cancer and treatment

Causes and Risk Factors of Breast Cancer

2011-06-29T18:47:00.001-07:00

Causes and Risk Factors of Breast CancerNo one knows exactly why a normal breast cell becomes a cancerous one, and there is probably no single cause. It is thought, however, that breast cancer results from a combination of risk factors. These risk factors can be grouped into several categories:

Hereditary risk: It has long been known that women whose mothers or sisters had breast cancer have a higher risk of developing the disease themselves. Recently, it has been discovered that breast cancer can develop when a woman inherits a breast cancer susceptibility gene from one of her parents. The most common of these genes are the BRCA1 and BRCA2 genes. These genes account for about 10 percent of all breast cancer cases and in families that have these genes, the risk of breast cancer can be very high. However, it is important to realize that 85 - 90 percent of breast cancers and NOT hereditary, and that all women need to be screened for breast cancer, even if no one in their families have ever had the disease.

Hormonal risk factors: The female hormones estrogen and progesterone are involved in breast cancer formation. For example, it is known that women who start to menstruate at an early age, or who have a late menopause have a higher risk of breast cancer than women who do not. It is also known that women who take hormone replacement therapy after menopause have an increased risk of breast cancer. Many studies have also been done looking at the risk of taking birth control pills. To date, these studies have not demonstrated an increased risk of breast cancer associated with use of these medications.

Age: Breast cancer becomes much more common as women grown older.

Gender: Most breast cancer occurs in women, although about 12,000 cases of breast cancer occur in men in the United States each year.

Diet and Exercise: Studies have shown that women who exercise are less likely to develop breast cancer than sedentary women. Studies have also shown that women who gain weight after menopause have an increased risk of breast cancer compared to women who do not. There are no clear links between diet and breast cancer risk, except for an increased risk of breast cancer in women who consume alcohol on a regular basis.

Symptoms of Breast CancerEarly breast cancer usually does not cause pain. In fact, when it first develops, breast cancer may cause no symptoms at all. But as the cancer grows, it can cause these changes:
a lump or thickening in the breast or armpit
a change in the size or shape of the breast
discharge from the nipple
a change in the color or texture of the skin of the breast or areola (such as dimpling, puckering, or scaliness).

Note: any changes in the breast should be reported to a doctor without delay. Symptoms can be caused by cancer or by a number of less serious conditions. Early diagnosis is especially important for breast cancer because the disease responds best to treatment before it has spread. The earlier breast cancer is found and treated, the better a woman's chance for complete recovery.

Diagnosis of Breast CancerThe diagnosis may be established by a careful physical examination, mammography, ultrasonography, and biopsy.
The doctor will examine the breasts using visual inspection and palpation. Visual inspection looks for changes in breast contour, new dimpling, nipple inversion, discharge, moles, puckering or persistent sores. Palpation is using the pads of the fingers to press down and feel the tissue around the breasts for any unusual lumps. Benign (non-cancerous) lumps may feel different from cancerous ones, but most times it is very difficult to determine whether a lump is cancerous without further testing.
Mammography is an x-ray of the breast that reveals suspicious areas that are denser than normal breast tissue or have abnormal deposits of calcium. Mammography is an important screening test which can show a breast cancer long before it is big enough to be felt in the breast. Women over age 40 should undergo a mammogram every year in order to detect breast cancers when they are small and can be treated easily. Since mammograms have been used routinely in the United States, the death rate from breast cancer has fallen dramatically as cancers are found earlier, when they are more likely to be curable.
Ultrasonography uses high frequency sound waves that enter the breast and bounce back. The pattern of their echoes produce a picture called a sonogram that detects whether the breast lump is solid (possibly cancerous) or filled with fluid (non-cancerous). An ultrasound is usually recommended to evaluate a palpable breast lump or an abnormality seen on a mammogram.
Many times when an abnormality is felt in the breast or seen on a mammogram, the doctor will recommend a biopsy. In a biopsy, tissue is removed from the breast and examined by a pathologist, who can tell if cancerous cells are present. There are three ways to do breast biopsies: fine needle aspiration, large core breast biopsy and surgical biopsy. Fine needle aspiration (FNA) uses a fine needle, inserted into the breast tissue, to withdraw cells from the suspicious area. Large core breast biopsy uses a large core needle in a spring-loaded device that removes "cores" or plugs of tissue from the suspicious area. Surgical biopsy is the surgical removal of part or all of the lump or suspicious area.

If breast cancer is diagnosed, the doctor will then determine the stage (phase or progression) of the cancer. The following staging system is used:
Carcinoma in situ is very early breast cancer. Cancer has not invaded into the normal breast tissue and is contained in either the breast duct (ductal carcinoma in situ) or the breast lobule (lobular carcinoma in situ). By definition, this type of cancer is not invasive and is not able to travel to the lymph nodes or other parts of the body.
Stage I means the tumor is no larger than two centimeters (cm) (about one inch) and has not spread outside the breast.
Stage II means the tumor is from two to five cm (roughly two inches) and/or has spread to the lymph nodes under the arm.
Stage III means the cancer is larger than five cm (about two inches) involves the underarm lymph nodes to a greater extent, and/or has spread to other lymph nodes or other tissues near the breast.
Stage IV means the cancer has spread to other organs of the body (metastatic cancer), most often the lungs, bones, and/or liver.

Treatment of Breast CancerThere are two methods of treatment - local and systemic.

Local treatments are used to remove or destroy the cancer cells in a specific area. Surgery and Radiation therapy are examples of local treatments.

Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormonal therapy examples of systemic treatments.

The right treatment method, however, depends on the size and location of the breast tumor; the results of the pathologist� s review of the tumor specimen, the woman's age, menopausal status, and general health; and the stage of the disease.

Local treatments

Surgery is the most common treatment for breast cancer. There are two types: breast-sparing surgery and mastectomy.

Breast-sparing surgery, also known as lumpectomy or partial mastectomy, removes the cancerous lump but not the entire breast. This is generally accompanied by a sampling of the under arm lymph nodes to see if the cancer has spread to this area. This sampling can either by achieved by removing all of the lymph nodes (known as full lymph node dissection) or a new procedure known as a sentinel node dissection. In this procedure, the surgeon injects a radioactive dye and/or a blue dye in the area around the tumor or around the nipple. The surgeon then finds the lymph nodes to which this dye travels and removes only those nodes. If there is cancer in one of these nodes with dye in it, then the rest of the nodes are removed. Otherwise, the nodes are left in place, which lowers the likelihood of developing complications such as arm swelling or pain after surgery. Studies have shown that women who have breast-sparing surgery require radiation therapy after surgery in order to reduce the risk that the cancer will come back in the breast.

The other type of surgery that is commonly performed in breast cancer is called a mastectomy. In this procedure, the entire breast is removed. This is usually done if the tumor is too large to remove without removing the entire breast, if the cancer is present in the skin of the breast (inflammatory breast cancer), or if the patient prefers this type of surgery. Again, the lymph nodes are sampled at the time of the mastectomy. Either a full axillary dissection may be performed or a sentinel lymph node dissection.

Radiation therapy (also called x-ray therapy, radiotherapy, or irradiation) uses high-energy rays to damage cancer cells and stop them from growing. Radiation is used after breast-conserving surgery to reduce the risk of the cancer returning in the breast. It may also be used after mastectomy if the cancer had spread to the lymph nodes. Radiation may come from an outside source or from radioactive materials placed directly in the breast. The patient receives external radiation treatments as an outpatient, usually five days a week for five or six weeks. At the end of that time, an extra "boost" of radiation is usually given to the treatment site. The boost may be either external (using electron beam therapy) or internal (using an implant). A short hospital stay may be required for implant radiation.

