diag and treatment

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=22 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="041000d2egerdp.gif"> <div> </div> </td> </tr><tr> <td valign="top" width=145 BGCOLOR="#333399" TEXT="#080000" background="040a2c00erkjzj.gif"> <div> <A HREF="index.htm" TARGET="_top" TITLE="TUMORS"><U><IMG SRC="0431e140.gif" border=0 width="30" height="20" ALT="up" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> <div> <A HREF="id63.htm" TARGET="_top" TITLE="chart"><U><IMG SRC="044280e0.gif" border=0 width="40" height="14" ALT="previous" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A><A HREF="id18.htm" TARGET="_top" TITLE="specificity"><U><IMG SRC="045280e0.gif" border=0 width="40" height="14" ALT="next" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> <div> <IMG BORDER="0" SRC="1x1.gif" HEIGHT="20" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="30"></div> <div>  <img src="HTMLobj-113/aniGif.gif" border="0" align="bottom" width="171" height="89">  </div> </td> <td valign="top" height=458 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#336600" FACE="Times New Roman" ><I>TUMORS</I></FONT><FONT SIZE="1" COLOR="#663399" FACE="Times New Roman" >    </FONT> |    <B> </B><FONT SIZE="2" COLOR="#0000BF" FACE="Times New Roman" ><A HREF="index.htm" TARGET="_top" TITLE="TUMORS"><U><B>home</B></U></A></FONT></div> <div> <IMG SRC="04207040.gif" border=0 width="263" height="4" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>diag and treatment</B></div> <div> <B>the diagnostic and treatment of course depend on the type of tumor and location and type of it with the classification , all these associated with or without the complication that the tumor even if benign will give.</B></div> <div> <B>the risk elimination and cause of it one of the step to look at .</B></div> <div> <B>in reality it is not the cancer which will kill but it consequences as destruction , infection, and poor nurishment.</B></div> <div> <B>don't forget when you are next to a patient thik first cancer as diagnostic differential which allowed you to not missing it</B></div> <bR> <bR> <div> <B>Diagnosis </B></div> <bR> <div> don't forget to listen to the patient and all symptoms and complain might be important for a good diagnostic and an effectif treatment. don't forget an early detection mean a 100%cure.</div> <div> exemple of symptomatology: rectoragia for instance or small hematuria can lead you to see and seek for cancer especially if they are microscopic, and a yerly screening is always good for prevention</div> <div> a history or familial cancer lead you to screen the all family as breast cancer or polyps in the colon</div> <div> behavior or strange headache think for a tumor in the brain , I had several cases similar where the doctors send these patient to psychiatry because young and strange behavior a neurological exam well done and ct scann lead to small tumors. </div> <div> If you have a sign or symptom that might mean cancer,  physical exam and ask about  medical history. </div> <bR> <div>  <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>imaging</U></I></FONT> procedures,</div> <div> <I><U>endoscopy</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >,</FONT></div> <div> sometimes an surgical exploration needed</div> <div>  laboratory tests.</div> <div>  In most cases, a <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>biopsy</U></I></FONT>, a procedure in which a sample of tissue is removed.</div> <div>  A <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>pathologist</U></I></FONT> examines the tissue under a microscope to check for cancer cells. </div> <div>  <A NAME="6"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <bR> <bR> <div> Imaging </div> <div>  </div> <div> X-rays are the most common way</div> <div> <FONT SIZE="3" COLOR="#000000" FACE="Arial" > a </FONT><I><U>CT</U></I><U> or </U><I><U>CAT scan</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" > uses a computer linked to an x-ray machine to make a series of detailed pictures. </FONT></div> <div> In <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>radionuclide scanning</U></I></FONT>, the patient swallows or is given an injection of a mildly <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>radioactive</U></I></FONT> substance. A machine (scanner) measures radioactivity levels in certain organs and prints a picture on paper or film. By looking at the amount of radioactivity in the organs, the doctor can find abnormal areas. </div> <div> <I><U>Ultrasonography</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" > is another procedure for viewing the inside of the body.</FONT></div> <div>  High-frequency sound waves that cannot be heard by humans enter the body and bounce back. Their echoes produce a picture called a sonogram. These pictures are shown on a monitor like a TV screen and can be printed on paper. </div> <div> In <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>MRI</U></I></FONT>, a powerful magnet linked to a computer is used to make detailed pictures of areas in the body. These pictures are viewed on a monitor and can also be printed. </div> <div>  <A NAME="7"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Endoscopy </div> <div> <I><U>Endoscopy</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" > , lighted tube called an endoscope. </FONT></div> <div> The exam is named for the organ involved (for example, colonoscopy to look inside the colon).</div> <div>  During the exam, don't forget biopsy even if normal macroscopy , if you did an endoscopy meaning a problem was there so the biopsy can detect a tumor in situ sometime , well if not tumoral or normal than good for the patient at least you have a piece of mind.