The Big C
The Big C is Cancer! Cancer happens when good cells go bad! When rebellious
cells no longer follow the rules. When cells go berserk and grow uncontrollably.
Cancer cells are basically bullies, using “muscle” (mass) to get their
way. Like most bullies, they are weak and intimidate healthy cells by
crowding them out. Cancer cells are greedy in nature and function below
normal cell level. They exist to eat and reproduce, and need larger and
larger amounts of cell nutrients (food) to keep going. They are unruly
cells that laugh in the face of normal cell “personal space” - they have
no respect for cell boundaries!
Cancer cells are mutinous and have the ability to invade normal tissues
and to spread to other areas of the body. There are special criteria cells
have to meet in order to be eligible for cancer duty. A cell must be capable
- Dividing and growing when it should not
- Invading surrounding areas
- Getting into the bloodstream
- Traveling to other parts of the body
- Establishing secondary tumors at distant sites
- Producing toxic substances that weaken the body.
The primary site is the place where the cancer cells begin to be
contrary. It is the original site of the cancer. Here, these defiant cells
grow and multiply in an uncontrolled manner to form a mass, called a primary
tumor. A secondary tumor is when the cancer spreads from the primary
site. Even though it is a secondary tumor, it is the same make-up as the
primary tumor. In other words, if the cancer begins in the breast and metastasizes
to the lung, the tumors in the lung are breast cancer secondary tumors and
will behave like breast cancer, not like lung cancer. In some cases, secondary
tumors grow faster than primary tumors, and may actually be noticed first.
Metastasis is when cancer spreads. When cancer cells metastasize,
they can: (1) travel throughout the body in the liquid portion of the
blood, (2) travel in clumps, (3) arrive at a distant site and form a tumor,
and (4) establish a blood supply to obtain their own nutrients. Developing
a blood supply (angiogenesis) is extremely important for the tumor - without
it the tumor would not be able to grow. Cancer cells can also metastasize
by entering the bloodstream (lymphatic system), thereby traveling to other
parts of the body, forming tumors and infiltrating organs.
Cancer cells form masses (lumps) called tumors, which can be benign
(non-cancerous) or malignant (cancerous). Benign tumors are generally
slow growing, do not spread to other parts of the body, can be removed
by surgery, and rarely grow back. Malignant tumors can spread and invade
and/or destroy nearby tissue, and are generally fast growing.
Tumors are classified by tissue type, cell type and site of origin. Tissue
types are: carcinoma (epithelial cells that line organs and cover
body surfaces - about 90% of all cancers), sarcoma (connective
tissue, muscle and bone - about 2% of all cancers), leukemia and lymphoma
(circulatory or lymphatic systems - about 8% of all cancers), blastoma
(embryonic tissue), teratoma (tissue derived from ectoderm, mesoderm
and endoderm embryonic germ layers), and neoplasm (named after
founding physician - Hodgkin’s lymphoma, Kaposi’s sarcoma).
Cell types are: adenomatous (ductal or glandular cells), squamous
(flat cells), myeloid (blood cells), and lymphoid (lymphocytes
or macrophages). The site of the tumor’s origin is where the cancer
first originated and may indicate the founder’s name and/or type of tissue
and/or cell type. For example: bone cancer - osteosarcoma, Ewing’s sarcoma;
eye cancer - retinoblastoma; or breast cancer - breast carcinoma of ductal
Cancer is a group of over 100 diseases. It is a life-threatening disease,
but it is not always fatal.
Symptoms & Diagnosis
** Symptoms - The list below can also represent infections
or other illnesses. If you are having problems, please check with your
doctor for consultation, testing and treatment.
** Diagnosis - Your doctor will go over your medical history and
give you a complete physical exam. General tests may include routine blood
work, urine and stool samples. Depending on the circumstances, your doctor
may run several diagnostic tests to determine the cause of your problems.
These possible tests for each cancer are listed below. Your doctor will
decide which tests to run to learn the cause of your symptoms.
To go directly to a particular section, click on one of the following
Symptoms - blood in the urine, pain during urination, frequent
urination, or feeling the need to urinate without results.
Diagnosis - rectal exam, (pelvic exam for women), urine tests,
cystoscopy, IVP (kidney and ureters x-ray), CT scan, ultrasound or MRI
of the abdomen and pelvis.
