these can be removed by surgery.

The main types of primary liver cancer are :

  • Hepatocellular carcinoma (HCC): Most primary liver cancers are HCC. They begin in hepatocyte cells. Sometimes they begin as a single tumor; other times they start in multiple spots in the liver. The latter is more common in people with liver damage, such as cirrhosis, and is more prevalent in this country.
  • Fibrolamellar HCC is a rare subtype that often has a higher chance for successful treatment than other types of liver cancer.
  • Bile duct cancers (cholangiocarcinomas): One or two of every 10 cases of liver cancer start in the bile ducts, which are small tubes that carry bile to the gallbladder. They are treated in the same way as HCC.
  • Angiosarcomas and hemangiosarcomas begin in blood vessels in the liver. These fast-growing liver cancers usually are not diagnosed until they are in advanced stages.
  • Hepatoblastoma: A very rare type of liver cancer, this most often is found in children. The survival rate is more than 90% if the cancer is caught early.

Liver Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best.

Unfortunately, screening tests have not been shown to improve liver cancer outcomes. In addition, tumors often are difficult to find during physical exams and may not produce symptoms until they are advanced. This means liver cancer often is diagnosed when it advanced.

We advise a proactive approach for people at high risk of liver cancer. We suggest screening every six months with an alpha-fetoprotein (AFP) blood test and ultrasound of the liver. If abnormalities are found, we follow up with a CT or CAT (computed axial tomography) scan.

Liver Cancer Risk Factors

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

  • History of hepatitis B or C virus
  • Cirrhosis, which develops when liver cells are damaged and replaced with scar tissue. Cirrhosis may be caused by :
    • Alcohol abuse
    • Certain drugs, chemicals or viruses
    • Non-alcoholic fatty liver, which causes too much iron in the liver
    • Hemachromatosis, which results in too much iron in the liver
    • Other rare conditions
  • Aflatoxins: Substances produced by fungus that contaminates peanuts, wheat, soybeans, corn and rice
  • Age: Liver cancer is found most often in people over 60 years old
  • Race/ethnicity: In the United States, Asian Americans and Pacific Islanders have the highest rates of liver cancer, followed by American Indians/Alaska Natives and Hispanics/Latinos, African Americans and whites. This is related to the incidence of hepatitis in each group.
  • Exposure to vinyl chloride and thorium dioxide
  • Anabolic steroids
  • Arsenic in drinking water from wells

Not everyone with risk factors gets liver cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Liver Cancer Staging

If you are diagnosed with liver cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Liver Cancer Stages

Stage I: There is one tumor, and it has not spread to nearby blood vessels.

Stage II: One of the following is found :

  • One tumor that has spread to nearby blood vessels
  • More than one tumor, none of which is larger than 5 centimeters

Stage IIIA: One of the following is found :

  • More than one tumor larger than 5 centimeters
  • One tumor that has spread to a major branch of blood vessels near the liver

Stage IIIB: There are one or more tumors of any size that have either :

  • Spread to nearby organs other than the gallbladder
  • Broken through the lining of the peritoneal cavity

Stage IIIC: The cancer has spread to nearby lymph nodes.

Stage IV: The liver cancer has spread beyond the liver to other places in the body, such as the bones or lungs. Tumors may be any size and also may have spread to nearby blood vessels and/or lymph nodes.

For adult primary liver cancer, stages also are grouped by how the cancer may be treated :

  • Localized resectable: The cancer is found in the liver only, has not spread and can be removed completely by surgery.
  • Localized and locally advanced unresectable: The cancer is found in the liver only and has not spread, but it cannot be removed completely by surgery.
  • Advanced: Cancer has spread throughout the liver or has spread to other parts of the body, such as the lungs and bone.

Liver cancer usually does not cause symptoms in the early stages. When it does have symptoms, they vary from person to person.

As the tumor grows, it may cause :

  • Weight loss
  • Pain in the right side of the upper abdomen or around the right shoulder blade
  • Loss of appetite
  • Swelling or bloating in the abdomen
  • Hard lump below the ribs on the right side
  • Tiredness or weakness
  • Nausea or vomiting
  • Fever
  • Jaundice, which causes yellow skin and eyes, and dark urine
  • Feeling of fullness after a small meal
  • Itching
  • Swollen veins on the abdomen
  • Becoming sicker if you have hepatitis or cirrhosis

Certain types of liver cancer produce hormones that may cause :

  • High blood-calcium levels that may cause constipation, nausea or confusion
  • Low blood-sugar levels that may cause tiredness or faint feeling
  • Enlarged breasts or shrinking of testicles in men
  • High red-blood cell count that may cause redness in the face

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

Our Treatment Approach

Here your care is personalized to deliver the most advanced therapies with the least impact on your body.

Surgery is the main treatment for liver cancer. The surgeon must have a high level of skill for it to be successful. Because many people with liver cancer have underlying liver damage, this delicate surgery must remove enough of the tumor to treat the cancer while leaving enough of the liver to function.

Liver cancer surgery has the best outcomes when it is done by a surgeon who performs a large number of these procedures.

Leading-edge Therapies

Our therapies include :

New forms of chemotherapy, including sorafenib, that target the blood vessels that keep tumors alive

  • Chemoembolization
  • Hepatic artery infusion to deliver chemotherapy directly to the liver
  • Targeted therapies to help your body fight the cancer

Our Liver Cancer Treatments

For the most part, liver cancer can be treated successfully only when it is found in an early stage, before it has spread. Your treatment will depend on :

  • The size of the tumor
  • Whether you have cirrhosis of the liver
  • Your general health

Here , your treatment for liver cancer is customized to your needs. One or more of the following therapies may be suggested to treat the cancer or help relieve symptoms.

Surgery

The best chance for successful treatment of liver cancer is with surgery. If all of the cancer can be removed, the possibility of successful treatment is higher. However, complete removal of liver cancer often is not possible because the cancer is large or has spread to other parts of the liver or the body. Also, the liver may be damaged because of other conditions. Surgeons try to remove as much of the tumor as possible while keeping enough of the liver to function.

Since the liver plays a part in blood clotting, bleeding after surgery is a frequent side effect. And, since the remaining liver still is damaged, the cancer may reappear.

The main types of surgery for liver cancer are :

  • Liver transplant: The diseased liver is removed, and then it is replaced with a healthy liver from a donor. If you have cirrhosis or if the tumor is large, a liver transplant likely will be the main treatment option. Liver transplant has a risk of serious infection and other health issues.
  • Partial hepatectomy: The part of the liver where the tumor is located is removed surgically.
  • Tumor ablation: A local treatment in which heat (radiofrequency ablation) or extreme cold (cryosurgery or cryotherapy) is used to freeze or burn the liver cancer away. Ablation may be used when surgical removal of the tumor is not possible.
  • Embolization: Tiny pellets of plastic or another material are injected into the arteries that carry blood to the tumor. The pellets block blood flow, which makes it harder for liver cancer to grow.

Radiation Therapy

Because radiation may destroy normal liver tissue as well as cancer cells, it can be used only in low doses for liver cancer. Radiation therapy cannot cure liver cancer, but it may be used to shrink the tumor or relieve pain.

Chemotherapy

Chemotherapy usually is not used to treat liver cancer because of a low response rate. Our experts also are working on new ways to give chemotherapy drugs directly into the liver, delivering higher doses of drugs than usually possible with fewer side effects. These include :

  • Chemoembolization: A needle is inserted into an artery in the groin, and then a tiny tube is threaded into an artery leading to the liver. A high dose of medicine then is given. Afterward, the artery is blocked to prevent it from feeding blood to the liver.
  • Hepatic artery infusion: A catheter (tube) is placed in the liver. Drugs are infused into a special implanted pump that delivers them continuously.
  • Targeted therapies: These innovative new drugs stop the growth of cancer cells by interfering with proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

Lung Cancer

Lung Cancer Diagnosis

If you have symptoms that may signal lung cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking habits; and your family history.

One or more of the following tests may be used to find out if you have lung cancer and if it has spread. These tests also may be used to find out if treatment is working.

The two main tests to find out if you have lung cancer are :

  • Chest X-rays: Photographs of the lungs to look for abnormal areas.
  • Sputum cytology: A sample of mucus or phlegm brought up by coughing is looked at under a microscope.

If chest X-rays show an abnormal area, one or more of these tests may be used to find out if you have lung cancer :

  • Bronchoscopy: A thin flexible tube with a tiny camera is inserted through the nose or mouth and down into the lungs. A bronchoscope also can be used to take a small tissue sample for biopsy.
  • Fine needle aspiration (FNA): A very small needle is placed into the tumor. Suction is used to remove a small amount of tissue, which is then looked at under a microscope.
  • Thoracentesis: Fluid from around the lungs is drawn out with a needle and looked at under a microscope.
  • Endobronchial Ultrasound (EBUS): Guided biopsy to check for lung cancer and find out if cancer has spread to nearby lymph nodes.
  • Video-Assisted thoracoscopic surgery (VATS)
  • Imaging tests, which may include :
    • CT or CAT (computed axial tomography)
    • MRI (magnetic resonance imaging) scans
    • PET (positron emission tomography) scans

Lung Cancer Facts

Lung cancer is the most common type of cancer in both men and women in this country. Most cases are linked to tobacco smoking.

The lungs, which help you breathe, are two sponge-like, cone-shaped organs in the chest. When you breathe in, oxygen comes through your mouth and nose. It then travels through the windpipe (trachea), which divides into two tubes called bronchi. These take the oxygen to the left and right lungs. The inside of the lungs includes smaller branches called bronchioles and alveoli, which are tiny air sacs.

Each lung is divided into sections called lobes. The right lung has three lobes. The left lung, which has two lobes, is smaller than the right lung because the heart is also on the right side of the body.

The pleura is a thin membrane that covers the outside of each lung and lines the inside wall of the chest. It usually contains a small amount of fluid and forms a protective lining around the lungs that allows them to move smoothly during breathing.

Cancer Grows in Lungs, May Spread

Lung cancer forms in the tissues of the lungs, most often in the cells that line air passages. It occurs when cells in your lungs grow and multiply uncontrollably, damaging surrounding tissue and interfering with the lungs’ normal function.

Lung cancer may spread through your lymph system. Lymph is a clear fluid that contains tissue waste and cells that help fight infection. It travels through your body in vessels that are similar to veins. Lymph nodes are small, bean-shaped organs that link lymph vessels.

Cancer cells can spread, or metastasize, to other parts of your body through the bloodstream as well. When lung cancer spreads to other organs, it still is called lung cancer.

Lung Cancer Types

Lung cancer is classified by the type of cells within the tumor. Each type of lung cancer grows and is treated in a different way. Lung cancers are divided into two main groups.

Non-small cell lung cancer (NSCLC): This is the most common type of lung cancer. The categories of non-small cell lung cancer are named for the type of cells in the cancer :

  • Adenocarcinoma begins in cells that line the alveoli and make mucus. It is found more often in nonsmokers, women and younger people.
  • Squamous cell carcinoma (cancer) begins in thin, flat cells in the lungs, and tobacco smoking most often causes it. It also is called epidermoid carcinoma.
  • Large cell carcinoma (cancer) begins in certain types of large cells in the lungs.

Small cell lung cancer: Also known as oat-cell cancer, this type of lung cancer makes up less than 20% of lung cancers and almost always is caused by tobacco smoking. It often starts in the bronchi, then quickly grows and spreads to other parts of the body, including the lymph nodes.

Other types of lung cancer

Less common types of lung cancer include :

  • Carcinoid tumors
  • Salivary gland carcinoma
  • Some sarcomas
  • Cancer of unknown primary

Lung metastases

Cancer found in the lungs is sometimes another type of cancer that started somewhere else in the body and spread, or metastasized, to the lungs. These tumors are called lung metastases, and they are not the same as lung cancer. They usually are the primary, or original, type of cancer.

Lung Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best.

Unfortunately, no standardized screening tests have been shown to improve lung cancer outcomes. However, here are some screening tests for those at risk.

Lung Cancer Risk Factors

Anything that increases your chance of getting lung cancer is a risk factor. Smoking is the main risk factor for lung cancer.

  • Smoking tobacco in cigarettes, cigars or pipes is responsible for 87% of lung cancer cases in the United States
  • The more years you smoke and the greater amount you smoke, the higher your risk of lung cancer
  • If you stop smoking, your risk becomes lower as time goes by
  • If you smoke and have other risk factors, your chance of getting lung cancer is higher

Other risk factors for lung cancer include :

  • Family history of lung cancer
  • Previous lung cancer
  • Exposure to certain materials including radiation, arsenic, radon, chromium, nickel, soot, tar or asbestos
  • Radiation therapy to the breast or chest
  • Air pollution
  • Secondhand smoke
  • Lung diseases such as tuberculosis (TB)

Not everyone with risk factors develops lung cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Lung Cancer Staging

If you are diagnosed with lung cancer, your doctor will determine the stage (or extent) of the disease. This is a way to classify the cancer by how far and to which parts of the body it has spread. Staging helps the doctor plan the best treatment for you. Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Staging is often the most important part of your treatment. If the cancer is staged improperly, you may not receive the right treatment.

Lung Cancer Stages :

Small-cell lung cancer stages

  • Limited stage: Cancer is in one lung and possibly in lymph nodes on the same side of the chest.
  • Extensive stage: Cancer has spread to the other lung, to lymph nodes on the other side of the chest, to the fluid around the lung or to other parts of the body.

Non-small cell lung cancer stages

Stage 0 through stage IB tumors in which cancer has not spread to the lymph nodes are considered early stage lung cancer.

  • Occult stage: Lung cancer cells are found in spit or in a sample of mucus (phlegm) taken during bronchoscopy, but a tumor cannot be seen in the lung by imaging or bronchoscopy, or a tumor is present but is too small to be biopsied.
  • Stage IA:Stage IA: Abnormal cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.
  • Stage IA: The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than 3 centimeters across. It is surrounded by normal tissue and does not invade the bronchus. Lung cancer cells are not found in nearby lymph nodes.
  • Stage IB: The tumor is larger or has grown deeper, but lung cancer cells are not found in nearby lymph nodes. The lung tumor is one of the following :
    • More than 3 centimeters across
    • Grown into the main bronchus
    • Grown through the lung into the pleura
  • Stage IIA: The lung tumor is no more than 3 centimeters across. Lung cancer cells are found in nearby lymph nodes.
  • Stage IIB: The lung cancer is one of the following :
    • Not found in nearby lymph nodes but has invaded the chest wall, diaphragm, pleura, main bronchus or tissue that surrounds the heart
    • Cancer cells are found in nearby lymph nodes and the tumor in the lung is one of the following :
      • More than 3 centimeters across
      • Grown into the main bronchus
      • Grown through the lung into the pleura
  • Stage IIIA: The tumor may be any size. Lung cancer cells are found in the lymph nodes near the lungs and bronchi and in the lymph nodes between the lungs on the same side of the chest as the lung tumor.
  • Stage IIIB: The tumor may be any size. Lung cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumor may have invaded nearby organs, such as the heart, esophagus or trachea. More than one malignant growth may be found within the same lobe of the lung. Cancer cells may be found in the pleural fluid.
  • Stage IV: Tumors may be found in more than one lobe of the same lung or in the other lung. Lung cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver or bone.

Lung cancer symptoms vary from person to person, and sometimes people with lung cancer don’t have symptoms. If you have symptoms, they may include :

  • A cough that does not go away and gets worse over time
  • Constant chest pain, often made worse by deep breathing, coughing or laughing
  • Arm or shoulder pain
  • Coughing up blood or rust-colored spit
  • Shortness of breath, wheezing or hoarseness
  • Repeated episodes of pneumonia or bronchitis
  • Swelling of the neck and face
  • Loss of appetite and/or weight loss
  • Feeling weak or tired
  • Clubbing of fingers

If lung cancer spreads to other parts of the body, it may cause :

  • Bone pain
  • Arm or leg weakness or numbness
  • Headache, dizziness or seizure
  • Jaundice (yellow coloring) of skin and eyes
  • Swollen lymph nodes in the neck or shoulder

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

Our Treatment Approach

We customize your treatment to deliver the most advanced, least invasive treatments available for lung cancer. And because your peace of mind is important to us, we specialize in techniques and therapies than can help preserve lung function.

Your lung cancer therapy may include :

  • Open surgery
  • Minimally invasive Video Assisted Thoracoscopic treatmrnt (VATS)
  • Targeted therapies
  • Cyberknife® stereotactic radiosurgery
  • Special techniques for treating cancers that invade the spinal column

Our Lung Cancer Treatments

If you are diagnosed with lung cancer, your doctor will discuss the best options to treat it. This depends on several factors, including :

  • The stage and type of lung cancer
  • Other lung problems, such as emphysema or chronic bronchitis
  • Possible side effects of treatment
  • Your general health

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

Surgery

Like all surgeries, lung cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure.

Lung cancer may be treated with surgery alone or combined with other treatments. Chemotherapy or radiation may be given :

  • Before surgery to shrink tumors. This is called induction or neoadjuvant therapy.
  • After surgery to help destroy cancer cells that may remain in the body. This is called adjuvant therapy.

Surgery is used less often for small cell lung cancer because this type of cancer spreads more quickly through the body and is not often found in the early stages when it is confined to the lungs.

The most common types of surgery for lung cancer are :

  • Wedge resection: Removal of the tumor and a pie- or wedge-shaped piece of the lung around the tumor
  • Lobectomy: Removal of the lobe of the lung with cancer
  • Segmentectomy or segmental resection: Removal of a segment, or part, of the lobe where the cancer is located
  • Sleeve resection: Removal of part of the bronchus

In addition, lymph nodes in the chest will be removed and looked at under a microscope to find out if the lung cancer has spread. This will help doctors decide if you need further treatment after surgery.

Video-assisted thoracic surgery (VATS): We are specially trained and highly skilled at performing this minimally invasive surgery, and they use the latest equipment available.

Other types of surgery

Sometimes surgery is needed to help problems caused by lung cancer or its treatment. This may include :

  • Laser surgery to open a blocked airway
  • Placement of small tubes (stents) to keep airways open
  • Cryosurgery to freeze and destroy cancer tissue
  • Placement of a Pleurx-Denver catheter to drain fluid that may accumulate in the pleural cavity (the layer of tissue that surrounds the lungs)
  • Cyberknife® stereotactic radiosurgery

Chemotherapy

We offers the most up-to-date and effective chemotherapy options for lung cancer. Chemotherapy is often the main treatment for small cell lung cancer or if the cancer has spread (metastasized). If surgery is not an option for you, your doctor may suggest chemotherapy and radiation.

Targeted Therapies

These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow us to target lung cancer more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. Radiation therapy may be used with chemotherapy and/or surgery.

The Thoracic Center provides the very latest radiation treatments for lung cancer, including :

  • Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
  • 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
  • Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Photodynamic Therapy (PDT)

In photodynamic therapy, a light-sensitive chemical is injected into the body, where it remains longer in cancer cells than it does in normal cells. The chemical is activated with a laser that initiates the destruction of cancer cells. PDT often is used on very small tumors or to reduce certain symptoms of lung cancer.

Multiple Myeloma

Multiple Myeloma Diagnosis

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

Blood and urine tests determine calcium levels and changes in abnormal proteins that multiple myeloma produces. In the blood, these proteins are called paraproteins. A test called serum protein electrophoresis (SPEP) measures paraproteins. In the urine, these proteins are called Bence-Jones proteins. They are measured by collecting a 24-hour urine sample and running a urine protein electrophoresis (UPEP).

A blood test called an immunofixation (IFE) test, may help find small traces of abnormal proteins.

Bone marrow aspiration and biopsy

Biopsy: Multiple myeloma can cause tumors called plasmacytomas in the boneor soft tissue around the bone. These tumors may be biopsied.

Imaging tests, which may include :

  • X-rays
  • Bone density scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • CT or CAT (computed axial tomography) scans

Multiple Myeloma Facts

Multiple myeloma is uncommon. Although its exact cause is unknown, multiple myeloma can be controlled in most patients, sometimes for many years. The development of new drugs has helped manage multiple myeloma in a larger number of patients and has resulted in longer average times of survival.

What is Multiple Myeloma ?

Multiple myeloma is a type of blood cancer that affects the bone marrow, the body's blood-forming system. In this disease, the plasma cells (a type of white blood cell) become abnormal and multiply rapidly. This causes them to interfere with the production of normal blood cells.

The plasma cells make an abnormal protein that is sent into the blood and urine. In the blood, these proteins are called monoclonal proteins (M proteins) or paraproteins. In the urine, they are called Bence Jones proteins.

If these proteins build up in large amounts, the kidneys may have trouble processing all of the protein. This may cause the kidneys to stop working as well as they should. Multiple myeloma cells also can eat away at areas of bone, putting these bones at higher risk of fracture.

Multiple Myeloma Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best.

Unfortunately, no standardized screening tests have been shown to improve multiple myeloma outcomes. However, we’re working to develop tests to detect multiple myeloma earlier.

Multiple Myeloma Risk Factors

The exact cause of multiple myeloma is not known and no avoidable risk factors have been found. However, certain things appear to make you more likely to develop multiple myeloma.

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

Not everyone with risk factors gets multiple myeloma. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Multiple Myeloma Staging

If you are diagnosed with multiple myeloma, your doctor will determine the stage of the disease. Staging is a way of determining how much disease is in the body and where it has spread. This information helps the doctor plan the best treatment. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Multiple Myeloma Stages

The International Staging System is used to determine the stage of multiple myeloma. It is based on two blood tests, the serum albumin and the serum Beta 2 microglobulin (β2M).

  • Stage I: Albumin ≥ 3.5 g/dL and β2M < 3.5 mg/L
  • Stage II: Albumin < 3.5 g/dL and β2M < 3.5 mg/L; or β2M ≥ 3.5 mg/L and < 5.5 mg/L
  • Stage III: β2M ≥ 5.5 mg/L

Multiple myeloma often doesn’t have symptoms at first. This can make it difficult to diagnose in the early stages. If you have symptoms, they may include :

  • Fractures: Myeloma cells produce substances called cytokines, which can trigger bone cells (osteoclasts) to destroy surrounding bone. When more than 30% of the bone has been destroyed, X-rays show a thinning of the bone (osteoporosis) or dark holes (lytic lesions). The weakened area of bone can break. This is called a pathological fracture.
  • Bone pain, especially in the middle and/or lower back, rib cage or hips. The pain can be mild or severe depending on the extent of the multiple myeloma, the speed with which it has developed, and whether fracture or nerve compression has occurred. Typically, movement makes the pain much worse.
  • Fatigue
  • Infection: Because myeloma cells crowd out normal white blood cells, which fight infection, there is a risk of infection. Symptoms depend on where the infection is. Pneumonia, bladder or kidney infections, sinusitis and skin infections are common.
  • Hypercalcemia: When the bone is destroyed, calcium is released into the blood. As the amount increases, the kidneys are unable to get rid of the calcium in the urine. Symptoms of hypercalcemia include thirst, nausea, constipation and confusion.
  • Blood problems, including low levels of white or red blood cells or platelets.
  • Kidney failure or "myeloma kidney" caused by too much protein or calcium in the blood.
  • Nervous system problems: Bones may press on nerves, causing pain, numbness or weakness. Too much protein in blood also may cause this.

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

Chemotherapy

Drug therapy is the usual starting point in treating multiple myeloma. We offer the most up-to-date and advanced chemotherapy options. Liposomal drug delivery is an innovative method that can help chemotherapy be more effective.

Possibilities may include :

  • Monoclonal antibodies, including Rituxan® (Rituximab)
  • Biological therapies that develop antibodies to destroy cancer cells
  • Proteasome inhibitors, such as bortezomib (Velcade®)
  • Immune modulators, such as thalidomide and lenalidomide, that modify the environment of the tumor cell and allow it to die
  • Small molecule treatment, such as panobinostat
  • Cytokine therapies
  • Vaccine therapy
  • Bisphosphonates help reduce high calcium levels and decrease the risk of bone fracture

Radiation Therapy

This usually is used to treat a specific area where there is bone destruction and pain. Radiation can destroy cancer cells more quickly than chemotherapy and has fewer side effects. For this reason, it often is used to get quicker pain relief and control severe bone loss

Stem Cell Transplants :

Plasma Exchange

If abnormal proteins become very high, leading to thickening of the blood, the plasma can be removed and replaced with normal plasma from a healthy donor. This can quickly relieve symptoms of increased blood thickness until chemotherapy/immunotherapy has a chance to destroy the multiple myeloma cells that are responsible for producing the abnormal protein.