</div> <div>  <A NAME="8"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Laboratory Tests </div> <div> Although no single test can be used to diagnose cancer, laboratory tests such as blood and urine tests give </div> <div> . If cancer is present, lab work may show the effects of the disease on the body. In some cases, special tests are used to measure the amount of certain substances in the blood, urine, other body fluids, or tumor tissue. The levels of these substances may become abnormal when certain kinds of cancer are present. </div> <div> tumoral markers</div> <div> lab test will include : a blood test for anemia [ex: an anemia in men look for colorectal cancer]</div> <div> liver, pancreas, kidney ect... special enzymes.</div> <div>  <A NAME="9"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Biopsy </div> <div> The physical exam, imaging, endoscopy, and lab tests can show that something abnormal is present, but a <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>biopsy</U></I></FONT> is the only sure way to know whether the problem is cancer. In a biopsy, [see characteristic of malignant and benign cells ]</div> <div>  <A NAME="10"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Staging </div> <div> When cancer is found, the patient's doctor needs to know the <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>stage</U></I></FONT>, or extent, of the disease to plan the best treatment.  <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>lymph nodes</U></I></FONT> find usually in a good exam near the tumor or far from it [no good prognostic] are removed and checked for cancer cells [the most frequent will be the axillary nodes in breast cancer [no good prognostic but here also it depend] the virshow or troisier nodes in the case of gastric cancer , in the lymphoma ect....]. If cancer cells are found in the lymph nodes, it may mean that the cancer has spread to other organs but sometimes not].</div> <bR> <div>  </div> <div>  <A NAME="11"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>Treatment </B></div> <bR> <div> Cancer is treated with :</div> <div> <I><U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">                 surgery</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >, </FONT></div> <div> <I><U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">radiation therapy</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >, </FONT></div> <div> <I><U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">chemotherapy</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >, </FONT></div> <div> <I><U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">hormone therapy</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >, </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>biological therapy</U></I></FONT>. </div> <bR> <div> Patients with cancer are often treated by a team of specialists, which may include a medical <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>oncologist</U></I></FONT> (specialist in cancer treatment), a surgeon, a radiation oncologist (specialist in radiation therapy), and others.</div> <div>  you  may decide as physician  to use one treatment method or a combination of methods.</div> <div>  The choice of treatment depends on the type and location of the cancer, the stage of the disease, the patient's age and general health, and other factors. </div> <div> Some cancer patients take part in a <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>clinical trial</U></I></FONT> (research study) using new treatment methods. Such studies are designed to improve cancer treatment. (Additional information can be found in the <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Clinical Trials</U></FONT> section.) </div> <div>  <A NAME="12"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Getting a Second Opinion </div> <div> Before starting treatment, the patient may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion; others may pay for a second opinion if the patient requests it. There are a number of ways to find specialists to consult for a second opinion: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The patient's doctor may suggest a specialist for a second opinion. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs in their area supported by the National Cancer Institute. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">any way in an hospital you always have meeting with the team and sometimes calling outside members to discuss the case and see what to do, may be done less in private practice.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">don't be proud or always sure , if you don't know or you are not sure seek second opinion or advise there is always some body with more experience and knoeldge , this is the patient life between your hands .</div> <div>  <A NAME="13"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Preparing for Treatment </div> <div> Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. Often, it helps to make a list of questions to ask the doctor. Patients may take notes or, with the doctor's consent, tape record the discussion. Some patients also find it helps to have a family member or friend with them when they talk with the doctor--to take part in the discussion, to take notes, or just to listen. </div> <div> Here are some questions a patient may want to ask the doctor: </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">What is my diagnosis? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">What is the stage of the disease? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">What are my treatment choices? Which do you recommend for me? Why? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">What are the chances that the treatment will be successful? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Would a clinical trial be appropriate for me? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">What are the risks and possible side effects of each treatment? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">How long will treatment last? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Will I have to change my normal activities? </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">What is the treatment likely to cost? who cares the patient life first.</div> <bR> <div> When a person is diagnosed with cancer, shock and stress are natural reactions. </div> <div> These feelings may make it difficult to think of every question to ask the doctor. </div> <div> Patients may find it hard to remember everything the doctor says. </div> <div> They should not feel they need to ask all their questions or remember all the answers at one time. </div> <div> They will have other chances for the doctor to explain things that are not clear and to ask for more information. </div> <div> this is why very often i prepare brochures and documentation for the patient being very explicite on the way it is and become and what expecting from treatment especially in surgery where the operation sometime are very heavy and longue .</div> <div>  <A NAME="14"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> Methods of Treatment </div> <bR> <div> <B>Surgery</B>--</div> <div> <I><U>Surgery</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" > is local therapy to remove the tumor. sometimes locoregional, and sometimes you have surprises as open and close [happen to me many times] nothing to do.this is why the videolaparoscopy procedures and exploration  are helpfull and can avoid any unnecessary opening if peritoneal metastases are found.</FONT></div> <bR> <div> Tissues around the tumor and nearby lymph nodes must also be removed during the operation. [curage ganglionaire] important for the follow up treatment</div> <bR> <div> never start with radiotherapy before a surgery , the scare are so important that it is hard and sometime impossible to remove the tumor in full. ex: thyroid or abdomen.</div> <div> don't forget even if it is not for a tumore to explore all the area for something else and first tumor if it is for normal surgery, this can avoid you to miss something that was not obvious </div> <div> exemple that is not tumor but to give you an idea is when you operate for an appendicitis explore for tumor and for a meckel diverticula 20 cm from the area that you are operating [this procedure is hardluy done with videolaparoscopy]</div> <bR> <div> <B>Radiation Therapy</B>--</div> <div> In <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>radiation therapy</U></I></FONT> (also called radiotherapy), high-energy rays are used to damage cancer cells and stop them from growing and dividing.</div> <div>  Like surgery, radiation therapy is local therapy; it can affect cancer cells only in the treated area.</div> <div>  Radiation may come from a machine (external radiation). It also may come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation). Some patients get both kinds of radiation therapy. </div> <div> External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. Patients are not radioactive during or after the treatment. </div> <bR> <div> For internal radiation therapy, the patient stays in the hospital for a few days. </div> <div> The implant may be temporary or permanent. </div> <div> Because the level of radiation is highest during the hospital stay, patients may not be able to have visitors or may have visitors only for a short time. </div> <div> Once an implant is removed, there is no radioactivity in the body. </div> <div> The amount of radiation in a permanent implant goes down to a safe level before the patient leaves the hospital. </div> <bR> <bR> <div> <B>Chemotherapy</B>--</div> <div> very heavy treatment making the patients more sick than they already are , with many consequences as vomiting , lost of hair ect... and other but if this will treat do not hesitate. </div> <div> Treatment with drugs to kill cancer cells is called <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>chemotherapy</U></I></FONT>. </div> <div> Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. </div> <div> Chemotherapy is <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>systemic</U></I></FONT> treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body. </div> <div> Often, patients who need many doses of IV chemotherapy receive the drugs through a <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>catheter</U></I></FONT> (a thin flexible tube). One end of the catheter is placed in a large vein in the chest. </div> <div> The other end is outside the body or attached to a small device just under the skin. Anticancer drugs are given through the catheter. This can make chemotherapy more comfortable for the patient. Patients and their families are shown how to care for the catheter and keep it clean. For some types of cancer, doctors are studying whether it helps to put anticancer drugs directly into the affected area. </div> <div> Chemotherapy is generally given in cycles: A treatment period is followed by a recovery period, then another treatment period, and so on. Usually a patient has chemotherapy as an outpatient--at the hospital, at the doctor's office, or at home. However, depending on which drugs are given and the patient's general health, the patient may need to stay in the hospital for a short time. </div> <bR> <div> <B>Hormone Therapy</B>--</div> <div> Some types of cancer, including most breast and prostate cancers [estrogen], depend on <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>hormones</U></I></FONT> to grow. </div> <div> . Sometimes, the patient has surgery to remove organs (such as the ovaries or testicles) that make the hormones; in other cases, the doctor uses drugs to stop hormone production or change the way hormones work.