Systemic treatments

Local treatments remove cancerous cells from the breast and under arm lymph nodes. However, cancerous cells may have left the breast before the surgery and be present in other parts of the body. These cells can grow into a tumor in one of these other body locations months to years later in what is called a breast cancer recurrence. Unfortunately, if this occurs, the cancer is said to be �metastatic� and although it is treatable, it is no longer curable. In order to reduce the chance of this happening, systemic or whole body treatments are often used after surgery to try to kill any cancer cells that may have escaped from the breast prior to surgery. There are two primary kinds of adjuvant systemic treatments:

Chemotherapy drugs are medications that kill rapidly growing cells such as cancer cells. These drugs can be given either by mouth or intravenously. Chemotherapy medications are very powerful and can have many side effects. In general, chemotherapy is used for large tumors or for cancers that have spread to the under arm lymph nodes. Some types of cancer are also not sensitive to hormonal therapy and chemotherapy is usually used in these situations. Finally, younger women appear to benefit more from chemotherapy than older women. It is important to speak to a medical oncologist to find out if chemotherapy is recommended.

There are many different types of chemotherapy drugs used in the treatment of breast cancer. The most commonly used drugs are adriamycin, cytoxan and paclitaxel (Taxol), or docetaxel (Taxotere). Chemotherapy is usually given in �cycles�. One cycle of chemotherapy usually involves going to the oncologist�s office and receiving intravenous chemotherapy once every two to three weeks. This is usually repeated four to eight times, depending on the size of the tumor and lymph node status.

In recent years, new types of chemotherapy drugs have been developed that are targeted to special types of breast cancer. The most important of these so far is known as trastuzumab or Herceptin. This medication was developed specifically to treat cancers that have too much of a growth protein known as HER-2/neu. About 20 - 30 percent of breast cancers fall into this category, and treatment with this new medication has been shown to greatly reduce the risk of dying from this type of breast cancer. Many new medications are under development for other types of breast cancer.

Hormone therapy is used to prevent cancer cells from getting the hormones they need to grow. Hormonal therapy is only useful in treating tumors that have either estrogen receptors or progesterone receptors. These types of cancer are said to be hormone receptor positive or hormone responsive.

In post-menopausal women, the ovaries are no longer producing female hormones. However, these women still do have estrogen in their bodies. It comes from the adrenal glands, which are small glands that sit above the kidneys. The adrenals make male hormones that are transformed into female hormones in fat cells. This is one of the reasons that women with more fatty tissue have higher estrogen levels.

In women who have gone through menopause, there are two types of medicine which can prevent estrogen from getting to any cancer cells that may have escaped the breast before surgery. The medication tamoxifen is an estrogen receptor blocker, meaning that it prevents estrogen in the body from getting to the cancer cells. The other type of medications are called aromatase inhibitors (including Arimidex, Femara, and Aromasin). These medications stop the transformation of male hormones into female hormones. Both of these types of medications work well to prevent breast cancer from returning.

In pre-menopausal women, most of the estrogen in the body comes from the ovaries. The most common type of hormonal therapy in this group is tamoxifen, since this works to block estrogen no matter where it comes from. At times, the ovaries might also be removed to decrease the amount of estrogen in the body. However, given the increased side effects from this type of procedure, this is usually not recommended outside of a clinical trial.

Choice of treatment is often a complicated issue and must be individualized for each patient, with the consultation of a medication oncologist, a radiation oncologist and a surgeon.

Prevention of Breast CancerExamine Your Breasts Every Month Beginning At Age 20 (see your doctor for self breast exam instructions). Check for: new lump (painful or not), unusual thickening of tissue, discharge from the nipples, change in the skin of nipples or breasts, or different breast size or shape than before.

Have Your Doctor Examine Your Breasts Every Year Or Two Beginning At Age 30

Have A Mammogram Every Year After Age 40

women and breast cancer

2011-06-29T18:47:00.000-07:00

Women who are at high risk of developing breast cancer may consider preventive mastectomy as a way of decreasing their risk of this disease. Some of the factors that increase a woman's chance of developing breast cancer include the following

Previous breast cancer— A woman who has had cancer in one breast is more likely to develop a new cancer in the opposite breast. Occasionally, such women may consider preventive mastectomy to decrease the chance of developing a new breast cancer.

Family history of breast cancer— Preventive mastectomy may be an option for a woman whose mother, sister, or daughter had breast cancer, especially if they were diagnosed before age 50. If multiple family members have breast or ovarian cancer, then a woman's risk of breast cancer may be even higher.

Breast cancer-causing gene alteration— A woman who tests positive for changes, or mutations, in certain genes that increase the risk of breast cancer (such as the BRCA1 or BRCA2 gene) may consider preventive mastectomy.

Lobular carcinoma in situ— Preventive mastectomy is sometimes considered for a woman with lobular carcinoma in situ, a condition that increases the risk of developing breast cancer in either breast.

Diffuse and indeterminate breast microcalcifications or dense breasts— Rarely, preventive mastectomy may be considered for a woman who has diffuse and indeterminate breast microcalcifications (tiny deposits of calcium in the breast) or for a woman whose breast tissue is very dense. Dense breast tissue is linked to an increased risk of breast cancer and also makes diagnosing breast abnormalities difficult. Multiple biopsies, which may be necessary for diagnosing abnormalities in dense breasts, cause scarring and further complicate examination of the breast tissue, by both physical examination and mammography.

Radiation therapy— A woman who had radiation therapy to the chest (including the breasts) before age 30 is at an increased risk of developing breast cancer throughout her life. This includes women treated for Hodgkin lymphoma.

It is important for a woman who is considering preventive mastectomy to talk with a doctor about her risk of developing breast cancer (with or without a mastectomy), the surgical procedure, and potential complications. All women are different, so preventive mastectomy should be considered in the context of each woman's unique risk factors and her level of concern.
How effective is preventive mastectomy in preventing or reducing the risk of breast cancer?

Existing data suggest that preventive mastectomy may significantly reduce (by about 90 percent) the chance of developing breast cancer in moderate- and high-risk women . However, no one can be certain that this procedure will protect an individual woman from breast cancer. Breast tissue is widely distributed on the chest wall, and can sometimes be found in the armpit, above the collarbone, and as far down as the abdomen. Because it is impossible for a surgeon to remove all breast tissue, breast cancer can still develop in the small amount of remaining tissue
What are the possible drawbacks of preventive mastectomy?

Like any other surgery, complications such as bleeding or infection can occur . Preventive mastectomy is irreversible and can have psychological effects on a woman due to a change in body image and loss of normal breast functions . A woman should discuss her feelings about mastectomy, as well as alternatives to surgery, with her health care providers. Some women obtain a second medical opinion to help with the decision.
What alternatives to surgery exist for preventing or reducing the risk of breast cancer?

Doctors do not always agree on the most effective way to manage the care of women who have a strong family history of breast cancer and/or have other risk factors for the disease. Some doctors may advise very close monitoring (periodic mammograms, regular checkups that include a clinical breast examination performed by a health care professional, and monthly breast self-examinations) to increase the chance of detecting breast cancer at an early stage . Some doctors may recommend preventive mastectomy, while others may prescribe tamoxifen or raloxifene, medications that have been shown to decrease the chances of getting breast cancer in women at high risk of the disease . (More information about tamoxifen and raloxifene is available in the National Cancer Institute's (NCI) fact sheets, Tamoxifen: Questions and Answers, which can be found at http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen on the Internet.

Doctors may also encourage women at high risk to limit their consumption of alcohol, eat a low-fat diet, engage in regular exercise, and avoid menopausal hormone use . Although these lifestyle recommendations make sense and are part of an overall healthy way of living, we do not yet have clear and convincing proof that they specifically reduce the risk of developing breast cancer.
What is breast reconstruction?

Breast reconstruction is a plastic surgery procedure in which the shape of the breast is rebuilt. Many women who choose to have preventive mastectomy also decide to have breast reconstruction, either at the time of the mastectomy or at some later time.

Before performing breast reconstruction, the plastic surgeon carefully examines the breasts and discusses the reconstruction options. In one type of reconstructive procedure, the surgeon inserts an implant (a balloon-like device filled with saline or silicone) under the skin and the chest muscles. Another procedure, called tissue flap reconstruction, uses skin, fat, and muscle from the woman's abdomen, back, or buttocks to create the breast shape. The surgeon will discuss with the patient any limitations on exercise or arm motion that might result from these operations.
What type of follow-up care is needed after reconstructive surgery?