Watchful Waiting

This approach involves closely monitoring multiple myeloma without active treatment.

Oesophaus Cancer

Esophageal Cancer Diagnostic Tests

If you have symptoms that may signal esophageal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have esophageal cancer and if it has spread. These tests also may be used to find out if treatment is working.

Imaging tests, which may include :

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

Biopsy

One of the following methods may be used to biopsy tissue to find out if you have esophageal cancer :

  • Endoscopy: An endoscope is inserted through the mouth or nose into the esophagus. The doctor looks at the esophagus and removes small pieces of tissue.
  • Endoscopic ultrasound (EUS) or endosonography: An endoscope is inserted through an opening in the body, usually the mouth or rectum. At the end of the tube are a light, a tiny camera and a device that sends out ultrasound (high-energy sound) waves to make images of internal organs.
  • Video endoscopy: An endoscope with a special fiber-optic camera is inserted through the mouth, allowing the doctor to view the esophagus and biopsy the suspicious area.
  • Bronchoscopy: Using a tool called a bronchoscope, which is similar to the endoscope, the doctor looks at the trachea (windpipe) and the tubes that go into the lungs.
  • Laryngoscopy: With a tool called a laryngoscope, which is similar to the endoscope, the doctor examines the larynx (voice box).
  • Thoracoscopy: A small incision is made between two ribs, and an instrument called a thoracoscope is inserted through it into the chest. The thoracoscope is similar to the endoscope. It lets the doctor view and biopsy the lymph nodes inside the abdomen and chest.

Esophageal Cancer Facts

It affects men much more often than women. Middle-aged men who are overweight with a history of acid reflux (heartburn) and smoking seem to be at the highest risk. Because the disease often has no symptoms in the early stages, it is usually detected at a more advanced stage that is more challenging to treat.

The esophagus is a foot-long tube that carries food and liquids from the mouth to the stomach. Its lining has several layers. Esophageal cancer begins in the cells of the inside lining. It then grows into the channel of the esophagus and the esophageal wall.

A sphincter, a special muscle that relaxes to let food in or out, is on each end of the esophagus. The one at the top lets food or liquid into the esophagus. The one on the bottom lets food enter the stomach.

Acid Reflux Raises Risk

This sphincter also prevents stomach contents from refluxing (coming) back into the esophagus. If stomach juices with acid and bile come into the esophagus, it causes indigestion or heartburn. Reflux and gastroesophageal reflux disease (GERD) are the medical names for heartburn.

If you have reflux for a long time, the cells at the end of the esophagus change to become more like the cells in the intestinal lining. This is called Barrett’s esophagus, and it is a pre-malignant condition. This means it can become esophageal cancer and needs to be watched closely.

Esophageal Cancer Types

The types of esophageal cancer are named after the cells where they begin.

  • Adenocarcinoma is the most common type of esophageal cancer in western societies, especially in white males. It starts in gland cells in the tissue, most often in the lower part of the esophagus near the stomach. The major risk factors include reflux and Barrett’s esophagus.
  • Squamous cell carcinoma or cancer, also called epidermoid carcinoma, begins in the tissue that lines the esophagus, particularly in the middle and upper parts. In the United States, this type of esophageal cancer is on the decline. Risk factors include smoking and drinking alcohol.
  • This is the most common type of esophageal cancer worldwide. In other countries, including Iran, northern China, India and southern Africa, this type of esophageal cancer is much more common than in the United States.

Our Approach

Our Gastrointestinal Center gives you comprehensive, exemplary esophageal cancer care every step of the way – from diagnosis to treatment and follow-up. We customize your care using a team approach that brings together a group of experts to focus on you.

These experts have at their fingertips the latest technology and techniques to diagnose and treat esophageal cancer, including minimally invasive surgery and one of the most-advanced proton therapy centers in the nation.

Specialized Expertise

You are followed by a team of highly specialized physicians and support specialists – all with extensive experience in esophageal cancer care. The surgeons, medical oncologists and radiation oncologists have dedicated their careers to the treatment of esophageal cancer.

Innovative Techniques

Minimally invasive procedures often are able to preserve the function of the esophagus and stomach and avoid the need for radical surgery. This allows you to retain higher levels of function and quality of life.

We’re often able to provide hope for advanced esophageal cancer that might not be available elsewhere, including therapies that deliver maximum effectiveness with the least impact on your body.

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best. Unfortunately, no standardized screening tests have been shown to improve esophageal cancer outcomes. However, we’re working to develop screening tests for those at risk.

If you have frequent heartburn, speak to your doctor about tests that may help find esophageal cancer early. We recommends an endoscopy if you have heartburn that :

  • Happens once a week or more
  • Lasts more than five years
  • Is not relieved by medicine
  • Suddenly goes away; this may reflect a change in the lining of the esophagus

Esophageal Cancer Risk Factors

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

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

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

Esophageal Cancer Staging

The most common system used to stage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). The TNM system describes three key pieces of information :

T refers to the size of the primary tumor and how far it has spread within the esophagus and to nearby organs

N refers to cancer spread to nearby lymph nodes

M indicates whether the esophageal cancer has metastasized (spread to distant organs)

Staging also takes into account the cell type of the cancer and the grade of the cancer. For squamous cell cancers, the location of the tumor can be a factor in staging.

T Stages

  • Tis: The cancer is only in the epithelium (the top layer of cells lining the esophagus). It has not started growing into the deeper layers. This stage also is known as high-grade dysplasia. In the past it was called carcinoma in situ.
  • T1: The cancer is growing into the tissue under the epithelium, such as the lamina propria, muscularis mucosa or submucosa
  • T2: The cancer is growing into the muscle layer (muscularis propria)
  • T3: The cancer is growing into the outer layer of tissue covering the esophagus (the adventitia)
  • T4: The cancer is growing into nearby structures
  • T4a: The cancer is growing into the pleura (the tissue covering the lungs), the pericardium (the tissue covering the heart), or the diaphragm (the muscle powering the lungs). The cancer can be removed with surgery.
  • T4b: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe), aorta (the large blood vessel coming from the heart), spine or other crucial structures.

N Stages

  • N0: The cancer has not spread (metastasized) to nearby lymph nodes
  • N1: The cancer has spread to one or two nearby lymph nodes
  • N2: The cancer has spread to three to six nearby lymph nodes
  • N3: The cancer has spread to seven or more nearby lymph nodes

M Stages

  • M0: The cancer has not spread (metastasized) to distant organs or lymph nodes
  • M1: The cancer has spread to distant lymph nodes and/or other organs

Grade

The grade of a cancer is based on how normal (or differentiated) the cells appear when they are looked at under the microscope. The higher the number, the more abnormal the cells look. Higher-grade tumors tend to grow and spread faster than lower-grade tumors.

  • GX: The grade cannot be assessed (treated in stage grouping as G1)
  • G1: The cells are well differentiated
  • G2: The cells are moderately differentiated
  • G3: The cells are poorly differentiated
  • G4: The cells are undifferentiated (these cells are so abnormal that doctors can't tell if they are adenocarcinoma or squamous cell carcinoma). For staging, G4 cancers are grouped with G3 squamous cell cancers.

Esophageal cancer often does not have symptoms in the early stages. If you have symptoms, they may include :

  • Indigestion and heartburn
  • Difficult or painful swallowing (dysphagia)
  • Pain, pressure or burning in the throat or chest
  • Weight loss, less appetite
  • Black tar-like stools
  • Anemia
  • Vomiting
  • Hoarseness
  • Persistent hiccups
  • Chronic cough
  • Hiccups
  • Pneumonia
  • High levels of calcium in the blood

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

Our Treatment Approach

When you are treated here for esophageal cancer, you are the focus of an incredible team of experts that personalizes your care. This helps increase your odds for successful treatment and maintaining the highest quality of life.

This group of oncologists, surgical oncologists, radiation oncologists, pathologists, as well as a specially trained support staff, is focused solely on esophageal cancer. This dedication and each person's level of experience -- sets this program apart from most others.

Experience Matters

Studies have shown that people have better outcomes in cancer programs that treat a high level of patients. We have one of the most active esophageal cancer programs in the nation. We offer many innovative treatments for esophageal cancer, including :

  • Minimally invasive surgeries and procedures
  • Endoscopic surgery for early disease
  • Other specialized surgical procedures
  • IMRT
  • Targeted therapies

Esophageal Cancer Treatments

If you are diagnosed with esophageal cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health. Your treatment for esophageal cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

This is the most common treatment for esophageal cancer that has not spread to the lymph nodes. The procedure most often performed is an esophagectomy, and there are several methods to perform it. Your doctor will recommend the best technique for you based on the location of the tumor and if it has spread.

Generally, the surgery includes removal of :

  • All or part of the esophagus
  • Part of the stomach
  • Lymph nodes that are close to the esophagus

The remaining stomach is pulled up into the chest or neck and connected to the remaining esophagus. You may need a feeding tube (a small tube that is inserted into the nose or mouth and into the stomach) until you are able to eat.

Side effects of the surgery may include :

  • Leaking at the site where the stomach and esophagus are joined. This may mean the stomach empties slowly, causing nausea and vomiting.
  • Trouble swallowing: An upper endoscopy to stretch passages may help
  • Heartburn
  • Digestive problems: You may be able to eat only small amounts of food at a time

To treat more-advanced stages of esophageal cancer, surgery may be combined with chemotherapy and/or radiation therapy.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow our doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

  • Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
  • 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
  • Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Chemotherapy: MD Anderson offers the most up-to-date and advanced chemotherapy options for esophageal cancer.

Photodynamic therapy (PDT): Laser-sensitive chemicals are injected into the esophageal cancer site. A laser beam then targets the chemicals to destroy the tumor. It may also be used to treat Barrett's esophagus or to help if a tumor is blocking the esophagus but cannot be treated with other methods.

Endoscopic mucosal resection (EMR): This minimally invasive technique may be used if the cancer is small and only on the surface of the esophagus. A needle is placed in the esophageal wall, and then saline (saltwater) is injected to make a bubble under the growth. Using suction, the lesion is removed.

Esophageal stents: Small, expandable metal or plastic tubes are placed over the tumor with the aid of an endoscope. Once placed, the stent can expand and open up the blocked part of the esophagus, allowing food and liquids to pass through easier.

Electrocoagulation: Electricity is used to burn off the tumor.

Targeted therapies: MD Anderson is among just a few cancer centers in the nation that are able to offer targeted therapies for some types of esophageal cancer. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

Oral Cancer

Since early diagnosis improves your chances for successful treatment, it’s important for oral (mouth) cancers and pre-cancerous lesions to be found as soon as possible. We use the most advanced techniques and technology to determine if a tumor is benign (not cancer), pre-cancer or cancer. In addition, we are working on new less-invasive optical techniques to help detect oral cancers.

Oral Cancer Diagnostic Tests

If you have symptoms that may indicate cancer, your dentist or doctor will examine the inside of your cheeks and lips, the floor and roof of the mouth, the tongue and the lymph nodes in your neck. He or she will ask questions about your health and past illnesses and dental problems. Be sure to tell your doctor or dentist if you use or have used tobacco in any form.

If your doctor suspects you may have oral cancer, one or more of the following tests may be used to find out if you have cancer and if it has spread.

Biopsy

If any abnormalities are discovered during the exam, a small tissue sample, or biopsy, usually is taken. This biopsy is important, as it is the only sure way to know if the abnormal area is cancer. A biopsy may be obtained by :

  • Brush biopsy or exfoliative cytology: This relatively new type of biopsy is painless and does not require anesthetic. The dentist or doctor rotates a small stiff-bristled brush on the area, causing abrasion or pinpoint bleeding. Cells from the area are collected and examined under a microscope by a pathologist. If results are inconclusive or show cancer, an incisional biopsy will be completed.
  • Incisional biopsy: This is the traditional, most frequently used type of biopsy. The doctor or dentist surgically removes part or all of the tissue where cancer is suspected. Usually, this procedure is completed in the doctor's office or clinic under local anesthesia. But if the tumor is inside the throat, the biopsy may be done in an operating room with general anesthesia.
  • Fine-needle-aspiration biopsy (FNA): This type of biopsy often is used if a patient has a lump in the neck that can be felt. In this procedure, a thin needle is inserted into the area. Then cells are withdrawn and examined under a microscope.
  • Mucosal staining: A blue dye called toluidine blue O is applied to the area where cancer is suspected. If any blue areas remain after rinsing, they probably will be investigated with a biopsy.
  • Chemiluminescent light: After you rinse your mouth with a mild acid solution, your mouth will be examined with a special light. Healthy cells do not reflect the light; cancerous cells do.

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scans
  • PET (positron emission tomography) scans
  • MRI (magnetic resonance imaging) scans
  • Chest and dental X-rays
  • Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for other cancers and determine how well you swallow.
  • Endoscopy

Our Approach

Our Head and Neck Center brings together an extraordinary level of expertise and experience to treat cancers of the oral cavity (mouth) and precancerous lesions of the oral area.

Each patient is followed closely by a team of experts including oncologists and radiation oncologists and when necessary surgeons, dentists and speech pathologists. These specially trained experts customize your care, including the most-advanced therapies with the least impact on your body.

Innovative Treatments Offer Hope

Here, your care for oral cancer is personalized and may include surgery, or other treatments including targeted therapies. If surgery is necessary, you can count on our renowned surgeons, who use the latest, least-invasive techniques.

Oral cancer and its treatment can affect talking, swallowing, eating and breathing. Here, patients with oral cancer receive the expertise of highly skilled head and neck surgeons, medical and radiation oncologists, plastic surgeons, dental oncologists and speech and swallowing specialists, all working together to provide the best chance for successful treatment for oral cancer with the least impact on your body.

We offer new strategies to maintain dental and oral health treatment. Our highly specialized speech pathologists and therapists are among the most experienced in the nation, particularly in the newest methods of voice restoration and speech.

Because early diagnosis gives you the best chance for successful treatment, the Oral Premalignancy Clinic provides a specialized setting for diagnosis, monitoring and treatment of precancerous lesions of the oral cavity. New optical techniques, less-invasive alternatives to biopsy, may help find some oral cancers earlier.

Oral Cancer Facts

Oral cancer is most often found in the buccal mucosa tongue, the lips and the floor of the mouth. It also can begin in the gums, the minor salivary glands, the lining of the lips and cheeks, the roof of the mouth or the area behind the wisdom teeth.

Chances of successfully treating oral cancer are highest when it is found early. Our team of experts in the Oral Premalignancy Clinic works closely together to detect and diagnose oral cancer in its early stages.

Oral Cancer Types

Almost all cancers of the mouth occur in squamous cells, the type of cells that line the mouth, tongue and lips. These are called squamous cell carcinomas (cancers). Not all tumors in the mouth are cancer. Some are benign (not cancer), and some are precancerous, meaning they may become cancer.

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

One of the most important screening methods for oral cancer is a thorough examination by a dentist each year. Be sure your dentist performs a mouth, head and neck screening as part of each exam. You also may want to ask your physician to perform a thorough head and neck exam during regular checkups.

Tell your dentist or doctor about any unusual or abnormal areas, sores or bumps in your mouth. Between visits, use a mirror to check your mouth. The Self Oral Examination provides screening for oral cancer or precancerous lesions.

Oral Cancer Risk Factors

Anything that increases your chance of getting oral cancer is a risk factor. The main risk factors for oral cancer are :

Tobacco use: Most people with oral cancer use tobacco in some form. The risk increases with the length of the habit and the amount of tobacco used. Specifically, pipe smoking increases the risk for cancer of the lip and the soft palate. People who use chewing tobacco or snuff are more likely to develop cancer of the gums, cheek and lips. Living with a smoker or working in a smoking environment can cause secondhand or passive smoking, which also may increase risk.

Alcohol: Most people with oral cancer are heavy drinkers, consuming more than 21 alcoholic drinks each week. People who drink alcohol and smoke are six times as likely to get oral cancer as people who do not drink. The combination of tobacco and alcohol is particularly dangerous.

Other risk factors include :

  • Gender: About two thirds of people with oral cancer are men
  • Race: The risk is higher for African Americans
  • Age: These cancers are found most often in people over 45
  • Prolonged sun exposure (lip cancer)
  • Long-term irritation caused by ill-fitting dentures
  • Poor nutrition, especially a diet low in fruits and vegetables
  • Immunosuppressive drugs
  • Infection with human papillomavirus (HPV)
  • Previous head and neck cancer
  • Radiation exposure
  • Lichen planus, a disease that affects the cells that line the mouth
  • Drinking mate, a beverage made from a type of holly tree common in South America
  • Chewing quids of betel, a stimulant common in Asia

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

Oral Cancer Prevention

Cancers of the mouth are among the most preventable cancers. One of the most important things you can do is visit a physician once a year for a complete oral examination.

To minimize your risk of developing oral cancer :

  • Avoid tobacco in all forms
  • Avoid alcohol
  • Remove your dentures at night and clean them daily
  • Have dentures evaluated by a dentist at least every five years
  • Limit sun exposure; wear a lip balm with sunscreen and a hat with a brim
  • Eat a well-rounded, healthy diet with a variety of fruits and vegetables

Oral Cancer Staging

If you are diagnosed with oral (mouth) cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This information helps the doctor treat the cancer. Once the staging classification is determined, the stage stays the same even if treatment is successful or the cancer spreads.

Disease stage is determined by the size of the primary tumor, how much it has invaded the tissues and whether the cancer has spread to the lymph nodes.

Stages of Oral Cancer

Stage 0: Cancer is "in situ," meaning it is isolated and has not traveled into a deeper layer of tissue or the lymph nodes, small almond-shape glands that help fight infection or trap tumor cells.

Stage I

  • Tumor is 2 centimeters (about ¾ inch) or smaller
  • Tumor has not spread to lymph nodes or other parts of the body

Stage II

  • Tumor is between 2 and 4 centimeters (from ¾ to 1½ inches)
  • Tumor has not spread to lymph nodes or other parts of the body

Stage III: Tumor is either :

  • Larger than 4 centimeters (1½ inches) or
  • Any size and has traveled to one lymph node on the same side of the head or neck. The lymph node with cancer measures 3 centimeters or less
  • Tumor has not spread to other parts of the body

Stage IV: Tumor is any size and has invaded deeply into muscle or facial skin or the jaws and has spread to :

  • More than one lymph node on the same side of the head or neck as the main tumor
  • Lymph nodes on one or both sides of the neck
  • Any lymph node that measures more than 6 centimeters (2½ inches)
  • Other parts of the body

Recurrent: The oral cancer has reappeared after it was treated. It may reappear in the oral cavity or another part of the body.

Symptoms of oral cancer vary from person to person. Often, symptoms may be caused by other problems that are not dangerous. But since early detection is important for successful treatment of oral cancer, see your doctor or dentist if you notice abnormal areas in your mouth. These may include the following :

Leukoplakia is a white area or spot in the oral cavity. About 25% of leukoplakias are cancerous or precancerous.

Erythroplakia is a red, raised area or spot that bleeds if scraped. About 70% of erythroplakias are cancerous or precancerous.

Erythroleukoplakia is a spot with both red and white areas.

Other oral cancer symptoms include :

  • Sore in the mouth or throat that doesn't heal
  • Loose teeth
  • Lump or thickening in the neck, face, jaw, cheek, tongue or gums
  • Dentures that cause discomfort or do not fit well
  • Difficulty chewing, swallowing or moving the tongue or jaw
  • Persistent bad breath
  • Unexplained weight loss

These symptoms usually do not mean you have cancer. However, it is important to discuss any symptoms with your doctor, since a correct diagnosis can help improve your chance for successful treatment. Also, these symptoms may signal other health problems.

Our Treatment Approach

The mouth is an important part of eating, breathing and talking, and we take special care to customize your oral cancer treatment to include the most advanced therapies with the least impact on your body.

Your care is followed closely by a team of healthcare professionals, led by a doctor who specializes in treating oral cancers. Other members of your team may include :

  • Head and neck surgeons, medical oncologists and radiation oncologists
  • Plastic and reconstructive surgeons
  • Dentists
  • Speech pathologists
  • Speech, occupational and physical therapists
  • Dietitians
  • Psychologists
  • Rehabilitation specialists

We specialize in minimally invasive techniques and innovative treatments, including tumor growth factor inhibitors. If reconstruction is needed, our plastic surgeons are among the most experienced in the country. We take special care to work with each patient to restore optimum physical function.

Our Oral Cancer Treatments

If you are diagnosed with oral cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

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

Surgery

Surgery is the most frequent treatment for oral cancer. The type of surgery depends on the type and stage of the tumor. Surgical techniques to treat oral cancer and deal with the side effects of treatment include :

  • Removal of the tumor or a larger area to remove the tumor and surrounding healthy tissue
  • Removal of part or all of the jaw
  • Maxillectomy (removal of bone in the roof of the mouth)
  • Removal of lymph nodes and other tissue in the neck
  • Plastic surgery, including skin grafts, tissue flaps or dental implants to restore tissues removed from the mouth or neck
  • Tracheotomy, or placing a hole in the windpipe, to assist in breathing for patients with large tumors or after surgical removal of the tumor
  • • Dental surgery to remove teeth or assist with reconstruction

Radiation Therapy

In cancer of the mouth, radiation therapy may be used alone to treat small or early-stage tumors. More often, radiation therapy is used after surgery, either alone or with chemotherapy for more advanced tumors. The method of radiation treatment used depends on the type and stage of cancer.

  • External-beam radiation therapy is the most frequently used method to deliver radiation therapy to the mouth. Intensity-modulated radiotherapy (IMRT) and proton therapy are aimed at treating the tumor while minimizing damage to surrounding normal tissue.
  • Internal radiation or brachytherapy delivers radiation with tiny seeds, needles or tubes that are implanted into the tumor. It is used sometimes for treating small tumors or with surgery in advanced tumors.

Chemotherapy

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

Tumor Growth Factor Inhibitors

Tumor growth factors are hormone-like substances that occur naturally in the body and cause cell growth. An epidermal growth factor (EGF) receptor on the surface of some oral cancer cells can bind to certain substances that stimulate tumor growth. New drugs are being tested that target EGF receptors and may stop cancer cells from growing.

After Treatment: Reconstruction and Rehabilitation

Oral cancer and its treatment often cause difficulty in speaking, swallowing and breathing. We work with you, defining your needs and making sure you receive the care you need. This may include speech, occupational and physical therapies and other methods.

After treatment, some patients with oral cancer need plastic or reconstructive surgery to help restore their appearance or regain the ability to speak or swallow. Our plastic and reconstructive surgeons are among the most skilled and experienced in the world.

Sometimes the surgeon can perform reconstructive surgery at the same time as your cancer surgery; in other cases it is best to wait. Your doctor will recommend the method that is best for you. If reconstructive surgery isn’t possible, you may be fitted for a dental prosthesis or implant. A therapist will show you how to use the device. Sometimes, grafts of skin, muscle or bone, which are moved from another part of body to the mouth, are used.

Ovarian Cancer

Ovarian Cancer Diagnostic Tests

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

Pelvic exam: The doctor inserts one or two gloved fingers into the vagina and presses on the lower abdomen with the other hand. Usually the doctor puts a finger in the vagina and rectum at the same time to feel deeper in the pelvis. A pelvic exam helps find out if there is a mass on either side of the uterus. This may be a sign of ovarian cancer.

CA-125 blood test: This blood test measures the level in your body of CA-125, a protein that is made by ovarian cancer cells. CA-125 is known as a tumor marker because its levels usually are higher in women with ovarian cancer. Testing CA-125 levels is most reliable when it is used to find cancer that has come back after treatment. Doctors look at how the levels of CA-125 have changed over time.

Measuring CA-125 levels also can be used :

  • To see if treatment is working
  • Predict if a treatment might be effective for ovarian and some other types of cancer

The CA-125 test alone cannot find ovarian cancer. A high level of CA-125 does not always mean you have ovarian cancer. Other conditions may raise the level of CA-125. Low levels of CA-125 do not mean you are cancer free. Some types of ovarian cancer produce only low levels of CA-125 or none at all.

Biopsy: The only way to find out for certain if a growth is ovarian cancer is for the doctor to remove cells from it and look at them under a microscope (biopsy). Tissue can be removed by :

  • Surgery
  • Laparoscopy
  • Fine needle aspiration (FNA)

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • Chest X-rays
  • Transvaginal ultrasound: A wand-shaped scanner is put into the vagina. It has a small ultrasound device on the end

Genetic Testing

If you are at high risk for ovarian cancer because of personal or family history, your doctor may ask you to have more tests, including some that give information about your genes. These tests may help you make important decisions about cancer prevention for yourself and your children. There are benefits and risks with genetic testing, which you should discuss with your doctor. Blood tests can find out if you have a BRCA1 or BRCA2 gene, which can cause ovarian cancer as well as breast cancer. Others test for genes that play a part in Lynch syndrome, an inherited colon cancer syndrome.