</div> <div>  Like chemotherapy, hormone therapy is systemic treatment; it affects cells throughout the body. </div> <bR> <bR> <div> <B>Biological Therapy</B>--genigenetic</div> <div> <I><U>Biological therapy</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (also called </FONT><I><U>immunotherapy</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >) is a form of treatment that uses the body's natural ability (</FONT><I><U>immune system</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >) to fight infection and disease or to protect the body from some of the side effects of treatment. </FONT><I><U>Monoclonal antibodies</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >, </FONT><I><U>interferon</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" >, </FONT><I><U>interleukin-2</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (IL-2), and several types of </FONT><I><U>colony-stimulating factors</U></I><FONT SIZE="3" COLOR="#000000" FACE="Arial" > (CSF, GM-CSF, G-CSF) are forms of biological therapy. </FONT></div> <div>  <A NAME="15"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>Side Effects of Cancer Treatment </B></div> <bR> <div> It is hard to limit the effects of treatment so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unpleasant side effects. </div> <div> The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently. Doctors try to plan the patient's therapy to keep side effects to a minimum and they can help with any problems that occur. </div> <div> <B>Surgery</B>--The side effects of surgery depend on the location of the tumor, the type of operation, the patient's general health, and other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient. </div> <div> <B>Radiation Therapy</B>--With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. The most common side effects are tiredness, skin reactions (such as a rash or redness) in the treated areas, and loss of appetite. Radiation therapy also may cause a decrease in the number of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>white blood cells</U></I></FONT>, cells that help protect the body against infection. Although the side effects of radiation therapy can be unpleasant, the doctor can usually treat or control them. It also helps to know that, in most cases, they are not permanent. </div> <div> <B>Chemotherapy</B>--The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, may bruise or bleed easily, and may have less energy. Cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may have side effects, such as loss of appetite, nausea and vomiting, hair loss, or mouth sores. For some patients, the doctor may prescribe medicine to help with side effects, especially with nausea and vomiting. Usually, these side effects gradually go away during the recovery period or after treatment stops. </div> <div> Hair loss, another side effect of chemotherapy, is a major concern for many patients. Some chemotherapy drugs only cause the hair to thin out, while others may result in the loss of all body hair. Patients may feel better if they decide how to handle hair loss before starting treatment. </div> <div> In some men and women, chemotherapy drugs cause changes that may result in a loss of fertility (the ability to have children). Loss of fertility may be temporary or permanent depending on the drugs used and the patient's age. For men, <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>sperm banking</U></I></FONT> before treatment may be a choice. Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Periods are more likely to return in young women. </div> <div> In some cases, <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>bone marrow transplantation</U></I></FONT> and <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>peripheral stem cell support</U></I></FONT> are used to replace tissue that forms blood cells when that tissue has been destroyed by the effects of chemotherapy or radiation therapy. (See more about these procedures in the Dictionary.) </div> <div> <B>Hormone Therapy</B>--Hormone therapy can cause a number of side effects. Patients may have nausea and vomiting, swelling or weight gain, and, in some cases, hot flashes. In women, hormone therapy also may cause interrupted menstrual periods, vaginal dryness, and, sometimes, loss of fertility. Hormone therapy in men may cause <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>impotence</U></I></FONT>, loss of sexual desire, or loss of fertility. These changes may be temporary, long lasting, or permanent. </div> <div> <B>Biological Therapy</B>--The side effects of biological therapy depend on the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients get a rash, and some bleed or bruise easily. In addition, interleukin therapy can cause swelling. Depending on how severe these problems are, patients may need to stay in the hospital during treatment. These side effects are usually short-term; they gradually go away after treatment stops. </div> <div> Doctors and nurses can explain the side effects of cancer treatment and help with any problems that occur. The National Cancer Institute booklets <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>Radiation Therapy and You</U></I></FONT> and <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>Chemotherapy and You</U></I></FONT> also have helpful information about cancer treatment and coping with side effects. </div> <div>  <A NAME="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>Nutrition for Cancer