Warning Signals: Breast changes that persist, such as a lump, thickening, swelling, dimpling, skin irritation, distortion, retraction, scaliness, pain, or tenderness of the nipple.
Risk Factors: Aging is a risk factor for breast cancer, as is personal or family history of breast cancer; early age at menarche; late age of menopause; never had children or late age at first live birth; and higher education and socioeconomic status. International variability in cancer incidence rates correlate with variations in diet, especially fat intake, although a causal role for dietary factors has not been firmly established.
Early Detection: The American Cancer Society recommends that women have a screening mammogram by age 40; women 40-49 should have a mammogram every 1-2 years; asymptomatic women age 50 and over should have a mammogram every year. In addition, a clinical physical examination of the breast is recommended every 3 years for women 20-40, and every year for those over 40. The American Cancer Society also recommends monthly breast self-examination as a routine good health habit for women 20 years or older. Most breast lumps are not cancer, but only a physician can make a diagnosis.
Treatment: Taking into account the medical situation and the patient's preferences, treatment may require lumpectomy (local removal of the tumor), mastectomy (surgical removal of the breast), radiation therapy, chemotherapy, or hormone manipulation therapy. Often, two or more methods are used in combination.
New techniques in recent years have made breast reconstruction possible after mastectomy, and the cosmetic results usually are good. Reconstruction has become an important part of treatment and rehabilitation.
Lung Cancer
Warning Signals: Persistent cough, sputum streaked with blood, chest pain, recurring pneumonia or bronchitis.
Risk Factors: Cigarette smoking; exposure to certain industrial substances, such as arsenic, certain organic chemicals and asbestos, particularly for persons who smoke; radiation exposure from occupational, medical, and environmental sources. Residential radon exposure may increase risk, especially in cigarette smokers. Exposure to passive cigarette smoke increases the risk for nonsmokers.
Early Detection: Because symptoms often don't appear until the disease is in advanced stages, early detection is very difficult. Chest X ray, analysis of the types of cells contained in sputum, and fiberoptic examination of the bronchial passages assist diagnosis.
Treatment: Treatment options include surgery, radiation therapy, and chemotherapy. In some cancers, chemotherapy alone or combined with radiation has replaced surgery as the treatment of choice; on this regimen, a large percentage of patients experience remission, which in some cases is long-lasting.
Prostate Cancer
Warning Signals: Weak or interrupted urine flow; inability to urinate, or difficulty starting or stopping the urine flow; the need to urinate frequently, especially at night; blood in the urine; pain or burning on urination; continuing pain in the lower back, pelvis, or upper thighs. Most of these symptoms are nonspecific and may be similar to those caused by benign conditions such as infection or prostate enlargement.
Risk Factors: Aging is a risk factor for prostate cancer, with over 80% of all prostate cancers diagnosed in men over age 65. The disease is most common in northwestern Europe and North America. It is rare in the Near East, Africa, Central America, and South America. For reasons not currently known, African Americans have the highest incidence rate in the world.
Early Detection: Every man 40 and over should have a digital rectal examination as part of his regular annual physical checkup. In addition, the American Cancer Society recommends that men 50 and over have annual prostate-specific antigen blood testing. If either result is suspicious, further evaluation in the form of transrectal ultrasound should be performed.
Treatment: Surgery, radiation, and/or hormones and anticancer drugs are treatment options. Hormone treatment and anticancer drugs may control prostate cancer for long periods by shrinking the size of the tumor, thus relieving pain.
Colorectal Cancer
Warning Signals: Rectal bleeding, blood in the stool, change in bowel habits.
Risk Factors: Personal or family history of cancer or polyps of the colon or rectum, and inflammatory bowel disease. High-fat and/or low-fiber diet may be associated with increased risk.
