ALL ABOUT THE CANCER OF TYPES

Laryngeal cancer

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insidermedicine in 60 - December 17, 2007

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Examination of the Larynx and Pharynx.avi

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supracricoid laryngectomy for larynx cancer

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I'm so happy I stopped smoking

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Santa's Helper and Throat Cancer-Mayo Clinic

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Cancer of the larynx (vocal cords cancer)

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Brian Nelson Loses Voice Box June 2008 Video Stroboscopy Laryngoscopy August 21, 2008 Is this related to my cancer?

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Brian Nelson Loses Voice Box June 2008 Video Stroboscopy Laryngoscopy August 21, 2008 Is this related to my cancer?

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Tokyo Artificial Larynx Interview

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Smoking's Toxic Truth: Larynx Cancer

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Followup care

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Followup care is important after treatment for cancer of the larynx. Regular checkups ensure that any changes in health are noted. Problems can be found and treated as soon as possible. The doctor will check closely to be sure that the cancer has not returned. Checkups include exams of the stoma, neck, and throat. From time to time, the doctor may do a complete physical exam and take x-rays. If you had radiation therapy or a partial laryngectomy, the doctor will also examine you with a laryngoscope.

Treatments for laryngeal cancer can affect the thyroid. A blood test can tell if the thyroid is making enough thyroid hormone. If the level is low, you may need to take thyroid hormone pills.

People who have laryngeal cancer have a chance of developing a new cancer in the mouth, throat, or other areas of the head and neck. This is especially true for those who are smokers or drink alcohol heavily. Most doctors strongly urge their patients to stop smoking and drinking to cut down the risk of a new cancer and other health problems.

The NCI has prepared a booklet for people who have completed their treatment to help answer questions about followup care and other concerns. Facing Forward Series: Life After Cancer Treatment provides tips for getting the most out of medical visits. It describes the kinds of help people may need.

Support for people with larynx cancer

Living with a serious disease such as cancer is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, people living with cancer get together to share what they have learned about coping with the disease and the effects of treatment. People interested in finding a support group may want to talk with their health care provider for suggestions.

People living with cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful for those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for help with rehabilitation, emotional support, financial aid, transportation, or home care.

The Cancer Information Service (1-800-4-CANCER) can provide printed materials on coping, as well as information to help patients and their families locate programs and services.

The promise of cancer research

Doctors all over the country are conducting many types of clinical trials. These are research studies in which people take part voluntarily. Studies include new ways to treat cancer of the larynx. Research already has led to advances, and researchers continue to search for more effective approaches.

People who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take very careful steps to protect their patients.

People with laryngeal cancer are participating in several types of treatment studies:

•Radiation therapy. Researchers are studying a new approach to radiation therapy. Patients receive radiation three times a day, 5 days a week, for just over 2 weeks, instead of once a day for 5 to 7 weeks.
•Drugs that reduce side effects. Researchers are testing therapies that reduce the side effects of radiation therapy. They are testing drugs that may help patients maintain their weight or help lessen damage to the skin during radiation therapy.
•Chemotherapy. Scientists are studying drugs that kill cancer cells. These drugs are used alone or in combination with radiation therapy to spare the larynx from surgery.
•Biological therapy. Scientists are studying monoclonal antibodies that slow or stop the growth of cancer.
If you are interested in learning more about joining a clinical trial, you may want to talk with your doctor. You may want to read Taking Part in Clinical Trials: What Cancer Patients Need To Know. NCI also offers an easy-to-read brochure called If You Have Cancer: What You Should Know About Clinical Trials. These NCI booklets describe how research studies are carried out and explain their possible benefits and risks. NCI's Web site includes a section on clinical trials at http://cancer.gov/clinical_trials. This section of the Web site provides general information about clinical trials. It also offers detailed information about specific ongoing studies of cancer of the larynx. The Cancer Information Service at 1-800-4-CANCER can answer questions and provide information from the NCI's database of clinical trials

Rehabilitation after surgery for larynx cancer

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Living with a stoma
Learning to live with the changes brought about by cancer of the larynx is a special challenge. The medical team will make every effort to help you return to your normal routine as soon as possible.
If you have a stoma, you will need to learn how to care for it:

•Before leaving the hospital, you will learn to remove and clean the trach tube, suction the trach, and care for the skin around the stoma.