Patients </B></div> <bR> <div> Some patients lose their appetite and find it hard to eat well. In addition, the common side effects of treatment, such as nausea, vomiting, or mouth sores, can make it difficult to eat. For some patients, foods taste different. Also, people may not feel like eating when they are uncomfortable or tired. </div> <div> Eating well means getting enough calories and protein to help prevent weight loss and regain strength. Patients who eat well during cancer treatment often feel better and have more energy. In addition, they may be better able to handle the side effects of treatment. </div> <div> Doctors, nurses, and dietitians can offer advice for healthy eating during cancer treatment. Patients and their families also may want to read the National Cancer Institute booklet <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>Eating Hints for Cancer Patients</U></I></FONT>, which contains many useful suggestions. </div> <div>  <A NAME="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>Clinical Trials </B></div> <bR> <div> When laboratory research shows that a new treatment method has promise, cancer patients can receive the treatment in carefully controlled trials. These trials are designed to find out whether the new approach is both safe and effective and to answer scientific questions. Often, <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>clinical trials</U></FONT> compare a new treatment with a standard approach so that doctors can learn which is more effective. </div> <div> Researchers also look for ways to reduce the side effects of treatment and improve the quality of patients' lives. Patients who take part in clinical trials make an important contribution to medical science. These patients take certain risks, but they also may have the first chance to benefit from improved treatment methods. </div> <div> Clinical trials offer important options for many patients. Cancer patients who are interested in taking part in a clinical trial should talk with their doctor. They may want to read <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>Taking Part in Clinical Trials: What Cancer Patients Need To Know</U></I></FONT>, a booklet that explains treatment studies and outlines some of their possible benefits and risks. </div> <div> One way to learn about clinical trials is through <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>PDQ</U></FONT>, a computerized resource developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials in progress all over the country. The Cancer Information Service can provide PDQ information to doctors, patients, and the public. </div> <div>  <A NAME="18"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>Support for Cancer Patients </B></div> <bR> <div> Living with a serious disease is difficult. Cancer patients and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services. </div> <div> Cancer patients may worry about holding their job, caring for their family, or keeping up daily activities. Worries about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or daily activities. Meeting with a social worker, counselor, or member of the clergy also can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships. </div> <div> Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. Also, it helps many patients to meet with others who are facing problems like theirs. Cancer patients often get together in support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another-- even if both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor. </div> <div> Often, a social worker at the hospital or clinic can suggest groups that help with rehabilitation, emotional support, financial aid, transportation, or home care. The American Cancer Society has many services for patients and families. Local offices of the American Cancer Society are listed in the white pages of the telephone directory. </div> <div> In addition, the public library has many books and articles on living with cancer. The Cancer Information Service also has information on local resources. </div> <div>  <A NAME="19"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>What the Future Holds </B></div> <bR> <div> Researchers are finding better ways to detect and treat cancer, and the chance of recovery keeps improving. Still, it is natural for patients to be concerned about their future. </div> <div> Sometimes patients use statistics to try to figure out their chance of being cured. It is important to remember, however, that statistics are averages based on large numbers of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike. The doctor who takes care of the patient is in the best position to discuss the chance of recovery (<FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>prognosis</U></I></FONT>). Patients should feel free to ask the doctor about their prognosis, but they should keep in mind that not even the doctor knows exactly what will happen. Doctors often talk about surviving cancer, or they may use the term remission rather than cure. Even though many cancer patients are cured, doctors use these terms because the disease may <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>recur</U></I></FONT>. </div> <div>  <A NAME="20"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></div> <div> <B>Causes and Prevention of Cancer </B></div> <bR> <div> The number of new cases of cancer in the United States is going up each year. People of all ages get cancer, but nearly all types are more common in middle-aged and elderly people than in young people. Skin cancer is the most common type of cancer for both men and women. The next most common type among men is prostate cancer; among women, it is breast cancer. Lung cancer, however, is