Early Detection: Digital rectal examination, stool blood test, and proctosigmoidoscopy are recommended for early detection. The American Cancer Society recommends digital rectal examination be performed annually after age 40. The stool blood test (fecal occult blood test) should be done annually after age 50. The Society recommends a proctosigmoidoscopy be done every 3-5 years after age 50. In proctosigmoidoscopy, the physician uses a long, lighted tube to inspect the rectum and lower colon. To detect cancers higher in the colon, longer, flexible instruments are being used, as well as a rigid scope. If any of these tests reveal possible problems, more extensive studies, such as colonoscopy (examination of the entire colon) and barium enema (an X-ray procedure in which the intestines are viewed), may be needed.
Treatment: Surgery, at times combined with radiation, is the most effective method of treating colorectal cancer. Combinations of chemotherapy and immunologic agents have recently been described as beneficial in postoperative patients with cancerous lymph nodes.
Bladder Cancer
Warning Signals: Blood in the urine, usually associated with increased frequency of urination.
Risk Factors: Smoking is the greatest risk factor, with smokers experiencing twice the risk of nonsmokers. Smoking is estimated to be responsible for approximately 47% of the bladder cancer deaths among men and 37% among women. People living in urban areas and workers exposed to dye, rubber, or leather also are at higher risk.
Early Detection: Bladder cancer is diagnosed by examination of the bladder wall with a cytoscope, a slender tube fitted with a lens and light that can be inserted into the tract through the urethra.
Treatment: Surgery, alone or in combination with other treatments, is used in over 90% of cases. Preoperative chemotherapy alone or with radiation before cystectomy (bladder removal) has improved some treatment results.
Lymphoma
Warning Signals: For Hodgkin disease: enlarged lymph nodes, itching, fever, night sweats, and weight loss. Fever can come and go in periods of several days or weeks. For non-Hodgkin lymphoma: enlarged lymph nodes, anemia, weight loss, and fever.
Risk Factors: Risk factors are largely unknown, but in part involve reduced immune function and exposure to certain infectious agents. Persons with organ transplants are at higher risk due to altered immune function. Human immunodeficiency virus (HIV) and human T-cell leukemia/lymphoma virus-I (HTLV-I) are associated with increased risk of non-Hodgkin lymphoma. Burkitt lymphoma in Africa is partly caused by the Epstein-Barr herpes virus. Other possible risk factors include exposures to herbicides, industrial solvents, and vinyl chloride.
Treatment: For Hodgkin disease, chemotherapy and radiotherapy are recommended for most patients. For non-Hodgkin lymphoma with localized lymph node disease, radiotherapy is recommended. Patients with later stage disease often benefit from the addition of chemotherapy.
Uterine Cancer
Warning Signals: Bleeding outside of the normal menstrual period or after menopause or unusual vaginal discharge.
Risk Factors: For cervical cancer: an early age at first intercourse, multiple sex partners, cigarette smoking, and certain sexually transmitted diseases. For endometrial cancer: early menarche, late menopause, history of infertility, failure to ovulate, tamoxifen or unopposed estrogen therapy, obesity.
Early Detection: The Pap smear, a simple procedure that can be performed at appropriate intervals by health care professionals, is done as part of a pelvic examination. The Pap smear is only partially effective in detecting endometrial cancer. Women 40 and over should have an annual pelvic exam, and those at high risk of developing endometrial cancer should have an endometrial tissue sample evaluated at menopause.
Treatment: Uterine cancers generally are treated by surgery or radiation or by a combination of the two. In precancerous (in situ) stages, changes in the cervix may be treated by cryotherapy (the destruction of cells by extreme cold), by electrocoagulation (the destruction of tissue through intense heat by electric current), or by local surgery. Precancerous endometrial changes may be treated with the hormone progesterone.
Melanoma
Warning Signals: Any unusual skin condition, especially a change in the size and color of a mole or other darkly pigmented growth or spot; scaliness, oozing, bleeding, or change in the appearance of a bump or nodule, the spread of pigmentation beyond its border, a change in sensation, itchiness, tenderness, or pain.