Our Approach

At our Gastrointestinal Center, your treatment for pancreatic cancer is customized carefully to provide the most advanced therapies with the least impact on your body. You are the focus of personalized care that brings together the most-advanced techniques and technologies and some of the nation's top pancreatic cancer professionals.

Your personal team of experts, which includes oncologists, surgeons, radiologists, gastroenterologists and a specially trained support staff, communicate closely about your care for pancreatic cancer. As an important part of the care team, you are involved in every decision.

Pancreatic Cancer Facts

The risk increases with age, and most cases are diagnosed between 60 and 80 years old. Pancreatic cancer usually has few, if any, signs or symptoms in the early stages when it would be most treatable.

The pancreas is a spongy, oblong organ about 6 inches long and 2 inches wide. It is located behind the lower part of the stomach, between the stomach and the spine. The pancreas is important because it makes insulin and other hormones that help the body absorb sugar and control blood sugar, and produces juices that aid in digestion.

Pancreatic Cancer Types

The pancreas contains two main types of cells :

  • Exocrine cells, which make digestive juices
  • Endocrine cells, which produce hormones

Almost all pancreatic cancers start in exocrine cells. These cells line the pancreatic duct (duct cells), through which pancreatic juices with digestive enzymes flow.

Adenocarcinoma is cancer of the exocrine cells. It accounts for 95% of pancreatic cancers.

Islet cell carcinoma involves endocrine cells. Most islet cell tumors are malignant, but some are benign, such as insulin-producing islet cell tumors. Tumors can be :

  • Functional and produce abnormally high amounts of hormones
  • Non-functional and produce no hormones

Pancreaticoblastoma is very rare. This type of pancreatic cancer is found mostly in young children.

Isolated sarcomas and lymphomas can occur in the pancreas. These are very rare.

Pseudopapillary neoplasms occur mostly in young women in their teens and 20s.

Ampullary cancer: This rare type of exocrine tumor begins where the bile duct (from the liver) and the pancreatic duct join with the small intestine. Since it causes yellowing of the skin and eyes, it may be found earlier than other types of pancreatic cancer.

Pancreatic Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Unfortunately, no standardized screening tests have been shown to improve pancreatic cancer outcomes. If you are at high risk for pancreatic cancer, speak to your doctor about whether testing might be right for you. This might include :

  • Endoscopic ultrasound: An endoscope with an ultrasound probe on the end is inserted through the mouth into the pancreas
  • CT or CAT (computed axial tomography) scans to look for abnormalities

Pancreatic Cancer Prevention

The number one way to prevent pancreatic cancer is to stop smoking.

Other lifestyle choices may lower your chances of getting pancreatic cancer, including :

  • Eating a healthy diet
  • Maintaining a healthy weight
  • Getting regular exercise

Pancreatic Cancer Staging

If you are diagnosed with pancreatic cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Pancreatic Cancer Stages

Stage 0: Cancer is found only in the lining of the pancreas. Stage 0 also is called carcinoma in situ.

Stage I: Cancer has formed and is in the pancreas only.

  • Stage IA: The tumor is 2 centimeters or smaller
  • Stage IB: The tumor is larger than 2 centimeters

Stage II: Cancer may have spread to nearby tissue and organs, and lymph nodes near the pancreas.

  • Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes
  • Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs

Stage III: Cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes.

Stage IV: Cancer may be of any size and has spread to distant organs, such as the liver, lung and peritoneal cavity. It also may have spread to organs and tissues near the pancreas or to lymph nodes.

Doctors also may use the following terms to talk about how far pancreatic cancer has spread :

  • Resectable: Cancer is in the pancreas and can be removed surgically.
  • Locally advanced (unresectable): Pancreatic cancer has spread to tissue and blood vessels around the pancreas but not to other parts of the body. It cannot be removed entirely by surgery. Surgery may be done to help symptoms or other problems.
  • Metastatic: Pancreatic cancer has spread to other parts of the body. Surgery is done only to relieve symptoms or other problems.

Pancreatic cancer often does not cause symptoms in the early stages. When it does have symptoms, they usually are caused by the relationship of the pancreas to other organs of the digestive system.

Signs you may have pancreatic cancer include :

  • Jaundice or yellowing of the skin or eyes
  • Change of color in urine and stool: Urine may turn orange or the color of iced tea. Stool may turn yellow or reddish, or become grey or chalky-white.
  • Pain in the abdomen or middle of the back
  • Bloating or feeling of fullness
  • Nausea, vomiting or indigestion
  • Fatigue
  • Lack of appetite or unexplained weight loss
  • Sudden-onset diabetes or sudden change in blood-sugar control in diabetics
  • Swollen gallbladder
  • Blood clots

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

Our Treatment Approach

We have the expertise and experience to fight pancreatic cancer on all fronts. Using the latest, most advanced therapies for pancreatic cancer, we personalize your care to ensure the most advanced treatment with the least impact on your body. We offer the latest innovative pancreatic cancer treatments including targeted therapies.

Frequently, treatment for pancreatic cancer requires more than one type of therapy.

Skilled Surgeons, Latest Techniques

The surgical techniques to treat pancreatic cancer are extremely complex. The surgeon must have a high degree of experience and skill to be successful.

If surgery is possible, our approach to pancreatic cancer usually is to complete chemotherapy and radiation before surgery. This method increases chances the tumor can be removed completely, helps chemotherapy and radiation be more effective, and makes for better recovery.

Pancreatic Cancer Treatments

If you are diagnosed with pancreatic cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

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

Surgery

Surgery for pancreatic cancer may be used to help treat the cancer or to help relieve symptoms such as blocked bile ducts or intestine.

Only about 10% of pancreatic cancers are contained entirely within the pancreas at the time of diagnosis. Attempts to remove the entire cancer may be successful in some patients. But even when the cancer seems to have not spread, cancer cells too few to detect may have spread to other parts of the body.

The main types of surgery for pancreatic cancer are :

  • Curative: attempt to treat cancer by removing it
  • Palliative: attempt to relieve symptoms and make you more comfortable

Curative Surgeries

Pancreaticoduodenectomy is the most common surgery to attempt to remove a pancreatic tumor. Also known as the Whipple procedure, this operation removes :

  • Head of the pancreas
  • Body of the pancreas (in some patients)
  • Part of the stomach
  • Duodenum (first part of the small intestine)
  • A small portion of the jejunum (second part of the small intestine)
  • Lymph nodes near the pancreas
  • Gallbladder
  • Part of the common bile duct

This major operation carries a high risk of complications, even when it is performed by experienced surgeons. About 30% to 50% of patients suffer complications, including leakage from surgical connections, infections and bleeding.

The surgery takes from six to 12 hours and requires a seven- to 10-day stay in the hospital. You may need nutritional support with a feeding tube or through a vein. Recovery will take about a month. It will be three months before your digestive system works well again.

Studies have shown this pancreatic cancer procedure is more successful and has less risk when it is performed at a major cancer center by doctors with extensive experience in the procedures.

Distal pancreatectomy removes only the tail of the pancreas, or the tail and a part of the body of the pancreas. The spleen usually is removed as well. This operation is used more often with islet cell tumors.

Total pancreatectomy, which removes the entire pancreas and the spleen, was once used for tumors in the body or head of the pancreas. However, when the entire pancreas is removed, patients are left without islet cells, which produce insulin. They develop hard-to-manage diabetes and become dependent on injected insulin. Studies have not shown any advantage to removing the whole pancreas.

Palliative Surgeries

Surgical techniques to help relieve symptoms of pancreatic cancer include :

Stent placement: Metal tubes that help keep the bile duct open are inserted, avoiding blockage. This procedure is used more often than biliary bypass. Stents may be placed with an endoscope.

Biliary bypass: The surgeon makes a cut in the gallbladder or bile duct and then sews it to the small intestine. This helps when a tumor is blocking the small intestine and causing bile to build up in the gallbladder. This surgery also may help relieve pain.

Gastric bypass: When pancreatic cancer blocks the stomach, the stomach may be sewn to the small intestine, allowing you to eat normally.

Ablative Techniques

These may be used to help treat exocrine pancreatic cancer when a few tumors have spread. They include :

Radiofrequency ablation (RFA) heats and destroys tissue with radio waves

Microwave thermotherapy uses microwaves to heat and destroy cancer

Cryosurgery or cryoablation freezes tissue to destroy it

Embolization or chemoembolization delivers substances, such as radiation therapy or chemotherapy, to the blood vessels around the tumor, cutting off the blood supply to the pancreatic cancer.

Chemotherapy: We offer the most up-to-date and advanced chemotherapy options for pancreatic cancer.

Radiation therapy: New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target pancreatic cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Targeted Therapies

These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

Nutrition and Pancreatic Cancer

If you have pancreatic cancer you may not feel like eating, especially when you are uncomfortable or tired. In addition, side effects of treatment, such as difficulty swallowing, nausea and vomiting, can make eating difficult.

Here dietitians are a part of your care team. They help establish diet plans and address specific nutritional needs.

Some pancreatic cancer patients who have problems swallowing may require a feeding (enteral) tube. Tube feeding may be temporary to treat acute conditions or long term in the case of chronic illness. A specially trained dietitian teaches patients and caregivers how to use and manage the tube and provides information about nutritional supplements.

Pancreatic Cancer

Pancreatic cancer often can be challenging to diagnose. Symptoms usually do not appear in the early stages, and if they do they may be mistaken for signs of another condition. Also, the pancreas is deep inside the body, behind several other organs. This makes it difficult to feel or see without proper equipment. Several medical tests usually are required to find and stage (determine extent of disease) pancreatic cancer. Accurate diagnosis and staging are important because they help your doctors choose the best type of treatment.

Pancreatic Cancer Diagnostic Tests

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

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scans: This is the primary test used to determine the stage of pancreatic cancer
  • PET (positron emission tomography) scans
  • MRI (magnetic resonance imaging) scans
  • Angiography: A type of X-ray that looks at blood vessels

Endoscopic ultrasound (EUS): A special endoscope (link) with an ultrasound probe and a small needle at the end is placed through the mouth and esophagus and into the first part of the small intestine. The doctor views the pancreas on a video screen. Surgical instruments, called biopsy forceps or brushes, may be inserted through the endoscope to remove tissue to examine under a microscope.

Endoscopic retrograde cholangiopancreatography (ERCP): This test for pancreatic cancer X-rays the ducts that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. An endoscope is put through the mouth, esophagus and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter, and an X-ray is taken. If the ducts are blocked by a tumor, a fine tube (stent) may be inserted into the duct to unblock it. The stent may be left in place to keep the duct open.

Blood tests: No single blood test can diagnose pancreatic cancer. Some blood tests, known as tumor markers, measure the levels of proteins made by cancer cells. Known tumor markers for pancreatic cancer include carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA). Blood tests also can evaluate the function of the liver and other organs that may be affected by a pancreatic tumor.

Biopsy is the removal of a small piece of tissue to view under a microscope. The ways to do a biopsy for pancreatic cancer include the following.

  • CT-guided Fine Needle Aspiration (FNA): A CT scan helps the doctor find the tumor and guide a small needle through the skin and abdomen into the pancreas.
  • Laparoscopy: This test is done in the operating room under general anesthesia. An endoscope (link) is guided through a very small cut in the abdomen. This lets the surgeon view the pancreas and find out if the cancer has spread. Tissue samples also can be taken.
  • Laparoscopy is not used to diagnose pancreatic cancer. It may be used to find out if the cancer has spread to other organs, such as the intestines, liver, lymph nodes and stomach.

Our Approach

The experts with us at Genitourinary Cancer Center are among the nation's most skilled and experienced at diagnosing and treating penile cancer. This translates to an extraordinary level of expertise that can make a direct difference in your successful treatment and recovery.

Customized, Comprehensive Care

Here, you receive personalized penile cancer care from a team of some of the most renowned experts in the nation. This group, which includes medical and surgical oncologists, as well as other physicians and a specially trained support staff, collaborates to ensure you receive the most advanced penile cancer treatments with the least impact on your body. And, as one of the premier cancer research institutions, we are able to offer a range of clinical trials of new agents to treat penile cancer.

Penile Cancer Facts

The penile cancer rate is much higher in India and some South American and African countries.

Penile cancer forms in the penis. It generally starts on the glans (head or tip) of the penis.

Penile Cancer Types

The penis contains several types of cells. Penile cancer is classified by the type of cells in which it develops. The main types of penile cancer are :

  • Squamous cell carcinoma
  • Kaposi sarcoma
  • Adenocarcinoma
  • Melanoma
  • Basal cell
  • Sarcoma

Penile Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Unfortunately, no standardized screening tests other than examining the penis have been shown to find penile cancer early. If you have a foreskin, examine the area underneath it regularly. Be sure to keep the area clean. Penile cancer can start as a reddened or scaly area or a sore on the penis. Report any changes to your doctor.

Penile Cancer Risk Factors

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

  • Age: Most cases are seen in men 50 to 70 years old. About a third are in men under 50
  • Tobacco use
  • Human papillomavirus (HPV): This sexually transmitted disease has more than a dozen subtypes. HPV 16 and HPV 18 are linked most often to penile cancer.
  • Lack of circumcision at birth
  • Phimosis: A condition that makes it difficult to pull back the foreskin. This can lead to the buildup of body oils, bacteria and other debris known as smegma
  • UV light treatment of psoriasis
  • AIDS (acquired immune deficiency syndrome)

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

Penile Cancer Staging

If you are diagnosed with penile cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Penile Cancer Stages

  • Stage 0: Penile cancer has not grown into tissue below the top layers of skin and has not spread to lymph nodes or distant sites.
  • Stage 1: Penile cancer has grown into tissue just below the superficial layer of skin but has not grown into blood or lymph vessels. It has not spread to lymph nodes or distant sites.
  • Stage II: Any of the following :
    • Penile cancer has grown into tissue just below the superficial layer of skin and is either high-grade or has grown into blood or lymph vessels. It has not spread to lymph nodes or distant sites.
    • The cancer has grown into one of the internal chambers of the penis (the corpus spongiosum or corpora cavernosum). The cancer has not spread to lymph nodes or distant sites.
    • The cancer has grown into the urethra (tube that urine passes through). It has not spread to lymph nodes or distant sites.
  • Stage IIIa: Penile cancer has grown into tissue below the superficial layer of skin. It also may have grown into the corpus spongiosum (tissue within the penis) or the urethra (the small tube through which urine passes from the bladder to the outside of the body). The cancer has spread to a single groin lymph node. It has not spread to distant sites.
  • Stage IIIb: Penile cancer has grown into the tissues of the penis and may have grown into the corpus spongiosum, the corpus cavernosum or the urethra. It has spread to two or more groin lymph nodes. It has not spread to distant sites.
  • Stage IV: Any of the following :
    • The cancer has spread to lymph nodes in the pelvis or the cancer spread in the groin lymph nodes has grown through the lymph nodes' outer covering and into the surrounding tissue. The cancer has not spread to distant sites.
    • Penile cancer has grown into the prostate or other nearby structures. It may or may not have spread to groin lymph nodes. It has not spread to distant sites.
    • The cancer has spread to distant sites.
  • Recurrent penile cancer is cancer that went away with treatment but later came back. Recurrent penile cancer may return in the penis or any other part of the body.

Some men who develop penile cancer have obvious symptoms in the early stages. Others may not have signs until the disease has spread. Symptoms vary from man to man. They may include :

  • Change in the skin of the penis
  • Wart-like growth or lesion that may or may not be painful
  • Open sore that won't heal
  • Reddish rash
  • Small, crusty bumps
  • Flat bluish brown growths
  • Swelling at the end of the penis
  • Persistent, smelly discharge under the foreskin
  • Swollen lymph nodes in the groin if the cancer has spread

You may not be able to see these changes unless the foreskin is pulled back.

Unfortunately, many men do not want to talk about these symptoms with their doctors. This may delay them from seeking treatment until penile cancer is advanced and harder to treat.

Although these symptoms may not mean you have penile cancer, you should report any changes in the penis to your doctor as soon as possible. They may be signs of another health problem.

Our Treatment Approach

When you are treated here for penile cancer, some of the nation's top specialists focus their expertise on you. They communicate with each other – and with you – to ensure you receive the most advanced treatment with the least impact on your body.

This means we have a higher level of experience and expertise, which is crucial to your treatment and recovery.

Like all surgeries, penile cancer surgery often is more successful when performed by a specialist with a great deal of experience. This is particularly true for organ-preserving surgeries, and plastic surgery reconstruction, which usually are used to treat penile cancer.

Penile Cancer Treatments

If you are diagnosed with penile cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

Surgery is the most frequent form of treatment for penile cancer, but laser therapy and radiation may be used for smaller tumors. The type of treatment usually depends on how far the cancer has spread.

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

Surgery

Surgery to remove all or part of the penis is called penectomy. Penile preservation surgery (the penis is not removed) is used to treat penile cancer whenever possible.

  • Circumcision: Surgical removal of the penis foreskin and some of the nearby skin. This procedure may be done if the penile cancer has not spread beyond the foreskin. It also may be done before radiation therapy.
  • Partial penectomy: The tumor is removed along with a margin of healthy tissue. In the past, a 2-centimeter margin was removed in all cases of penile cancer. Recent research suggests such wide margins may not be needed. Surgeons try to spare as much of the glans (head) and shaft as possible to keep urinary and sexual function.
  • Total penectomy: Removal of the entire penis for treatment of large penile cancer tumors. The surgeon reroutes the urethra (tiny tubes that urine passes through) behind the testicles, and an urethrostomy (hole) is created so you can urinate. Penile reconstruction surgery using a flap of skin from the forearm to create a new penis has been done, but the procedure is rare.
  • Mohs surgery (microscopically-controlled surgery): The surgeon surgically removes a thin layer of skin and looks at it right away under a microscope. This process is repeated until the cells are free of cancer.
  • Laser surgery: Light from a laser vaporizes penile cancer cells.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow us to target penile cancer more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. In penile cancer, radiation therapy may be used to treat early stage tumors, with surgery to remove lymph nodes, and in advanced cancers to control spread and help relieve symptoms.

Chemotherapy

We offer the most up-to-date and advanced chemotherapy options for penile cancer.

  • Topical chemotherapy: An anti-cancer medicine, usually 5-fluorouracil or 5-FU, is applied as a cream for several weeks. This generally is used only for precancerous or very early penile cancer.
  • Systemic chemotherapy: Medicine injected into a vein or given by mouth.
  • Imiquimod: A drug in a cream form that boosts the body's immune system. It sometimes is used to treat very early stage penile cancer.

Penile Cancer

Since penile cancers begin in the skin of the penis, men often notice them in the early stages. However, some men are hesitant to mention the changes to their doctors, which delays their treatment.

Penile Cancer Diagnosis

If you have symptoms that may signal penile cancer, your doctor will ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family medical history. The doctor will examine your penis.

If your doctor suspects you may have penile cancer, one or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.

Biopsy: A biopsy usually is the first test performed to find out if you have penile cancer. The type of procedure depends on the type of tissue or lesion.

  • Incisional biopsy: A small part of abnormal tissue is removed. This procedure is used most often for lesions that are larger, ulcerated or that appear to have spread deep into the tissue.
  • Excisional biopsy: The whole growth or lesion is removed. Usually, this type of biopsy is performed for small abnormal areas. If the lesion is on the foreskin, you doctor may suggest circumcision.

Fine needle aspiration (FNA): This type of biopsy may be used to examine the tissue in lymph nodes. A thin needle is inserted into the groin area. Then cells are drawn out and looked at under a microscope.

Imaging tests, which may include :

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

Our Approach

The experts with us at Genitourinary Cancer Center are among the nation's most skilled and experienced at diagnosing and treating penile cancer. This translates to an extraordinary level of expertise that can make a direct difference in your successful treatment and recovery.

Customized, Comprehensive Care

Here, you receive personalized penile cancer care from a team of some of the most renowned experts in the nation. This group, which includes medical and surgical oncologists, as well as other physicians and a specially trained support staff, collaborates to ensure you receive the most advanced penile cancer treatments with the least impact on your body. And, as one of the premier cancer research institutions, we are able to offer a range of clinical trials of new agents to treat penile cancer.

Penile Cancer Facts

The penile cancer rate is much higher in India and some South American and African countries.

Penile cancer forms in the penis. It generally starts on the glans (head or tip) of the penis.

Penile Cancer Types

The penis contains several types of cells. Penile cancer is classified by the type of cells in which it develops. The main types of penile cancer are :

  • Squamous cell carcinoma
  • Kaposi sarcoma
  • Adenocarcinoma
  • Melanoma
  • Basal cell
  • Sarcoma

Penile Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Unfortunately, no standardized screening tests other than examining the penis have been shown to find penile cancer early. If you have a foreskin, examine the area underneath it regularly. Be sure to keep the area clean. Penile cancer can start as a reddened or scaly area or a sore on the penis. Report any changes to your doctor.

Penile Cancer Risk Factors

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

  • Age: Most cases are seen in men 50 to 70 years old. About a third are in men under 50
  • Tobacco use
  • Human papillomavirus (HPV): This sexually transmitted disease has more than a dozen subtypes. HPV 16 and HPV 18 are linked most often to penile cancer.
  • Lack of circumcision at birth
  • Phimosis: A condition that makes it difficult to pull back the foreskin. This can lead to the buildup of body oils, bacteria and other debris known as smegma
  • UV light treatment of psoriasis
  • AIDS (acquired immune deficiency syndrome)

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

Penile Cancer Staging

If you are diagnosed with penile cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Penile Cancer Stages

Stage 0: Penile cancer has not grown into tissue below the top layers of skin and has not spread to lymph nodes or distant sites.

Stage I: Penile cancer has grown into tissue just below the superficial layer of skin but has not grown into blood or lymph vessels. It has not spread to lymph nodes or distant sites.

Stage II: Any of the following :

  • Penile cancer has grown into tissue just below the superficial layer of skin and is either high-grade or has grown into blood or lymph vessels. It has not spread to lymph nodes or distant sites.
  • The cancer has grown into one of the internal chambers of the penis (the corpus spongiosum or corpora cavernosum). The cancer has not spread to lymph nodes or distant sites.
  • The cancer has grown into the urethra (tube that urine passes through). It has not spread to lymph nodes or distant sites.

Stage IIIa: Penile cancer has grown into tissue below the superficial layer of skin. It also may have grown into the corpus spongiosum (tissue within the penis) or the urethra (the small tube through which urine passes from the bladder to the outside of the body). The cancer has spread to a single groin lymph node. It has not spread to distant sites

Stage IIIb: Penile cancer has grown into the tissues of the penis and may have grown into the corpus spongiosum, the corpus cavernosum or the urethra. It has spread to two or more groin lymph nodes. It has not spread to distant sites.

Stage IV: Any of the following :

  • The cancer has spread to lymph nodes in the pelvis or the cancer spread in the groin lymph nodes has grown through the lymph nodes' outer covering and into the surrounding tissue. The cancer has not spread to distant sites.
  • Penile cancer has grown into the prostate or other nearby structures. It may or may not have spread to groin lymph nodes. It has not spread to distant sites.
  • The cancer has spread to distant sites.

Recurrent penile cancer is cancer that went away with treatment but later came back. Recurrent penile cancer may return in the penis or any other part of the body.

Some men who develop penile cancer have obvious symptoms in the early stages. Others may not have signs until the disease has spread. Symptoms vary from man to man. They may include :

  • Change in the skin of the penis
  • Wart-like growth or lesion that may or may not be painful
  • Open sore that won't heal
  • Reddish rash
  • Small, crusty bumps
  • Flat bluish brown growths
  • Swelling at the end of the penis
  • Persistent, smelly discharge under the foreskin
  • Swollen lymph nodes in the groin if the cancer has spread

You may not be able to see these changes unless the foreskin is pulled back.

Unfortunately, many men do not want to talk about these symptoms with their doctors. This may delay them from seeking treatment until penile cancer is advanced and harder to treat.

Although these symptoms may not mean you have penile cancer, you should report any changes in the penis to your doctor as soon as possible. They may be signs of another health problem.

Our Treatment Approach

When you are treated here for penile cancer, some of the nation's top specialists focus their expertise on you. They communicate with each other – and with you – to ensure you receive the most advanced treatment with the least impact on your body.

This means we have a higher level of experience and expertise, which is crucial to your treatment and recovery.