•If the air is too dry, as it may be in heated buildings in the winter, the tissues of the windpipe and lungs may produce extra mucus. Also, the skin around the stoma may get sore. Keeping the skin around the stoma clean and using a humidifier at home or at the office can lessen these problems.
•It is very dangerous for water to get into the windpipe and lungs through the stoma. Wearing a special plastic stoma shield or holding a washcloth over the stoma keeps water out when showering or shaving. Other types of stoma covers-such as scarves, neckties, and specially made covers-help keep moisture in and around the stoma. They help filter smoke and dust from the air before it enters the stoma. They also catch any fluids that come out of the windpipe when you cough or sneeze. Many people choose to wear something over their stoma even after the area heals. Stoma covers can be attractive as well as useful.
•When shaving, men should keep in mind that the neck may be numb for several months after surgery. To avoid nicks and cuts, it may be best to use an electric shaver until the numbness goes away.
People with stomas work in almost every type of business and can do nearly all of the things they did before. However, they cannot hold their breath, so straining and heavy lifting may be difficult. Also, swimming and water skiing are not possible without special instruction and equipment to keep water from entering the stoma.

Some people may feel self-conscious about the way they look and speak. They may be concerned about how other people feel about them. They may be concerned about how their sexual relationships may be affected. Many people find that talking about these concerns helps them. Counseling or support groups may also be helpful.

Learning to speak again

Talking is part of nearly everything we do, so it's natural to be scared if your voice box must be removed. Losing the ability to talk-even for a short time-is hard. Patients and their families and friends need understanding and support during this time.

Within a week or so after a partial laryngectomy, you will be able to talk in the usual way. After a total laryngectomy, however, you must learn to speak in a new way. A speech pathologist usually meets with you before surgery to explain the methods that can be used. In many cases, speech lessons start before you leave the hospital.

Until you begin to talk again, it is important to have other ways to communicate. Here are some ideas that you may find helpful:

•Keep pads of paper and pens or pencils in your pocket or purse.
•Use a typewriter, computer, or other electronic device. Your words can be printed on paper, displayed on a screen, or produced in a male or female voice.
•Carry a small dictionary or a picture book and point to the words you need.
•Write notes on a "magic slate" (a toy with a plastic sheet that covers black wax; lifting the plastic erases the sheet).

The health care team can help patients learn new ways to speak. It takes practice and patience to learn techniques such as esophageal speech or tracheoesophageal puncture speech, and not everyone is successful. How quickly a person learns, how understandable the speech is, and how natural the new voice sounds depend on the extent of the surgery on the larynx.

Esophageal speech

A speech pathologist can teach you how to force air into the top of your esophagus and then push it out again. The puff of air is like a burp. It vibrates the walls of the throat, making sound for the new voice. The tongue, lips, and teeth form words as the sound passes through the mouth.

This type of speech sounds low pitched and gruff, but it usually sounds more like a natural voice than speech made by a mechanical larynx. There is also no device to carry around, so your hands are free.

Tracheoesophageal puncture

For tracheoesophageal puncture (TEP), the surgeon makes an opening between the trachea and the esophagus. The opening is made at the time of initial surgery or later. A small plastic or silicone valve fits into this opening. The valve keeps food out of the trachea. After TEP, patients can cover their stoma with a finger and force air into the esophagus through the valve. The air produces sound by making the walls of the throat vibrate. The sound is a lot like natural speech.

Mechanical speech

You may choose to use a mechanical larynx while you learn esophageal or TEP speech or if you are unable to use these methods. The device may be powered by batteries (electrolarynx) or by air (pneumatic larynx).

Many different mechanical devices are available. The speech pathologist will help you choose the best device for your needs and abilities and will train you to use it.

One kind of electrolarynx looks like a small flashlight. It makes a humming sound. You hold the device against your neck, and the sound travels through your neck to your mouth. Another type of electrolarynx has a flexible plastic tube that carries sound into your mouth from a hand-held device. There are also devices that are built into a denture or retainer and can be worn inside your mouth and operated by a hand-held remote control.

A pneumatic larynx is held over the stoma and uses air from the lungs instead of batteries to make it vibrate. The sound it makes travels to the mouth through a plastic tube

Side effects of treatment for larynx cancer

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Cancer treatments are very powerful. Treatments that remove or destroy cancer cells are likely to damage healthy cells, too. That's why treatments often cause side effects. This section describes some of the side effects of each kind of treatment.

Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and how they can be managed. It may help to know that although some side effects may not go away completely, most of them become less troubling.

