Cancer

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BREAST CANCER


Also called: Breast carcinoma Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there a number of risk factors. Risks that you cannot change include

Age - the chance of getting breast cancer rises as a woman gets older Genes - there are two genes, BRCA1 and BRCA2, that greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested. Personal factors - beginning periods before age 12 or going through menopause after age 55 Other risks include being overweight, using hormone replacement therapy, taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.

Symptoms of breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early when it is most treatable. Treatment may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.

Men can have breast cancer, too, but the number of cases is small.



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Risk Factors

No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for breast cancer:

Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause. Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast. Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk. Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer. Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. NCI offers publications on gene testing. Reproductive and menstrual history: The older a woman is when she has her first child, the greater her chance of breast cancer. Women who had their first menstrual period before age 12 are at an increased risk of breast cancer. Women who went through menopause after age 55 are at an increased risk of breast cancer. Women who never had children are at an increased risk of breast cancer. Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer. Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer. Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women. Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life. Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer. Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study. Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese. Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity. Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer. Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.

But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.

If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.





Symptoms

Common symptoms of breast cancer include:

A change in how the breast or nipple feels A lump or thickening in or near the breast or in the underarm area Nipple tenderness A change in how the breast or nipple looks A change in the size or shape of the breast A nipple turned inward into the breast The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange. Nipple discharge (fluid) Early breast cancer usually does not cause pain. Still, a woman should see her health care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not due to cancer. Other health problems may also cause them. Any woman with these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible




Follow-up Care

Follow-up care after treatment for breast cancer is important. Recovery is different for each woman. Your recovery depends on your treatment, whether the disease has spread, and other factors.

Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer.

You should report any changes in the treated area or in your other breast to the doctor right away. Tell your doctor about any health problems, such as pain, loss of appetite or weight, changes in menstrual cycles, unusual vaginal bleeding, or blurred vision. Also talk to your doctor about headaches, dizziness, shortness of breath, coughing or hoarseness, backaches, or digestive problems that seem unusual or that don't go away. Such problems may arise months or years after treatment. They may suggest that the cancer has returned, but they can also be symptoms of other health problems. It is important to share your concerns with your doctor so problems can be diagnosed and treated as soon as possible.

Follow-up exams usually include the breasts, chest, neck, and underarm areas. Since you are at risk of getting cancer again, you should have mammograms of your preserved breast and your other breast. You probably will not need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. Your doctor may order other imaging procedures or lab tests.

Facing Forward Series: Life After Cancer Treatment is an NCI booklet for people who have completed their treatment. It answers questions about follow-up care and other concerns. It has tips for making the best use of medical visits. It also suggests ways to talk with the doctor about creating a plan of action for recovery and future health.


MESOTHELIOMA


Mesothelioma is a serious and rare form of lung cancer. It is most frequently seen in men between the ages of 50 to 70. Women are affected far less frequently. In the US, between 2000 and 3000 cases are diagnosed each year. Estimates suggest that the incidence of mesothelioma for every 100,000 in the US is about 1.8 and 0.9 internationally. This form of cancer affects people of every race equally. The number of people who have been diagnosed with mesothelioma has increased significantly in the past 30 years. Although many advances in treatment have been made, there is no cure for this type of cancer.

In mesothelioma, the cells of the mesothelium become cancerous and grow out of control. The mesothelium is a protective, two-layered membrane that covers the internal organs of the body including the lungs, heart and abdominal organs. Between these layers, the cells produce fluid, which allows easy movement of the heart and lungs within the chest cavity. The layer that covers the lungs is called the pleura, and the layer that covers the heart is called the pericardium. The peritoneum lines the abdominal cavity. Mesothelium also lines the male and female reproductive organs. Mesothelioma can affect any of these cells, but is usually seen in the pleural or peritoneal mesothelium. The most common form of mesothelioma is pleural.

The primary risk factor for developing mesothelioma is exposure to asbestos. Between 70-80% of people diagnosed with mesothelioma have been exposed to asbestos, usually in the workplace. Although it is possible to develop mesothelioma without any exposure to asbestos, it is very rare. While one person for every million people in the US will be diagnosed with mesothelioma, about 7-13 men who have been exposed to asbestos will be diagnosed with the disease. Symptoms frequently take 20 years to develop, but can take as long as 50 years to occur.

When cancerous cells invade the mesothelium, it becomes increasingly difficult to breathe. In the pleural form of mesothelioma, tumors growing in the mesothelium cause pleural effusions, which prevent the smooth movement of the lungs and other organs in the chest. Peritoneal mesothelioma invades the abdominal cavity and can cause loss of appetite weight loss, nausea and vomiting. Most patients seek medical care after having symptoms only 4-6 months.

Mesothelioma is a very aggressive form of cancer. Because it takes so long for symptoms to appear it can spread to the other organs in the chest, the chest wall and into the lymph nodes. The cancerous cells spread, or metastasize from the mesothelium into other parts of the body and damage internal tissues and organs. Treatment is more effective when the disease is detected early.