Like all surgeries, penile cancer surgery often is more successful when performed by a specialist with a great deal of experience. This is particularly true for organ-preserving surgeries, and plastic surgery reconstruction, which usually are used to treat penile cancer.

Penile Cancer Treatments

If you are diagnosed with penile cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

Surgery is the most frequent form of treatment for penile cancer, but laser therapy and radiation may be used for smaller tumors. The type of treatment usually depends on how far the cancer has spread.

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

Surgery

Surgery to remove all or part of the penis is called penectomy. Penile preservation surgery (the penis is not removed) is used to treat penile cancer whenever possible.

  • Circumcision: Surgical removal of the penis foreskin and some of the nearby skin. This procedure may be done if the penile cancer has not spread beyond the foreskin. It also may be done before radiation therapy.
  • Partial penectomy: The tumor is removed along with a margin of healthy tissue. In the past, a 2-centimeter margin was removed in all cases of penile cancer. Recent research suggests such wide margins may not be needed. Surgeons try to spare as much of the glans (head) and shaft as possible to keep urinary and sexual function.
  • Total penectomy: Removal of the entire penis for treatment of large penile cancer tumors. The surgeon reroutes the urethra (tiny tubes that urine passes through) behind the testicles, and an urethrostomy (hole) is created so you can urinate. Penile reconstruction surgery using a flap of skin from the forearm to create a new penis has been done, but the procedure is rare.
  • Mohs surgery (microscopically-controlled surgery): The surgeon surgically removes a thin layer of skin and looks at it right away under a microscope. This process is repeated until the cells are free of cancer.
  • Laser surgery: Light from a laser vaporizes penile cancer cells.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow us to target penile cancer more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. In penile cancer, radiation therapy may be used to treat early stage tumors, with surgery to remove lymph nodes, and in advanced cancers to control spread and help relieve symptoms.

Chemotherapy

We offer the most up-to-date and advanced chemotherapy options for penile cancer.

  • Topical chemotherapy: An anti-cancer medicine, usually 5-fluorouracil or 5-FU, is applied as a cream for several weeks. This generally is used only for precancerous or very early penile cancer.
  • Systemic chemotherapy: Medicine injected into a vein or given by mouth.
  • Imiquimod: A drug in a cream form that boosts the body's immune system. It sometimes is used to treat very early stage penile cancer.

Prostate Cancer

If you have prostate cancer, it’s important to get an accurate diagnosis as soon as possible. This helps increase the odds for successful treatment and recovery.

Prostate Cancer Diagnosis

If you have symptoms that may signal prostate cancer, your doctor will ask you questions about your health, your lifestyle and your family medical history.

One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.

Digital Rectal Exam (DRE)

The simplest screening test for prostate cancer is the digital rectal exam (DRE). The health care provider gently inserts a gloved forefinger into the rectum to feel the prostate gland for enlargement or other abnormalities, such as a lump.

The DRE is not a definitive cancer test, but regular exams help detect changes in the prostate over time that might signal cancer or pre-cancerous conditions.

Although this test usually is not as reliable as the PSA blood test, a DRE may be able to find cancer if a man has a normal PSA level. A DRE also may be used to tell if prostate cancer has spread or returned after treatment.

Prostate-specific antigen (PSA) Test

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. It is found mostly in semen, but a small amount is in the blood as well.

A blood test measures the amount of PSA circulating in the blood, expressed in nanograms per milliliter (ng/mL). This level is used to assess prostate cancer risk. A higher PSA level usually means a higher chance of having prostate cancer.

However, the test has limitations. PSA is produced by both prostate tissue and prostate cancer. Sometimes prostate cancer does not produce much PSA and higher levels can be caused by factors other than cancer, including :

  • Enlarged prostate, also called benign prostatic hyperplasia (BPH), which is found often in older men.
  • Age: PSA levels normally go up slowly as men age
  • Infection or inflammation of the prostate, which also is called prostatitis
  • PSA may rise briefly after ejaculation, then return to normal levels

On the other hand, certain conditions may make PSA levels low, even when a man has prostate cancer. These include :

  • Some drugs used to treat BPH or other conditions
  • Certain herbal medicines or supplements
  • Obesity

Despite its limitations, PSA testing has helped detect prostate cancer in countless men. In 1984, before PSA testing was available, the chance of finding early prostate cancer was about 50%. In 1993, after PSA testing became widely used, that figure jumped to more than 90%.

Men with very low PSA levels may need to be tested every two years. However, if PSA is higher, the doctor may recommend more frequent testing.

Because prostate cancer develops slowly, physicians usually do not recommend the PSA test for men who are older than 75 or have other significant health issues.

Additional PSA Testing

Besides screening, PSA testing can be used in other ways in men who have been diagnosed with prostate cancer. For instance, it may :

  • Help doctors plan your treatment or further testing
  • Determine if cancer has metastasized (spread beyond the prostate)
  • Find out if treatment is working or cancer has returned
  • Aid in active surveillance (also called watchful waiting) by showing if cancer is growing

Biopsy

If your doctor suspects prostate cancer, a biopsy may be performed. This is the only way to tell for sure if you have prostate cancer.

Biopsies for prostate cancer are done in a doctor’s office or other facility as an outpatient procedure. A local anesthetic like dentists use, often lidocaine, is injected into the area close to the prostate to make the procedure more comfortable.

A small transrectal ultrasound (TRUS) probe with an imaging device is inserted into the rectum so the doctor can view the prostate on a video screen. Using this image as a guide, the physician injects a thin needle through the wall of the rectum into the prostate. Several tiny samples of tissue are removed.

Sometimes a biopsy will not find prostate cancer, even if it is there. If your doctor is concerned that you may have prostate cancer based on a follow-up PSA test, a second biopsy may be performed.

Prostate Cancer Risk Assessment

If you are diagnosed with prostate cancer, your doctor will make a series of estimates about the risk the disease may be harmful in the future. Factors include :

  • Gleason score (see below)
  • PSA level
  • Clinical stage, which is based on findings of the digital rectal exam (DRE)

Low risk:

  • Less than 10% chance of having spread to other parts of the body
  • Low risk of progressing if not treated
  • PSA less than 10 ng/nL
  • Gleason score of 6 or lower
  • No tumor felt on DRE or feels contained within the prostate gland with only a small abnormal area

Intermediate risk:

  • 10% to 15% chance of having spread
  • Higher chance (up to 70% over 15 years) of progressing if not treated
  • PSA of 10 to 20 ng/mL
  • Gleason score of 7
  • Tumor can be felt on one or both sides of the prostate on DRE, but it seems to be contained within the gland

High risk:

  • Aggressive features that increase the chance of spreading now or in the future
  • PSA over 20 ng/mL
  • Gleason score of 8 to10
  • Tumor can be felt on DRE and seems to have spread outside the gland

Gleason Grading System

If a biopsy finds prostate cancer, it will be classified using the Gleason grading system. This helps doctors choose the best treatment options and predict how quickly the cancer is growing.

Prostate cancer contains several types of cells. The Gleason system uses the numbers 1 to 5 to grade the most common (primary) and next most common (secondary) cell types found in a tissue sample. The sum of these two numbers is the Gleason score, which indicates how aggressive the tumor is. The higher the Gleason score, the more aggressive the cancer.

Gleason grades 1 and 2 are rarely seen since these changes are now usually classified as benign or occur at the center of the gland and remain undiscovered. That means the usual lowest grade is 3. Gleason scores of :

  • 3+3 are low grade and have the lowest risk of harm
  • 3+4 and 4+3 are intermediate risk — the latter being the more aggressive type
  • 4+4 through 5+5 are the highest risk

If the prostate cancer is determined to be intermediate or high risk, imaging tests such as bone scans and CAT (computed axial tomography) or MRI (magnetic resonance imaging) scans may be used to determine if the cancer has spread.

Taken together, the disease risk status and imaging results will help your doctor plan the best treatment.

Our specialized group communicates and collaborates closely – with you and each other – to be sure you receive the most advanced prostate cancer care with the least impact on your body. Your team includes medical, surgical and radiation oncologists, as well as a specially trained support staff. They work with the latest technology and techniques, including :

  • Open prostatectomy (often with nerve-sparing techniques)
  • Minimally invasive laparoscopic robotic prostatectomy
  • Intensity modulated radiation therapy (IMRT)
  • Proton therapy
  • Brachytherapy
  • Cryotherapy
  • Targeted therapies
  • Vaccine therapy
  • Hormonal therapy
  • Active surveillance

Prostate Cancer Facts

  • Prostate cancer is the type of cancer found most often among men in the and second only to lung cancer as a cause of cancer deaths among men in this country.
  • The survival rate is increasing, and awareness, screening and improved therapies are some of the reasons. If found early, prostate cancer has a good chance for successful treatment. In fact, prostate cancer sometimes does not pose a significant threat to a man’s life and can be observed carefully instead of treated immediately.
  • The prostate is a walnut-size gland in the male reproductive system. Just below the bladder and in front of the rectum, it surrounds part of the urethra, a tube that empties urine from the bladder. The prostate helps produce semen and nourish sperm.
  • The prostate begins to develop while a baby is in his mother’s womb. Fueled by androgens (male hormones), it continues to grow until adulthood.
  • Sometimes, the part of the prostate around the urethra may keep growing, causing benign prostatic hyperplasia (BPH). While this condition may interfere with passing urine and needs to be treated, it is not prostate cancer.

Prostate Cancer Types

  • Almost all prostate cancers begin in the gland cells of the prostate and are known as adenocarcinomas.
  • Pre-cancerous changes of the prostate: By age 50, about half of all men have small changes in the size and shape of the cells in the prostate. This is called prostatic intraepithelial neoplasia (PIN).
  • Some research has indicated these cellular changes may eventually develop into prostate cancer. But this is controversial, and preventive treatment is not recommended.
  • If PIN is present, the best strategy is to be certain a thorough biopsy procedure shows no invasive cancer. If PIN is the only finding, then careful follow-up screening with a prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) is recommended.

Prostate Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Prostate cancer screening is a controversial topic. Screening tests include :

  • Digital rectal exam (DRE)
  • Prostate-specific antigen (PSA) blood test

While screening detects prostate cancer earlier than waiting for symptoms to develop, only a small number of these cancers may be harmful or life threatening. The overall chance of being harmed by prostate cancer is difficult to predict, and it depends on a man’s age, health, and the grade or stage of the cancer. Since prostate cancer grows slowly, the risks of treatment may outweigh the advantages, especially in older men and men with other health problems.

Educate Yourself about Testing

Men older than 40 should educate themselves about the advantages and limitations of prostate cancer screening. Prostate cancer screening may lead to more invasive tests or treatment that may not be necessary. On the other hand, it may not detect some aggressive cancers in the early stages. Talk to your doctor about whether screening is right for you.

In general, prostate cancer screening should begin at age :

  • 50 for most men
  • 45 for African-American men or men with family histories (father, brother, son) of prostate cancer
  • Men older than 75 should consult their doctors about screening.

Screening has Limits

In many men, the PSA level slowly increases over time because of a condition called benign (non-cancerous) prostatic hyperplasia (BPH). It may be difficult to differentiate between BPH and prostate cancer since both can cause a PSA elevation. Sometimes, the threat of prostate cancer is evaluated based on the speed at which PSA increases.

While PSA and DRE are the best available prostate cancer screening tools, they have limitations. Researchers are working to develop more advanced tools. If you have regular PSA screening, keep track of your PSA values in a file or spreadsheet. The PSA trend is an important factor in predicting cancer and this complete history of screening results will also be helpful if you change doctors.

Why to choose us -

  • Leading - edge prostate cancer treatments
  • Minimally invasive, nerve-sparing and sural nerve graft surgical procedures
  • Latest radiotherapy techniques for prostate cancer, including intensity modulated radiation therapy (IMRT) and brachytherapy
  • Team of experts provides personalized care for prostate cancer

Prostate Cancer Risk Factors

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

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

Prostate Cancer Prevention

Certain actions may help lower your risk of prostate cancer:

  • Eat at least five servings of fruits and vegetables daily and eat less red meat. Decrease fat intake.
  • Tell your doctor about supplements you take. Some of these may decrease the PSA level. A recent large study found that selenium and vitamin E, once thought to decrease risk of prostate cancer, have no effect.
  • Exercise regularly
  • Maintain your ideal weight

Other ways to avoid prostate cancer are being investigated. These include :

  • Lycopenes: These substances found in tomatoes, pink grapefruit and watermelon may help prevent damage to cells.
  • Proscar® (finasteride) or Avodart® (dutesteride): If you are at high risk for prostate cancer, talk to your urologist or other provider who is familiar with studies about these drugs

Prostate cancer often shows no symptoms in the early stages. If symptoms do appear, they vary from man to man. Signs you may have prostate cancer may include :

  • Painful or burning urination
  • Inability to urinate or difficulty in starting to urinate
  • Difficulty trying to hold back urination
  • Weak or interrupted urine flow
  • Frequent or urgent need to urinate
  • Trouble emptying the bladder completely
  • Blood in the urine or semen
  • Continual pain in the lower back, pelvis, hips or thighs
  • Difficulty having an erection

Having any of these symptoms does not mean you have prostate cancer. Some of the same symptoms can occur with BPH (benign prostatic hypertrophy) or other health problems. If you notice one or more of these symptoms for more than two weeks, see your doctor.

Our Treatment Approach

With us, you receive customized care that is planned by some of the nation’s leading experts. Your personal team of specialists communicates and collaborates at every step to be sure you receive the most advanced therapies with the least impact on your body.

Your options for prostate cancer treatment may include :

  • Open prostatectomy (often with nerve-sparing techniques)
  • Minimally invasive laparoscopic robotic surgery
  • Intensity modulated radiation therapy (IMRT)
  • Proton therapy
  • Brachytherapy
  • Cryotherapy
  • Molecular-targeted therapy
  • Vaccine therapy and gene therapy
  • Hormone therapy
  • Active surveillance

We have a multidisciplinary prostate cancer clinic to help you decide which prostate cancer treatment is best for you.

If you and your physician decide surgery is your best alternative, you should look for a surgeon with as much experience as possible in performing the procedure. Studies have shown this increases odds for successful surgery with fewer side effects.

In addition, our status as one of the nation’s most active prostate cancer research centers enables us to offer a wide range of clinical trials of new treatments for all stages of prostate cancer.

Prostate Cancer Treatments

If you are diagnosed with prostate cancer, your doctor will discuss the best options to treat it. This depends on several factors, including :

  • Your age and general health
  • Stage and grade of cancer
  • Whether the cancer has spread
  • Side effects of treatment

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

Surgery

The most frequent surgical procedure to treat prostate cancer is radical prostatectomy, which is removal of :

  • The entire prostate gland
  • Both seminal vesicles, which play a part in making semen
  • A short segment of the urine tube that passes through the prostate

The urinary system is reconstructed by suturing (sewing) the bladder opening to the urethra. In some patients, one or more lymph node groups in the pelvic area may be removed to find out if the prostate cancer has spread. This is called lymphadenectomy or lymph node dissection. In more advanced prostate cancer, one or both of the neurovascular bundles, which play a part in erectile function, may be partially or completely removed.

Prostate Cancer Surgery Techniques

The two main surgical techniques for removal of the prostate are :

Open: A large incision is made in the lower abdomen, and the prostate is removed.

Robot-assisted (laparoscopic) minimally invasive: Multiple small incisions are made in the abdomen, and then an endoscope connected to robotic arms is inserted. A miniature video camera and surgical tools are attached to the end of the endoscope. The surgeon, seated at a console, can view the surgery site on a video screen and control the robotic arms

The robotic technique is commonly used in the United States. Studies show robotic-assisted surgery may result in :

  • Less blood loss
  • Shorter hospital stays
  • Less urinary tract scarring
  • Fewer complications

However, the techniques are fairly equal in retaining urinary and sexual function and controlling cancer. The experience of the surgeon probably will affect your result more than which set of tools is used.

Recovery of function after prostate cancer surgery

Urinary control: Most men have stress urinary incontinence (leakage of a small amount of urine when laughing, sneezing, coughing, etc.) after a radical prostatectomy.

  • Within a few days to three months, most men have 90% or more of the urinary function they had before surgery.
  • At one year, approximately 95% of men have pre-surgery levels of urinary control or are very close.
  • Approximately 10% have rare urinary accidents and wear protective pads.
  • Fewer than 5% have permanent significant leakage problems.

Sexual function: Since the prostate and seminal vesicles produce the majority of semen, sexual climax after a prostatectomy does not produce fluid. However, the climax response is preserved.

The success of preserving sexual function (the ability to maintain erections for sex) depends on :

  • Age, sexual function before surgery and medical history
  • Number of nerve bundles spared
  • Experience and expertise of the surgeon

Radiation Therapy

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

The newest radiation therapy techniques and remarkable skill allow our doctors to target tumors more precisely than ever before, delivering the maximum amount of radiation with the least damage to healthy cells.

We provides the most advanced radiation treatments for prostate cancer, including :

  • Intensity-modulated radiotherapy (IMRT): External radiation which is tailored to the specific shape of the tumor, avoiding surrounding normal organs
  • Brachytherapy: Tiny radioactive seeds are placed in the prostate very close to the tumor and left permanently

Because the prostate can move within the body from day to day, techniques are used to ensure the radiation is being given to the exact location of the organ each day. These include :

  • Ultrasound imaging through the abdomen
  • Implanting gold markers that show up on X-rays
  • CT or CAT (computed axial tomography) scan
  • Proton therapy

Hormone Therapy

The majority of prostate cancers are hormone-sensitive, which means male hormones (androgens) such as testosterone fuel growth of the cancer.

About one-third of prostate cancer patients require hormone therapy (also called androgen deprivation), which blocks testosterone production or blocks testosterone from interacting with the tumor cells. This reduces the tumor size or makes it grow more slowly.

While hormone therapy may help control prostate cancer, it does not cure it.

Hormone therapy is most often used for late-stage, high-grade tumors (Gleason score of 8 or higher) or in patients with cancer that has spread outside the prostate. However, doctors have different opinions about the length and timing of hormone therapy.

Hormone therapy may be used to treat prostate cancer if :

  • Surgery or radiation is not possible
  • Cancer has metastasized (spread) or recurred (come back after treatment)
  • Cancer is at high risk of returning after radiation
  • Shrinking the cancer before surgery or radiation increases the chance for successful treatment

Intermittent hormone therapy is a variation of hormone therapy in which drugs are used for a period of time, then stopped and started again. For some men, this approach to prostate cancer causes fewer side effects. The effectiveness of this approach is still being studied, but it appears particularly useful in some situations.

The types of hormone therapies for prostate cancer are :

Anti-androgens: These drugs, which include Eulexin® (flutamide or flutamin) and Casodex® (bicalutamide), block testosterone from interacting with the cancer cell. They are taken by mouth every day.

Anti-androgens are used most often in combination with LHRH agonists (see below). Occasionally, anti-androgens are used as an alternative to LHRH agonists if the side effects are excessive for the patient.

LHRH agonists: These drugs work by over-stimulating the pituitary gland to release luteinizing hormone-releasing hormone (LHRH). After an initial surge, this signals the testicles to suppress testosterone production. Treatments are injections, which last from one to six months, or implants of small pellets just under the skin.

LHRH agonists may cause a spike or flare in the testosterone level before treatment takes effect. To offset this effect, anti-androgens may be given for a few weeks before the initial LHRH injection. The effects of LHRH are usually not permanent, such that testosterone production may resume once the medication is stopped.

Orchiectomy: Surgical removal of the testicles. This removes the organ, which produces testosterone, and is another way to keep testosterone from the prostate cancer. Orchiectomy is an efficient, cost-effective and convenient method of reducing testosterone, and it is an option if you will be treated with testosterone suppression indefinitely. After this surgery, most men cannot have erections.

Side effects of hormone therapies for prostate cancer may include :

  • Impotence, inability to get or maintain an erection
  • Loss of libido (sex drive)
  • Hot flashes
  • Growth of breast tissue and tenderness of breasts
  • Loss of muscle mass, weakness
  • Decreased bone mass (osteoporosis)
  • Shrunken testicles
  • Depression
  • Loss of self-esteem, aggressiveness/alertness and higher cognitive functions such as prioritizing or rationalization
  • Anemia (low red blood cell count)
  • Weight gain
  • Fatigue
  • Higher cholesterol levels
  • Increased risk of heart attacks, diabetes and high blood pressure (hypertension)

If you are treated with hormone therapy and have side effects, be sure to mention them to your doctors. Many of these side effects can be treated successfully.

Gene Therapy

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

Cryotherapy

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

Targeted Therapies

MD Anderson is leading some of the world’s most innovative research into these newer agents that are specially designed to treat each cancer’s specific genetic/molecular profile to help your body fight the disease.

Vaccine Therapy

These agents help the body fight the cancer on a molecular basis.

Chemotherapy

Most physicians reserve the use of chemotherapy for prostate cancer that has spread to other organs and is no longer responding to hormone therapy.

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

Active Surveillance or Watchful Waiting

Because prostate cancer usually grows slowly, some men with prostate cancer, especially those who are older or have other health problems, may never be treated for it. Instead, their doctors may recommend active surveillance, an approach also known as "watchful waiting."

This approach involves closely monitoring the prostate cancer without active treatment such as surgery or radiation therapy. Biopsies and PSA tests are repeated at set intervals, and treatment may be recommended if the tumor shows an increase in the volume or the grade (Gleason score).

Long-term studies of active surveillance for men with low-volume, low-grade prostate cancer tumors show that approximately 70% can maintain this approach for up to 10 years without requiring treatment.

Side Effects of Treatment

After treatment for prostate cancer, you may have side effects. These depend the therapy you received and may involve :

  • The urinary tract (the bladder and the urethra)
  • The bowels, particularly the rectum
  • Impotence and sexual function

Talk to your doctor about any side effects you have. Treatments are available to help with most of them.

Sexuality after Prostate Cancer

Impotence, or not being able to maintain an erection to have sex, may be a problem after prostate cancer treatment. This may be temporary or permanent. If you are able to get an erection, you may be able to achieve orgasm. However, no semen will be ejaculated during orgasm. Some people call this dry orgasm.

Talk to your health care provider about erection problems. Treatments include pills (such as Viagra®, Levitra® or Cialis®), vacuum erection devices and medications given by injections (shots).

Fertility after Prostate Cancer

Surgery to treat prostate cancer usually requires cutting the tubes between the testicles and urethra that transport the sperm and semen. Furthermore, surgery removes the prostate and seminal vesicles that produce the semen. Radiation significantly decreases the amount of semen that is produced, and semen is necessary to carry the sperm. This makes it impossible to father children without highly sophisticated sperm retrieval and in-vitro fertilization procedures.

If you want to have children in the future, it may be a good idea to bank sperm before cancer treatment. Speak to your doctor if you want more information or have questions.

Rectal Cancer

Rectal Cancer Diagnosis

If you have symptoms that may signal rectal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have rectal cancer and if it has spread. These tests also may be used to find out if treatment is working.

Digital rectal exam: The doctor inserts a gloved finger into the rectum to feel for polyps or other problems.

Fecal occult blood test (FOBT): This take-home test looks for blood in stool. A stool sample is examined for traces of blood not visible to the naked eye.

Fecal immunochemical test (FIT): This take-home test detects blood proteins in stool.

Endoscopic tests, which may include :

  • Proctoscopy: A thin, tube-like instrument (proctoscope) is inserted into the rectum. This lets the doctor view the rectum. Suspicious tissue or polyps can be biopsied (removed) for examination.
  • Sigmoidoscopy: Flexible plastic tubing with a camera on the end (sigmoidoscope) is inserted into the rectum. This gives the doctor a view of the rectum and lower colon. Suspicious tissue or polyps can be biopsied (removed) for examination. The tumor can be marked to help the doctor do minimally invasive surgery. Also called flexible sigmoidoscopy or flex-sig.
  • Colonoscopy: A colonoscope is a longer version of a sigmoidoscope. Doctors use it to look at the entire colon.
  • Endoscopic ultrasound (EUS): An endoscope is inserted into the body. A probe at the end of the endoscope bounces high-energy sound waves (ultrasound) off internal organs to make a picture (sonogram). Also called endosonography.

Imaging tests, which may include :

  • CT or CAT (computed tomography) scan
  • MRI (magnetic resonance imaging) scan
  • PET/CT (positron emission tomography) scan
  • Virtual colonoscopy or CT (computed tomography) colonoscopy: A scope is not put into the rectum, and you do not have to be sedated.
  • Double contrast barium enema (DCBE): Barium is a chemical that allows the bowel lining to show up on X-ray. A barium solution is given by enema. Then a series of X-rays are taken.