Women who have reconstructive surgery are monitored carefully to detect and treat complications, such as infection, movement of the implant, or contracture (the formation of a firm, fibrous shell or scar tissue around the implant caused by the body's reaction to the implant). Women who have tissue flap reconstruction may want to ask their surgeon about physical therapy, which can help them adjust to limitations in activity and exercise after surgery . Routine screening for breast cancer is also part of the postoperative follow-up, because the risk of cancer cannot be completely eliminated. When women with breast implants have mammograms, they should tell the radiology technician about the implant. Special procedures may be necessary to improve the accuracy of the mammogram and to avoid damaging the implant. However, women who have had reconstructive surgery on both breasts should ask their doctors whether mammograms are still necessary

asbestors as one of the causes of cancer

2011-06-29T18:31:00.000-07:00

Asbestos is the name given to a group of minerals that occur naturally in the environment as bundles of fibers that can be separated into thin, durable threads. These fibers are resistant to heat, fire, and chemicals and do not conduct electricity. For these reasons, asbestos has been used widely in many industries.

Chemically, asbestos minerals are silicate compounds, meaning they contain atoms of silicon and oxygen in their molecular structure.

Asbestos minerals are divided into two major groups: Serpentine asbestos and amphibole asbestos. Serpentine asbestos includes the mineral chrysotile, which has long, curly fibers that can be woven. Chrysotile asbestos is the form that has been used most widely in commercial applications. Amphibole asbestos includes the minerals actinolite, tremolite, anthophyllite, crocidolite, and amosite. Amphibole asbestos has straight, needle-like fibers that are more brittle than those of serpentine asbestos and are more limited in their ability to be fabricated .
How is asbestos used?

Asbestos has been mined and used commercially in North America since the late 1800s. Its use increased greatly during World War II . Since then, asbestos has been used in many industries. For example, the building and construction industries have used it for strengthening cement and plastics as well as for insulation, roofing, fireproofing, and sound absorption. The shipbuilding industry has used asbestos to insulate boilers, steam pipes, and hot water pipes. The automotive industry uses asbestos in vehicle brake shoes and clutch pads. Asbestos has also been used in ceiling and floor tiles; paints, coatings, and adhesives; and plastics. In addition, asbestos has been found in vermiculite-containing garden products and some talc-containing crayons.

In the late 1970s, the U.S. Consumer Product Safety Commission (CPSC) banned the use of asbestos in wallboard patching compounds and gas fireplaces because the asbestos fibers in these products could be released into the environment during use. In addition, manufacturers of electric hairdryers voluntarily stopped using asbestos in their products in 1979. In 1989, the U.S. Environmental Protection Agency (EPA) banned all new uses of asbestos; however, uses developed before 1989 are still allowed. The EPA also established regulations that require school systems to inspect buildings for the presence of damaged asbestos and to eliminate or reduce asbestos exposure to occupants by removing the asbestos or encasing it

In June 2000, the CPSC concluded that the risk of children’s exposure to asbestos fibers in crayons was extremely low However, U.S. manufacturers of these crayons agreed to eliminate talc from their products.

In August 2000, the EPA conducted a series of tests to evaluate the risk for consumers of adverse health effects associated with exposure to asbestos-contaminated vermiculite. The EPA concluded that exposure to asbestos from some vermiculite products poses only a minimal health risk. The EPA recommended that consumers reduce the low risk associated with the occasional use of vermiculite during gardening activities by limiting the amount of dust produced during vermiculite use. Specifically, the EPA suggested that consumers use vermiculite outdoors or in a well-ventilated area; keep vermiculite damp while using it; avoid bringing dust from vermiculite into the home on clothing; and use premixed potting soil, which is less likely to generate dust

The regulations described above and other actions, coupled with widespread public concern about the health hazards of asbestos, have resulted in a significant annual decline in the U.S. use of asbestos. Domestic consumption of asbestos amounted to about 803,000 metric tons in 1973, but it had dropped to about 2,400 metric tons by 2005 .
What are the health hazards of exposure to asbestos?

People may be exposed to asbestos in their workplace, their communities, or their homes. If products containing asbestos are disturbed, tiny asbestos fibers are released into the air. When asbestos fibers are breathed in, they may get trapped in the lungs and remain there for a long time. Over time, these fibers can accumulate and cause scarring and inflammation, which can affect breathing and lead to serious health problems

Asbestos has been classified as a known human carcinogen (a substance that causes cancer) by the U.S. Department of Health and Human Services, the EPA, and the International Agency for Research on Cancer . Studies have shown that exposure to asbestos may increase the risk of lung cancer and mesothelioma (a relatively rare cancer of the thin membranes that line the chest and abdomen). Although rare, mesothelioma is the most common form of cancer associated with asbestos exposure. In addition to lung cancer and mesothelioma, some studies have suggested an association between asbestos exposure and gastrointestinal and colorectal cancers, as well as an elevated risk for cancers of the throat, kidney, esophagus, and gallbladder . However, the evidence is inconclusive.

Asbestos exposure may also increase the risk of asbestosis (an inflammatory condition affecting the lungs that can cause shortness of breath, coughing, and permanent lung damage) and other nonmalignant lung and pleural disorders, including pleural plaques (changes in the membranes surrounding the lung), pleural thickening, and benign pleural effusions (abnormal collections of fluid between the thin layers of tissue lining the lungs and the wall of the chest cavity). Although pleural plaques are not precursors to lung cancer, evidence suggests that people with pleural disease caused by exposure to asbestos may be at increased risk for lung cancer .
Who is at risk for an asbestos-related disease?

Everyone is exposed to asbestos at some time during their life. Low levels of asbestos are present in the air, water, and soil. However, most people do not become ill from their exposure. People who become ill from asbestos are usually those who are exposed to it on a regular basis, most often in a job where they work directly with the material or through substantial environmental contact.

Since the early 1940s, millions of American workers have been exposed to asbestos. Health hazards from asbestos fibers have been recognized in workers exposed in the shipbuilding trades, asbestos mining and milling, manufacturing of asbestos textiles and other asbestos products, insulation work in the construction and building trades, and a variety of other trades. Demolition workers, drywall removers, asbestos removal workers, firefighters, and automobile workers also may be exposed to asbestos fibers. Studies evaluating the cancer risk experienced by automobile mechanics exposed to asbestos through brake repair are limited, but the overall evidence suggests there is no safe level of asbestos exposure As a result of Government regulations and improved work practices, today’s workers (those without previous exposure) are likely to face smaller risks than did those exposed in the past.

Individuals involved in the rescue, recovery, and cleanup at the site of the September 11, 2001, attacks on the World Trade Center (WTC) in New York City are another group at risk of developing an asbestos-related disease. Because asbestos was used in the construction of the North Tower of the WTC, when the building was attacked, hundreds of tons of asbestos were released into the atmosphere. Those at greatest risk include firefighters, police officers, paramedics, construction workers, and volunteers who worked in the rubble at Ground Zero. Others at risk include residents in close proximity to the WTC towers and those who attended schools nearby. These individuals will need to be followed to determine the long-term health consequences of their exposure .

One study found that nearly 70 percent of WTC rescue and recovery workers suffered new or worsened respiratory symptoms while performing work at the WTC site. The study describes the results of the WTC Worker and Volunteer Medical Screening Program, which was established to identify and characterize possible WTC-related health effects in responders. The study found that about 28 percent of those tested had abnormal lung function tests, and 61 percent of those without previous health problems developed respiratory symptoms . However, it is important to note that these symptoms may be related to exposure to debris components other than asbestos.

Although it is clear that the health risks from asbestos exposure increase with heavier exposure and longer exposure time, investigators have found asbestos-related diseases in individuals with only brief exposures. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after their first exposure. It can take from 10 to 40 years or more for symptoms of an asbestos-related condition to appear

There is some evidence that family members of workers heavily exposed to asbestos face an increased risk of developing mesothelioma This risk is thought to result from exposure to asbestos fibers brought into the home on the shoes, clothing, skin, and hair of workers. To decrease these exposures, Federal law regulates workplace practices to limit the possibility of asbestos being brought home in this way. Some employees may be required to shower and change their clothes before they leave work, store their street clothes in a separate area of the workplace, or wash their work clothes at home separately from other clothes .

Cases of mesothelioma have also been seen in individuals without occupational asbestos exposure who live close to asbestos mines

What factors affect the risk of developing an asbestos-related disease?