Treatment is aimed at reducing the size of tumors, and relieving symptoms. Chemotherapy, radiation treatment and surgery are some of the traditional treatment strategies used to help patients live longer, with fewer symptoms. New advances in photodynamic therapy and immunotherapy give hope for prolonging the lives of patients with mesothelioma. On average, however, the life expectancy after being diagnosed with mesothelioma is less than one year




Mesothelioma Symptoms

Mesothelioma develops many years after exposure to asbestos. Sometimes, it may be 30 to 40 years before symptoms occur. Unfortunately, in the early stages of the disease, symptoms may be vague or not noticeable. Thus, if you have been exposed to asbestos in the past, even for a very brief time, it’s important to have regular check-ups to detect any lung abnormalities, even if you don’t have symptoms.

Benign lung disease, such as asbestosis is common in people who have been exposed to asbestos. The symptoms can be very similar, and only a complete medical exam can provide an accurate diagnosis.

Early detection of mesothelioma allows doctor to use more effective and more powerful treatments. For this reason, you should watch carefully for any of the symptoms of mesothelioma.

Symptoms of Mesothelioma may include:

Coughing Shortness of breath or difficulty breathing Difficulty Sleeping Weight Loss Pain in chest and abdomen Fluid in the chest Usually, difficulty breathing and a lingering cough bring patients into the doctor for evaluation. This occurs because tumors of the mesothelium make if hard for the lungs to expand smoothly. Large tumors, or tumors that spread to the chest wall can cause chest pain. When fluid builds up in the pleura, breathing can be even more difficult while lying down, making it hard to sleep. The spread of cancerous cells takes a toll on your body, causing weakness, extreme fatigue. Changes in your body’s ability to absorb nutrients as a result of invasion into the abdomen can cause weight loss. 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.

Depending on the type of mesothelioma, slightly different symptoms can occur. Peritoneal disease has an effect on the intestines, liver and other structures in the abdominal cavity. As fluid builds up, the abdomen can become very expanded. Because the liver plays a big part in manufacturing the substances needed to control bleeding, there is often a change in your ability to make blood clots. Weight loss occurs for several reasons, and is more dramatic in this form of the disease. The pleural form of mesothelioma can also cause damage to the upper airway. Swallowing can become difficult, and voice changes can occur if the larynx is affected.

Specific symptoms of Peritoneal mesothelioma:

Weight loss Abdominal pain Buildup of fluid in the abdomen Bowel obstruction Abnormal blood clotting Abdominal mass Fever Specific symptoms of Pleural Mesothelioma:

Pain in the lower back Pain in the side of chest A persistent cough Shortness of breath Husky voice Difficulty swallowing Fever Regardless of the location, malignant mesotheliomas occur in three forms. The epithelioid type is the most common, accounting for 50-70% of all mesotheliomas. Between 20-35% of mesotheliomas are sarcomatoid. The remaining 7-20% of tumors are classified as mixed/biphasic. Epithelioid mesothelioma has the best outlook for survival.

If your symptoms suggest you may have mesothelioma, you doctor will order a number of tests. Imaging studies like X-rays, CT scans and MRI show any abnormalities within the lungs. A complete blood count and levels of specific proteins can help make the diagnosis. However, the diagnosis of mesothelioma cannot be made by blood work and imaging studies in every case. Other more common diseases such as benign asbestos-related pleural disease and metastatic adenocarcinoma can have very similar appearances on imaging studies. Biopsy, and the use of special staining are often necessary for the accurate diagnosis of mesothelioma.

Promising studies on the early detection of mesothelioma may soon provided more accurate methods for diagnosis. If you have these warning signs you should consultant a qualified medical professional immediately. Only a doctor can make a diagnosis.


Treatment Options

Even though mesothelioma is incurable, treatment is available. Treatment can prolong your life and make you more comfortable. The traditional therapies used in cancer treatment are the mainstay of mesothelioma treatment. These treatments are used alone and in combination to reduce the damage mesothelioma causes to your body.

Chemotherapy Radiation treatment Surgery The type of treatment that is right for you depends on several factors. The best options for treatment can only be determined after a thorough evaluation by your medical team. An oncologist is a cancer specialist and will most likely lead the process. You may also see a radiologist, pulmonary therapists and an oncology-nursing specialist. To help you cope with discomfort and the emotions stirred up by a serious illness, a social worker can also be a part of your care team. Learn more about the finding a medical team that is experienced in caring for people with mesothelioma.

The size and location of your tumor and the stage of your cancer must first be determined. To determine the stage of your cancer, MRI and CT scans are used. These tests are excellent at helping your doctor visualize the size, location and extend of any lung tumors. Other specialized testing using radionuclides can help tell if the disease has spread, or metastasized outside of the chest and abdominal cavities.


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