Blood test for carcinoembryonic antigen (CEA): This blood test looks for CEA, a tumor marker made by most rectal cancers. It also can be used to measure tumor growth or find out if cancer has come back after treatment.

Our Approach

Our Colorectal Center cares for rectal cancer with a specialized team approach that is personalized, yet comprehensive. Your therapy is customized to meet your unique needs, providing the most advanced treatment with the fewest side effects.

Our rectal cancer treatment options include the most effective therapies, including proton therapy, intensity modulated radiation therapy (IMRT) and novel chemotherapies. Many of these are available at only a few cancer centers in India.

Advanced sphincter-preserving surgical techniques may help you avoid the need for a colostomy. If a colostomy is necessary, our specialized team of specially trained nutritionists and enterostomal nurses helps you make that transition.

Rectal Cancer Expertise

Many times, we can offer minimally invasive laparoscopic and robotic surgeries to patients with rectal cancer. These minimally invasive techniques often help reduce pain, recovery time and time in the hospital.

If chemotherapy is needed to treat rectal cancer, we offer the latest, most advanced options. Our world-renowned team of colorectal medical oncologists directs your therapy to maximize benefit while minimizing the risk for impact on your body. If radiation therapy is recommended, our colorectal radiation oncologists specialize in treating rectal cancer with the most effective techniques.

We have special expertise in advanced rectal cancer that has spread (metastasized) to other parts of the body. We offer novel chemotherapy and biological agents, as well as a dedicated surgery program with extensive experience in advanced disease.

Rectal Cancer Facts

When rectal cancer is found early, chances are good it can be treated successfully. Colon cancer and rectal cancer sometimes are grouped together and called colorectal cancer.

The rectum is a part of the digestive system, also called the gastrointestinal (GI) tract. The colon is the first 4 to 6 feet of the large intestine, also called the large bowel. The rectum is the last part of the large intestine, which ends in the anus.

Rectal cancer develops slowly and usually starts as polyps, which are overgrowths of tissue in the lining of the colon. Rectal cancer may develop within a polyp, but not all polyps contain cancer.

Rectal Cancer Types

More than 95% of colorectal cancers are adenocarcinomas. Approximately 90% of colorectal adenocarcinomas began as adenomas, which are a type of polyp that may become cancer.

Rectal Cancer Screening

Cancer screening exams are important medical tests done when you’re healthy and don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are best.

When it is detected very early, rectal cancer has a greater than 90% chance for successful treatment. That’s why you should be screened regularly.

We recommends the following screening guidelines for people at average risk with no colorectal cancer symptoms :

Beginning at age 50, men and women should follow ONE of these screening schedules :

Colonoscopy every 10 years ,polyps can be removed during the test

Virtual colonoscopy (also known as CT colonography) every five years. A colonoscopy will be performed if polyps are found. If you choose a virtual colonoscopy, check with your insurance provider before scheduling an exam. Not all insurance providers cover the cost of this exam.

Fecal occult blood test (FOBT) every year. This take-home test finds hidden blood in the stool, which may be a sign of cancer. A colonoscopy will be performed if blood is found.

Review your screening colonoscopy report and note what was found, including :

  • Number of polyps
  • Type of each polyp
  • Size of each polyp

To get a copy of your colonoscopy report, call the clinic or doctor who did the test. Ask for both the colonoscopy and pathology reports. Share this information with your doctor at your next check-up. The doctor will use this information to decide if your chances of getting colon cancer are higher than normal.

Rectal Cancer Risk Factors

Anything that increases your chance of getting rectal cancer is a risk factor. Rectal cancer risk factors include :

  • Age: Rectal cancer is found most often in people over 50 years old
  • Family history of colorectal cancer or polyps
  • Inherited disorders such as hereditary nonpolyposis colorectal cancer (HNPCC or Lynch) syndrome or familial adenomatous polyposis (FAP)
  • Race or ethnic background: African Americans and Jews of Eastern European descent (Ashkenazi Jews) are at higher risk
  • Inflammatory bowel disease (Crohn’s disease or chronic ulcerative colitis)
  • Colorectal cancer or polyps
  • Obesity
  • Lack of exercise
  • Eating a lot of red meat, processed meats or meats cooked at very high heat
  • Diabetes Type 2
  • Cigarette smoking
  • Drinking too much alcohol

Not everyone with risk factors gets rectal cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor. If you are concerned about inherited family syndromes that may cause rectal cancer, we offer advanced genetic testing to let you know your risk.

Rectal Cancer Prevention

Certain lifestyle choices may lower your chances of getting rectal cancer. Try to :

  • Have regular screening tests
  • Stay at a healthy weight
  • Exercise regularly
  • Eat a healthy diet with lots of fruits and vegetables
  • Avoid cigarettes
  • Drink alcohol only in moderation

Rectal Cancer Staging

If you are diagnosed with rectal cancer, your doctor will find the stage of the disease. Staging is a way of determining how much disease is in the body and where it has spread. This information helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Rectal Cancer Stages

  • Stage 0: Abnormal cells are found in the innermost lining of the rectum. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 also is called carcinoma in situ.
  • Stage I: Cancer has formed and spread into the first (submucosa) or second (muscle) layers of the rectal wall. It has not spread outside of the rectum.
  • Stage II: Cancer has spread outside of the rectal walls into the surrounding fat or nearby tissue. It has not gone into the lymph nodes. It is divided into stages IIA, IIB, or IIC depending on the extent of local tumor involvement.
  • Stage III: Cancer has spread to nearby lymph nodes. It has not spread to other parts of the body. It is divided into stages IIIA, IIIB, or IIIC depending on the extent of local tumor involvement and the number of lymph nodes that contain cancer.
  • Stage IV: Cancer has spread to other parts of the body, such as the liver, lungs or ovaries. It is divided into stages IVA and IVB depending on the number of different other parts of the body to which the cancer has spread.

Rectal cancer often does not have symptoms in the early stages. When it does have symptoms, they vary from person to person. Most rectal cancers begin as polyps, small non-cancerous growths on the rectum wall that can grow larger and become cancer.

Symptoms of rectal cancer may include :

  • Rectal bleeding
  • Blood in the stool or toilet after a bowel movement
  • Diarrhea or constipation that does not go away
  • A change in size or shape of your stool
  • Discomfort or urge to have a bowel movement when there is no need
  • Abdominal pain or a cramping pain in your lower stomach
  • Bloating or full feeling
  • Change in appetite
  • Weight loss without dieting
  • Fatigue

These symptoms do not always mean you have rectal cancer. But if you notice one or more of these signs for more than two weeks, see your doctor.

Our Treatment Approach

Here, your care for rectal cancer is customized by a team of experts with incredible expertise and experience. We work together to provide the most advanced, least invasive therapy, while focusing on your quality of life. Your treatment team may include :

  • Surgical oncologists
  • Medical oncologists
  • Radiation oncologists
  • Gastroenterologists
  • Genetics specialists
  • Gynecologists
  • Specially trained nurses, ostomy nurses, nutritionists and social workers

Our doctors have special expertise in treating hereditary types of rectal cancer, as well as rectal cancer that has metastasized (spread) to other parts of the body or has returned being treated. Advanced genetic testing allows us to personalize your treatment for rectal cancer and determine if you or any of your family members may be at risk for other cancers.

Our Rectal Cancer Treatments

If you are diagnosed with rectal cancer, your doctor will discuss the best options to treat it. This depends on several factors, including :

  • The stage of the cancer
  • The location of the cancer in the rectum
  • If rectal cancer has just been diagnosed or has come back
  • If rectal cancer has spread to other parts of the body
  • Your general health

One or more of the following therapies may be recommended to treat rectal cancer or help relieve symptoms.

Surgery

Surgery is the most common treatment for rectal cancer. It is the main treatment for rectal cancer that has not spread to distant sites. Surgery for rectal cancer is most successful when done by a specialist with a great deal of experience in rectal cancer surgery

Rectal cancer may be treated with surgery alone or surgery combined with radiation, chemotherapy and/or other treatments. Chemotherapy or radiation may be given :

  • Before surgery to improve the effectiveness of surgery with less impact on your body. This is called neoadjuvant therapy.
  • After surgery to help keep you cancer free. This is called adjuvant therapy.

The type of surgical method used to treat rectal cancer depends on the stage and location of the tumor. Your doctor may recommend one of the following :

  • Polypectomy: Suspicious or cancerous polyps on the inside surface of the rectum usually can be removed during a colonoscopy. A colonoscope, which is a long tube with a camera in the end, is inserted into the rectum. The doctor guides it to the area needing treatment. A tiny, scissor-like tool or wire loop removes the polyp.
  • Local excision: If rectal cancer tumors are small and have not grown into the wall of the rectum, they sometimes may be removed through the anus.
  • Proctectomy (rectal resection): The area of the rectum where the cancer is located, along with some healthy surrounding tissue around the rectum, is removed. Nearby lymph nodes are removed (biopsied) and looked at under a microscope.

Depending on where the tumor is, the colon may be reconnected to the rectum or anus. This is called sphincter-preserving surgery. If the tumor is too low within the rectum or anus, a colostomy may be needed.

In a colostomy, a stoma (hole) is cut in the abdomen wall into the colon. Body waste goes through the stoma into colostomy, which is a plastic bag outside the body. Sometimes, a temporary ileostomy may be used to allow the reconnection of the bowel to heal after surgery.

Surgery may be done by :

Sphincter preservation surgery with or without stoma

  • Traditional open surgery
  • Minimally invasive surgery

Your doctor will decide which method is best for you.

During minimally invasive surgery, small cuts are made in the abdomen. A tiny camera and surgical instruments are inserted. The surgeon uses video imaging to perform the surgery just as would be done with open surgery. Minimally invasive surgery sometimes is done with the surgical robot (da Vinci®).

Minimally invasive surgeries for rectal cancer include endoscopic mucosal resection and endoluminal stent placement.

Pelvic exenteration: If rectal cancer has spread into other organs, such as the colon, bladder, prostate or female reproductive organs, those organs may be removed during surgery. Often a colostomy may be needed for elimination of bodily waste. Even with extensive resection, the expert surgeons at MD Anderson sometimes can perform sphincter- preserving surgery to avoid a colostomy.

Chemotherapy

We offer the most up-to-date and effective chemotherapy options for rectal cancer.

Targeted Therapies

We offer novel therapies for certain types of rectal cancer. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow, survive and spread.

Radiation Therapy

New radiation therapy techniques and expertise allow our doctors to target rectal cancer more precisely, delivering the maximum amount of radiation to the tumor with the least damage to healthy cells.

We provide the most advanced radiation treatments for rectal cancer, including :

  • Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
  • 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
  • Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor to reduce damage to normal tissue.

Skin Cancer

A biopsy of the suspicious lesion is the only way to find out for sure if you have skin cancer. Your doctor will remove a small amount of tissue from the area. The sample then is looked at under a microscope. This also helps your doctor plan the best treatment for you.

Skin Cancer Types

The two most common kinds of skin cancer are :

Basal cell carcinoma :

  • More than 90% of all skin cancers
  • Slow-growing and seldom spreads
  • If left untreated, can spread and invade bone and other tissues under the skin

Squamous cell carcinoma :

  • Can be more aggressive than basal cell carcinoma
  • Is more likely to grow deep below the skin and spread to distant parts of the body

These types of skin cancer sometimes are called nonmelanoma skin cancer. When they are found early, they can almost always be cured.

Other Types of Skin Cancer

Actinic (solar) keratosis: A precancerous condition that can develop into squamous cell carcinoma. It appears as rough, red or brown, scaly patches on the skin. They are often more easily felt than seen. Like skin cancer, actinic keratosis usually is found on sun-exposed areas of the body, but it can be found on other parts of the body as well.

Melanoma: A cancer that begins in the cells that produce skin pigment. It is less common than basal or squamous cell skin cancers, but it is more dangerous and can be deadly. If caught early, there is nearly a 97% chance for cure.

Skin Cancer Screening

Screening tests may be able to find certain types of cancer if a person is at risk but does not have symptoms. Early detection of skin cancer greatly increases the odds of successful treatment.

Skin Cancer Risk Factors

Anything that increases your chance of getting skin cancer is a risk factor.

Sun damage is the main risk factor for skin cancer. Artificial sunlight from tanning beds causes the same risk for skin cancer as natural sunlight. There is no such thing as a safe tan.

Other risk factors for skin cancer include :

  • Age: The longer you are exposed to the sun over time, the higher your risk of developing skin cancer.
  • Fair complexion, blond or red hair, freckles, blue eyes and/or a tendency to sunburn
  • Previous skin cancer
  • Living in a sunny climate
  • Working around coal tar, arsenic compounds, creosote, pitch and paraffin oil
  • Previous skin injuries, such as a major scar or burn
  • Actinic keratosis, a precancerous condition of thick, scaly patches of skin

Not everyone with risk factors gets skin cancer. However, if you have risk factors, it’s a good idea to discuss them with your health care provider.

Skin Cancer Prevention

You can lower your risk of getting skin cancer by making certain choices.

  • Avoid sunburn
  • Limit sun exposure
  • Do not use tanning beds or other artificial sunlight sources
  • Wear a sunscreen rated at least SPF 30, a broad-brimmed hat and a long-sleeved shirt when you’re outside
  • Wear sunglasses when you are outside
  • Stay inside in the sun’s peak hours between 10 a.m. and 3 p.m.
  • Protect your children. Babies under 6 months old should be completely shielded from direct sun exposure. Apply sunscreen to infants over 6 months old, and teach older children to make applying sunscreen a regular habit before they go outside.
  • Examine your skin monthly. Have any suspicious moles checked by a health care practitioner.
  • If you are at risk, have your skin examined at least once each year by a dermatologist.

Skin cancer symptoms vary from person to person. They may include a :

  • Change on the skin, such as a new spot or one that changes in size, shape or color
  • Sore that doesn’t heal
  • Spot or sore that changes in sensation, itchiness, tenderness or pain
  • Small, smooth, shiny, pale or waxy lump
  • Firm red lump that may bleed or develops a crust
  • Flat, red spot that is rough, dry or scaly

If you notice one or more of them for more than two weeks, see your doctor.

Your care for skin cancer with us includes a treatment plan customized to your specific type of cancer. Surgery is the most common therapy for skin cancer. Basal and squamous cell skin cancers usually are removed by one of the following surgeries.

Local wide excision and Reconstruction :

Mohs Surgery

Very thin layers of tissue are removed and looked at immediately under a microscope. If skin cancer cells can be seen in the layer, the dermatologic surgeon continues shaving off layers one at a time until all cancerous tissue is removed. Mohs surgery causes less scarring and has a shorter healing period than removing the entire area at once.

Mohs surgery is done at a doctor's office as an outpatient in a hospital. The skin is numbed. Occasionally a mild sedative may be given.

Cryosurgery

Cryosurgery is less invasive than conventional surgery. The doctor applies liquid nitrogen or argon gas to the cancer tissue to freeze and destroy it. The tissue is then allowed to thaw. This process may be repeated.

Because the doctor can focus cryosurgical treatment on a limited area, destruction of nearby healthy tissue may be avoided. The treatment may be used with other therapies, including surgery, chemotherapy, hormone therapy and radiation. Sometimes cryosurgery is an option when surgery is not possible.

Laser Surgery

Lasers use an intense, focused beam of light to destroy skin cancer tissue. The laser destruction, plus the body's immune response to the injury, results in a blistered wound that takes several weeks to heal.

The laser can be set to remove the skin in controlled layers, depending on the depth of the cancer. The surgeon may remove the top layer only or the top layer plus the next deeper layer and so on.

Lasers may be used to treat :

  • Skin cancer in hard-to-reach places such as between the toes
  • Superficial skin cancers
  • Precancers
  • Scars after skin cancer surgery
  • Noncancerous skin growths

Electrodessication

A scraping instrument (curette) and electrical currents are used to destroy and burn small and superficial skin cancer. This also is called "scraping and burning." The abnormal area is treated, along with a rim of surrounding skin called a safety margin.

Soft Tissue Sarcoma

We have the latest methods and technology to be sure you get the most accurate diagnosis possible. This can make a difference in the success of your treatment.

Accurate Diagnosis is Essential

Since sarcomas are complex and can develop in so many places in the body, they can be difficult to diagnose. However, it’s important to have an accurate diagnosis of the type and extent of the sarcoma before you are treated.

Getting the wrong diagnosis may actually be harmful and make therapy have less chance for success. A biopsy that is not done correctly can cause the cancer to spread and make your treatment more difficult. It is best for the surgeon who does the biopsy to also remove the tumor.

If at all possible, your first biopsy should be at the cancer center where you will receive treatment. Try to go to a cancer center that sees a large number of sarcoma patients and has a specialized sarcoma team that includes specialized pathologists.

If you have symptoms that may signal sarcoma, your doctor will examine you and ask you questions about your health and your family medical history.

Sarcoma Diagnostic Tests

The only way to be certain a tumor is sarcoma is a biopsy (removing a small number of cells to examine under a microscope). Imaging tests may be used before or after biopsy to determine the location and extent of the tumor.

Biopsy

The doctor will choose one of the following types of biopsy depending on where the tumor is.

Fine needle aspiration (FNA): A very small needle is placed into the tumor and suction is applied. CT (computed tomography) scans may be used to help guide the needle. Doctors trained to read these types of biopsies then review the small numbers of cells that are drawn into the needle.

If the test shows that the tumor may be a sarcoma, another type of biopsy probably will be done to remove a larger piece of tissue.

Core needle: The doctor uses a needle slightly larger than the one used in an FNA biopsy to remove a cylindrical sample of tissue.

Incisional: An incision (cut) is made in the skin and a small part of tumor is removed

Excisional: An incision (cut) is made in the skin and the entire growth is removed surgically

Imaging tests, which may include :

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

Our Approach

Our sarcoma center features one of the few medical teams in the world devoted to soft-tissue sarcomas. Our experts customize your care to deliver the most successful treatment, while focusing on your quality of life.

We see more sarcoma patients in a day than many cancer centers do in a year. This gives us a level of expertise and experience that can make a difference in your outcome.

Diagnosis of sarcomas can be challenging, but accurate diagnosis is essential to successful treatment. In fact, having an inaccurate or unsuccessful biopsy can be harmful. Our pathologists are dedicated to sarcoma, and they use the latest, most-sophisticated tests to pinpoint the type and extent of the cancer.

Sarcoma Facts

Sarcomas can start anywhere in the body. Typically, they develop in the soft tissues that surround, connect or support the body’s structure and organs. This includes muscles, joints, tendons, fat, blood vessels, nerves and tissues. They also can begin in the body’s organs.

Sarcoma Types

Some soft-tissue sarcomas are benign (not cancer), and others are malignant (cancer). There are more than 30 types of sarcoma, making each extremely rare.

Sarcomas are classified into groups that have similar types of cancer cells and symptoms. They usually are named for the type of tissue where they start. Sarcomas within a classification often are treated the same way.

The main types of soft-tissue sarcoma begin in :

  • Muscle tissue
  • Peripheral nerve tissue
  • Joint tissue
  • Blood and lymph vessels
  • Fibrous tissue

Sarcomas of uncertain tissue type: In this type of sarcoma, doctors are not able to determine the exact type of tissue where the cancer began.

Sarcoma Screening

Screening tests may be able to find certain types of cancer if a person is at risk but does not have symptoms. Unfortunately, no standardized screening tests have been shown to improve sarcoma outcomes.

If someone in your family has had a sarcoma or other type of cancer when he or she was young, or if certain diseases (see Risk Factors) run in your family, you should talk to your doctor about genetic testing.

Sarcoma Risk Factors

Anything that increases your chance of getting cancer is a risk factor. For sarcoma, risk factors include :

Inherited genetic conditions such as :

  • Von Recklinghausen disease
  • Li-Fraumeni syndrome
  • Gardner syndrome
  • Inherited retinoblastoma
  • Werner syndrome
  • Gorlin syndrome
  • Tuberous sclerosis

Damage or removal of lymph nodes during previous cancer treatments.

Exposure to vinyl chloride, a chemical used in making plastics.

Previous radiation treatment for another cancer.

Not everyone with risk factors gets sarcoma. However, if you have risk factors, it’s a good idea to discuss them with your health care provider.

Sarcoma Staging

If you are diagnosed with sarcoma, your doctor will determine the stage (or extent) of the disease.

Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis).

Once the staging classification is determined, the stage stays the same even if treatment is successful or the cancer spreads.

Sarcoma Stages

The system often used to stage sarcomas is the TNM system of American Joint Committee on Cancer.

T stands for the size of the tumor.

N stands for spread to lymph nodes (small bean-shaped collections of immune system cells found throughout the body that help fight infections and cancers).

M is for metastasis (spread to distant organs).

In soft tissue sarcomas, an additional factor, called grade (G), is part of tumor stage. The grade is based on how the sarcoma cells look under the microscope.

Grade

The official staging system divides sarcomas into three grades (1 to 3). The grade of a sarcoma helps predict how rapidly it will grow and spread, as well as your outlook for successful treatment (prognosis). The grade is part of what is used to determine the stage of a sarcoma.

The grade of a sarcoma is based on the way the cancer looks under the microscope. In grading a cancer, the pathologist considers three factors :

  • How closely the tumor resembles normal tissue (differentiation) on a scale of 1 to 3
  • How many of the cells appear to be dividing, on a scale of 1 to 3 (mitotic count)
  • How much of the tumor is made up of dying tissue. (tumor necrosis)

These factors are scored, and then the scores are added together to determine the grade of the tumor. The sarcomas with cells looking more normal and with fewer cells dividing are generally placed in a low-grade category. Low-grade tumors are slow growing, slower to spread, and often have a better outlook (prognosis) than higher-grade tumors. The grade is usually based on the way the cells look and how many are dividing, but certain types of sarcoma are automatically given higher scores for differentiation. This affects the overall score so much that they are never considered to be low grade. Examples of these include synovial sarcoma and embryonal sarcoma.

The scores for each factor are added up to determine the grade for the cancer. Higher-grade cancers tend to grow and spread faster than lower-grade cancers.

  • GX: the grade cannot be assessed because of incomplete information
  • Grade 1 (G1): total score of 2 or 3
  • Grade 2 (G2): total score of 4 or 5
  • Grade 3 (G3): total score of 6 or higher

Tumor

  • T1: The sarcoma is 5 cm (2 inches) or less across
  • T1a: The tumor is superficial -- near the surface of the body.
  • T1b: The tumor is deep in the limb or abdomen.
  • T2: The sarcoma is greater than 5 cm across.
  • T2a: The tumor is superficial -- near the surface of the body.
  • T2b: The tumor is deep in the limb or abdomen.

Lymph nodes

  • N0: The sarcoma has not spread to nearby lymph nodes.
  • N1: The sarcoma has spread to nearby lymph nodes.

Metastasis

  • M0: No distant metastases (spread) of sarcoma are found.
  • M1: The sarcoma has spread to distant organs or tissues (such as the lungs).

Stage grouping for soft tissue sarcomas

To assign a stage, information about the tumor, its grade, lymph nodes, and metastasis is combined by a process called stage grouping. The stage is described by Roman numerals from I to IV with the letters A or B. The stage is useful in selecting treatment, but other factors, like where the sarcoma is located, also impact treatment planning and outlook.

Stage IA

  • T1, N0, M0, G1 or GX: The tumor is not larger than 5 cm (2 inches) across (T1). It has not spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 1 (or the grade cannot be assessed).

Stage IB

  • T2, N0, M0, G1 or GX: The tumor is larger than 5 cm (2 inches) across (T2). It has not spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 1 (or the grade cannot be assessed).

Stage IIA

  • T1, N0, M0, G2 or G3: The tumor is not larger than 5 cm (2 inches) across (T1). It has not spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 2 or 3.

Stage IIB

  • T2, N0, M0, G2: The tumor is larger than 5 cm (2 inches) across (T2). It has not spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 2.

Stage III: Either

  • T2, N0, M0, G3: It is larger than 5 cm (2 inches) across (T2). It has not spread to lymph nodes (N0) or more distant sites (M0). The cancer is grade 3, OR
  • Any T, N1, M0, any G: The cancer can be any size (any T) and any grade. It has spread to nearby lymph nodes (N1). It has not spread to distant sites (M0)

Stage IV

  • Any G, Any T, Any N, M1: The tumor has spread to lymph nodes near the tumor (N1) and/or to distant sites (M1). It can be any size (any T) and grade (any G).