Several factors can help to determine how asbestos exposure affects an individual, including
Dose (how much asbestos an individual was exposed to).
Duration (how long an individual was exposed).
Size, shape, and chemical makeup of the asbestos fibers.
Source of the exposure.
Individual risk factors, such as smoking and pre-existing lung disease.

Although all forms of asbestos are considered hazardous, different types of asbestos fibers may be associated with different health risks. For example, the results of several studies suggest that amphibole forms of asbestos may be more harmful than chrysotile, particularly for mesothelioma risk, because they tend to stay in the lungs for a longer period of time
How does smoking affect risk?

Many studies have shown that the combination of smoking and asbestos exposure is particularly hazardous. Smokers who are also exposed to asbestos have a risk of developing lung cancer that is greater than the individual risks from asbestos and smoking added together There is evidence that quitting smoking will reduce the risk of lung cancer among asbestos-exposed workers Smoking combined with asbestos exposure does not appear to increase the risk of mesothelioma However, people who were exposed to asbestos on the job at any time during their life or who suspect they may have been exposed should not smoke.
How are asbestos-related diseases detected?

Individuals who have been exposed (or suspect they have been exposed) to asbestos fibers on the job, through the environment, or at home via a family contact should inform their doctor about their exposure history and whether or not they experience any symptoms. The symptoms of asbestos-related diseases may not become apparent for many decades after the exposure. It is particularly important to check with a doctor if any of the following symptoms develop
Shortness of breath, wheezing, or hoarseness.
A persistent cough that gets worse over time.
Blood in the sputum (fluid) coughed up from the lungs.
Pain or tightening in the chest.
Difficulty swallowing.
Swelling of the neck or face.
Loss of appetite.
Weight loss.
Fatigue or anemia.

A thorough physical examination, including a chest x-ray and lung function tests, may be recommended. The chest x-ray is currently the most common tool used to detect asbestos-related diseases. However, it is important to note that chest x-rays cannot detect asbestos fibers in the lungs, but they can help identify any early signs of lung disease resulting from asbestos exposure .

Studies have shown that computed tomography (a series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine) may be more effective than conventional chest x-rays at detecting asbestos-related lung abnormalities in individuals who have been exposed to asbestos .

A lung biopsy, which detects microscopic asbestos fibers in pieces of lung tissue removed by surgery, is the most reliable test to confirm the presence of asbestos-related abnormalities. A bronchoscopy is a less invasive test than a biopsy and detects asbestos fibers in material that is rinsed out of the lungs. It is important to note that these tests cannot determine how much asbestos an individual may have been exposed to or whether disease will develop . Asbestos fibers can also be detected in urine, mucus, or feces, but these tests are not reliable for determining how much asbestos may be in an individual’s lungs

How can workers protect themselves from asbestos exposure?

The Occupational Safety and Health Administration (OSHA) is a component of the U.S. Department of Labor (DOL) and is the Federal agency responsible for health and safety regulations in maritime, construction, manufacturing, and service workplaces. OSHA established regulations dealing with asbestos exposure on the job, specifically in construction work, shipyards, and general industry, that employers are required to follow. In addition, the Mine Safety and Health Administration (MSHA), another component of the DOL, enforces regulations related to mine safety. Workers should use all protective equipment provided by their employers and follow recommended workplace practices and safety procedures. For example, National Institute for Occupational Safety and Health (NIOSH)-approved respirators that fit properly should be worn by workers when required.

Workers who are concerned about asbestos exposure in the workplace should discuss the situation with other employees, their employee health and safety representative, and their employers. If necessary, OSHA can provide more information or make an inspection. Regional offices of OSHA are listed in the “United States Government” section of a telephone directory’s blue pages (under “Department of Labor”).

More information about asbestos is available on the OSHA Asbestos Web page, which has links to information about asbestos in the workplace, including what OSHA standards apply, the hazards of asbestos, evaluating asbestos exposure, and controls used to protect workers.

The two types of bone cancer are primary and secondary. Primary bone cancer originates in the bone or tissues adjoined to the bone such as connective tissue.

2011-06-29T18:26:00.000-07:00

The two types of bone cancer are primary and secondary. Primary bone cancer originates in the bone or tissues adjoined to the bone such as connective tissue. Secondary bone cancers, also known as bone metastases, are cancers that originated in another place in the body and then spread to the bone. The cells in bone metastases resemble the cells from the cancer's origin. They are not bone cells that have become cancerous, as in the case of primary bone cancers.

Primary bone cancers: The most common types of primary bone cancers include Osteosarcoma, Chondrosarcoma, and Ewing's sarcoma. Osteosarcoma develops in new tissue of growing bones and occurs most commonly in children or adolescents. Chondrosarcoma originates in cartilage, which is a type of connective tissue that serves as a protective layer between bones ends. Ewing 's sarcoma originates in immature nerve tissue within bone marrow. This type of bone cancer also occurs more frequently in children and adolescents. Less common bone cancers include malignant fibrous histocytoma and fibrosarcoma. These cancers are similar to Osteosarcoma in that they occur mainly in the extremities, except they occur in adults.

Cancers Metastatic to Bone or (Secondary bone cancers): Although most cancers can spread to or invade bone, the most common cancers that spread to bone are multiple myeloma, breast, prostate, lung, kidney, and thyroid cancer. The ribs, pelvis and spine are normally the first bones impacted by bone metastases, while bones more distant from the central skeleton are less frequently affected. It is not well understood why certain cancers metastasize to bone more than others. However, some general observations about bone metastases are as follows:
Breast cancer is the most common type of cancer to spread to bone, followed by prostate, then lung.
Carcinomas, or cancers that arise from tissues that line or cover organs, are much more likely to metastasize to bone than sarcomas, cancers that originate in connective tissue (cartilage, fat, or muscle).
Bone metastases from kidney cancer may occur many years after the primary cancer has been treated.
Signs and Symptoms of Bone Cancer

The first symptom of bone cancer is usually pain or tenderness near the cancer. Bone pain is caused by stretching of the periosteum (thick membrane that covers bone) by the cancer, or by stimulation of nerves within the bone. Bone pain may be hard to differentiate from ordinary low back pain or arthritis. Usually the pain due to bone metastasis is fairly constant, even at night. It can be worse in different positions, such as standing up, which may compress the cancer in a weight bearing bone. If pain lasts for more than a week or two, doesn't seem to be going away, and is unlike other pain that may have been experienced, it should be evaluated by a physician.

A patient may also experience a pathological fracture as the first sign of bone cancer. A pathological fracture is a break in a bone due to problems within the bone itself rather than by external factors, such as force. Pathological fractures are caused when the cancer destroys enough bone that the skeleton can no longer support normal body functions adequately.
Diagnosing Bone Cancer

Bone cancer may be evaluated by the use of either radiological tests, surgical biopsy, or blood tests.

Radiological Tests

Radiological tests, including X-ray, bone scan, and skeletal survey, remain the best method for evaluating cancer in the bones.

X-ray When a patient experiences pain that is suspected to be a result of bone cancer, the first step in diagnosis is usually to X-ray the area near the pain. When enough of the healthy bone in any area is worn away by metastatic lesions, the damaged area will show up as a dark spot on the X-ray that look like holes in the bones.

Bone Scan A more comprehensive test used to diagnose bone cancer is a type of X-ray called a bone scan. In this test, low level radioactive particles are injected into a vein. They circulate through the body and are selectively picked up by the bones. A high concentration of these radioactive particles indicates the presence of rapidly growing cancer cells.

Skeletal Survey In order to diagnose blastic lesions, or lesions where extra bone has built up, a skeletal survey may be utilized. This is a form of X-ray. Normally an X-ray is selective for a particular area of concern, but with a skeletal survey, all areas are imaged. All patients with multiple myeloma and many with breast cancer undergo a skeletal survey to detect bone metastases that have not yet developed observable symptoms.

Other Occasionally, other radiological procedures may be used to assess bone cancer, such as a computed axial tomography (CAT) scan, magnetic resonance imaging (MRI) scan, or PET scan.

