Understanding Cancer

The word cancer refers to changes in the body's cells that allow these cells to grow out of control. These cells often grow very fast, crowding out normal cells in the area around the cancer. Cancer cells also have the ability to spread, ormetastasize, to other organs in the body, causing additional damage in areas of the body not connected with the original cancer site.

Cancer can occur in almost any cell. It begins when the cell's DNA, or genetic information, becomes damaged. DNA controls all cell functions, including when to divide (reproduce) and when to die. When DNA is damaged, some cells become unstable, dividing more often than normal cells or failing to die when they should. Most of the time, the body's immune system finds these damaged cells and destroys them. However, if this normal process does not happen, atumor can begin.

A tumor is a mass, or collection, of abnormal cells. Tumors can be eitherbenign or malignant.

• Benign tumors (noncancerous) can grow and expand in size, but they do not invade surrounding tissue or travel to other areas of the body.

• Malignant tumors (cancerous) are made up of cells that are very different from normal cells. These cancer cells can, and often do, invade nearby tissues. They also can travel away from the original (primary) site to other parts of the body, causing tumors in other organs (distant sites) in a process called metastasis.

Types of Cancer

A solid tumor is a localized mass of abnormal cells. Solid tumors are divided into broad categories based on the type of tissue where the cancer first occurred; carcinomas, sarcomas, and lymphomas are examples of solidtumors. Table 1-1 shows different types of cancer and where they originate.1 In addition, cancers are defined by the type of cell or organ where they came from. For example, a cancer beginning in the colon is called colon cancer or coloncarcinoma. Cancers originating in certain cells found in the skin are called basal cell carcinomas

Not all cancers, however, form solid tumors. Cancers of the blood or bone marrow (hematologic malignancies), are often referred to a "liquid tumors" because they do not form a defined mass of abnormal cells like solid tumors do. Examples of liquid tumors include leukemia and multiple myeloma.

Table 1-1: Types of Cancer¹

Type of Cancer	Cell Type of Origin
Carcinoma	Skin or tissues that line or cover internal organs
Sarcoma	Bone, cartilage, fat muscle, blood vessels, or other connective or supportive tissue
Central nervous system cancer	Tissues of the brain and spinal cord
Lymphoma	Cells of the immune system
Leukemia andmyeloma	Blood forming tissue, such as the bone marrow

Causes of Cancer

Although every patient and family member wants to know what may have caused their cancer, the reason a particular person developed cancer is, in many cases, not well understood.

Cancer occurs because normal cells become abnormal due to harmful mutations in one or more genes.4 While the reasons that cells become abnormal are not completely understood, certain known risk factors increase the chance that genes will become mutated. Still, not all people who have risk factors will develop cancer—in fact, most people with a particular risk factor do not develop cancer. On the other hand, some people who have no known risk factors will get cancer. Separate risk factors may combine over time to cause normal cells to become abnormal.

Known Risk Factors for Cancer

Below are some known risk factors for cancer.

• • An individual person's risk of cancer increases with advancing age, even though many cancers can develop at any age.
• • Some gene mutations that increase the risk of cancer can be passed from parent to child.
• • Menopausal hormone therapy with estrogen and/or progestin can increase the risk of breast cancer.
• • Infection with some viruses and bacteria can increase the risk of cancer. Even so, cancer is not contagious. Examples of viruses and bacteria that can increase the risk of cancer include:
• o Infection with certain types of the human papillomavirus (HPV) is a major cause of cervical cancer.
• o Infection with the Epstein-Barr virus is associated with an increased risk of lymphoma.
• o The Helicobacter pylori bacterium can cause some kinds of stomach cancer.
• • Exposure to ultraviolet radiation from the sun, sunlamps, and tanning booths can cause skin damage that increases the risk of skin cancer.
• • Exposure to ionizing radiation, such as radon gas, x-rays, and radioactive fallout, can increase the risk of many kinds of cancer. The risk of cancer from low-dose x-rays is very small.
• • Exposure to chemicals such as benzene, metals such as nickel, or substances such as asbestos has been shown to increase the risk of cancer.
• • Poor diet, lack of physical activity, or being overweight may increase the risk of developing many kinds of cancer.
• • Having more than two alcoholic drinks per day over many years may increase the risk of developing cancer of the mouth, throat, esophagus, larynx, liver, or breast.
• • Tobacco smoking increases the risk of developing cancer in the lungs, throat, voice box, mouth, esophagus, bladder, kidney, stomach, pancreas, or cervix. People who smoke are also more likely to develop a cancer of the blood cells called acute myeloid leukemia. Use of snuff or chewing tobacco increases the risk of developing cancer of the mouth.

Treating Cancer

Because cancer is a complicated disease that takes many different forms, it is treated in many different ways. Treatment is tailored to the specific needs of the patient.

Cancer treatments vary depending upon four main factors:

• Type of cancer

• Stage of cancer

• Your overall condition

• Goal of treatment

Your doctor will determine the stage and grade of your cancer. Learn aboutstaging and grading of cancer.

The goals of cancer treatment also vary:

• Cure

• Prolong life

• Reduce unwanted symptoms or effects of the cancer

Your doctor may recommend one or more treatments, also referred to asmodalities, to achieve your goals. Increasingly, it is common to use several treatments at the same time or in sequence in order to prevent both local recurrence and recurrence throughout the body. This is referred to as a multi-modality treatment. Modalities include chemotherapy, surgery, radiation therapy, biological therapy, and hormone therapy. Chemotherapy is one of the best ways to help you achieve your treatment goals. Find out about treating cancer with chemotherapy.