It may also help to talk with other patients. A social worker, nurse, or other member of the medical team can set up a visit with someone who has had the same treatment.

The NCI provides helpful booklets about cancer treatments and coping with side effects, such as Radiation Therapy and You and Eating Hints for Cancer Patients. See the "National Cancer Institute Information Resources" and "National Cancer Institute Booklets" sections for other sources of information about side effects.

Radiation therapy
People treated with radiation therapy may have some or all of these side effects:

•Dry mouth. Drinking lots of fluids can help. Some patients find artificial saliva helpful. It comes in a spray or squeeze bottle.
•Sore throat or mouth. Your health care provider may suggest special rinses to numb your throat and mouth and help relieve the soreness.
•Delayed healing after dental care. Many doctors recommend having a dental exam and any needed dental work before radiation therapy.
•Tooth decay. Good mouth care can help keep your teeth and gums healthy and can help you feel better. If it's hard to floss or brush your teeth in the usual way, you can try using gauze, a soft toothbrush, or a toothbrush that has a spongy tip instead of bristles. A mouthwash made with diluted peroxide, salt water, baking soda, or a combination can keep your mouth fresh and help protect your teeth from decay. It may also be helpful to use fluoride toothpaste or rinse.
•Changes in sense of taste and smell. During radiation therapy, food may taste or smell different.
•Fatigue. During radiation therapy, you may become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually advise their patients to stay as active as they can.
•Changes in voice quality. Your voice may be weak at the end of the day. It may also be affected by changes in the weather. Voice changes and the feeling of a lump in your throat may come from swelling in the larynx caused by the radiation. The doctor may suggest medicine to reduce this swelling.
•Skin changes in treated area. The skin in the treated area may become red or dry. Good skin care is important at this time. Try to expose this area to the air but protect it from the sun. Avoid wearing clothes that rub, and do not shave the treated area. You should not put anything on your skin before radiation treatments. Also, you should never use lotion or cream without your doctor's advice.
Surgery

People who have surgery may have any of these side effects:

•Pain. You may be uncomfortable for the first few days after surgery. However, medicine can usually control the pain. You should feel free to discuss pain relief with the doctor or nurse.
•Low energy. It is common to feel tired or weak after surgery. The length of time it takes to recover from an operation is different for each patient.
•Swelling in the throat. For a few days after surgery, you won't be able to eat, drink, or swallow. At first, you will receive fluid through an intravenous (IV) tube placed into your arm. Within a day or two, you will get fluids and nutrition through a feeding tube (put in place during surgery) that goes through your nose and throat into your stomach. When the swelling goes away and the area begins to heal, the feeding tube will be removed. Swallowing may be difficult at first, and you may need the help of a nurse or speech pathologist. Soon you will be eating your regular diet. If you need a feeding tube for longer than one week, you may get a tube that goes directly into the abdomen. Most patients slowly return to eating solid foods by mouth, but for a very few patients, the feeding tube may be permanent.
•Increased mucus production. After the operation, the lungs and windpipe produce a lot of mucus, also called sputum. To remove it, the nurse applies gentle suction by placing a small plastic tube in the stoma. You will learn to cough and suction mucus through the stoma without the nurse's help.

•Numbness, stiffness, or weakness. After a laryngectomy, parts of the neck and throat may be numb because nerves have been cut. Also, the shoulder, neck, and arm may be weak and stiff. You may need physical therapy to improve your strength and flexibility after surgery.
•Changes in physical appearance. Your neck will be somewhat smaller, and it will have scars. Some patients find it helpful to wear clothing that covers the neck area.
•Tracheostomy. Patients who have surgery will have a stoma. With most supraglottic and partial laryngectomies, the stoma is temporary. After a short recovery period, the tube can be removed, and the stoma closes up. You should then be able to breathe and talk in the usual way. In some people, however, the voice may be hoarse or weak.
After a total laryngectomy, the stoma is permanent. If you have a total laryngectomy, you will need to learn to speak in a new way. The section called "Learning to Speak Again" has more information.

More information about stomas may be found in the "Living with a Stoma" section.