Surgical Biopsy

Either a needle biopsy or an incisional biopsy may also be useful for diagnosing bone cancer. During a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue. The tissue is then examined under a microscope to determine whether it is cancerous. Biopsies are best done by orthopedic oncologists—doctors experienced in the diagnosis of cancer involving the bone.

Blood Tests

The early detection of bone cancer is important for effective management. In the past, pain and fractures were often the first signs of cancer involving bones. Unfortunately, by the time these signs occur, the cancer cells are already present and have begun to impact the patients overall bone health. Relying on these signs typically results in a late diagnosis of bone cancer. Blood tests that can detect the presence of bone cancers before they manifest in pain or fractures may be useful for identifying patients that would benefit from treatment before complications develop.

Cancers in the bone cause an increase in bone remodeling activity. Normal bone is constantly being remodeled, or broken down and rebuilt. Cancer cells disrupt the balance between the activity of osteoclasts (cells that break down bone) and osteoblasts (cells that build bone). When cancer cells are in the bones, some proteins, genes, or byproducts from the building blocks of bone are produced at a higher rate than during normal remodeling.

Measuring blood levels of these substances, called biological markers, can be useful for diagnosing cancer involving the bones. Higher levels can indicate that a cancer has progressed. Though most biological markers are not routinely used for the diagnosis of bone cancers at this time, some are very useful, while others show promise for the future.

Bone specific alkaline phosphatase (BSAP) is an enzyme that is present in the cells that participate in bone formation, called osteoblasts. BSAP has been used for many years to detect increases in bone formation activity. Blood levels of BSAP are increased in patients with bone cancer and other conditions that result in increased bone remodeling. Increases in BSAP have been detected in patients with bone metastasis caused by prostate cancer, and to a lesser degree, in bone metastases from breast cancer. Unfortunately, BSAP is not completely specific for cancer because alkaline phosphatases are also produced by other organs and can be elevated by other conditions. Nonetheless, BSAP can be monitored in patients who are known to be at risk of bone metastases.

An abnormal growth of cells in the brain is called a brain tumor. Brain tumors may be malignant (cancerous) or benign (non-cancerous).

Suspicions of a brain tumor may first arise from abnormal behavior or other symptoms. Symptoms are typically investigated with a series of tests aimed at making a diagnosis. If a brain tumor is the diagnosis, further information about the cancer cells is necessary to determine the best possible approach to treatment. There are many types of brain tumors that differ based on which type of cells make up the tumor. Also, determining the extent of the cancer helps the doctor to understand the likelihood that the tumor will spread into other brain tissues, a characteristic which may also be referred to as the aggressiveness of the cancer.

The following is an overview of brain cancers, including information on the following topics:
Symptoms of Brain Cancer
Tests for Diagnosing Brain Cancer
The Diagnosis: Brain Tumor Malignancy, Type, and Grade
Benign or Malignant?
Tumor Grade
Types of Brain Tumors
Introduction to Treatments for Brain Cancer
Surgery
Radiation Therapy
Chemotherapy

Symptoms of Brain Tumors

Symptoms of brain tumors vary widely depending on the type and location of the tumor. However, some of the most common symptoms are nausea, vomiting, and headaches. These are often caused by increased intracranial pressure, or increased pressure within the skull, which causes compression of the brain tissue.

In addition to increasing pressure, tumors encroach on and/or damage surrounding normal tissue as they grow. In the case of brain tumors, this can result in impaired cognitive functions and associated symptoms. The symptoms associated with brain tumors depend largely on where the tumor is located. The different areas of the brain, called lobes, are responsible for different brain functions. For example, memory is performed primarily in the frontal lobe of the brain (the front part of the brain, located right behind the forehead). A brain tumor in the frontal lobe may be associated with memory loss. However, the areas of the brain perform a variety of functions, therefore, symptoms may be diverse.

Symptoms associated with the main parts of the brain may include one or more of the following:

Frontal lobe (located in the front, behind the forehead)
Memory loss
Impaired sense of smell
Vision loss
Behavioral, emotional and cognitive changes
Impaired judgment

Parietal lobe (near the crown of the head)
Impaired speech
Inability to write
Lack of recognition

Occipital lobe (rear and bottom of the skull)
Vision loss in one or both eyes and seizures

Temporal lobe (located at the side of the head, behind the temples)
Impaired speech
Seizures
Some patients may not exhibit any symptoms

Brainstem (located deep in the brain)
Irritability
Difficulty speaking and swallowing
Drowsiness
Headache, especially in the morning
Muscle weakness on one side of the face or body
Vision loss, drooping eyelid or crossed eyes
Vomiting
Diagnostic Tests for Brain Tumors

Doctors may utilize several tests to diagnose a brain tumor. The purpose for conducting diagnostic tests are to first, determine whether an abnormal growth is malignant (cancerous) or benign (non-cancerous), and second, if it is malignant, to determine what type of cancer it is, and how extensively it has spread, which is called the stage of the disease.

The tests that are commonly conducted to diagnose brain tumors include:
Neurological examination
Magnetic resonance imaging (MRI)
Computed tomography (CT)
Positron emission tomography (PET)
Biopsy

Neurological examination: The goal of neurological examination is to evaluate the nervous system to determine whether any abnormalities exist. A typical exam involves testing of reflexes, sensation, muscle strength, eye and mouth movement, coordination, and alertness.

Magnetic resonance imaging (MRI): MRI is perhaps the most valuable test that doctors use to diagnose brain tumors. MRI uses a strong magnet and radiofrequency waves to produce an image of internal organs and structures. Under the influence of the strong magnet, the hydrogen atoms in the body line up like compass needles. Next, the patient is exposed to radio waves that cause the hydrogen atoms to momentarily change positions. In the process of returning to their orientation under the influence of the magnet, they emit a brief radio signal. The intensity of these radio waves reflects what type of tissue exists in that area of the body. The MRI system goes through the area of the body being imaged, point by point, collecting information from how the radio waves emit. A computer generates an image of organs and structures based on these radio wave recordings.

MRI is useful for diagnosing brain tumors because it provides accurate:
Description of anatomy of the brain and shape of possible tumor tissue and
Definition of the extent of surrounding edema (swelling).

The brain stem is a part of the brain located near the base of the skull. MRI is the best test for identifying brain stem structures and tumors.

Computed tomography (CT): A CT scan is a detailed X-ray. The CT imaging system is comprised of a motorized table that moves the patient through a circular opening and an X-ray machine that rotates around the patient as they move through. Detectors on the opposite side of the patient from where the X-ray entered record the radiation exiting that section of the patient's body, creating an X-ray "snapshot" at one position (angle). Many different "snapshots" are collected during one complete rotation of the X-ray machine. A computer then assembles the series of X-ray images into a cross-section, or a picture of one small slice of the body. A CT scan is a series of these cross-sectional images.

CT scan is a less expensive test than MRI and provides good definition of extra-axial brain tumors, or brain tumors that are not located deep in the skull. However, this type of scan does not provide effective definition of the extent of swelling and only provides a single plane image, rather than a three-dimensional image. CT scans are useful for identifying acoustical neurinomas or meningiomas.

Positron emission tomography (PET): Unlike techniques that provide anatomical images, such as X-ray, CT, and MRI, PET scans show chemical and physiological changes related to metabolism. This is important because these functional changes often occur before structural changes in tissues. PET images may therefore show abnormalities long before they would be revealed by X-ray, CT, or MRI.

Before a PET scan, a patient will receive an injection of a radiopharmaceutical, which is a drug labeled with a basic element of biological substances, called an isotope. These isotopes distribute in the organs and tissues of the body and mimic natural substances such as sugars, water, proteins, and oxygen. This radioactive substance is then taken up by the cancer cells, thereby allowing the radiologist to visualize areas of increased activity.

After the patient has received the injection, a small amount of radiation is passed through the body, which detects the isotopes and reveals details of cellular-level metabolism. Although the radiation is different from that used in radiography, it's roughly equivalent to what is administered in two chest X-rays. After the scan is complete, the radiation does not stay in the body for very long.

PET scans are often used after an anatomical scan, such as MRI or CT, has shown that an abnormal mass does exist. With a PET image that reflects the metabolic activity of the tumor, doctors are able to determine whether the tumor is benign or malignant. PET is also used to accurately determine the stage of the brain tumor.

