| Friday, October 24, 2008 |
| Q&A about Bladder Cancer |
1. How common is bladder cancer?
Approximately 54,300 new cases of bladder cancer were diagnosed in 2001 in the United States, and 12,400 patients died. The male-to-female ratio is almost 3:1.
2. What are the risk factors for bladder cancer?
Cigarette smoking, exposure to aniline dyes or aromatic amines, phenacetin abuse, and chemotherapy (cyclophosphamide).
3. How does bladder cancer present?
Painless hematuria (gross or microscopic). Frequency, urgency, and dysuria also may be presenting symptoms, especially for carcinoma in situ (CIS).
4. What is the most common histologic type of bladder cancer?
Transitional cell carcinoma (TCC) makes up > 90% of bladder cancers. Other histologic types include adenocarcinoma, squamous cell carcinoma, and urachal carcinoma.
5. How is TCC of the bladder treated?
With transurethral resection of the bladder tumor. Further treatment is determined by the pathologic stage of the disease.
6. Is CIS a less aggressive type of bladder cancer?
No. TCC in situ is a flat but poorly differentiated tumor. It can metastasize and should be treated as an aggressive form of bladder cancer.
7. How is CIS treated?
Immunotherapy with intravesical bacillus Calmette-Guérin (BCG) is currently the first-line treatment. Response rates to BCG approach 70%. Other intravesical agents, such as mitomycin C, are generally less effective than BCG.
8. What are the side effects of BCG?
Mild symptoms of urinary frequency, urgency, and dysuria are common. Myalgias and low-grade fever (flulike symptoms) also occur. High or persistent fever suggests a more serious problem requiring antituberculous therapy. Rarely, death from BCG has been reported.
9. How is muscle-invasive bladder cancer treated?
Radical cystectomy (or cystoprostatectomy in men) with some form of urinary diversion.
10. What types of urinary diversion are used with radical cystectomy?
Diversion techniques require either a conduit or a continent reservoir. The most common is an ileal conduit. An external collection device must be worn with a conduit. Continent reservoirs are made of combinations of large and small bowel and must be emptied via the urethra or a continent stoma
11. How is metastatic bladder cancer treated?
Metastatic bladder cancer requires chemotherapy. Most regimens include a platinum-based agent.
12. Can invasive bladder cancer be cured without removal of the entire bladder?
This issue is controversial. Some cancers may be suitable for partial cystectomy (i.e., tumors isolated in the dome of the bladder). Investigations are ongoing to evaluate transurethral resection of bladder tumor plus radiation and chemotherapy to try to preserve the bladder in invasive TCC. |
posted by Treatments cancer Lymph Node tumor @ 10:12 AM  |
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| Sunday, July 13, 2008 |
| Prostate Cancer - Questions and Answers |
Prostate cancer is the most common malignancy diagnosed in men in the United States.
The best screening method is a combination of digital rectal exam and serum prostate-specific antigen.
Clinically localized prostate cancer is treated with surgery, radiation, cryotherapy, or watchful waiting.
1. How common is prostate cancer?
It is the most common malignancy diagnosed in men in the United States; almost 200,000 new cases were diagnosed in 2001.
2. Do most men die with prostate cancer, rather than from it?
Yes, but approximately 31,500 men died of prostate cancer in 2001 in the United States. Thus, it should not be treated as benign.
3. What are the early symptoms of prostate cancer?
There are none. By the time significant symptoms develop, the disease is likely to be advanced. This is an argument for screening to detect prostate cancer.
4. What is the best screening method for prostate cancer?
Digital rectal examination (DRE) combined with serum prostate-specific antigen (PSA). Since PSA testing was introduced, there has been a stage migration with less metastatic disease and more local-regional disease being detected.
5. How is prostate cancer diagnosed?
It is diagnosed with prostate biopsy, which is a biopsy using transrectal ultrasound for guidance. Many cancers are discovered incidentally at transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).
6. When is prostate biopsy indicated?
When either the PSA or DRE result is abnormal.