Chemotherapy

The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anticancer drugs affect cells that divide rapidly:

•Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of your body. If your blood cells are affected, you are more likely to get infections, may bruise or bleed easily, and may feel very weak and tired.
•Cells in hair roots: Chemotherapy can lead to hair loss, but hair will grow back. However, the new hair may be different in color and texture.
•Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with new or improved drugs.
Nutrition

Some people who have had treatment for cancer of the larynx may lose their interest in food. Soreness and changes in smell and taste may make eating difficult. Yet good nutrition is important. Eating well means getting enough calories and protein to prevent weight loss, regain strength, and rebuild healthy tissues.

If eating is difficult because your mouth is dry from radiation therapy, you may want to try soft, bland foods moistened with sauces or gravies. Thick soups, puddings, and milkshakes often are easier to swallow. The nurse and the dietitian will help you choose the right foods.

After surgery or radiation therapy, some people need feeding tubes placed into the abdomen. Most people slowly return to a regular diet. Learning to swallow again may take some practice with the help of a nurse or speech pathologist. Some people find liquids easier to swallow; others do better with solid foods. You will find what works best for you.

Methods of treatment

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Cancer of the larynx may be treated with radiation therapy, surgery, or chemotherapy. Some patients have a combination of therapies.

Radiation therapy (also called radiotherapy) uses high-energy x-rays to kill cancer cells. The rays are aimed at the tumor and the tissue around it. Radiation therapy is local therapy. It affects cells only in the treated area. Treatments are usually given 5 days a week for 5 to 8 weeks.

Laryngeal cancer may be treated with radiation therapy alone or in combination with surgery or chemotherapy:

•Radiation therapy alone: Radiation therapy is used alone for small tumors or for patients who cannot have surgery.
•Radiation therapy combined with surgery: Radiation therapy may be used to shrink a large tumor before surgery or to destroy cancer cells that may remain in the area after surgery. If a tumor grows back after surgery, it is often treated with radiation.
•Radiation therapy combined with chemotherapy: Radiation therapy may be used before, during, or after chemotherapy.
After radiation therapy, some people need feeding tubes placed into the abdomen. The feeding tube is usually temporary.

These are questions you may want to ask your doctor before having radiation therapy:

•Why do I need this treatment?
•What are the risks and side effects of this treatment?
•Are there any long-term effects?
•Should I see my dentist before I start treatment?
•When will the treatments begin? When will they end?
•How will I feel during therapy?
•What can I do to take care of myself during therapy?
•Can I continue my normal activities?
•How will my neck look afterward?
•What is the chance that the tumor will come back?
•How often will I need checkups?

Surgery is an operation in which a doctor removes the cancer using a scalpel or laser while the patient is asleep. When patients need surgery, the type of operation depends mainly on the size and exact location of the tumor.

There are several types of laryngectomy (surgery to remove part or all of the larynx):

•Total laryngectomy: The surgeon removes the entire larynx.
•Partial laryngectomy (hemilaryngectomy): The surgeon removes part of the larynx.
◦Supraglottic laryngectomy: The surgeon takes out the supraglottis, the top part of the larynx.
◦Cordectomy: The surgeon removes one or both vocal cords.
Sometimes the surgeon also removes the lymph nodes in the neck. This is called lymph node dissection. The surgeon also may remove the thyroid.

During surgery for cancer of the larynx, the surgeon may need to make a stoma. (This surgery is called a tracheostomy.) The stoma is a new airway through an opening in the front of the neck. Air enters and leaves the windpipe (trachea) and lungs through this opening. A tracheostomy tube, also called a trach ("trake") tube, keeps the new airway open. For many patients, the stoma is temporary. It is needed only until the patient recovers from surgery. More information about stomas can be found in the "Living with a Stoma" section.

After surgery, some people may need a temporary feeding tube.

This picture shows the pathways for air and food after a total laryngectomy.

The stoma is the new opening into the trachea.

Here are some questions to ask the doctor before having surgery:
•How will I feel after the operation?
•Will I need a tracheostomy?
•Will I need to learn how to take care of myself or my incision when I get home?
•Where will the scars be? What will they look like?
•Will surgery affect my ability to speak? If so, who will teach me how to speak in a new way?
•When can I get back to my normal activities?

Chemotherapy is the use of drugs to kill cancer cells. Your doctor may suggest one drug or a combination of drugs. The drugs for cancer of the larynx are usually given by injection into the bloodstream. The drugs enter the bloodstream and travel throughout the body.