the leading cause of death from cancer for both men and women in the United States. Brain cancer and leukemia are the most common cancers in children and young adults. </div> <div> The more we can learn about what causes cancer, the more likely we are to find ways to prevent it. Scientists study patterns of cancer in the population to look for factors that affect the risk of developing this disease. In the laboratory, they explore possible causes of cancer and try to determine what actually happens when normal cells become cancerous. </div> <div> Our current understanding of the causes of cancer is incomplete, but it is clear that cancer is not caused by an injury, such as a bump or bruise. And although being infected with certain viruses may increase the risk of some types of cancer, cancer is not contagious; no one can "catch" cancer from another person. </div> <div> Cancer develops gradually as a result of a complex mix of factors related to environment, lifestyle, and heredity. Scientists have identified many risk factors that increase the chance of getting cancer. They estimate that about 80 percent of all cancers are related to the use of tobacco products, to what we eat and drink, or, to a lesser extent, to exposure to radiation or cancer-causing agents (<FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>carcinogens</U></I></FONT>) in the environment and the workplace. Some people are more sensitive than others to factors that can cause cancer. </div> <div> Many risk factors can be avoided. Others, such as inherited risk factors, are unavoidable. It is helpful to be aware of them, but it is also important to keep in mind that not everyone with a particular risk factor for cancer actually gets the disease; in fact, most do not. People at risk can help protect themselves by avoiding risk factors where possible and by getting regular checkups so that, if cancer develops, it is likely to be found early. </div> <div> These are some of the factors that are known to increase the risk of cancer: </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Tobacco.</B> Tobacco causes cancer. In fact, smoking tobacco, using "smokeless" tobacco, and being regularly exposed to environmental tobacco smoke without smoking are responsible for one-third of all cancer deaths in the United States each year. Tobacco use is the most preventable cause of death in this country. </div> <div> Smoking accounts for more than 85 percent of all lung cancer deaths. If you smoke, your risk of getting lung cancer is affected by the number and type of cigarettes you smoke and how long you have been smoking. Overall, for those who smoke one pack a day, the chance of getting lung cancer is about 10 times greater than for nonsmokers. Smokers are also more likely than nonsmokers to develop several other types of cancer (such as oral cancer and cancers of the larynx, esophagus, pancreas, bladder, kidney, and cervix). The risk of cancer begins to decrease when a smoker quits, and the risk continues to decline gradually each year after quitting. </div> <div> The use of smokeless tobacco (chewing tobacco and snuff) causes cancer of the mouth and throat. Precancerous conditions, or tissue changes that may lead to cancer, begin to go away after a person stops using smokeless tobacco. </div> <div> Exposure to environmental tobacco smoke, also called involuntary smoking, increases the risk of lung cancer for nonsmokers. The risk goes up 30 percent or more for a nonsmoking spouse of a person who smokes. Involuntary smoking causes about 3,000 lung cancer deaths in this country each year. </div> <div> If you use tobacco in any form and you need help quitting, talk with your doctor or dentist, or join a smoking cessation group sponsored by a local hospital or voluntary organization. For information on such groups or other programs, call the Cancer Information Service or the American Cancer Society. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Diet.</B> Your choice of foods may affect your chance of developing cancer. Evidence points to a link between a high-fat diet and certain cancers, such as cancer of the breast, colon, uterus, and prostate. Being seriously overweight appears to be linked to increased rates of cancer of the prostate, pancreas, uterus, colon, and ovary, and to breast cancer in older women. On the other hand, studies suggest that foods containing fiber and certain nutrients help protect us against some types of cancer. </div> <div> You may be able to reduce your cancer risk by making some simple food choices. Try to have a varied, well-balanced diet that includes generous amounts of foods that are high in fiber, vitamins, and minerals. At the same time, try to cut down on fatty foods. You should eat five servings of fruits and vegetables each day, choose more whole-grain breads and cereals, and cut down on eggs, high-fat meat, high-fat dairy products (such as whole milk, butter, and most cheeses), salad dressings, margarine, and cooking oils. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Sunlight.</B> <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>Ultraviolet radiation</U></I></FONT> from the sun and from other sources (such as sunlamps and tanning booths) damages the skin and can cause skin cancer. (Two types of ultraviolet radiation--UVA and UVB--are explained in the Medical Terms section.) Repeated exposure to ultraviolet radiation increases the risk of skin cancer, especially if you have fair skin or freckle easily. The sun's ultraviolet rays are strongest during the summer from about 11 a.m. to about 3 p.m. (daylight saving time). The risk is greatest at this time, when the sun is high overhead and shadows are short. As a rule, it is best to avoid the sun when your shadow is shorter than you are. </div> <div> Protective clothing, such as a hat and long sleeves, can help block the sun's harmful rays. You can also use sunscreens to help protect yourself. Sunscreens are rated in strength according to their SPF (sun protection factor), which ranges from 2 to 30 and higher. Those rated 15 to 30 block most of the sun's harmful rays. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Alcohol.</B> Drinking large amounts of alcohol increases the risk of cancer of the mouth, throat, esophagus, and larynx. (People who smoke cigarettes and drink alcohol have an especially high risk of getting these cancers.) Alcohol can damage the liver and increase the risk of liver cancer. Some studies suggest that drinking alcohol also increases the risk of breast cancer. So if you drink at all, do so in moderation--not more than one or two drinks a day. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Radiation.</B> X-rays used for diagnosis expose you to very little radiation and the benefits nearly always outweigh the risks. However, repeated exposure can be harmful, so it is a good idea to talk with your doctor or dentist about the need for each x-ray and ask about the use of shields to protect other parts of your body. </div> <div> Before 1950, x-rays were used to treat noncancerous conditions (such as an enlarged thymus, enlarged tonsils and adenoids, ringworm of the scalp, and acne) in children and young adults. People who have received radiation to the head and neck have a higher-than-average risk of developing thyroid cancer years later. People with a history of such treatments should report it to their doctor and should have a careful exam of the neck every 1 or 2 years. </div> <div> Also, radiation used in the treatment of some types of cancer can increase the risk of developing a second cancer. Patients having radiation therapy may want to discuss this issue with their doctor. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chemicals and other substances in the workplace.</B> Being exposed to substances such as metals, dust, chemicals, or pesticides at work can increase the risk of cancer. Asbestos, nickel, cadmium, uranium, radon, vinyl chloride, benzidene, and benzene are well-known examples of carcinogens in the workplace. These may act alone or along with another carcinogen, such as cigarette smoke. For example, inhaling asbestos fibers increases the risk of lung diseases, including cancer, and the cancer risk is especially high for asbestos workers who smoke. It is important to follow work and safety rules to avoid contact with dangerous materials. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Hormone replacement therapy.</B> Many women use <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>estrogen</U></I></FONT> therapy to control the hot flashes, vaginal dryness, and osteoporosis (thinning of the bones) that may occur during menopause. However, studies show that estrogen use increases the risk of cancer of the uterus. Other studies suggest an increased risk of breast cancer among women who have used high doses of estrogen or have used estrogen for a long time. At the same time, taking estrogen may reduce the risk of heart disease and osteoporosis. </div> <div> The risk of uterine cancer appears to be less when <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>progesterone</U></I></FONT> is used with estrogen than when estrogen is used alone. But some scientists are concerned that the addition of progesterone may also increase the risk of breast cancer. </div> <div> Researchers are still studying and finding new information about the risks and benefits of taking replacement hormones. A woman considering hormone replacement therapy should discuss these issues with her doctor. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Diethylstilbestrol (DES).</B> DES is a form of estrogen that doctors prescribed from the early 1940s until 1971 to try to prevent miscarriage. In some daughters of women who were given DES during pregnancy, the uterus, vagina, and cervix do not develop normally. DES-exposed daughters also have an increased chance of developing abnormal cells (dysplasia) in the cervix and vagina. In addition, a rare type of vaginal and cervical cancer has been found in a small number of DES-exposed daughters. Women who took DES during pregnancy may have a slightly increased risk of developing breast cancer. DES-exposed mothers and daughters should tell their doctor about this exposure. DES daughters should have regular special pelvic exams by a doctor familiar with conditions related to DES. </div> <div> Exposure to DES before birth does not appear to increase the risk of cancer in DES-exposed sons; however, reproductive and urinary system problems may occur. These men should tell the doctor and should have regular medical checkups. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Close relatives with certain types of cancer.</B> A small number of cancers (including <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><I><U>melanoma</U></I></FONT> and cancers of the breast, ovary, and colon) tend to occur more often in some families than in the rest of the population. It is not always clear whether a pattern of cancer in a family is due to heredity, factors in the family's environment, or chance. Still, if close relatives have been affected by cancer, it is important to let your doctor know this and then follow the doctor's advice about cancer prevention and checkups to detect problems early. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">and many other especially in our century there is more hazardous factor than 400 years ago, and with the pollution our gene are degrading.</div> <bR> </td> </tr></table></body>