Risk Factors: Excessive exposure to ultraviolet radiation; fair complexion; occupational exposure to coal tar, pitch, creosote, arsenic compounds, or radium.
The sun's ultraviolet rays are strongest between 10:00 a.m. and 3:00 p.m. Exposure at these times should be avoided, and protective clothing should be worn. Sunscreens should be used. These come in various strengths, ranging from those facilitating gradual tanning to those that allow practically no tanning. Because of the possible link between severe sunburns in childhood and greatly increased risk of melanoma in later life, children, in particular, should be protected from the sun.
Early Detection: Early detection is critical. Recognition of changes in skin growths or the appearance of new growths is the best way to find early skin cancer. Adults should practice skin self-evaluation once a month, and suspicious lesions should be evaluated promptly by a physician. A sudden or progressive change in a mole's appearance should be checked by a physician. Melanomas often start as small, molelike growths that increase in size, change color, become ulcerated, and bleed easily from a slight injury. A simple ABCD rule outlines the warning signals of melanoma: A is for asymmetry. One-half of the mole does not match the other half. B is for border irregularity. The edges are ragged, notched, or blurred. C is for color. The pigmentation is not uniform. D is for diameter greater than 6 mm. Any sudden or progressive increase in size should be of special concern.
Treatment: For malignant melanoma, the primary growth must be adequately excised, and it may be necessary to remove nearby lymph nodes. Removal and microscopic examination of all suspicious moles are essential. Advanced cases of melanoma are treated according to the characteristics of the case.
Oral Cancer
Warning Signals: A sore that bleeds easily and doesn't heal; a lump or thickening; a red or white patch that persists. Difficulty in chewing, swallowing, or moving tongue or jaws are often late changes.
Risk Factors: Cigarette, cigar, or pipe smoking; use of smokeless tobacco; excess use of alcohol.
Early Detection: Cancer can affect any part of the oral cavity, including the lip, tongue, mouth, and throat. Dentists and primary care physicians have the opportunity, during regular checkups, to see abnormal tissue changes and to detect cancer at an early, curable stage.
Treatment: Principal methods are radiation therapy and surgery. Chemotherapy is being studied as an adjunct to surgery in advanced disease.
Leukemia
Warning Signals: Fatigue, paleness, weight loss, repeated infections, bruising easily, and nosebleeds or other hemorrhages. In children, these symptoms can appear suddenly. Chronic leukemia can progress slowly and with few symptoms.
Risk Factors: Leukemia strikes both sexes and all ages. Causes of most cases are unknown. Persons with Down syndrome and certain other genetic abnormalities have higher than normal incidence of leukemia. It has also been linked to excessive exposure to ionizing radiation and to certain chemicals such as benzene, a commercially used toxic liquid that is also present in lead-free gasoline. Certain forms of leukemia and lymphoma are caused by a retrovirus, HTLV-I (human T-cell leukemia/lymphoma virus-I).
Early Detection: Because symptoms often resemble those of other, less serious conditions, leukemia can be difficult to diagnose early. When a physician does suspect leukemia, diagnosis can be made using blood tests and biopsy of the bone marrow.
Treatment: Chemotherapy is the most effective method of treating leukemia. Various anticancer drugs are used, either in combination or as single agents. Transfusions of blood components and antibiotics are used as supportive treatments. To prevent persistence of hidden cells, therapy of the central nervous system has become standard treatment, especially in acute lymphocytic leukemia. Under appropriate conditions, bone marrow transplantation may be useful in the treatment of certain leukemias.
Pancreatic Cancer
Warning Signals: Cancer of the pancreas is a "silent disease," one that occurs without symptoms until it is in advanced stages.