Signs of sarcoma vary from person to person. Many times sarcoma does not have symptoms in the early stages. Only about half of soft-tissue sarcomas are found in the early stages before they spread.

The location of the sarcoma makes a difference in the symptoms. For instance if they start :

• On the arms or legs, you may notice a lump that grows over a period of weeks to months. It may hurt, but it usually doesn’t.

• In the retroperitoneum (the back wall inside the abdomen), they may cause problems that have symptoms, such as pain. Tumors may cause blockage or bleeding of the stomach or bowels. They may grow large enough for the tumor to be felt in the abdomen.

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

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

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

Our Treatment Approach

We are committed to providing you with the most-advanced treatments for sarcoma with the least impact on your body. Your sarcoma treatment is customized specifically for you.

Because sarcoma is rare, most oncologists treat few if any patients in their careers. Statistics show that sarcoma patients have better outcomes when they are treated at large comprehensive cancer centers where specialized oncologists have more experience with the disease.

Our surgeons are among the most skilled in the world in surgery for sarcoma. They use the latest techniques, including limp-sparing surgeries. Usually patients are able to avoid the loss of an arm or leg.

Our Sarcoma Treatments

Sarcomas usually are treated with a combination of therapies that may include surgery, chemotherapy and radiation. If you are diagnosed with sarcoma, your doctor will discuss the best options to treat it. This depends on several factors, including :

  • The location and type of sarcoma
  • If the cancer has spread
  • Possible impact on your body
  • Your general health

Your treatment for sarcoma will be customized to your particular needs. It may include one or more of the following.

Surgery

Like all surgeries, sarcoma surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure.

Surgery is the main treatment for soft-tissue sarcomas. The surgeon removes the tumor, as well as a margin of healthy tissue around it to take out as many cancer cells as possible. You may receive chemotherapy or radiation therapy before or after the surgery.

Because of a special type of surgery called limb-sparing surgery, which often is followed with radiation therapy, most patients do not have to have arms or legs removed to treat sarcoma.

Chemotherapy

We offer the most up-to-date and advanced chemotherapy options. Chemotherapy may be used as the main treatment for sarcoma or with surgery or radiation. A combination of two or more chemotherapy drugs may be used. Sometimes limb profusion, a special way to give a more focused dose of chemotherapy may be used.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow our doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Radiation therapy usually is not used as the main treatment for sarcoma, but it may be used before surgery to shrink the tumor or after surgery to destroy remaining cancer cells. If you cannot have surgery, you may receive radiation therapy to help with pain and other symptoms. We provides the most advanced radiation treatments, including :

  • Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
  • 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
  • Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Stomach Cancer

Because stomach cancer often does not have symptoms until it has spread to other parts of the body or has symptoms that are mistaken for other conditions, it can be challenging to diagnose.

However, it is important for stomach cancer to be diagnosed as soon and as accurately as possible. This helps increase your odds for successful treatment and lowers the chance of side effects.

The experts with us are among the most skilled and experienced in diagnosing and staging stomach cancer. They use specialized advanced technology with pinpoint focus and reliable outcomes.

Precise Diagnostic Tools

In addition to standard diagnostic procedures, we offer endoscopic ultrasound, which gives specially trained doctors the ability to look inside the stomach and examine its walls for stomach cancer or pre-cancerous changes. This test, which is not available at many cancer centers, also allows physicians to view and biopsy the lymph nodes around the stomach.

Because stomach cancer can spread inside the abdomen and often is not detectable by any other means, we often perform staging laparoscopies, minimally invasive procedures to see if tumors have spread in abdomen.

We differentiate between gastrointestinal stromal tumor (GIST) and leiomyosarcoma (LMS) with near perfect accuracy. This will have wider application in more individualized diagnosis and treatment of stomach cancer and other types of cancer.

Stomach Cancer Diagnostic Tests

If you have symptoms that may signal stomach cancer, your doctor will examine you and ask you questions about your health, your lifestyle, including smoking and drinking habits, and your family medical history.

If stomach cancer is suspected, early tests may include :

  • X-rays of the gastrointestinal tract
  • Testing a stool sample for traces of blood

In addition, one or more of the following tests may be used to find out if you have stomach cancer, if it has spread or if treatment is working.

Biopsy: A biopsy is the removal of tissue to examine under a microscope. Different methods are available to obtain the tissue, depending on where it is located. In stomach cancer, biopsies usually are performed by endoscopy. An endoscope is inserted through the mouth, nose or an incision into the esophagus and stomach. The endoscope has a tool to remove tissue samples for examination.

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scans
  • PET (positron emission tomography) scans
  • MRI (Magnetic resonance imaging)
  • Chest and dental X-rays

Endoscopic ultrasound: Using specialized equipment, doctors insert an endoscope equipped with a small ultrasound device into the stomach. It produces sound waves that produce an image on a video screen.

Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for stomach cancer.

Blood tests, which may include :

  • Complete blood count (CBC) to look for anemia (low level of red blood cells) that may be caused by internal bleeding
  • β-hCG (beta-human chorionic gonadotropin), CA-125 and CEA(carcinoembryonic antigen) assays that measure certain chemicals in the blood

Our Approach

When you are treated for stomach cancer at our Gastrointestinal Center, you are the focus of some of the world's leading experts. They discuss your case at every juncture, planning together to ensure you receive personalized care that ensures the most-advanced treatments with the least impact on your body.

Your personal team of stomach cancer experts may include oncologists, surgeons and radiation oncologists, as well as specially trained nutritionists, nurses and others. They provide complete yet specialized treatment that is designed to provide optimum results and recovery. Stomach cancer can have a marked impact on your life, and our experts guide you every step of the way to help you cope and adjust.

Stomach Cancer Facts

According to the American Cancer Society, more than 21,000 new cases of stomach cancer were diagnosed in this country in 2009. Most cases are in people over age 65.

Stomach cancer, also called gastric cancer, has become much less common in the United States and Europe over the past 60 years. While the rates of stomach cancer in general are declining, cancers in the area of the stomach near where it joins the esophagus are increasing.

While stomach cancer is becoming less common in this country, it is the second leading cause of cancer death in much of the rest of the world, especially Japan, Eastern Europe, South America and parts of the Middle East. This may be due to differences in diet, the rate of infection with Helicobacter pylori and the environment.

Stomach Cancer Anatomy

Many times, people refer to the abdomen, the area between the hips and chest, as the stomach. But in medical terms, the word stomach refers only to the organ.

The stomach, a J-shaped organ, is in the upper abdomen. After you chew and swallow food, it moves through a hollow tube called the esophagus into the stomach. The stomach mixes the food with gastric juices and begins digestion of the food.

The lining of the stomach has three main layers :

  • Mucosal (inner)
  • Muscularis (middle)
  • Serosal (outer)

Generally, stomach cancer starts when cells in the mucosal layer change. Sometimes these changes develop into cancer, but most times they do not. Stomach cancer usually grows slowly and may not show symptoms for many years.

Stomach Cancer Types

Most stomach cancers are adenocarcinomas, which develop in the cells of the mucosa. However, stomach cancer can develop anywhere in the organ and spread to other parts of the body by growing beyond the stomach wall, entering the bloodstream or reaching the lymphatic system.

The other types of cancer found in the stomach are considered rare. They include :

  • Lymphoma, which affects a body’s immune system
  • Gastrointestinal stromal tumors, often called GIST or gastric sarcomas
  • Carcinoid tumors, which affect the hormone-producing cells of the stomach

Stomach Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest. Unfortunately, no standardized screening tests have been shown to improve stomach cancer outcomes. However, here at MD Anderson, we’re working to develop screening tests for those at risk.

If you are at high risk for stomach cancer, talk to your doctor about tests to find out if you have stomach cancer.

Stomach Cancer Risk Factors

Although the exact cause of stomach cancer is not known, certain factors seem to increase your risk of developing the disease. These include :

  • Eating foods preserved through pickling, salting and drying or that contain nitrates
  • Eating foods that have not been stored or prepared correctly
  • Obesity: Men who are obese have a higher risk of cancer in the part of the stomach nearest the esophagus
  • Infection with Helicobacter pylori: This type of bacteria, or germ, is a common cause of ulcers and may cause chronic inflammation in the stomach lining. This sometimes develops into pre-cancerous changes and cancer
  • Tobacco and alcohol abuse: Smoking and drinking excessive amounts of alcohol appear to increase the likelihood of cancer in the upper part of the stomach. Some studies have shown that smoking doubles the risk of stomach cancer.
  • Family history: If close relatives have any of the following conditions, you may be at a higher risk of stomach cancer :
    • Stomach cancer
    • Hereditary non-polyposis colon cancer (HNPCC)
    • Li-Fraumeni syndrome
  • Having any of the following medical conditions :
    • Pernicious anemia
    • Chronic stomach inflammation and intestinal polyps
    • Menetrier disease
    • Epstein-Barr virus
    • Acid reflux or chronic indigestion
    • Stomach lymphoma
    • Type A blood
    • Prior stomach surgery
  • Gender: The majority of stomach cancer patients are male
  • Age: Most individuals who develop stomach cancer are older than 55
  • Ethnicity: In the United States, stomach cancer occurs more often in Hispanic Americans and African Americans than in non-Hispanic whites. It is found most in Asian/Pacific Islanders
  • Working in the rubber, metal, coal and timber industries, as well as those who have been exposed to asbestos fibers, have a higher risk for stomach cancer
  • Geography: More people in Japan, China, Southern and Eastern Europe, and Central and South America develop stomach cancer than those in Northern and Western Africa, South Central Asia and North America
  • Not everyone with risk factors gets stomach cancer. However, if you have risk factors, you should discuss them with your doctor.

Stomach Cancer Prevention

Making healthy lifestyle choices may help prevent stomach cancer. These include :

  • Eating a healthy diet with plenty of fruits and vegetables and little red meat or processed meats
  • Maintaining a healthy weight
  • Avoiding tobacco and limit alcohol

Stomach Cancer Staging

If you are diagnosed with stomach cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Stages of Stomach Cancer

Stage 0: Abnormal cells are found in the inside lining of the mucosal (innermost) layer of the stomach wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I: Stomach cancer has formed. Stage I is divided into stage IA and stage IB, depending on where the cancer has spread.

  • Stage IA: Cancer has spread completely through the mucosal (innermost) layer of the stomach wall
  • Stage IB: Cancer has spread to either :
    • Completely through the mucosal (innermost) layer of the stomach wall and is found in up to six lymph nodes near the tumor
    • The muscularis (middle) layer of the stomach wall

Stage II: Stomach cancer has spread to one of the following :

  • Through the mucosal (innermost) layer of the stomach wall and to seven to 15 lymph nodes near the tumor
  • The muscularis (middle) layer of the stomach wall and to up to six lymph nodes near the tumor
  • The serosal (outermost) layer of the stomach wall but not to lymph nodes or other organs

Stage III is divided into stage IIIA and stage IIIB depending on where the cancer has spread :

Stage IIIA: Stomach cancer has spread to the :

  • Muscularis (middle) layer of the stomach wall and seven to 15 lymph nodes near the tumor
  • Serosal (outermost) layer of the stomach wall and one to six lymph nodes near the tumor
  • Organs next to the stomach but not to lymph nodes or other parts of the body

Stage IIIB: Stomach cancer has spread to the serosal (outermost) layer of the stomach wall and seven to 15 lymph nodes near the tumor.

Stage IV: Stomach cancer has spread to one of the following :

  • Organs next to the stomach and to at least one lymph node
  • More than 15 lymph nodes
  • Other parts of the body

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

Symptoms of stomach cancer may include :

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

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

Stomach Cancer Treatments

If you are diagnosed with stomach cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer, the location of the tumor and your general health.

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

Surgery

Surgery is the most common treatment for stomach cancer, many times with chemotherapy and radiation. If all three therapies are needed, Surgery for stomach cancer is delicate and challenging, and it requires special expertise. Studies have shown that patients do better when their surgeons have a high level of experience, and MD Anderson surgeons are among the most experienced in the country.

Surgical techniques for stomach cancer may include :

  • Endoscopic mucosal resection: An endoscope is inserted down the throat and into the stomach, allowing doctors to remove certain types of early, non-invasive stomach cancers.
  • Subtotal (partial) gastrectomy: The cancerous part of the stomach, nearby lymph nodes (tissues that filter infection and disease) and parts of other organs near the tumor are surgically removed.
  • Total gastrectomy: The entire stomach, nearby lymph nodes and sometimes the spleen, parts of the esophagus, intestines, pancreas and other organs where the cancer has spread, are removed. The esophagus is reconnected to the small intestine you can continue to eat and swallow.

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

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

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

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

Chemotherapy: Chemotherapy for stomach cancer often is given before surgery to shrink the tumor. We offers the most advanced chemotherapy regimens with the fewest side effects.

Radiation therapy: We use the most precise methods of radiation therapy, targeting the stomach cancer while limiting damage to surrounding areas.

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

Gene therapy: We have the expertise to examine each tumor carefully to determine gene-expression profiles, which then guide us toward the most effective, gentlest treatment targeted to your specific cancer. Gene therapy is a personalized medicine approach that sets us above and beyond most cancer centers and allows us to attack the specific causes of each stomach cancer.

Testicular Cancer

You have testicular cancer, it is important to get an accurate diagnosis to help increase your chances for successful treatment. At MD Anderson, our specialized experts use the most modern and accurate technology to diagnose testicular cancer and pinpoint the extent (stage) of the disease.

When an ultrasound shows a mass in your testicle, it is likely your doctor will perform a surgical removal of the testicle (orchiectomy). An incision is made in the groin rather than the scrotum, to avoid possibly spreading cancer cells. A tissue sample from the testicle is examined under a microscope to determine the presence of testicular cancer cells and the stage of the disease.

Other Testicular Cancer Diagnostic Tests

If you have symptoms that may signal testicular cancer, your doctor will perform a physical exam and ask you questions about your health, lifestyle, and family history.

One or more of the following tests may be used to find out if you have testicular cancer and if it has spread. These tests also may be used to find out if treatment is working.

Blood tests : Special blood tests that detect certain protein "markers" are used to diagnose and find out the extent of testicular cancer before and after orchiectomy. These tests include:

  • Alpha-fetoprotein (AFP): Elevated levels of this protein, which normally is produced by a fetus in the womb, may indicate the presence of a germ cell tumor in men.
  • Beta human chorionic gonadotropin (b-HCG): Increased levels of this protein, normally found in pregnant women, can indicate the presence of several types of cancer, including testicular cancer.
  • Lactate dehydrogenase (LDH): This enzyme is related to increased energy production by the body's cells and tissues, which sometimes can indicate cancer.

Testicular Cancer Facts

Testicular cancer occurs most often in younger men. It is the most-often diagnosed cancer in men between ages 20 and 34. However, it accounts for only 1% of all cancers that occur in men. When testicular cancer is detected early, there is a nearly 99% chance for successful treatment. Approximately 8,500 new cases of testicular cancer are diagnosed each year, and about 350 men, or less than 5%, die of the disease.

The testicles (also called testes) are a pair of male sex glands that are in a sac-like pouch (the scrotum) under the penis. They produce and store sperm and also are the body’s main source of male hormones. These hormones control the development of the reproductive organs and male characteristics.

Testicular cancer occurs when cells in the testicles grow and multiply uncontrollably, damaging surrounding tissue and interfering with the normal function of the testicle. If the disease spreads, it is still called testicular cancer.

Testicular Cancer Types

There are two basic types of testicular cancer, each with subtypes :

Germ cell tumors occur in the cells that produce sperm. Tumor types include :

  • Seminomas, the type found most often, are responsible for half of testicular cancer cases. They are generally slow growing and responsive to treatment.
  • Nonseminomas tend to grow and spread faster than seminomas. Tumor types include :
    • Embryonal carcinoma (about 20% of testicular cancers)
    • Yolk sac carcinoma (most often occurs in infants and young boys)
    • Choriocarcinoma, a rare and extremely aggressive cancer
    • Teratomas

Stromal tumors occur in the testicular tissue where hormones are produced. Stromal tumor types include :

  • Leydig cell tumors, which occur in cells that produce male sex hormones
  • Sertoli cell tumors, which occur in cells that nourish germ cells

Testicular Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Unfortunately, no standardized screening tests have been shown to improve testicular cancer outcomes. However, here at MD Anderson, we’re working to develop screening tests for those at risk.

Most testicular cancers are found by men themselves, either unintentionally or through self-examination. If you notice anything unusual about your testicles, be sure to consult a doctor. Examination of the testicles should be part of your annual physical exam.

Testicular Cancer Risk Factors

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

  • Age: Most cases occur between the ages of 15 and 40, and testicular cancer is the type of cancer found most often in men ages 20 to 34
  • Race: White men are 5 to 10 times more likely to develop testicular cancer than men of other races
  • Family or personal history of testicular cancer
  • Undescended testicle (cryptorchidism): Men with testicles that did not move down into the scrotum before birth are at increased risk. Men who had surgery to correct this condition are still at high risk of testicular cancer.
  • Abnormal testicular development
  • Klinefelter's syndrome: A sex chromosome disorder characterized by low levels of male hormones, sterility, breast enlargement, and small testes.
  • Human immunodeficiency virus (HIV) or AIDS
  • Previous treatment for testicular cancer

Not everyone with risk factors gets testicular cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Testicular Cancer Staging

If you are diagnosed with testicular cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way to determine how much disease is in the body and where it has spread when it is diagnosed. This information is important because it helps your doctor determine the best type of treatment for you.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.

Testicular Cancer Stages

Stage 0 (carcinoma in situ): Abnormal cells are found in the tiny tubules where sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called carcinoma in situ.

Stage IA: Cancer is in the testicle and epididymis (tube connecting ducts in rear of testicle to vas deferens) and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal.

Stage IB: Cancer is one of the following :

  • In the testicle and epididymis and has spread to the blood or lymph vessels in the testicle
  • Spread to the outer layer of the membrane surrounding the testicle
  • In the spermatic cord or the scrotum and may be in the blood or lymph vessels of the testicle
  • All tumor marker levels are normal

Stage IS: Cancer is found anywhere within the testicle, spermatic cord or the scrotum and either :

  • All tumor marker levels are slightly above normal.
  • One or more tumor marker levels are moderately above normal or high.

Stage IIA: Cancer is one of the following :

  • Anywhere within the testicle, spermatic cord or scrotum
  • In up to 5 lymph nodes in the abdomen, none larger than 2 centimeters
  • All tumor marker levels are normal or slightly above normal.

Stage IIB: Cancer is anywhere within the testicle, spermatic cord or scrotum and has spread to either :

  • Up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none is larger than 5 centimeters
  • More than 5 lymph nodes that are not larger than 5 centimeters
  • All tumor marker levels are normal or slightly above normal

Stage IIC: Cancer :

  • Is anywhere within the testicle, spermatic cord or scrotum and
  • Has spread to a lymph node in the abdomen and the tumor is larger than 5 centimeters
  • All tumor marker levels are normal or slightly above normal

Stage IIIA: Cancer is all of the following :

  • Anywhere within the testicle, spermatic cord or scrotum
  • Spread to one or more lymph nodes in the abdomen
  • Spread to distant lymph nodes or to the lungs
  • The level of one or more tumor markers may range from normal to slightly above normal

Stage IIIB: Cancer :

  • Is anywhere within the testicle, spermatic cord or scrotum
  • May have spread to one or more nearby or distant lymph nodes or to the lungs
  • The level of one or more tumor markers may range from normal to high

Stage IIIC: Cancer :

  • Is anywhere within the testicle, spermatic cord or scrotum
  • May have spread to one or more nearby or distant lymph nodes or to the lungs or anywhere else in the body
  • The level of one or more tumor markers may range from normal to very high

Symptoms of testicular cancer vary from man to man. Signs you may have testicular cancer include :

  • Small, hard lump that is often painless
  • Change in consistency of the testicles
  • Feeling of heaviness in the scrotum
  • Dull ache in the lower abdomen or the groin
  • Sudden collection of fluid in the scrotum
  • Pain or discomfort in a testicle or in the scrotum
  • Breast growth or loss of sexual desire
  • In boys, growth of facial and body hair at an abnormally young age
  • Lower back pain if cancer spreads

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

Our Treatment Approach

Treatment for testicular cancer at MD Anderson focuses on the most modern techniques in surgery, chemotherapy and other therapies. We customize your treatment to include the most-advanced procedures with the least impact on your body.

Our renowned team of experts considers all the options, and then choose the best course of action specifically for you. Your personalized testicular cancer treatment may include :

  • Surgery by a dedicated team of urologists, vascular surgeons, and anesthesiologists with expertise in this complex cancer
  • Special nerve-sparing surgical procedures to retain as much function as possible
  • The most modern restoration and prosthetic techniques
  • Dose-dense chemotherapy, which allows a higher level of drugs to be given and may help prevent stem cell transplant in some patients
  • Stem cell transplants at one of the premier programs in the country

Our Testicular Cancer Treatments

If you are diagnosed with testicular cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health.

At MD Anderson, your treatment for testicular cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

High inguinal Orchiectomy: Surgery to remove the testicle. In most cases, orchiectomy is performed during testicular cancer diagnosis. The testicle is removed through an incision in the groin, and tissue samples are examined to determine the stage of the testicular cancer.

Retroperitoneal lymph node dissection (RPLND): For some patients, especially those with nonseminoma testicular cancer, surgery may also involve removal of lymph nodes in the abdominal area. This is done at the same time as the orchiectomy or in a second surgical procedure.

Nerve-sparing techniques: To preserve normal ejaculation, the surgeons at MD Anderson are skilled in surgical techniques that may avoid damage to the nerves surrounding retroperitoneal lymph nodes in some men.

Reconstructive surgery: Men who are uncomfortable with their appearance after orchiectomy can have a prosthesis implanted in the scrotum that provides the look and feel of a real testicle.

Possible side effects of testicular cancer surgery

If one testicle is removed to treat testicular cancer, most men can get erections and have sex if they are getting enough testerone. If both testicles are removed, a man cannot father a child or make enough testosterone to have sex. In this case, testosterone needs to be taken in the form of a gel, patch or shot.

Because both surgical procedures may affect fertility, you may want to talk to your doctor about sperm banking if you want to start a family at some point. Sperm cells can be collected before cancer treatment and frozen for future use.

Radiation Therapy

Seminomas, which are the form of testicular cancer found most often, are very sensitive to radiation treatment. In fact, the treatment dosage is only about one-third of that required for prostate cancer, and the treatment cycle is only two weeks.

Radiation is performed after surgery to remove the testicle (orchiectomy). If the tumor was a seminoma, the oncologist may choose "watchful waiting" to see if the testicular cancer returns or use radiation to treat the lymph nodes along the spine, where the majority of recurrences are located.

Even if testicular cancer comes back, it is still treatable with radiation or chemotherapy. Radiation treatment has an average recurrence rate of about 5%. Radiation also can be used after chemotherapy if any cancer remains.

Other types of testicular cancer (nonseminoma) are more resistant to radiation. They are treated with orchiectomy, chemotherapy, and surgery to remove affected lymph nodes.

Chemotherapy

Chemotherapy is sometimes used in conjunction with surgical removal of the testicle to make sure all the cancer cells have been destroyed. For men with advanced tumors that have spread beyond the testicle or metastasized (spread) to distant areas of the body, chemotherapy is usually given for 9 weeks or longer.

The most frequently used chemotherapy combinations for testicular cancer are :

• BEP: Blenoxane® (bleomycin), Etopophos® or Vepesid® (etoposide), and Platinol® (cisplatin)

• EP: Etopophos® or Vepesid® (etoposide) and Platinol® (cisplatin)

For men with poor-risk testicular cancer, MD Anderson uses an approach called dose-dense chemotherapy. A higher number of chemotherapy drugs are given at more-frequent intervals; this allows the cancer cells less time to recover between each treatment.

Stem Cell Transplantation

A stem cell transplant is used most often for testicular cancers that have returned after successful treatment. MD Anderson has one of the most-advanced stem cell transplant centers in the nation.

Throat Cancer

It's important for throat cancer to be diagnosed as early and accurately as possible. This helps increase your chances for successful treatment and keeping the maximum ability to speak and swallow.

The experts at MD Anderson are among the most skilled and experienced in the nation in diagnosing and staging throat cancer. They use specialized, advanced technology that has pinpoint focus and reliable results, including three-dimensional imaging that provides detailed information.

Throat Cancer Diagnostic Tests

If you have symptoms that may signal throat cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; your sexual history; and your family medical history.

The tests used to diagnose throat cancer and find out if it has spread depend on the type of cancer. Tests also may be used to find out if treatment has damaged other tissues or organs. One or more of the following tests may be used.