Chemotherapy is used to treat laryngeal cancer in several ways:

•Before surgery or radiation therapy: In some cases, drugs are given to try to shrink a large tumor before surgery or radiation therapy.
•After surgery or radiation therapy: Chemotherapy may be used after surgery or radiation therapy to kill any cancer cells that may be left. It also may be used for cancers that have spread.
•Instead of surgery: Chemotherapy may be used with radiation therapy instead of surgery. The larynx is not removed and the voice is spared.
Chemotherapy may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.

These are questions you may want to ask your doctor before having chemotherapy:
•Why do I need this treatment?
•What will it do?
•Will I have side effects? What can I do about them?
•How long will I be on this treatment?
•How often will I need checkups?

Treatment for larynx cancer

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Staging
To plan the best treatment, your doctor needs to know the stage, or extent, of your disease. Staging is a careful attempt to learn whether the cancer has spread and, if so, to what parts of the body. The doctor may use x-rays, CT scans, or magnetic resonance imaging to find out whether the cancer has spread to lymph nodes, other areas in your neck, or distant sites.

Treatment
People with cancer of the larynx often want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. However, shock and stress after a diagnosis of cancer can make it hard to remember what you want to ask the doctor. Here are some ideas that might help:
•Make a list of questions.
•Take notes at the appointment.
•Ask the doctor if you may use a tape recorder during the appointment.
•Ask a family member or friend to come to the appointment with you.
Your doctor may refer you to a specialist who treats cancer of the larynx, such as a surgeon, otolaryngologist (an ear, nose, and throat doctor), radiation oncologist, or medical oncologist. You can also ask your doctor for a referral. Treatment usually begins within a few weeks of the diagnosis. Usually, there is time to talk to your doctor about treatment choices, get a second opinion, and learn more about the disease before making a treatment decision.

Getting a second opinion
Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if you or your doctor requests it. There are a number of ways to find a doctor for a second opinion:

•Your doctor may refer you or you may ask for a referral to one or more specialists. At cancer centers, several specialists often work together as a team. The team may include a surgeon, radiation oncologist, medical oncologist, speech pathologist, and nutritionist. At some cancer centers, you may be able to see them all on the same day.
•The Cancer Information Service, at 1-800-4-CANCER, can tell you about treatment centers near you.
•A local medical society, a nearby hospital, or a medical school can often provide the names of specialists in your area.
•The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")
Preparing for treatment

The doctor can describe your treatment choices and the results you can expect for each treatment option. You will want to consider how treatment may change the way you look, breathe, and talk. You and your doctor can work together to develop a treatment plan that meets your needs and personal values.

The choice of treatment depends on a number of factors, including your general health, where in the larynx the cancer began, the size of the tumor, and whether the cancer has spread.

If you smoke, a good way to prepare for treatment is to stop smoking. Studies show that treatment is more likely to be successful for people who don't smoke. Your doctor or the Cancer Information Service (1-800-4-CANCER) may be able to suggest ways to help you stop smoking.

You may want to talk with the doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option. Patients who join trials have the first chance to benefit from new treatments that have shown promise in earlier research. The section on "The Promise of Cancer Research" has more information about research in progress.

These are questions you may want to ask your doctor before treatment begins:

•Where is my cancer and has it spread?
•What are my treatment choices? Which do you recommend for me? Why?
•What are the benefits of each treatment?
•What are the risks and possible side effects of each treatment?
•How will I look after treatment?
•How will I speak after treatment? Will I need to work with a speech therapist?
•Will I have problems eating?
•Will I need to change my daily activities?
•When can I return to work?
•What is the treatment likely to cost? Is this treatment covered by my insurance plan?
•Would a clinical trial (research study) be right for me? Can you help me find one?
•How often will I need checkups?

You do not need to ask all your questions or understand all the answers at once. You will have many chances to ask the doctor and the rest of the health care team to explain things that are not clear and to ask for more information.

Symptoms

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The symptoms of cancer of the larynx depend mainly on the size of the tumor and where it is in the larynx. Symptoms may include the following:

•Hoarseness or other voice changes
•A lump in the neck
•A sore throat or feeling that something is stuck in your throat
•A cough that does not go away
•Problems breathing
•Bad breath
•An earache
•Weight loss
These symptoms may be caused by cancer or by other, less serious problems. Only a doctor can tell for sure.