Risk Factors: Very little is known about what causes the disease or how to prevent it. Risk increases after age 50, with the most cases occurring between ages 65 and 79. Smoking is a risk factor; incidence is more than twice as high for smokers as nonsmokers. Some studies have suggested associations with chronic pancreatitis, diabetes, or cirrhosis, but these findings have not been confirmed. In countries where the diet is high in fat, pancreatic cancer rates are higher.
Early Detection: At present, only a biopsy yields a certain diagnosis, and because of the "silent" course of the disease, the need for biopsy is likely to be obvious only after the disease has advanced. Researchers are focusing on ways to diagnose pancreatic cancer before symptoms occur. Ultrasound imaging and computerized tomography (CT) scans are being tried.
Treatment: Surgery, radiation therapy, and anticancer drugs are treatment options but have had little influence on the outcome. Diagnosis is usually so late that none of these is used.
Ovarian Cancer
Warning Signals: Ovarian cancer is often "silent," showing no obvious signs or symptoms until late in its development. The most common sign is enlargement of the abdomen, which is caused by the accumulation of fluid. Rarely will there be abnormal vaginal bleeding. In women over 40, vague digestive disturbances (stomach discomfort, gas, distention) that persist and cannot be explained by any other cause may indicate the need for a thorough evaluation for ovarian cancer.
Risk Factors: Risk for ovarian cancer increases with age. The highest rates are for women over 60. Women who have never had children are twice as likely to develop ovarian cancer as those who have. Early age at first pregnancy, early menopause, and the use of oral contraceptives, which reduces the frequency of ovulation, appear to be protective against ovarian cancer. If a woman has had breast cancer, her chances of developing ovarian cancer double. Certain rare genetic disorders are associated with increased risk. With the exception of Japan, the highest incidence rates are reported from the more industrialized countries.
Early Detection: Periodic, thorough pelvic examinations are important. The Pap smear, useful in detecting cervical cancer, does not reveal ovarian cancer. Women over the age of 40 should have a cancer-related checkup every year.
Treatment: Surgery, radiation therapy, and drug therapy are treatment options. Surgery usually includes the removal of one or both ovaries (oophorectomy), the uterus (hysterectomy), and the fallopian tubes (salpingectomy). In some very early tumors, only the involved ovary will be removed, especially in young women. In advanced disease, an attempt is made to remove all intraabdominal disease to enhance the effect of chemotherapy.
Cancer in Children
Cancers in children often are difficult to recognize. Parents should see that their children have regular medical checkups and should be alert to any unusual symptoms that persist. These include an unusual mass or swelling; unexplained paleness and loss of energy; sudden tendency to bruise; a persistent, localized pain or limping; prolonged, unexplained fever or illness; frequent headaches, often with vomiting; sudden eye or vision changes; and excessive, rapid weight loss.
Some of the main childhood cancers are as follows:
Leukemia.
Osteogenic sarcoma and Ewing sarcoma are bone cancers. These may cause no pain at first, and swelling in the area of the tumor is often the first sign.
Neuroblastoma can appear anywhere but usually in the abdomen, where a swelling occurs.
Rhabdomyosarcoma, the most common soft tissue sarcoma, can occur in the head and neck area, genitourinary area, trunk, and extremities.
Brain cancers in early stages may cause headaches, blurred or double vision, dizziness, difficulty in walking or handling objects, and nausea.
Lymphomas and Hodgkin disease are cancers that involve the lymph nodes but also may invade bone marrow and other organs. They may cause swelling of lymph nodes in the neck, armpit, or groin. Other symptoms may include general weakness and fever.
Retinoblastoma, an eye cancer, usually occurs in children under age 4. When detected early, cure is possible with appropriate treatment.
Wilms' tumor, a kidney cancer, may be recognized by a swelling or lump in the abdomen.
Childhood cancers can be treated by a combination of therapies. Treatment is coordinated by a team of experts including oncologic physicians, pediatric nurses, social workers, psychologists, and others who assist children and their families.
Source: From the American Cancer Society, Inc., Cancer Facts & Figures, 1993. Used with permission.