Symptoms - headaches (that are worse in the morning), convulsions,
nausea (vomiting), weakness or loss of feeling in arms or legs, lack of
coordination in walking, abnormal eye movements, changes in vision, drowsiness,
personality or memory, changes in speech.
Diagnosis - neurological exam, CT scan and/or MRI, skull x-ray,
EEG, brain scan, angiogram, myelogram (spinal x-ray), biopsy.
Symptoms - lump or thickening in or near
the breast or in the underarm area, a change in the size or shape of the
breast; a discharge from the nipple, or a change in the color or feel
of the skin of the breast, areola or nipple.
Diagnosis - clinical breast exam (palpation),
mammography, ultrasound, needle biopsy (aspiration), surgical biopsy,
various scans, x-rays, blood (marker) tests.
Symptoms - abnormal bleeding (bleeding
between regular periods, after sexual intercourse, douching or a pelvic
exam), menstrual bleeding that is heavier than usual or lasts longer than
usual; bleeding after menopause, and/or increased vaginal discharge.
Diagnosis - pelvic exam, Pap test, colposcopy,
biopsy, ECC (cervical tissue sample), cone biopsy, D&C (cervical and uterine
Symptoms - diarrhea or constipation,
blood in or on the stool, stools that are narrower than usual, general
stomach discomfort (bloating, fullness, cramps), frequent gas pains, a
feeling that the bowel doesn’t empty completely, loss of weight for no
reason, constant tiredness.
Diagnosis - rectal exam, (possible pelvic exam
for women); routine, occult and CEA (tumor marker) blood tests, sigmoidoscopy
and/or colonoscopy, barium enema, CT and liver scan.
Symptoms - (Retinoblastoma) - white pupils,
poorly aligned eyes, red and painful eye, poor vision, inflammation of
surrounding eye tissue, an enlarged pupil, different colored irises.
Diagnosis - retina exam, ultrasound exam, CT
scan and MRI, blood tests, spinal tap, possible bone marrow biopsy.
Symptoms - painless swelling in lymph nodes in groin,
neck or underarm area; fevers, night sweats, tiredness, weight loss, itching skin.
Diagnosis - blood tests, x-rays of chest, bones, liver and spleen;
biopsy (looking for Reed-Sternberg cells). To determine staging: biopsies of lymph nodes,
liver, bone marrow; lymphangiograms, CAT scan, various x-rays.
Symptoms - blood in the urine, mild discomfort
or dull ache in the flank region
Diagnosis - urine tests, IVP (kidney and ureters
x-ray), ultrasound and CT scan of abdomen and pelvis, other kidney tests.
Symptoms - a persistent cough, a feeling of
a lump in the throat, hoarseness or changes in the voice, trouble swallowing.
In the area above the vocal cords: a lump on the neck, a sore throat,
or earache. In the area below the vocal cords: difficulty breathing or
Diagnosis - neck exam, indirect laryngoscopy,
direct laryngoscopy, biopsy, x-rays and scans.
Symptoms - anemia, lethargy, pale complexion,
shortness of breath, bruising, bleeding, body itching, enlarged lymph
nodes, pain in the breastbone, discomfort in groin, neck or armpit, fatigue,
feeling of fullness in abdomen after eating (even a small meal), weight
loss without loss of appetite, mild fever, night sweats, increased number
or severity of infections.
Diagnosis - blood tests, bone marrow sample,
CT scan of abdomen, various x-rays and scans. For CML, special tests for
the Philadelphia chromosome.
Symptoms - mild loss of appetite, some weight
loss, mild nausea, jaundice, drowsiness and confusion. Also, in early
stages, mild ache/discomfort in upper right of abdomen; and in later stages,
severe ache/pain in upper right side of abdomen, center of abdomen or
Diagnosis - ultrasound or CT scan of the liver,
AFP (alpha-fetoprotein) blood tests and other blood tests, liver biopsy.
Symptoms - a persistent or worsening
cough, constant chest pain, coughing up blood, shortness of breath, wheezing
or hoarseness; repeated problems with pneumonia or bronchitis, swelling
of the neck and face, loss of appetite or weight loss, fatigue.