Diagnosis

If you have symptoms of cancer of the larynx, the doctor may do some or all of the following exams:

•Physical exam. The doctor will feel your neck and check your thyroid, larynx, and lymph nodes for abnormal lumps or swelling. To see your throat, the doctor may press down on your tongue.
•Indirect laryngoscopy. The doctor looks down your throat using a small, long-handled mirror to check for abnormal areas and to see if your vocal cords move as they should. This test does not hurt. The doctor may spray a local anesthesia in your throat to keep you from gagging. This exam is done in the doctor's office.
•Direct laryngoscopy. The doctor inserts a thin, lighted tube called a laryngoscope through your nose or mouth. As the tube goes down your throat, the doctor can look at areas that cannot be seen with a mirror. A local anesthetic eases discomfort and prevents gagging. You may also receive a mild sedative to help you relax. Sometimes the doctor uses general anesthesia to put a person to sleep. This exam may be done in a doctor's office, an outpatient clinic, or a hospital.
•CT scan. An x-ray machine linked to a computer takes a series of detailed pictures of the neck area. You may receive an injection of a special dye so your larynx shows up clearly in the pictures. From the CT scan, the doctor may see tumors in your larynx or elsewhere in your neck.
•Biopsy. If an exam shows an abnormal area, the doctor may remove a small sample of tissue. Removing tissue to look for cancer cells is called a biopsy. For a biopsy, you receive local or general anesthesia, and the doctor removes tissue samples through a laryngoscope. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if a tumor is cancerous.

Who's at risk for larynx cancer?

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No one knows the exact causes of cancer of the larynx. Doctors cannot explain why one person gets this disease and another does not. We do know that cancer is not contagious. You cannot "catch" cancer from another person.

People with certain risk factors are more likely to get cancer of the larynx. A risk factor is anything that increases your chance of developing this disease.

Studies have found the following risk factors:

•Age. Cancer of the larynx occurs most often in people over the age of 55.
•Gender. Men are four times more likely than women to get cancer of the larynx.
•Race. African Americans are more likely than whites to be diagnosed with cancer of the larynx.
•Smoking. Smokers are far more likely than nonsmokers to get cancer of the larynx. The risk is even higher for smokers who drink alcohol heavily. People who stop smoking can greatly decrease their risk of cancer of the larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus. Also, quitting smoking reduces the chance that someone with cancer of the larynx will get a second cancer in the head and neck region. (Cancer of the larynx is part of a group of cancers called head and neck cancers.)
•Alcohol. People who drink alcohol are more likely to develop laryngeal cancer than people who don't drink. The risk increases with the amount of alcohol that is consumed. The risk also increases if the person drinks alcohol and also smokes tobacco.
•A personal history of head and neck cancer. Almost one in four people who have had head and neck cancer will develop a second primary head and neck cancer.
•Occupation. Workers exposed to sulfuric acid mist or nickel have an increased risk of laryngeal cancer. Also, working with asbestos can increase the risk of this disease. Asbestos workers should follow work and safety rules to avoid inhaling asbestos fibers.
Other studies suggest that having certain viruses or a diet low in vitamin A may increase the chance of getting cancer of the larynx. Another risk factor is having gastroesophageal reflux disease (GERD), which causes stomach acid to flow up into the esophagus.

Most people who have these risk factors do not get cancer of the larynx. If you are concerned about your chance of getting cancer of the larynx, you should discuss this concern with your health care provider. Your health care provider may suggest ways to reduce your risk and can plan an appropriate schedule for checkups.

What is cancer?

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What is cancer?

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of your body. Normally, cells grow and divide to form new cells as your body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor. Growths on the larynx also may be called nodules or polyps. Not all growths are cancer. Growths can be benign or malignant:

Benign growths are not cancer:

•They are rarely life-threatening.
•Usually, benign tumors can be removed, and they seldom grow back.
•Cells from benign tumors do not spread to tissues around them or to other parts of the body.
Malignant growths are cancer:

•They are generally more serious and may be life-threatening.
•Malignant tumors usually can be removed, but they can grow back.
•Cells from malignant tumors invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how cancer cells spread from the original cancer (the primary tumor) to form new tumors in other organs. The spread of cancer is called metastasis. Different types of cancer tend to spread to different parts of the body.
Cancer of the larynx also may be called laryngeal cancer. It can develop in any part of the larynx. Most cancers of the larynx begin in the glottis. The inner walls of the larynx are lined with cells called squamous cells. Almost all laryngeal cancers begin in these cells. These cancers are called squamous cell carcinomas.