Biopsy: When CT, MRI, or PET scans show evidence of abnormal brain tissue, a biopsy is often necessary to confirm the diagnosis. A biopsy involves removing a sample of the abnormal tissue for examination under a microscope. There are a variety of different types of biopsies and the method used to gain a tissue sample depends on the size and location of the suspected tumor.
A typical biopsy is the surgical removal of a mass of abnormal cells.
Fine needle aspiration involves guiding a thin needle into the tumor and gently sucking out cells for microscopic evaluation.
A stereotactic biopsy utilizes a computer and a three-dimensional scan to direct the placement of the aspiration needle

To learn more about biopsies and stereotactic techniques, go to Surgery for Brain Tumors .
The Diagnosis: Brain Tumor Malignancy, Type, and Grade

The results from diagnostic tests provide detailed information from which a team of healthcare providers can make an accurate diagnosis. The diagnosis includes identifying whether the tumor is benign or malignant , the type of brain tumor , and the tumor grade , or the extent to which the cells have mutated and invaded nearby brain tissue. An accurate diagnosis is critical for determining optimal treatment.
Benign or Malignant?

Brain tumors are designated as benign or malignant based on how cells from the biopsy sample appear under a microscope. Typically, benign tumors are less aggressive and more treatable than malignant tumors.

Benign brain tumors: A benign brain tumor consists of cells that have a normal or almost normal appearance when viewed under a microscope. The tumor is very slow-growing, has distinct borders that form a capsule, and does not spread into adjacent brain tissue. Benign brain tumors grow like a balloon being blown up, with an intact capsule and no direct invasion of brain tissue. However, benign brain tumors can cause brain damage or be considered life-threatening due to their ability to encroach into areas of the brain occupied by normal cells, causing increased pressure on and dysfunction in these cells.

Surgery alone is often curative for benign tumors that are located where complete removal is possible. The most common benign brain tumors are meningiomas and neural sheath tumors (neurilemmoma).

Malignant brain tumors: A malignant, or cancerous, brain tumor grows into and invades adjacent normal brain tissue but rarely spreads outside the brain. Malignant brain tumors can be slow- or fast-growing and are usually life threatening due to their ability to invade and destroy normal brain tissue. Malignant brain tumors can spread to other locations in the brain and spine because they lack distinct borders and are difficult to remove without prohibitive damage to normal brain tissue. Cells from malignant brain tumors can also break away from the initial site and travel to distant parts of the brain and spine by way of the cerebrospinal fluid. However, most malignant brain tumors remain localized, in the area where they began.

There are two types of malignant brain tumors, primary and metastatic. Primary brain tumors originate from cells in the brain and there are many types of these. The most common type of malignant primary brain tumor is glioblastoma multiforme (grade IV astrocytoma ), which make up approximately 20% of all primary brain tumors.

Metastatic brain tumors are any cancers that have spread from another area of the body to the brain. Cancers that commonly spread to the brain include breast and lung cancers.
Tumor Grade

The grade of a tumor is determined by the degree to which the tumor cells appear different from normal cells when viewed under the microscope. Grade is an important factor because the extent to which the cancer has differentiated, or mutated compared to normal cells, may help determine the best possible treatment option.

Grade I tumors: Grade I tumors are the least malignant, meaning they appear almost normal when viewed under a microscope. These tumors grow slowly and are usually associated with good long-term survival. Surgery alone can be an effective treatment for this grade of tumor. Pilocytic astrocytoma, craniopharyngioma, and many tumors of neurons, such as gangliocytoma and ganglioglioma, are examples of grade I tumors.

Grade II tumors (well-differentiated): Grade II tumors have a slightly abnormal appearance when viewed under a microscope and are relatively slow growing. While the cells in grade II tumors are not normal, they are still well-differentiated, which means they have distinct boundaries, and thus are not as aggressive as high-grade tumors. However, they can invade adjacent normal tissue, and sometimes these tumors recur as a higher grade.

Grade III tumors (anaplastic): Grade III tumors are, by definition, malignant, although there isn't always a sharp distinction between a grade II and a grade III tumor. The cells of a grade III tumor are actively reproducing abnormal cells and spreading into adjacent normal brain tissue. These tumors tend to recur, often as a higher grade.

Grade IV tumors (blastomas): The most malignant tumors are designated as grade IV. They have a bizarre appearance when viewed under the microscope, reproduce rapidly, and permeate adjacent normal brain tissues. These tumors induce the formation of new blood vessels so that they can maintain their rapid growth. They also have areas of dead cells in their center. The World Health Organization (WHO) designates grade IV tumors as ‘blastomas'. Glioblastoma multiforme is a grade IV glioma, and the most common example of a grade IV tumor.
Types of Brain Tumors

The main distinction for brain tumors is whether they originated in the brain or spread from another location to the brain such as the breast or lung. The latter are called secondary or metastatic brain tumors and the cells are identical to the cancer cells from the original location.

Cancers that originate in the brain are called primary brain tumors. There are many different kinds of primary brain tumors and they are classified by the type of tissue in which they begin. The most common brain tumors are gliomas, which begin in the glial cells located in the brain that perform supportive functions for the cells that conduct neural impulses. There are also many types of non-glial brain tumors that arise from other types of cells in the brain; however, most of these tumors are rare. The main types of primary brain tumors include the following:

Metastatic Brain Tumors

Gliomas
Astrocytomas
Ependymomas
Oligodendroglioma
Mixed gliomas

Non-glial Brain Tumors
Craniopharyngiomas
Germ cell tumors
Meningiomas
Pineal tumors
Pituitary adenomas
Primitive neuroectodermal tumors (PNET)
Schwannomas

Metastatic Brain Tumors

Metastatic brain tumors are cancers that have spread from their site of origin to the brain. CNS metastases usually occur by way of the bloodstream. A cancer cell may break away from the original location in the body and travel in the circulatory system until it gets lodged in a small capillary network in brain tissue. Metastatic brain tumors are the most common brain tumor, occurring as much as four times more frequently than primary brain tumors. The cancers that most commonly metastasize to the brain are breast and lung cancer.

For more information, go to the information center for the primary cancer that has spread, such as Breast Cancer or Lung Cancer .
Gliomas

About half of all primary brain tumors and about one-fifth of all primary spinal cord tumors are gliomas, meaning that they grow from glial cells. Glial cells provide supportive functions for the neurons, the brain cells that conduct nerve impulses.

Astrocytomas: Astrocytomas are the most common form of glioma and the most common type of primary brain tumor. These tumors can develop in any part of the central nervous system: the brain, brain stem, or spinal cord. Astrocytomas are further classified based on how the cells look under a microscope. Cells that are well differentiated mean that they have clear boundaries and structure. They are the least malignant form of brain tumor.
Non-invasive astrocytoma: Non-invasive astrocytomas are tumors that grow slowly and usually do not grow into the tissues around them. There are two types of non-invasive astrocytomas called juvenile pilocytic and subependymal.
Diffuse astrocytoma (stage I-II astrocytoma): Diffuse astrocytomas contain cells that are relatively normal and are considered to be low-grade tumors. They grow relatively slowly and may sometimes be completely removed through surgery. However, even well-differentiated astrocytomas can be life-threatening if they are inaccessible. In some cases, these tumors can also progress or recur as higher grade tumors.
Anaplastic astrocytoma (stage III astrocytoma): Anaplastic astrocytomas grow more rapidly than low-grade tumors and contain cells with malignant traits, meaning they appear very different from normal cells when viewed under a microscope.
Glioblastoma multiforme (stage IV astrocytoma, GBM): The most advanced stage of astrocytoma is called glioblastoma multiforme, or GBM. These tumors grow rapidly, invade nearby tissue and contain cells that are very malignant. GBM is among the most common and devastating primary brain tumors that affect adults.
Recurrent glioblastoma multiforme: GBM that has returned or advanced after initial treatment is considered to be recurrent disease. Recurrent GBM may occur after initial treatment of a lower grade astrocytoma, such as diffuse or anaplastic.