Diagnosis - chest x-ray, sputum cytology (mucus
test), biopsy, bronchoscopy (or mediastinoscopy), needle aspiration, thoracentesis
(fluid sample), thoracotomy (surgery), CT scan, liver ultrasound and/or
bone scan, various blood tests.
Symptoms - enlarged lymph nodes in neck, armpit
or groin, loss of energy, loss of appetite, weight loss, excessive sweating
at night, general overall feeling of not feeling well.
Diagnosis - lymph node biopsy, staging tests
to determine type of lymphoma, chest x-ray, liver ultrasound, bone marrow
sample, CT scan or MRI, lymphogram.
Symptoms - Early stage - bone pain in the back
or ribs, broken bones, weakness, fatigue, weight loss or repeated infections.
Advanced stage - nausea, vomiting, problems urinating, constipation, and
weakness or numbness in the legs.
Diagnosis - blood and urine tests for M bands,
bone marrow aspiration, bone marrow biopsy, x-rays.
Symptoms - painless swelling of lymph nodes in groin,
neck or underarm area; unexplained fever, night sweats, constant fatigue, itchy skin,
weight loss, reddened skin patches.
Diagnosis - physical exam checking lymph nodes in the groin,
neck or underarm area, blood tests, x-rays, CAT scan, MRI, lymphangiogram, biopsy.
Symptoms - ongoing fatigue, abdominal swelling and/or pain; bloating
and/or feeling of fullness, pressure; vague but persistent gastrointestinal complaints
(gas, nausea, indigestion); frequency and/or urgency of urination in the absence of an infection,
constipation and diarrhea, back aches, vaginal discharge, pain during intercourse, and
menstrual disorders (abnormal bleeding, postmenopausal bleeding).
Diagnosis - pelvic exam, ultrasound scan, CT scan, barium enema,
IVP (kidney and ureters x-ray); blood tests, especially the CA-125 (tumor marker);
laparoscopy, laparotomy, further surgery (possible oophorectomy, removal of the ovary).
A Pap test does not detect ovarian cancer. There is NO test for ovarian cancer.
You should not rely totally on the CA-125, it can give false positives. Every woman should
have a vaginal-rectal exam. If anything is unusual, a transvaginal ultrasound
and CA-125 should be performed in CONJUNCTION with each other. You should request these
3 diagnostic tests, if you have several symptoms for more than 3 - 4 weeks.
Symptoms - pain in the upper abdomen (spreading
to the back), nausea, loss of appetite, weight loss, weakness. If common
bile duct is blocked by tumor, the skin and whites of the eyes may become
yellow, and urine may become dark.
Diagnosis - blood, urine and stool tests, upper
GI series, CT scan, ultrasound, and/or MRI, ERCP (pancreatic duct x-ray),
PTC (liver x-ray), angiography (x-rays of blood vessels after dye injection),
biopsy, laparascopy, laparotomy.
Symptoms - a need to urinate frequently (especially
at night), difficulty starting urination or holding back urine; inability
to urinate, weak or interrupted flow, painful or burning urination, painful
ejaculation, blood in urine or semen, frequent pain or stiffness in the
lower back, hips, or upper thighs.
Diagnosis - rectal exam, urine tests, biopsy,
bone scan, CT scan of abdomen and pelvis, ultrasound scan; blood tests,
especially the PSA (prostate-specific antigen), IVP (kidney and ureters
x-ray), TURP (transurethral resection of the prostate).
Symptoms - a change on the skin, especially
a new growth or a sore that does not heal; signs of scaliness, oozing,
bleeding or a change in the appearance of a bump or nodule. Signs of melanoma:
one half of a mole does not match the other half (asymmetry); the edges
are ragged, notched or blurred (border irregularity); the pigmentation
is not uniform; shades of tan, brown and black are present (color); the
diameter is greater than 6 millimeters.
Diagnosis - excisional biopsy, blood tests,
x-rays, scans, sentinel node sampling (melanoma).
Symptoms - heartburn, pain in the abdomen, nausea,
vomiting, diarrhea or constipation, bloating, loss of appetite, weakness
and fatigue, vomiting blood or having blood in the stool.
Diagnosis - fecal occult and routine blood tests,
upper GI series, endoscopy, biopsy, scans.