Biopsy

Different methods are used to obtain tissue for a biopsy, depending on where the tumor is located.

Conventional incisional biopsy: This is the traditional, most frequently used type of biopsy. The doctor surgically removes part or all of the tissue where cancer is suspected.

Fine-needle-aspiration biopsy (FNA): This type of biopsy may be used if you have a lump in your neck that can be felt. A thin needle is inserted into the area, and then cells are withdrawn and examined under a microscope.

Endoscopy: An endoscope (a long, thin tube with a light and lens through which the doctor can view organs and tissue) is inserted through the mouth, nose or an incision. The endoscope has a tool to remove tissue samples.

Imaging tests, which may include :

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

Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for cancer and find out how well you swallow.

Laryngeal videostroboscopy, which lets the doctor look at the larynx and see how well you swallow.

Fiberoptic endoscopic examination of swallowing (FEES): A small, flexible endoscope is inserted through the nose, allowing the doctor to examine swallowing.

Our Approach

At MD Anderson's Head and Neck Center, some of the world's leading throat cancer experts focus extraordinary expertise on each patient. Your care is carefully planned to address your needs and to ensure you receive the most advanced treatment with the least impact on your body.

MD Anderson is known nationwide as one of the leading centers for treatment of throat cancer. We have developed approaches that have enabled thousands of patients with throat cancer to avoid radical surgery and enjoy a better quality of life, treating the cancer while saving the ability to speak and swallow.

We take a team approach to throat cancer care, providing comprehensive, yet highly specialized, treatment. Your personal team of experts may include oncologists; surgeons and plastic surgeons; radiation oncologists; dentists; speech pathologists and swallowing experts; dietitians; and physical, occupational and speech therapists.

Throat Cancer Facts

The American Cancer Society estimates that about 38,000 people in the United States were diagnosed with throat cancer in 2011. Throat cancer is a general term, but it is often used to refer to cancer of the :

Pharynx, a hollow tube between the nose and esophagus (swallowing tube) that includes the :

  • Nasopharynx: the upper section, which is behind the nose
  • Oropharynx: the middle section, which is behind the mouth
  • Hypopharynx: the bottom section, which is behind the voice box (larynx)

Larynx, also called the voice box, which is the part of the throat containing the vocal cords that help you speak. The larynx has three parts :

  • Glottis: the middle portion that contains the vocal cords
  • Supraglottis: the area above the vocal cords
  • Subglottis: the area below the vocal cords and above the trachea (windpipe)

Approximately half the cases of throat cancer are found in each of the larynx and pharynx. The number of new cases of smoking-related cancers, such as cancer of the larynx and many cancers of the pharynx, is declining.

The number of new oropharynx cancers is increasing, however, because of a relatively new cause of this disease, human papillomavirus (HPV). Patients with HPV-related oropharynx cancer are less likely to smoke and may have a better outlook than patients with smoking-related oropharynx cancer.

Throat Cancer Types

Most throat cancers are squamous cell carcinomas. This means they develop in the squamous cells that line the throat.

Other less frequent types of throat cancer include cancers of the minor salivary glands.

Throat Cancer Screening

Cancer screening exams are important medical tests done when you're at risk but don't have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Unfortunately, no standardized screening tests have shown to improve throat cancer outcomes. However, here at MD Anderson, we're working to develop screening tests for those at risk.

Throat Cancer Risk Factors

Anything that increases your chance of getting throat cancer is a risk factor. People who smoke, especially those who drink alcohol, are at the most at risk for developing throat cancer. Read more about MD Anderson's smoking cessation clinical trials.

Another risk factor for oropharynx cancer is infection with human papillomavirus (HPV), which is spread though sexual contact, particularly oral sex.

Other risk factors include :

  • Gender: Men are up to five times more likely to get cancer of the throat than women
  • Race: African American men have the highest risk
  • Age: Most cases occur over the age of 65
  • Exposure to certain chemicals, including nickel, asbestos and sulfuric acid fumes

Throat Cancer Staging

Staging is the process of finding out how far the cancer has spread. This is important because the type of treatment and the outlook for recovery depend on the stage of the cancer.

The staging system most often used for throat cancer is the TNM staging system, also known as the American Joint Committee on Cancer (AJCC) system.

This system gives three key pieces of information :

  • T stands for tumor (how far it has spread within the larynx or pharynx and to nearby tissues)
  • N describes whether the cancer has spread to lymph nodes
  • M stands for metastasis (spread of the cancer) to distant organs

All of this information is combined to arrive at a disease stage. After stage 0 (which is carcinoma in situ or cancer that has not grown beyond the lining layer of cells), stages are labeled using Roman numerals from I through IV (that is, 1 through 4). The smaller the number, the less the cancer has spread. A higher number, for example, stage IV, means a more serious stage of the disease.

Symptoms of throat cancer vary from person to person. They may include :

  • Hoarseness or other change in the voice
  • Difficulty swallowing or the feeling that something is caught in the throat
  • Persistent sore throat
  • Ear pain
  • Lump in the neck
  • Cough
  • Breathing problems
  • Unexplained weight loss

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

Throat Cancer Treatments

Depending on the type of cancer and how far it has spread, you may be treated with one or a combination of therapies.

Surgery

Our skilled surgeons are experts at performing surgery for patients with throat cancer. Revolutionary new technologies in robotics and laser surgery have ushered in a new era of surgery for throat cancer. Our surgeons have the most-advanced equipment and technology to perform advanced surgeries such as the following :

Minimally invasive or endoscopic surgery: This new technique allows surgeons to remove whole tumors through the mouth, without incisions and little or no change in speech and swallowing function.

Transoral Laser Microsurgery (TLM): A flexible, hollow-core fiber transmits CO2 laser energy, enabling surgeons to reach otherwise unreachable areas and to perform a 360-degree resection around tumors in ways that were previously not possible

Transoral Robotic Surgery (TORS): Robotic-assisted surgery offers the advantages of computer technology, specialized surgical instruments and advanced three-dimensional imaging. At MD Anderson, the da Vinci® Surgical System is the latest addition to our surgical tools for head and neck cancer.

Supracricoid Partial Laryngectomy: The supraglottis, vocal cords and thyroid cartilage are removed, while other structures that are needed to swallow and produce speech are spared.

Chemotherapy

Chemotherapy may be used to shrink a tumor before surgery or kill lingering cancer cells after surgery and/or radiation treatment. A combination of chemotherapy and radiation therapy may be used as a primary treatment for patients with larger tumors or those who cannot tolerate surgery.

MD Anderson offers the most advanced chemotherapy combination regimens, with the least impact on the body.

Radiation Therapy

New radiation therapy techniques, such as intensity-modulated radiotherapy (IMRT) and proton therapy [LINK], and remarkable skill allow MD Anderson doctors to target throat cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Radiation treatments include :

  • Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
  • 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
  • Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Proton Therapy

The Proton Therapy Center at MD Anderson offers the most advanced form of radiation treatment available in the Southwest. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means that this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.

Proton therapy delivers high radiation doses directly to the tumor site, with limited, if any, damage to nearby healthy tissue. This pencil-beam technology pioneered by the cancer experts at MD Anderson’s Proton Therapy Center – and available at only a few other centers worldwide – is an important tool for fighting certain head and neck cancers. For some patients, this therapy results in better cancer control with fewer side effects.

Doctors at the Proton Therapy Center work closely with the skilled specialists in the Head and Neck Center to provide comprehensive care for patients who have benign (non-cancer) or malignant (cancer) head and neck tumors.

Targeted Therapies

MD Anderson is among the few cancer centers in the nation that are able to offer patients targeted therapies for some types of throat cancer. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.

After Treatment

Speech: The Section of Speech Pathology and Audiology at MD Anderson offers patients the most advanced techniques for restoring speech after larynx (voice box) cancer and its treatment. Experts provide specialized therapies to help patients regain their voice after partial or total removal of the larynx.

Swallowing: Experts in the Swallowing Outcomes Research Laboratory are dedicated to evaluating and treating patients who have difficulty after treatment. MD Anderson’s swallowing service is one of the leaders in the country and serves as a model for the management of patients treated for throat cancers.

Survivorship: Throat cancer patients are strongly urged not to smoke or drink alcohol during and after treatment. Drinking and smoking can make treatments less successful, and they can greatly increase the chance of the cancer returning. MD Anderson has a survivorship clinic dedicated to the needs of head and neck cancer patients.

Regular follow-up and screening is vital due to the high risk of throat cancer returning to the throat or other areas in the head and neck region. Patients may need to see their doctors every three to six months for the first two years after treatment, since 80% to 90% of new cancers occur within the first three years.

Thyroid Cancer

If you have symptoms that may signal thyroid cancer, your doctor will examine your neck and throat, feeling for lumps or swelling. Your doctor will also complete a medical history. This involves asking questions about your symptoms, other health problems and health problems in other members of your family. If anyone in your family has had thyroid cancer or parathyroid or adrenal tumors, be sure to tell your doctor.

One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.

Fine-needle aspiration biopsy (FNA): Biopsy (removal of a small number of cells and looking at them under a microscope) is the only way to tell for sure if you have thyroid cancer. In FNA, a thin needle is inserted into the nodule, and cells are taken out to biopsy. Most thyroid nodules are proved by FNA to be benign (not cancer). If the FNA is inconclusive (not showing clearly if the nodule is cancerous), more testing may be needed.

Imaging tests, which may include :

  • Ultrasound
  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans

Radioactive thyroid scan: If a nodule is papillary or follicular cancer, a radioactive thyroid scan may be used after thyroid surgery to determine if cancer remains or has spread to other parts of the body. Medullary thyroid cancer cells don't absorb iodine, so this test is not useful in this type of thyroid cancer.

Blood tests

Genetic testing: If you have medullary thyroid cancer, you will be given a blood test to determine if you carry a gene that sometimes causes this cancer. If the test is positive, your children and parents should be tested to see if they have the gene or thyroid cancer. More than 90% of people who have the gene will eventually develop thyroid cancer.

If your child has the gene, the doctor probably will suggest removal of the thyroid. Although children rarely develop cancer before 5 years old, one type of MTC known as MEN-2B can develop in the early months of life. If the thyroid is removed, then that person will take daily thyroid medication for the rest of his or her life.

Your personal medical team is made up of experts from several specialties. They work together, communicating and collaborating with each other and with you, to ensure you receive seamless, coordinated care.

If your treatment for thyroid cancer includes surgery, our talented surgeons use the most advanced techniques that are proven to have good results. In some cases, video-assisted or robotic surgery may be used, while minimizing or eliminating a neck scar.

Thyroid Cancer Facts

According to the American Cancer Society, about 45,000 people are diagnosed with thyroid cancer each year in the United States. About 75% of these are women, making it the eighth-most-common cancer in women. Thyroid cancer is seen most often in adults, with two-thirds of the cases occurring between ages 20 and 55.

Although thyroid cancer accounts for about 1% of all cancers, it is becoming more common. At least 450,000 people in the United States have completed treatment or are living with thyroid cancer.

Thyroid cancer is usually a slow-growing cancer. It is one of the least dangerous cancers in most cases, and the five-year survival rate for thyroid cancer is almost 97%.

Thyroid Gland Anatomy

Thyroid cancer begins in the thyroid gland, which is a small butterfly-shaped gland in the front of the neck at the base of the throat. The thyroid is part of the body's endocrine system, a system of glands that control hormones in the body. It normally weighs less than an ounce, and it cannot be seen or felt in most people; however it has an important function. The thyroid makes hormones that help regulate the body's heart rate, blood pressure, temperature and metabolism (the breakdown of food to create energy).

The thyroid has two halves, or lobes, one on each side of the neck. It wraps around the trachea (windpipe) just under the larynx (Adam's apple). A thin strip of tissue known as the isthmus connects the two halves.

Thyroid gland cells are the only cells in the body that absorb and retain iodine. Iodine is needed to make thyroid hormones.

Two kinds of cells are found in the thyroid :

  • Follicular cells are the most common. They produce thyroid hormone, which is important for growth, mental function and helping the body create energy.
  • Parafollicular cells (also known as C cells) produce a small amount of the hormone calcitonin, which has a minor role to control calcium metabolism. Most parafollicular cells are in the upper third of each lobe.

Thyroid Cancer Types

Thyroid cancer is grouped by the type of thyroid cells where the cancer begins. Papillary, follicular and anaplastic thyroid cancers begin in the follicular cells. Papillary and follicular cancers—the most common thyroid cancers—are sometimes referred to together as differentiated thyroid cancer. They have similar treatment.

Papillary thyroid cancer is the most common type of thyroid cancer, accounting for about 80% of thyroid cancers. While papillary thyroid cancer typically occurs in only one lobe of the thyroid gland, it may arise in both lobes in up to 10% to 20% of cases. Papillary thyroid cancer is most common in women of childbearing age. It sometimes is caused by exposure to radiation.

Even though papillary thyroid cancer is usually not an aggressive type of cancer, it often metastasizes (spreads) to the lymph nodes in the neck. Papillary thyroid cancer treatment usually is successful.

Follicular thyroid cancer accounts for about 10% of thyroid cancers. Like papillary thyroid cancer, follicular thyroid cancer usually grows slowly. Its outlook is similar to papillary cancer, and its treatment is the same.

Follicular thyroid cancer usually stays in the thyroid gland but sometimes spreads to other parts of the body, such as the lungs or bone. However, it usually does not spread to lymph nodes. It is more common in countries where diets do not contain enough iodine.

Hurthle cell carcinoma, also called oxyphil cell carcinoma, is a type of follicular thyroid cancer. Most patients diagnosed with Hurthle cell cancer do well, but the outlook may change based on the extent of disease at the time of diagnosis.

Medullary thyroid cancer (MTC) is the only type of thyroid cancer that develops in the parafollicular cells of the thyroid gland. It accounts for 3% to 10% of thyroid cancers. Medullary cancer cells usually make and release into the blood proteins called calcitonin and/or carcinoembryonic antigen, which can be measured and used to follow the response to treatment for the disease.

Sometimes medullary cancer spreads to the lymph nodes, lungs or liver before a nodule is found or the patient has symptoms. MTC can be treated more successfully if it is diagnosed before it has spread.

There are two types of MTC :

  • Sporadic MTC is more common, accounting for 85% of medullary thyroid cancers. It is found mostly in older adults and is not inherited.
  • Familial MTC is inherited, and it often develops in childhood or early adulthood. If familial MTC occurs with tumors of certain other endocrine organs (parathyroid and adrenal glands), it is called multiple endocrine neoplasia type 2 (MEN 2). (link to more information). If you have a family history of MTC, it is important for you and your children to be tested for the gene that causes the disease.

Anaplastic thyroid cancer is the most dangerous form of thyroid cancer. It is makes up only 1% of thyroid cancers. It is believed that anaplastic thyroid cancer grows from a papillary or follicular tumor that mutates further to this aggressive form. Anaplastic thyroid cancer spreads rapidly into areas such as the trachea, often causing breathing difficulties.

Anaplastic thyroid cancer sometimes is called undifferentiated thyroid cancer because the cells are so different from normal thyroid tissue.

Thyroid Cancer Screening

Cancer screening exams are important medical tests done when you’re healthy and don’t have symptoms. They help find cancer at its earliest stage, when the chances for curing it are best. Unfortunately, standardized screening tests have not been shown to improve thyroid cancer outcomes.

Although thyroid cancer sometimes has no symptoms, many tumors are found in the early stages when patients or their doctors find lumps or nodules in their throats. Some doctors suggest you examine your neck carefully twice a year. Be sure your doctor includes a cancer-related exam in your annual exam.

If other people in your family have or had familial medullary thyroid cancer, you and your children should have blood tests as early as possible to find out if you have the gene that causes this cancer. If you or your children have the gene, your doctor may suggest surgically removing the thyroid gland to lower the risk of cancer. More than 90% of people with the gene develop thyroid cancer.

Thyroid Cancer Risk Factors

Anything that increases your chance of getting thyroid cancer is a risk factor. Risk factors include :

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

Not everyone with risk factors gets thyroid cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Thyroid Cancer Prevention

Preventing thyroid cancer is not possible in most cases. However, certain steps may reduce the risk.

  • Exposure to X-rays is a proven cause of thyroid cancer, and young children may be most at risk. Therefore, it may be wise to minimize X-rays in children.
  • In the United States, most table salt contains. However, you might want to eat a diet that includes foods with iodine, such as fish, shellfish, eggs, dairy products, onions, radishes, potatoes, bananas, parsley and kelp.
  • If a family member had or has medullary thyroid cancer and is found to have the familial form of the disease, siblings, children and parents should be tested as soon as possible to see if they have inherited a gene that makes thyroid cancer more likely. If they have the gene, they may decide to have the thyroid surgically removed to lower the risk of cancer.

Thyroid Cancer Staging

If you are diagnosed with thyroid cancer, your doctor may do more tests to determine how big the tumor is and whether the cancer has spread to more places in the body. This process is called staging, and it helps your doctor plan your treatment. It also provides information about the expected outcome, or prognosis, of your cancer. Once the staging classification is determined, the stage stays the same even if treatment is successful or the cancer spreads.

Papillary and Follicular Thyroid Cancer Stages

People who are less than 45 years old have only Stage I or Stage II papillary or follicular thyroid cancer.

Stage I

Patient is less than 45 years old :

  • Tumor of any size
  • Cancer may have spread to other parts of the neck or nearby lymph nodes
  • Cancer has not spread to other parts of the body

Patient is 45 or older :

  • Tumor is 2 centimeters (about three-fourths of an inch) or less
  • Tumor is in the thyroid only
  • Cancer has not spread to other parts of the neck or body

Stage II

Patient is less than 45 years old :

  • Cancer has spread to distant areas, such as lungs or bone
  • Cancer may have spread to lymph nodes near these areas

Patient is 45 years or older

  • Tumor is between 2 and 4 centimeters (three-quarters to 1½ inches)
  • Tumor is in the thyroid only

Stage III

  • Patient is 45 years or older
  • Tumor is larger than 4 centimeters (1½ inches) or spread slightly outside thyroid
  • Tumor is of any size, but it has spread outside the thyroid and to lymph nodes in neck

Stage IVA

  • Patient is 45 years or older
  • Tumor is any size
  • Tumor has spread within the neck and to lymph nodes in the neck and upper chest

Stage IVB

  • Patient is 45 years or older
  • Tumor is any size
  • Cancer has spread to the neck near the backbone or around blood vessels in the neck or upper cheek
  • Cancer may have spread to lymph nodes

Stage IVC

  • Patient is 45 years or older
  • Cancer has spread to other parts of the body, such as the lungs or bone
  • Cancer may have spread to nearby lymph nodes

Medullary Thyroid Cancer Stages

Stage 0

  • No tumor has formed
  • Cancer is detected by screening tests

Stage 1

  • Tumor is 2 centimeters (three-quarters of an inch) or smaller
  • Tumor is in the thyroid only

Stage II

  • Tumor is between 2 centimeters and 4 centimeters (¾ to 1½ inches)
  • Tumor is in the thyroid only

Stage III

  • Tumor is larger than 4 centimeters (1½ inches)
  • Tumor is any size and has spread outside the thyroid to lymph nodes in the neck

Stage IVA

  • Tumor is any size
  • Tumor has spread within the neck and/or to lymph nodes in the neck or upper chest

Stage IVB

  • Tumor is any size
  • Tumor has spread to the neck, near the backbone or around blood vessels in the neck or upper chest
  • Cancer may have spread to lymph nodes

Stage IVC

  • Tumor has spread to other parts of the body, such as the lungs or bone
  • Cancer may have spread to nearby lymph nodes

Anaplastic thyroid cancer always is considered stage IV.

Recurrent thyroid cancer is cancer that returns after the original cancer has been treated. Although it usually comes back in the neck, thyroid cancer can appear in other parts of the body.

When thyroid cancer is found early, you have a higher chance for successful treatment. Unfortunately, thyroid cancer often has few or no signs. When it does have symptoms, they vary from person to person. If you do have symptoms, they may include :

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

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

Our Treatment Approach

When you have thyroid cancer, it is important to be treated by experts with a high level of expertise. Surgery is often part of the treatment for thyroid cancer. Like all surgeries, thyroid cancer surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure.

For some patients, robotic surgery and minimally invasive approaches may help maintain appearance.

Because we are one of the nation’s foremost cancer centers, we offer a number of clinical trials of innovative new therapies.

If you are diagnosed with thyroid cancer, your doctor will discuss the best options to treat it. This depends on several factors, including :

  • Type of thyroid cancer
  • Size of the nodule
  • Your age and health
  • Stage of cancer

Your treatment for thyroid cancer will be customized to your particular needs. In most cases of differentiated (papillary and follicular) thyroid cancer, two or more of these methods may be used. Most patients with medullary thyroid cancer are treated with surgery only. Patients with anaplastic thyroid cancer may be treated with chemotherapy and radiation therapy, or they may be candidates for a clinical trial.

Surgery

Most people with thyroid cancer are treated with surgery. Many also are treated with additional methods.

The surgery most likely will be one of the following :

Total thyroidectomy: The entire thyroid is removed

Lobectomy:Only the side of the thyroid where the tumor is located is removed. This type of surgery may be used for papillary cancers smaller than 1 centimeter (about ½ inch) that have not spread.

Lymph node dissection-Lymph nodes in the area of the tumor or in the neck and/or chest also may be removed.

If your entire thyroid gland is removed, you will take thyroid hormone replacement pills daily for the rest of your life.

Surgical teams at MD Anderson offer a variety of minimally invasive techniques for thyroid surgery, including minimally invasive video-assisted thyroid (MIVAT) surgery and robotic thyroid surgery through transaxillary and facelift incisions.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

The type of radiation used depends on the type and stage of your cancer. Thyroid cancer may be treated with :

Radioactive iodine: You drink a liquid or swallow a pill that contains radioactive iodine, which collects in thyroid tissue and destroys cancer cells. This method also is used to eliminate any thyroid cells in other parts of the body remaining after thyroidectomy or thyroid cancer.

If radioactive iodine is used after surgery, you may be asked to discontinue your thyroid hormone medicine to make the iodine more effective. This can sometimes be uncomfortable. A newer method gives thyroid stimulating hormone (TSH) by injection and does not require stopping thyroid medicine. Women should not become pregnant for six months to a year after radioactive iodine treatment.

External beam radiation: This type of therapy is most effective for thyroid cancers that do not absorb iodine, including anaplastic thyroid cancer. It may be used to fight thyroid cancer cells remaining after surgery or if cancer spreads to the bones.

Thyroid Hormone Therapy

This treatment uses thyroid hormone pills to stop the growth of cancer cells. In papillary or follicular thyroid cancer, hormone treatment may be used to lower the level of thyroid stimulating hormone (TSH), which may help stop the cancer from coming back. In other thyroid cancers, it may be used to keep thyroid hormone levels normal.

Chemotherapy

Chemotherapy often is used in combination with external beam radiation therapy to treat anaplastic thyroid cancer. It is usually not effective in other types of thyroid cancer.

Urinary Bladder Cancer

Bladder Cancer Diagnosis

If you have symptoms that may signal bladder cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have bladder cancer and if it has spread. These tests also may be used to find out if treatment is working.

Blood and urine tests

Cystoscopy: This is the most frequent and reliable test for bladder cancer. A thin tube with a camera on the end (cystoscope) is inserted into the bladder through the urethra. The cystoscope also can be used to take a tissue sample for biopsy and treat superficial tumors without surgery. However, cystoscopy is not always accurate when performed alone, and flat lesions (carcinoma in situ) and small papillary tumors can be missed

Imaging tests, which may include :

  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • Intravenous pyelogram (IVP): A dye is injected, which then travels through the urinary system and shows up on an X-ray
  • Bone scan
  • Chest X-ray
  • CT urogram

Bladder Cancer Facts

Each year, almost 71,000 new cases of bladder cancer are diagnosed in this country. Men, Caucasians and smokers have twice the risk of bladder cancer as the general population. Almost all the people who develop bladder cancer are over 55 years old. When it is diagnosed and treated in the early stages, bladder cancer is usually highly treatable.

The bladder is a hollow organ in the lower abdomen. It stores urine, the waste that is produced when the kidneys filter the blood. The bladder has an elastic and muscular wall that allows it to get larger and smaller as urine is stored or emptied.

Urine passes from the two kidneys into the bladder through tubes called ureters. Urine leaves the bladder through another tube called the urethra. The urethra is longer in men than women.

Bladder cancer begins in the inside layer of the bladder and grows into the walls, becoming more difficult to treat.