Ependymomas: Brain tumors that develop from cells that line the hollow cavities of the brain and the canal containing the spinal cord are called ependymomas. Most of these tumors are usually benign (non-cancerous) and slow growing.
Well-differentiated ependymoma (stage II): Well-differentiated ependymomas have cells that look very much like normal cells and grow quite slowly.
Anaplastic ependymoma (stage III): Anaplastic ependymomas are ependymal tumors that do not look like normal cells and grow more quickly than well-differentiated ependymal tumors.
Ependymoblastoma (stage IV): Ependymoblastomas are rare cancers that usually occur in children. They may grow very quickly.

Oligodendroglioma: Oligodendroglioma tumors begin in the brain cells called oligodendrocytes, which provide support and nourishment for the cells that transmit nerve impulses.
Well-differentiated oligodendrogliomas are slow-growing tumors that look very much like normal cells.
Anaplastic oligodendrogliomas grow more quickly, and the cancer cells look very different from normal cells.

Mixed gliomas: Gliomas that occur in more than one type of brain cell are called mixed and may involve astrocytes, ependymal cells, and/or oligodendrocytes. Mixed gliomas include three separate types of tumors: mixed astrocytoma-ependymoma, mixed astrocytoma-oligodendroglioma and mixed astrocytoma-ependymoma-oligodendroglioma.
Non-glial Brain Tumors

Craniopharyngiomas: Another tumor that develops in the region of the pituitary gland near the hypothalamus is called a craniopharyngioma. These tumors are usually benign; however, they are sometimes considered malignant because they can press on or damage the hypothalamus and affect vital functions. These tumors occur most often in children and adolescents.

Germ cell tumors: Germ cell tumors arise from developing sex cells, called germ cells. There are different kinds of germ cells, including germinomas, embryonal carcinomas, choriocarcinomas, and teratomas.

Meningiomas: Meningiomas are very common brain tumors that occur in the membranes that cover and protect the brain and spinal cord (the meninges). Meningiomas usually grow slowly and tend to affect more women than men. Most meningiomas are considered to be benign tumors; however, even benign brain tumors can cause disability and may sometimes be life-threatening. Malignant meningioma is a rare tumor that grows more quickly than benign meningiomas. Types of malignant meningioma include anaplastic meningioma, hemangiopericytoma and papillary meningioma.

Pineal tumors: Pineal region tumors are tumors found in or around the pineal, gland, a tiny organ located near the center of the brain that mediates changes in energy with light and darkness, causing sleepiness with darkness and alertness with increasing light. The tumors can be slow-growing ( pineocytomas ) or fast-growing ( pineoblastomas ). The pineal region is very difficult to reach, and these tumors often cannot be removed.

Pituitary adenomas: The pituitary gland is a small, pea-sized structure located at the base of the brain in the center of the head, behind the eyes. It is very important because it secretes several chemical messengers known as hormones, which help control the body's other glands and regulate growth, metabolism, maturation, and other essential body processes. Cancers of the pituitary gland are called pituitary adenomas. Almost all adenomas are benign, but their slow expansion compresses normal structures that surround it, suppressing normal pituitary function and sometimes causing headaches or problems with vision. Pituitary adenomas rarely metastasize or spread to other areas of the body. Doctors classify pituitary tumors into two groups—secreting and nonsecreting. Secreting tumors release unusually high levels of pituitary hormones, triggering a variety of symptoms.

Primitive neuroectodermal tumors (PNET): PNETs are rare tumors that occur in children and young adults. The most common type of PNET is medulloblastoma, which arises from developing nerve cells that normally do not remain in the body after birth. These brain tumors begin in the lower part of the brain and may spread from the brain to the spine.

Schwannomas: Tumors that begin in Schwann cells, which produce the myelin that protects the acoustic nerve (nerve of hearing), are called schwannomas and are typically benign. Acoustic neuromas are a type of schwannoma. They occur mainly in adults and affect women twice as often as men.
Introduction to Treatments for Brain Cancer

Brain tumors are typically treated with surgery, radiation therapy, chemotherapy, or some combination of these three modalities.

Surgery: Surgery is the primary treatment for brain tumors that can be removed without causing severe damage. Many benign (non-cancerous) tumors are treated only by surgery but most malignant (cancerous) tumors require treatment in addition to the surgery, such as radiation therapy and/or chemotherapy.

The goals of surgical treatment for brain tumors are multiple and may include one or more of the following:
Confirm diagnosis by obtaining tissue that is examined under a microscope
Remove all or as much of the tumor as possible
Reduce symptoms and improve quality of life by relieving intracranial pressure caused by the cancer
Provide access for implantation of internal chemotherapy or radiation
Provide access for delivering intra-surgical treatments, including hypertherapy or laser surgery

To learn more, go to Surgery for Brain Tumors.

Radiation: Radiation therapy may be used alone or in combination with surgery and/or chemotherapy in the treatment of primary or metastatic brain tumors. The three primary ways that radiation therapy is administered in the treatment of brain tumors are with:
A machine that directs radioactive beams from outside the body, called external beam radiation (EBRT),
A computer and image guided technique that directs radiation only at the tumor, called stereotactic radiosurgery, or
A radioactive implant that is placed in or near the tumor, called brachytherapy.

EBRT is the conventional technique for administering radiation therapy for brain tumors, but stereotactic radiosurgery has also become a standard treatment. The most recent advance in the radiation treatment of brain tumors is the brachytherapy technique called GliaSite radiotherapy system, which involves placing a balloon in or near the tumor during surgery and then passing a radioactive material into the balloon for treatment.

To learn more, go to Radiation Therapy for Brain Tumors.

Chemotherapy: Chemotherapy is any treatment involving the use of toxic drugs to kill cancer cells. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.

Treating brain tumors with chemotherapy is more complicated than treating tumors elsewhere in the body because of a natural defense system called the blood-brain barrier that protects the brain from foreign substances. The blood-brain barrier prevents foreign substances, such as drugs, from passing from the blood into brain tissues. For a drug to be effective in treating brain tumors, a sufficient quantity must either pass through the blood-brain barrier or be administered in a way that bypasses it altogether. Furthermore, not all brain tumors are sensitive to or respond to chemotherapy, even if the drug does penetrates the blood-brain barrier. Actively dividing cells are the most vulnerable to chemotherapy. Most tumor cells and some normal cells fall into that category.

lungs cancerLung cancer is the No.1 killer among all types of cancer in the United States. It is estimated that lung cancer accounts for about 15% of all new cancer cases in 2010, but will cause nearly 30% of all cancer deaths. Over the past three decades, little improvement has been achieved in extending the lives of lung cancer patients. In the late 1970s, about 37% of people survived one year or longer after initial diagnosis; now, three decades later, this number had only improved to 42%.

But there is hope. NFCR funds numerous leading researchers who are committed to finding more effective strategies for preventing, diagnosing and treating lung cancer. Through their dedicated efforts to build risk prediction models, identify cancer genes in early-stage lung cancer, design cutting-edge devices for monitoring drug response, and seek new strategies to overcome tumor drug resistance, NFCR scientists are leading the battle against the deadliest cancer.

Cancer risk reduction

2011-06-29T18:18:00.000-07:00

Choice of cancer treatment is influenced by several factors, including the specific characteristics of your cancer; your overall condition; and whether the goal of treatment is to cure your cancer, keep your cancer from spreading, or to relieve the symptoms caused by cancer. Depending on these factors, you may receive one or more of the following:
Surgery
Chemotherapy
Radiation therapy
Hormonal therapy
Targeted therapy
Biological therapy

One or more treatment modalities may be used to provide you with the most effective treatment. Increasingly, it is common to use several treatment modalities together (concurrently) or in sequence with the goal of preventing recurrence. This is referred to as multi-modality treatment of the cancer.
Surgery

Surgery is used to diagnose cancer, determine its stage, and to treat cancer. One common type of surgery that may be used to help with diagnosing cancer is a biopsy. A biopsy involves taking a tissue sample from the suspected cancer for examination by a specialist in a laboratory. A biopsy is often performed in the physician’s office or in an outpatient surgery center. A positive biopsy indicates the presence of cancer; a negative biopsy may indicate that no cancer is present in the sample.

When surgery is used for treatment, the cancer and some tissue adjacent to the cancer are typically removed. In addition to providing local treatment of the cancer, information gained during surgery is useful in predicting the likelihood of cancer recurrence and whether other treatment modalities will be necessary.