Symptoms - lump in either testicle or any enlargement
of a testicle, a feeling of heaviness in the scrotum, dull ache in lower
abdomen or groin, sudden collection of fluid in the scrotum, pain in testicle
or scrotum, enlargement or tenderness of breasts, lump in the neck, pain
in the back, shortness of breath (due to lung metastasis).
Diagnosis - testicular-specific blood tests
(AFP and Beta HCG), chest x-ray, urine tests, CT scans of abdomen or chest,
lymphogram, ultrasound scan of the liver, IVP (kidney and ureters x-ray),
inguinal orchiectomy (removal of testicle through the groin).
Symptoms - signs of a lump in the middle part
of the neck
Diagnosis - thyroid scan and/or ultrasound test,
biopsy (needle aspiration), surgical biopsy, CT scan of the neck.
Symptoms - abnormal vaginal bleeding or discharge,
difficult or painful urination, pain during intercourse, pain in the pelvic
Diagnosis - pelvic exam (with rectal), Pap test,
biopsy, D&C (uterine tissue sample), various scans and x-rays.
** Once cancer is diagnosed, and before treatment, it is broken down
into stages and grades so your doctor can learn more about it and treat
Staging involves learning how extensive the cancer is:
- how large the tumor (T) is;
- if it has spread to the lymph nodes (N);
- if there is any metastasis (M).
The numbers after the letters indicate “how much” the cancer has spread.
For instance, T2 N1 M0 would mean the tumor is about 1 to 2 inches in diameter,
involving one or more lymph nodes, with no known metastasis.
Stages range from 0 to IV.
Stage 0 - the tumor has not spread to nearby tissue.
Stage I - a small invasive cancer without known metastasis.
Stages II & III - more advanced, usually with lymph node involvement.
Stage IV - progressive, typically with metastasis.
Grading involves learning how aggressive the cancer is - ranging from least to most aggressive.
The higher the grade, the more aggressive (faster growing) the cancer.
Grades range from I to IV. Cancers that look more aggressive require different treatment.
The stage and grade of the cancer is very important to your
choice of treatment options.
Affectionately referred to by survivors as “cut, burn and poison,” surgery,
radiation and chemotherapy are the three most common and conventional
treatment options for cancer. Other treatment options - biologic, hormonal
and alternative therapies - are also available, as well as clinical trials.
Surgery is the most “popular” treatment option
and usually the first choice in treating cancer. It is the easiest and
most effective method used to treat certain types of cancer. Surgery is
used quite frequently for doing biopsies, removing growths that may become
cancerous, determining the extent of the cancer, and removing malignant
tumors. It can also be used to relieve pain or to remove secondary tumors.
Radiation therapy is used to destroy or shrink
tumors by directing high-energy rays to cancer cells to stop them from
growing and dividing. It can be delivered externally or internally. External
radiation is when the body receives high-dose radiation directed
at the tumor from a machine outside the body. Internal
radiation, called brachytherapy, is when
radioactive material is placed within the body in or near the tumor. This
allows a higher dose of radiation to a smaller area than external radiation.
Radiation can be used in conjunction with surgery and/or chemotherapy,
or by itself. It is not usually used on cancer that has already spread
to other parts of the body. Radiation therapy is also known as radiotherapy,
cobalt therapy, electron beam therapy, x-ray therapy, and irradiation.
Chemotherapy is using drugs to kill cancer.
Chemotherapy (anticancer) drugs can be used singly or as a combination
of several drugs (combination chemotherapy). Chemotherapy drugs are administered
intravenously or IV (into a vein), orally or PO (by mouth, in pill form),
intramuscularly or IM (into a muscle), subcutaneously or SQ or SC (under
the skin), intralesionally or IL (directly into the cancerous area), or
topically (applied to the skin). Because chemotherapy circulates in the
blood, it can reach parts of the body where cancer may spread and is capable
of killing cancer cells far away from the original site. This is called
systemic treatment. Chemotherapy is used to
keep cancer from spreading, to slow cancer growth, to kill cancer cells
that may spread from the primary site, and to relieve symptoms caused
by cancer. It can be received alone or in combination with surgery and/or
radiation, called adjuvant therapy.
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