Bladder Cancer Types

Bladder cancer is classified based on the type of cells it contains. The main types of bladder cancer are :

Transitional cell bladder cancer: About 90% of bladder cancers are transitional cell carcinomas – cancers that begin in the urothelial cells, which line the inside of the bladder. Cancer that is confined to the lining of the bladder is called non-invasive bladder cancer.

Squamous cell bladder cancer: This type of bladder cancer begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation. These cancers occur less often than transitional cell cancers, but they may be more aggressive.

Adenocarcinoma: Bladder cancer that develops in the inner lining of the bladder as a result of chronic irritation and inflammation. This type of bladder cancer tends to be aggressive.

Bladder Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

When bladder cancer is found in the early stages, it has a much higher rate of successful treatment. If you are at high risk for bladder cancer, talk to your doctor about screening tests, which may include cystoscopy, imaging tests, or blood and urine tests.

People considered at high risk for bladder cancer are at least 50 years old with hematuria (blood in the urine), or under age 50 with visible hematuria.

Bladder Cancer Risk Factors

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

  • Smoking tobacco: This is the greatest risk factor for bladder cancer. Smokers, including pipe and cigar smokers, are two to three times more likely than nonsmokers to get bladder cancer. Chemicals in tobacco smoke are absorbed into the blood, and then they pass through the kidneys and collect in the urine. These chemicals can damage the inside of the bladder and increase your chances of getting bladder cancer.
  • Age: The chance of developing bladder cancer increases with age, and it is uncommon in people under 40
  • Race: Bladder cancer occurs twice as often in Caucasians as it does in African-Americans and Hispanics. Asians have the lowest rate of developing the disease
  • Gender: Men are up to four times as likely as women to get bladder cancer
  • Personal history of bladder cancer: Bladder cancer has a 50% to 80% chance of returning after treatment. This is the highest of any cancer, including skin cancer
  • Exposure to chemicals: People who work around certain chemicals are more likely to get bladder cancer. These include :
    • People who work in the rubber, chemical and leather industries
    • Hairdressers
    • Machinists and metal workers
    • Printers
    • Painters
    • Textile workers
    • Truck drivers
    • People who work at dry cleaners
  • Infections: People infected with certain parasites, which are more common in tropical climates, have an increased risk of bladder cancer
  • Treatment with cyclophosphamide or arsenic: These drugs, which are used in the treatment of cancer and other conditions, raise the risk of bladder cancer. Arsenic in drinking water may increase risk too.
  • Chronic bladder problems: Infections and kidney stones may be risk factors, but no direct link has been established
  • History of taking a fangchi, a Chinese herb
  • Having a kidney transplant
  • Hereditary nonpolyposis colon cancer (HNPCC, also called Lynch syndrome)

Not everyone with risk factors gets bladder cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

The most frequent bladder cancer symptom is blood in the urine (hematuria), which causes the urine to appear rusty or deep red in color. However, hematuria cannot always be detected by the naked eye, and it can be a symptom of other conditions such as kidney or bladder stones or urinary tract infection.

Other bladder cancer symptoms may include :

  • Changes in bladder habits
  • Painful urination
  • Frequent urination
  • Having the urge to urinate

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

Your bladder cancer care is customized to include the most advanced therapies. Many of these are available at only a few locations in India, including :

  • Advanced surgical and reconstructive procedures
  • Laparoscopic robotic surgery
  • Conformal 3D and IMRT radiotherapy
  • Immunotherapy, including Bacillus Calmette-Guérin (BCG)
  • Latest chemotherapy options

Our skilled surgeons, who utilize the latest bladder cancer and reconstruction techniques, are among the most experienced in the nation. This can make an essential difference in the success of your treatment and recovery.

Uterine Cancer

Early and accurate diagnosis of uterine cancer can help increase the chance for successful treatment. We use the most advanced techniques and technology to diagnose uterine cancer and find out the exact extent of the disease. This helps your doctor choose the best type of treatment for you. Our staff includes pathologists, diagnostic radiologists and specially trained technicians who are highly skilled in diagnosing uterine cancer.

Uterine Cancer Diagnostic Tests

If you have symptoms that may signal uterine cancer, your doctor will examine you and ask you questions about your :

  • Health
  • Lifestyle, including smoking and drinking habits
  • Family history

If your doctor thinks you might have uterine cancer, the first step will be a biopsy. Your doctor will decide the best way to do the biopsy. Methods include :

Endometrial biopsy: A thin, flexible tube is inserted through the cervix and into the uterus. Using suction, a small amount of tissue is removed through the tube.

D&C (dilation and curettage): If an endometrial biopsy does not provide enough tissue or if a uterine cancer diagnosis is not definite, a D&C may be done. The cervix is dilated (enlarged) with a series of increasingly larger metal rods. A tool called a curette then is used to take cells from the uterus lining.

Hysteroscopy: A thin, telescope-like device with a light (hysteroscope) is put into the uterus through the vagina. The doctor then looks at the uterus and the openings to the fallopian tubes. Small pieces of tissue can be removed. Hysteroscopy may be done with a D&C.

One or more of the following tests may be used to find out if you have uterine cancer and if it has spread. These tests also may be used to find out if treatment is working.

Surgery, which may include :

  • Hysterectomy: Removal of the uterus
  • Bilateral salpingo-oophorectomy: Removal of the uterus, ovaries and Fallopian tubes
  • Lymph node dissection: Removal of lymph nodes in the pelvis and lower abdomen

Imaging tests, which may include :

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

Blood tests, which may include :

  • Complete blood count (CBC)
  • CA 125: Uterine cancers sometimes release this substance into the blood. This test, which is being studied at MD Anderson, measures levels of CA 125. High levels of CA 125 may mean the cancer has spread beyond the uterus or come back after treatment.

Genetic Testing

The Gynecological Cancer Genetics Clinic offers genetic testing for some women with uterine cancer or who are at risk. Genetic counseling may be recommended if you :

  • Were diagnosed with endometrium cancer before age 50
  • Have had colon or rectal cancer
  • Have any close relatives with colon, rectal or endometrium cancer
  • Have a relative who has tested positive for a Lynch syndrome gene mutation (MLH1, MSH2, MSH6, PMS2 genes)

Teams of some of the nation's top uterine cancer experts consider all the options, and then they recommend the most-advanced therapies with the least impact on your body. They have at their fingertips the latest technology and techniques, backed by one of the leading uterine cancer research programs in the United States.

Personalized Uterine Cancer Care

Your treatment team, which may include medical, surgical and radiation oncologists; gynecologists; pathologists; and diagnostic radiologists, collaborates and communicates each step of the way. A specially trained staff with experience in caring for women with uterine cancer supports the team.

Surgery often is part of the treatment for uterine cancer. At MD Anderson, our highly specialized surgeons are among the most experienced and skillful in the country. In many cases, they are able to perform minimally invasive surgeries for uterine cancer. These procedures may help lessen the time it takes you to heal and the time you need to spend in the hospital.

Uterine Cancer Facts

Uterine cancer, or cancer of the uterus (womb), also may be called endometrial cancer. It is the :

  • Fourth most common cancer in women
  • Most common cancer of women’s reproductive organs
  • Each year, more than 40,000 women in the United States are diagnosed with uterine cancer. The average age for diagnosis of uterine cancer is 60. However, the number of younger women with uterine cancer is going up. Of uterine cancers, about :
  • 25% are found before women go through menopause
  • 5% are found before women are 40 years old

Early Diagnosis is Key

Most uterine cancers develop over a period of years. They may start as less serious problems such as endometrial hyperplasia, which is an overgrowth of cells in the lining of the uterus.

Fortunately, many uterine cancers are found early because of warning signs such as abnormal or postmenopausal bleeding. If uterine cancer is found in the earliest stages, it often can be treated successfully.

Uterus Plays a Part in Reproduction

The uterus is where a fetus grows when a woman is pregnant. It is hollow and pear shaped with two main parts :

  • The cervix, which is the bottom part and extends into the vagina (the birth canal)
  • The body of the uterus is the upper part. It also may be called the corpus. It has two main parts :
    • Muscle wall, which contracts when a woman has a baby
    • Inner lining (endometrium)

When a woman menstruates (has a period), the endometrium becomes thicker. If she does not become pregnant, the new endometrial tissue goes out of the body as menstrual flow (blood). This happens about every month until a woman stops having periods. When a woman stops having periods it is called menopause (change of life).

Uterine Cancer Types

There are three types of uterine cancer.

Endometrial cancer: Almost all uterine cancers start in the lining of the uterus (endometrium). The two main types of endometrial cancer are :

  • Endometroid adenocarcinoma: This accounts for most cases of endometrium cancer.
  • Uterine carcinosarcoma: The cancer cells look like endometrium cancer and sarcoma.

Uterine sarcomas: These are less common types of uterine cancer and start in the muscle wall of the uteru

Uterine Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Most women do not need to be screened for uterine cancer. However, you should :

  • Pay attention to your body
  • Know the symptoms of uterine cancer and report any signs to your doctor
  • Lower your risk factors
  • Talk to your doctor about pelvic exams and Pap tests

Women with Lynch syndrome (hereditary nonpolyposis colorectal cancer syndrome or HNPCC) should have endometrial biopsies every year beginning at age 35.

Uterine Cancer Risk Factors

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

  • Obesity: Being overweight raises your risk two to four times. A higher level of fat tissue increases your level of estrogen.
  • Eating a diet high in fat
  • Age: More than 95% of uterine cancers occur in women 40 and older
  • Tamoxifen: This breast cancer drug can cause the uterine lining to grow. If you take Tamoxifen and have changes in your menstrual period or bleeding after menopause, it is important to let your doctor know.
  • Estrogen replacement therapy (ERT) without progesterone if you have a uterus. Birth control pills may lower your risk
  • Personal/family history of uterine, ovarian or colon cancer. This may be a sign of Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC).
  • Ovarian diseases, such as polycystic ovarian syndrome (PCOS)
  • Complex atypical endometrial hyperplasia: This precancerous condition may become uterine cancer if not treated. Simple hyperplasia rarely becomes cancer.
  • Diabetes
  • Never having been pregnant
  • Number of menstrual cycles (periods): If you started having periods before 12 years old or went through menopause late, your risk of uterine cancer may be higher
  • Breast or ovarian cancer
  • Pelvic radiation to treat other kinds of cancer. The main risk factor for uterine sarcoma is a history of high-dose radiation therapy in the pelvic area.

Not everyone with risk factors gets uterine cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Uterine Cancer Staging

If you are diagnosed with uterine cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.

Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Uterine Cancer Stages

Stage IA: Cancer is in the endometrium (uterine lining) only, the inner half of the myometrium (muscle wall), or the glands in the cervix

Stage IB: Cancer has spread to outer half of the myometrium

Stage II: Cancer has spread to cervix connective tissue

Stage IIIA: Cancer has spread to :

  • The outer layer of uterus
  • Other pelvic organs including the fallopian tubes or ovaries

Stage IIIB: Cancer has spread to the vagina

Stage IIIC: Cancer has spread to lymph nodes near the uterus

Stage IVA: Cancer has spread the bladder and/or bowel wall

Stage IVB: Cancer has spread beyond the pelvis, including lymph nodes in the abdomen or groin

Uterine cancer symptoms vary from woman to woman. If you have gone through menopause, see your doctor if you have any vaginal bleeding, spotting or unusual discharge.

If you have not gone through menopause, see your doctor if you have any of the following symptoms for more than two weeks :

  • Unusual bleeding, such as between periods or heavier flow
  • Abnormal vaginal discharge
  • Pelvic pain or pressure
  • Weight loss

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

We personalize your care to include the most-advanced treatments with the least impact on your body. For uterine cancer, surgery often is one of the main treatments.

Surgical Skill, Experience

Like all surgeries, uterine cancer surgery is most successful when done by a specialist with a great deal of experience in the particular procedure. We perform a large number of uterine cancer surgeries each year, using the least-invasive and most-advanced techniques. For some patients, minimally invasive surgeries can mean faster healing and less time in the hospital.

Our Uterine Cancer Treatments

If you are diagnosed with uterine cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health. One or more of the following therapies may be recommended to treat uterine cancer or help relieve symptoms.

Surgery

Surgery is the main treatment for uterine cancer. Usually surgery for uterine cancer includes :

  • Total hysterectomy (surgical removal of the uterus)
  • Bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes)
  • Biopsy of the omentum, a fat pad in the pelvis
  • Removal of lymph nodes in the pelvis and lower abdomen

Sometimes a radical hysterectomy is done. This means removal of the :

  • Uterus
  • Cervix and surrounding tissue
  • Upper vagina

Depending on your health and how far uterine cancer has spread, surgery may be :

  • Minimally invasive: After making several small incisions (cuts) in the abdomen, the doctor uses a laparoscope (link to definition) or robotic surgery (link to definition) to remove the organs. The uterus often is removed through the vagina.
  • Open: A large incision is made in the abdomen

Surgery for uterine cancer may include :

Pelvic washings: The surgeon puts saline (salt water) into the pelvic area after the uterus has been removed. The saline is then examined under a microscope.

Tumor debulking: If the cancer has spread into the abdomen, it may be debulked. This means the surgeon removes as much of the cancer as possible before other types of treatment.

Radiation Therapy

Radiation therapy may be used to treat uterine cancer after a hysterectomy or as the main treatment when surgery is not possible. Depending on the stage and grade of the cancer, radiation therapy also may be used at other points of treatment.

New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target uterine cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

MD Anderson provides the most advanced radiation treatments for uterine cancer, including :

  • Brachytherapy: Tiny radioactive seeds are placed in the body close to the tumor
  • 3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor
  • Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Talk to your doctor about possible side effects of radiation treatment for uterine cancer. Some women get lymphedema in their legs. This is caused by blockage of the lymph fluid. Lymphedema may not start until months after treatment, but it usually does not go away. However, there are treatments to help.

Chemotherapy

MD Anderson offers the most up-to-date and advanced chemotherapy options for uterine cancer.

Hormone Therapy

Some hormones can cause certain uterine cancers to grow. If tests show the cancer cells have receptors where hormones can attach, drugs can be used to reduce hormones or block them from working.

Hormones that may be used to treat uterine cancer include :

  • Progestins
  • Tamoxifen
  • Aromatase inhibitors

Vaginal Cancer

Vaginal Cancer Diagnostic Tests

If you have symptoms that may signal vaginal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family history.

One or more of the following tests may be used to find out if you have vaginal cancer and if it has spread. These tests also may be used to find out if treatment is working.

Biopsy

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

Imaging tests, which may include :

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

Endoscopic tests, which may include :

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

Your care team works together closely, communicating and collaborating often to be sure you receive the most comprehensive and efficient care. The group may include surgical, medical, radiation and gynecological oncologists; surgeons and reconstructive surgeons; diagnostic radiologists and pathologists. A specially trained support staff joins them in delivering your care for vaginal cancer.

MD Anderson treats more women each year with this complex type of cancer than most oncologists in the nation. This gives us a level of experience and expertise that is rare and translates to more successful outcomes for many women with vaginal cancer.

Surgical Skill

Surgery often is one of the methods used to treat vaginal cancer. Our skilled surgeons – who include some of the top reconstructive surgeons in the country – are known for innovative techniques and excellent outcomes.

Vaginal Cancer Facts

According to the American Cancer Society, only about 2,300 women are diagnosed with vaginal cancer each year in the United States. This represents about 1% of cancers of the reproductive system in women.

The vagina sometimes is called the birth canal, because a baby passes through it during the last part of birth. It is a 3- to 4-inch tube that goes from the cervix (bottom section of the uterus or womb) to the vulva (the outside part of female genitals).

Vaginal Cancer Types

The types of vaginal cancer are classified by the type of cell in which they begin.

Squamous cell carcinoma (cancer): About 75% of vaginal cancers are squamous cell cancers, which start in the vagina lining. These cancers develop slowly, sometimes over many years. Often they begin as vaginal intraepithelial neoplasia (VAIN), which is a precancerous condition. VAIN is found most often in women who have had hysterectomies (removal of the uterus), cervical cancer or cervical precancer.

Adenocarcinoma: This type of cancer makes up about 15% of vaginal cancers. It starts in the gland cells of the vagina and is most often found in women over 50. A subtype called clear cell adenocarcinoma is found in younger women whose mothers took the drug DES when they were pregnant.

Melanoma: Fewer than 10% of vaginal cancers are melanomas, which start in the cells that give the skin color.

Sarcoma: About 4% of vaginal cancers are sarcomas, which start within the wall of the vagina. The most common type is rhabdomyosarcoma, which usually is found in children.

Less Common Types

Sometimes cancer that begins in other parts of the body spreads (metastasizes) to the vagina. When this happens, the cancer is named for the part of the body where it started. Cancer of the cervix and vagina is called cervical cancer.

Vaginal Cancer Screening

Cancer screening exams are important medical tests done when you’re at risk but don’t have symptoms. They help find cancer at its earliest stage, when the chances for successful treatment are highest.

Screening may be able to find certain types of vaginal cancer in women without symptoms. You should have a pelvic exam every year. Pap tests are not necessary after age 65 or a hysterectomy that was done for reasons other than treatment of cervical dysplasia (precancer) or cancer.

In addition, MD Anderson recommends testing for HPV (human papilloma virus) for some women over 30 years old. This can be done at the same time as your Pap tests.

Vaginal Cancer Risk Factors

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

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

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

Vaginal Cancer Prevention

Certain lifestyle choices may lower your chance of getting vaginal cancer. You should :

  • Avoid HPV infection
    • Postpone sexual activity
    • Limit number of sexual partners
  • Avoid sex with :
    • Men who have not been circumcised
    • Partners who have had many sex partners
  • Speak to your doctor about HPV vaccination
  • Use condoms. They don’t prevent HPV, but they lower the risk
  • Do not smoke. Have regular checkups and pelvic exams
  • Treat any pre-cancerous conditions of the genitals

Vaginal Cancer Staging

If you are diagnosed with vaginal cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.

Vaginal Cancer Stages

The stage of most vaginal cancers is most often described using the FIGO (International Federation of Gynecology and Obstetrics) System of Staging combined with the American Joint Committee on Cancer (AJCC) TNM system. This system classifies the diseases in Stages 0 through IV depending on the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M for metastasis).

Tumor extent (T)

  • Tis: Cancer cells are only in the most superficial layer of cells of the vagina without growth into the underlying tissues. This stage is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). It is not included in the FIGO system.
  • T1: The cancer is only in the vagina.
  • T2: The cancer has grown through the vaginal wall, but not as far as the pelvic wall.
  • T3: The cancer is growing into the pelvic wall.
  • T4: The cancer is growing into the bladder or rectum or is growing out of the pelvis.

Lymph node spread of cancer (N)

  • N0: The cancer has not spread to lymph nodes
  • N1: The cancer has spread to lymph nodes in the pelvis or groin (inguinal region)

Distant spread of cancer (M)

  • M0: The cancer has not spread to distant sites
  • M1: The cancer has spread to distant sites

Stage Grouping

Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage in a process called stage grouping. The stages identify tumors that have a similar outlook and are treated in a similar way.

Stage 0 (Tis, N0, M0): In this stage, cancer cells are only in the top layer of cells lining the vagina (the epithelium) and have not grown into the deeper layers of the vagina. Cancers of this stage cannot spread to other parts of the body. Stage 0 vaginal cancer is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). This stage is not included in the FIGO system.

Stage I (T1, N0, M0): The cancer has grown through the top layer of cells but it has not grown out of the vagina and into nearby structures (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

Stage II (T2, N0, M0): The cancer has spread to the connective tissues next to the vagina but has not spread to the wall of the pelvis or to other organs nearby (T2). (The pelvis is the internal cavity that contains the internal female reproductive organs, rectum, bladder, and parts of the large intestine.) It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

Stage III: Either of the following :

  • T3, any N, M0: The cancer has spread to the wall of the pelvis (T3). It may (or may not) have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0), OR
  • T1 or T2, N1, M0: The cancer is in the vagina (T1) and it may have grown into the connective tissue nearby (T2). It has spread to lymph nodes nearby (N1), but has not spread to distant sites (M0).

Stage IVA (T4, Any N, M0): The cancer has grown out of the vagina to organs nearby (such as the bladder or rectum) (T4). It may or may not have spread to lymph nodes (any N). It has not spread to distant sites (M0).

Stage IVB (Any T, Any N, M1): Cancer has spread to distant organs such as the lungs (M1).

Symptoms of vaginal cancer vary from woman to woman. They may include :

  • Abnormal vaginal bleeding, especially after sex
  • Abnormal vaginal discharge
  • A mass or bump in the vagina
  • Pain during sex
  • Constipation
  • Pain when you urinate
  • Pain in the pelvic area that does not go away

If you have these symptoms, it probably does not mean you have cancer. They usually are caused by conditions, such as infections, that are not cancer. However, if you notice any of these signs, you should see a doctor.

Like all surgeries, vaginal cancer surgery is most successful when performed by a specialist with as much experience as possible in the particular procedure :

  • Surgical methods that allow some women to keep the ability to have children
  • Reconstructive surgery after treatment

Our Vaginal Cancer Treatments

If you are diagnosed with vaginal cancer, your doctor will discuss the best options to treat it. This depends on several factors, including :

  • Type and stage of the cancer
  • Your age and general health
  • If you want to have children

Your treatment for vaginal cancer will be customized to your particular needs. Sometimes two or more treatments are combined. Chemotherapy and/or radiation may be used before surgery to help shrink the tumor and make it easier to remove. Sometimes radiation is used to treat lymph nodes that may have cancer.

One or more of the following therapies may be recommended to treat vaginal cancer or help relieve symptoms.

Topical Therapy

A drug is applied directly onto the cancer. Topical therapy is not used to treat invasive vaginal cancer.

Surgery

Surgery may be used for :

  • Early stage vaginal cancer
  • Sarcomas
  • Melanomas

Your team of doctors will decide which method is best for you. Common surgeries for vaginal cancer include :

Laser surgery: This procedure may be used to treat precancerous changes, but it is not used for invasive vaginal cancer. Abnormal cells are burned off with a laser beam.

Excision: The cancer and some tissue on each side of it are surgically removed.

Vaginectomy: All or part of the vagina is removed.

Trachelectomy: The cervix and surrounding tissue are surgically removed but not the vagina. This procedure sometimes can be used for young women who wish to keep the ability to have children.

Lymph nodes may be removed during surgery too. A cerclage or stitch is used to help support the base of the uterus. If more cancer is found during the surgery, a hysterectomy probably will be done.

This is a highly specialized procedure that requires a great deal of skill on the part of the surgeon to be successful. If you are considering this surgery to treat vaginal cancer, be sure the doctor performing it has a high level of experience in this procedure.

Hysterectomy: This operation removes the uterus and the cervix, but not the tissue next to the uterus. The vagina and nearby lymph nodes are not removed. The surgery may be done through the vagina or through an incision (cut) in the abdomen.

Radical hysterectomy: The cervix, uterus, part of the vagina, the tissues surrounding the cervix (parametria) and nearby lymph nodes are removed, either through the vagina or a cut on the abdomen. The ovaries and fallopian tubes also may be removed at the same time. This is called a bilateral salpingo-oophorectomy (BSO).

Vaginal reconstruction: After surgery to remove the vaginal cancer, some women are able to have surgery to make a new vagina from tissue or skin from elsewhere on the body. This allows you to have intercourse.

Lymphadenectomy: If cancer has spread to lymph nodes in the groin or pelvis areas, or the surgeon wants to examine them to see if cancer has spread, it may be necessary to remove the glands surgically. This also is called a lymph node dissection. Lymphedema (link), which is caused by decreased fluid drainage, may be a side effect of this surgery.

Pelvic exenteration: Although this surgery is used rarely for vaginal cancer, it may be needed if the cancer has come back or it cannot be treated with radiation. As well as the organs and tissues removed in a radical hysterectomy, the bladder, cervix, rectum and part of the colon are removed.

  • If the bladder is removed, a piece of intestine may be used to make a new bladder. Then urine may be drained through a catheter (tube) into a urostomy, which is a small opening on the abdomen, or into a small plastic bag worn on the outside of the body.
  • If the rectum and part of the colon are removed, you may have a colostomy, which is an opening on the abdomen that allows solid waste (stool) to pass into a small bag worn on the outside of the body. Sometimes the colon may be reconnected so that a colostomy is not needed.

Chemotherapy

MD Anderson offers the most up-to-date and advanced vaginal cancer chemotherapy options.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow us to target vaginal cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

  • Brachytherapy: Tiny radioactive seeds or rods are placed in the body close to the tumor
  • External beam radiation: From a machine outside the body

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