Learn more about surgery.
Chemotherapy

Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.

More than half of all people diagnosed with cancer receive chemotherapy. For millions of people who have cancers that respond well to chemotherapy, this approach helps treat their cancer effectively, enabling them to enjoy full, productive lives. Furthermore, many side effects once associated with chemotherapy are now easily prevented or controlled, allowing many people to work, travel, and participate in many of their other normal activities while receiving chemotherapy.

Learn more about chemotherapy treatment and the management of side effects.
Radiation Therapy

Radiation therapy, or radiotherapy, uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment used to eliminate or eradicate visible tumors. Radiation therapy is not typically useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer. Radiation may be used to cure or control cancer, or to ease some of the symptoms caused by cancer. Sometimes radiation is used with other types of cancer treatment, such as chemotherapy and surgery, and sometimes it is used alone.

For more information, go to Radiation Therapy.
Hormonal Therapy

Hormones are naturally occurring substances in the body that stimulate the growth of hormone sensitive tissues, such as the breast or prostate gland. When cancer arises in breast or prostate tissue, its growth and spread may be caused by the body’s own hormones. Therefore, drugs that block hormone production or change the way hormones work, and/or removal of organs that secrete hormones, such as the ovaries or testicles, are ways of fighting cancer. Hormone therapy, similar to chemotherapy, is a systemic treatment in that it may affect cancer cells throughout the body.
Targeted Therapy

A targeted therapy is one that is designed to treat only the cancer cells and minimize damage to normal, healthy cells. Cancer treatments that “target” cancer cells may offer the advantage of reduced treatment-related side effects and improved outcomes.

Conventional cancer treatments, such as chemotherapy and radiation therapy, cannot distinguish between cancer cells and healthy cells. Consequently, healthy cells are commonly damaged in the process of treating the cancer, which results in side effects. Chemotherapy damages rapidly dividing cells, a hallmark trait of cancer cells. In the process, healthy cells that are also rapidly dividing, such as blood cells and the cells lining the mouth and GI tract are also damaged. Radiation therapy kills some healthy cells that are in the path of the radiation or near the cancer being treated. Newer radiation therapy techniques can reduce, but not eliminate this damage. Treatment-related damage to healthy cells leads to complications of treatment, or side effects. These side effects may be severe, reducing a patient's quality of life, compromising their ability to receive their full, prescribed treatment, and sometimes, limiting their chance for an optimal outcome from treatment.
Biological Therapy

Biological therapy is referred to by many terms, including immunologic therapy, immunotherapy, or biotherapy. Biological therapy is a type of treatment that uses the body’s immune system to facilitate the killing of cancer cells. Types of biological therapy include interferon, interleukin, monoclonal antibodies, colony stimulating factors (cytokines), and vaccines.
Personalized Cancer Care

There is no longer a “one-size-fits-all” approach to cancer treatment. Even among patients with the same type of cancer, the behavior of the cancer and its response to treatment can vary widely. By exploring the reasons for this variation, researchers have begun to pave the way for more personalized cancer treatment. It is becoming increasingly clear that specific characteristics of cancer cells and cancer patients can have a profound impact on prognosis and treatment outcome. Although factoring these characteristics into treatment decisions makes cancer care more complex, it also offers the promise of improved outcomes.

The idea of matching a particular treatment to a particular patient is not a new one. It has long been recognized, for example, that hormonal therapy for breast cancer is most likely to be effective when the breast cancer contains receptors for estrogen and/or progesterone. Testing for these receptors is part of the standard clinical work-up of breast cancer. What is new, however, is the pace at which researchers are identifying new tumor markers, new tests, and new and more targeted drugs that individualize cancer treatment. Tests now exist that can assess the likelihood of cancer recurrence, the likelihood of response to particular drugs, and the presence of specific cancer targets that can be attacked by new anti-cancer drugs that directly target individual cancer cells.

How much do daily habits like diet and exercise affect your risk for cancer? Much more than you might think. Research has shown that poor diet and not being active are two key factors that can increase a person's cancer risk. The good news is that these are things you can control.

Except for quitting smoking, some of the most important things you can do to help reduce your cancer risk are:
Get to and stay at a healthy weight.
Be physically active on a regular basis.
Make healthy food choices.

The evidence for this is strong: Each year, about 570,000 Americans die of cancer; fully one-third of these deaths are linked to poor diet, physical inactivity, and carrying too much weight.
Control your weight.

Staying at a healthy weight is important to reduce the risk of cancer and other chronic diseases, such as heart disease and diabetes. Being overweight or obese increases the risk of several cancers, including cancers of the breast (in women past menopause), colon, endometrium, esophagus, kidney, among others.

Being overweight can increase cancer risk in many ways. One of the main ways is that excess weight causes the body to produce and circulate more of the hormones estrogen and insulin, which can stimulate cancer growth.
What's a healthy weight?

One of the best ways to get an idea if you are at a healthy weight is to check your Body Mass Index (BMI), a score based on the relationship between your height and weight. Use our easy online BMI calculator to find out your score. To reduce cancer risk, most people need to keep their BMIs below 25. Ask your doctor what your BMI number means and what action (if any) you should take.

If you are trying to control your weight, a good first step is to watch portion sizes, especially of foods high in calories, fat, and added sugars. Try writing down what and how much you eat and drink for a week and see where you can cut down on portion sizes, cut back on some not-so-healthy foods and drinks, or both!
Be more active.

Watching how much you eat will help you control your weight. The other key is to increase the amount of physical activity you do. Being active helps reduce your cancer risk by helping with weight control, and can also help improve your hormone levels and the way your immune system works.

More good news -- physical activity helps you reduce your risk of heart disease and diabetes, too! So grab your tennis shoes and head out the door!

The latest recommendations for adults call for at least 30 minutes of intentional moderate to vigorous activity a day -- this is over and above usual daily activities like using the stairs instead of the elevator at your office or doing housework -- on 5 or more days per week. Even better, shoot for 45 to 60 minutes. For kids, the recommendation is 60 minutes or more on at least 5 days a week.

Activities considered moderate are those that make you breathe as hard as you would during a brisk walk. This includes things like walking, biking, even housework and gardening. Vigorous activities make you use large muscle groups and make your heart beat faster, make you breathe faster and deeper, and also make you sweat.
Eat healthy foods.

Eating well is also important to improve your health and reduce your cancer risk. Take a good hard look at what you typically eat each day and try these tips to build a healthy diet plan for yourself:

Vegetables and fruits: Eat at least 5 servings of vegetables (including legumes, or peas and beans) and fruits each day. Try to eat those with the most color (a sign of high nutrient content). These foods are packed with vitamins, minerals, antioxidants, and many other substances that work together to lower risk of many cancers, including cancers of the lung, mouth, esophagus, stomach, and colon. Not only that, if prepared properly, vegetables and fruits are usually low in calories, so eating them in place of higher-calorie foods can help you control your weight.

Whole grains: Aim for at least 3 servings of whole grains each day. There are easy ways to add whole grains to your diet -- eat oatmeal at breakfast, choose 100% whole-wheat bread or wraps for your lunchtime sandwich, use brown rice at dinner instead of white.

Processed and red meats: Cutting back on processed meats like hot dogs, bologna, bacon, and deli meat, and red meats like beef, pork, and lamb may help reduce the risk of colon and prostate cancers. These foods are also high in saturated fat, so eating less of them and eating them less often will also help lower your risk of heart disease.

Adopting a healthier lifestyle is easier for people who live, work, play, or go to school in an environment that supports healthy behaviors. Working together, communities can create the type of environment where healthy choices are easy to make.

We all can contribute to those changes: Let's ask for healthier food choices at our workplaces and schools. For every junk food item in the vending machine, ask for a healthy alternative. Support restaurants that help you to eat well by offering options like smaller portion sizes, lower-calorie items, and whole-grain products. And let's help make our communities safer and more appealing places to walk, bike, and be active.
The bottom line

One third of all cancer deaths are related to diet and activity factors. Let's challenge ourselves to lose some extra pounds, to increase our physical activity, to make healthy food choices, and to look for ways to make our communities healthier places to live, work, and play.