Your doctor may also discuss combining your chemotherapy with other treatments. Learn about treating cancer in other ways.

Reasons to Be Optimistic

As you move beyond the initial shock of learning that you have cancer to begin the journey of surviving cancer, you have many good reasons to be optimistic. Science and medicine have made—and continue to make—tremendous progress in treating cancer and in making treatments more manageable, both physically and emotionally. Chemotherapy is one of the most significant advances in the history of medicine. For millions of people, it helps treat their cancer effectively and helps them enjoy full, productive lives. However, chemotherapy is not without side effects and risks. Learn about managingchemotherapy side effects

No one would call having cancer or undergoing chemotherapy a normal experience, but by proactively managing your treatment with your doctor, including potential side effects, you can help ensure that your life stays as close to normal as possible.

Don't forget: You are not alone. Fighting cancer is a team effort that involves family, friends, and your healthcare team.

Read More

Mesothelioma: Questions and Answers

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.

1. What is the mesothelium?
   
   The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.
   
   The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
   
   
2. What is mesothelioma?
   
   Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
   
   
3. How common is mesothelioma?
   
   Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
   
   
4. What are the risk factors for mesothelioma?
   
   Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.
   
   Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
   
   Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
   
   
5. Who is at increased risk for developing mesothelioma?
   
   Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
   
   The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
   
   There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
   
   
6. What are the symptoms of mesothelioma?
   
   Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
   
   These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.
   
   
7. How is mesothelioma diagnosed?
   
   Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
   
   A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
   
   If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
   
   Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
   
   
8. How is mesothelioma treated?
   
   Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
   
   
   • Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
     
     
   • Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
     
     
   • Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
     
   
   To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.
   
   
9. Are new treatments for mesothelioma being studied?
   
   Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.
   
   People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI's cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI's Cancer.gov Web site, located at http://www.cancer.gov/clinicaltrials on the Internet, provides general information about clinical trials and links to PDQ.
   
   People considering clinical trials may be interested in the NCI booklet Taking Part in Cancer Treatment Research Studies. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.

Read More

Mesothelioma Chemotherapy

Chemotherapy is often one component of mesothelioma treatment that is difficult for the lay person to grasp. Part of the problem is that the literature dealing with this subject is jargon intensive. The other problem is that the science and research are ever advancing. Understanding chemotherapy is truly a moving target. As a nurse, I can assist in cutting through some of the medical jargon, but I would be remiss if I didn't inform patients at the beginning that the principle source of information should be their oncologist, or cancer specialist doctor.

Your oncology doctor is reading all the latest research, and is highly motivated to defeat your cancer, and extend your life. Ask all of your questions without holding back.

All three of the basic approaches to treating mesothelioma; surgery, radiation therapy, and chemogtherapy, are potentially frightening to a patient. Chemotherapy is perhaps a little more difficult to penetrate rationally, and weigh the risks, versus rewards. Certainly, the list of possible side effects is quite intimidating. Mesothelioma, however, is a killer and you must trust your oncologist as he will want to throw everything that he thinks can work at this disease.

If surgery is an option for you, it may be followed by radiation therapy, and/or chemotherapy in order to try to kill the microscopic cancer cells that remain in your body.

The chemotherapy agents that your doctor selects will often be a combination or recipe of drugs that when used together have better outcomes than when used by themselves.

One of the medications that you may encounter is Cisplatin. Cisplatin messes up the DNA strands inside cancer cells by crossing them during cell division and causing these abnormal DNA-crossed cells to die. Another medication , doxorubicin forms free radicals that fracture the DNA strands inside cancer cells. Pemetoexed slows or stops tumor growth by blocking cell enzymes required for the production of RNA and DNA. There are many others, and there are treatment programs that combine medications with radiation. Your treatment will be customized for your specific needs.

All chemotherapy agents have some possible side effects. Remember though, drugs affect different people differently. Fatigue affects many cancer patients, often due to anemia. You will probably be taking high potency vitamins to help combat this. Other blood changes that may occur are low platelets, affecting blood clotting, and low white blood cells, which can affect your resistance to infection. You may experience various gastrointestinal problems, such as vomiting, nausea, diarrhea, or constipation. You may also develop yeast infections, and sores in the mouth. There is also a condition known as "chemo brain". "Chemo brain" is difficulty concentrating, focusing, fuzziness, and poor memory. Side effects may cause you to make some lifestyle changes during the chemotherapy treatment. These side effects ease and go away after the round of chemo is complete.

When you are receiving chemotherapy, what is happening is that the chemo is attacking the cancer cells. Unfortunately, some of the normal cells are also affected. This is why most of the side effects occur. The normal cells that are affected are primarily the fast growing cells. Cancers themselves are fast growing cells. Normal fast growing cells are the bone marrow, where blood cells are produced, the blood cells themselves, the digestive tract including the mouth and stomach, and the hair follicles. Some drugs affect vital organs as well.

Your close relationship with your oncologist is very important. Defeating mesothelioma is a team effort, and he is your quarterback. You are the team owner, so you must play an active role.

Ed Desmond is a small business owner, and works as a Registered Nurse. For more on mesothelioma treatment see Mesothelioma Treatment Articles and resources about mesothelioma treatment.

Read More