7. Does an elevated PSA level mean a man has prostate cancer?
No. PSA can be elevated with BPH, prostatitis, or after prostate trauma. It is prostate specific, not prostate cancer specific.
8. What is a free PSA?
Free PSA is the percentage of PSA that is not bound to a serum protein carrier. The ratio of free to total PSA is helpful in determining when to do a prostate biopsy. "Free" is good because a higher ratio of free to total PSA is less likely to represent a prostate cancer.
9. Are there any known risk factors for prostate cancer?
Yes. African-American men and men with a family history of prostate cancer are at an increased risk. A high-fat diet may play a role in increasing risk of many cancers, including prostate cancer.
10. What is Gleason's sum?
It's a score that the pathologist gives prostate cancer to estimate its aggressiveness. The two predominant patterns of cancer are scored 1 to 5, and the sum is, therefore, between 2 and 10. Tumors can be well differentiated (2, 3, 4), moderately differentiated (5, 6, 7), or poorly differentiated (8, 9, 10).
11. How is clinically localized prostate cancer treated?
Surgery (radical prostatectomy), radiation therapy by external beam or interstitial seed implant, cryotherapy, or watchful waiting.
12. How is advanced metastatic prostate cancer treated?
Hormonal ablation therapy (orchiectomy or luteinizing hormone-releasing hormone agonist drugs) or chemotherapy, but these treatments are palliative and not curative.
13. What is the best treatment for prostate cancer?
This is highly controversial. Patients must weigh factors such as age, overall health, grade and stage of the disease, and risk of side effects versus complications from the various treatment options. |
| posted by Treatments cancer Lymph Node tumor @ 10:12 AM |
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| Sunday, July 30, 2006 |
| WHAT IS CANCER? |
1. What is a neoplasm?
A neoplasm is a new growth of tissue (tumor) in which cells grow progressively under conditions that do not prompt the growth of normal cells. A malignant neoplasm (cancer) is composed of cells that invade other tissues and spread.
2. What kinds of cancers are there?
Malignant tumors of epithelial (surface tissue) cells are carcinomas. Malignant tumors of mesenchymal (connective tissue) cells are sarcomas. Carcinomas and sarcomas are solid tumors. Hematologic malignancies, such as leukemia, are liquid tumors of mesenchymal origin.
3. What about skin cancers?
Most basal cell and squamous skin cancers are life-threatening only if neglected. They occur in tremendous numbers and are seldom fatal with proper treatment. Although the general principles of cancer management apply to skin cancers, they usually are not considered in the same class with other solid tumors.
4. Why is cancer bad for you?
There is no simple answer. The replacement of normal tissue by tumor eventually causes organ dysfunction. If a tumor outgrows its blood supply and becomes necrotic, local inflammation ensues. Often obstruction (with compromise of the lumen) of the gastrointestinal tract, bile ducts, or airway develops as the tumor grows. Occasionally the cancer bleeds (but life-threatening bleeding is rare). Nerve invasion or inflammation typically cause pain, which may be excruciating. Cancers also may elaborate humoral factors (e.g., gastrin) that cause symptoms.
5. Are all cancers life-threatening?
Cancer is a fatal disease. It is uncommon for a patient with an untreated cancer to die of something else. Currently more than 50% of patients with cancer in the United States are cured.
6. How do cancers start?
No one knows, but cells begin to grow under circumstances when they should not. They stop responding to antigrowth signals, promote their own blood supplies, are seemingly able to replicate endlessly, and do not undergo programmed cell death (apoptosis).
7. Is this process the same for all cancers?
No, the order in which these changes take place seems to vary among types of cancer and even between individual tumors with the same histologic type. Occasionally, a single mutation alone causes cancer, but many genetic alterations are usually involved.
8. Do all cancers spread?
About 25% of patients with solid tumors have detectable metastases at the time of diagnosis. Fewer than 50% of the remainder develop metastases during the course of treatment. At diagnosis, a cancer is usually at least 1 cm in diameter (and often much larger), containing millions of cells. It is surprising that metastases have not occurred in all patients at the time of diagnosis. |
| posted by Treatments cancer Lymph Node tumor @ 6:29 AM |
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