If cancer of the larynx spreads (metastasizes), the cancer cells often spread to nearby lymph nodes in the neck. The cancer cells can also spread to the back of the tongue, other parts of the throat and neck, the lungs, and other parts of the body. When this happens, the new tumor has the same kind of abnormal cells as the primary tumor in the larynx. For example, if cancer of the larynx spreads to the lungs, the cancer cells in the lungs are actually laryngeal cancer cells. The disease is called metastatic cancer of the larynx, not lung cancer. It is treated as cancer of the larynx, not lung cancer. Doctors sometimes call the new tumor "distant" disease

What is the larynx?

2010-05-04T00:21:00.000-07:00

The larynx is an organ at the front of your neck. It is also called the voice box. It is about 2 inches long and 2 inches wide. It is above the windpipe (trachea). Below and behind the larynx is the esophagus.

The larynx has two bands of muscle that form the vocal cords. The cartilage at the front of the larynx is sometimes called the Adam's apple.

The larynx has three main parts:

•The top part of the larynx is the supraglottis.
•The glottis is in the middle. Your vocal cords are in the glottis.
•The subglottis is at the bottom. The subglottis connects to the windpipe.
The larynx plays a role in breathing, swallowing, and talking. The larynx acts like a valve over the windpipe. The valve opens and closes to allow breathing, swallowing, and speaking:

•Breathing: When you breathe, the vocal cords relax and open. When you hold your breath, the vocal cords shut tightly.
•Swallowing: The larynx protects the windpipe. When you swallow, a flap called the epiglottis covers the opening of your larynx to keep food out of your lungs. The food passes through the esophagus on its way from your mouth to your stomach.
•Talking: The larynx produces the sound of your voice. When you talk, your vocal cords tighten and move closer together. Air from your lungs is forced between them and makes them vibrate. This makes the sound of your voice. Your tongue, lips, and teeth form this sound into words.

Lung Cancer: Through My Children's Eyes -Part 1of3

2010-03-27T01:37:00.000-07:00

Man Fights Lung Cancer As It Kills Him

2010-03-27T01:35:00.001-07:00

Lung Cancer Patient Coughs Up 38 Dead Tumors on Natural Mineral Protocal

2010-03-27T01:34:00.002-07:00

Graphic Lung Cancer Anti Smoking ad

2010-03-27T01:34:00.001-07:00

Healthbeat - Lung Cancer

2010-03-27T01:33:00.001-07:00

lung cancer and CT scan

2010-03-27T01:32:00.005-07:00

lung cancer and CT scan

2010-03-27T01:32:00.004-07:00

Anti-smoking Ad: Smoking Causes Emphysema, Lung Cancer

2010-03-27T01:32:00.003-07:00

Anti-smoking Ad: Smoking Causes Emphysema, Lung Cancer

2010-03-27T01:32:00.001-07:00

Lung Cancer - Just Stop It

2010-03-27T01:29:00.000-07:00

Bronchoscopy - lung cancer that invaded the tracheal carina

2010-03-27T01:28:00.000-07:00

Cancer Facts : How Does Lung Cancer Develop?

2010-03-27T01:24:00.000-07:00

Lung Cancer

2010-03-27T01:21:00.000-07:00

Expectations (Prognosis)

2010-03-27T01:19:00.002-07:00

Expectations (Prognosis)
How well a patient does depends on the following:

Type of lung cancer
Whether or not the cancer has spread
Your age
Your overall health
How well you respond to treatment
The earlier the cancer is found, the better the chances of survival. Lung cancer is a deadly disease. Nearly 60% of people with lung cancer die within a year. However, some people are cured and go on to live many years.

Complications
The cancer may spread to other parts of the body (metastasis). Cancer treatment can cause significant side effects.

Calling Your Health Care Provider
Call your health care provider if you develop symptoms of lung cancer (particularly if you smoke).

Prevention
If you smoke, quit. It is never too late to stop smoking. You should also avoid breathing in the smoke from other people's cigarettes, cigars, or pipes.

Eating a diet rich in fruits and vegetables may help prevent some cases of lung cancer.

References
Alberg AJ, Ford JG, Samet JM; American College of Chest Physicians. Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:29S-55S.

Bach PB, Silvestri GA, Hanger M, Jett JR. Screening for lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:69S-77S.

National Cancer Institute. Lung Cancer Home Page. Bethesda, MD: U.S. National Institutes of Health. Accessed August 3, 2008

Jett JR, Schild SE, Keith RL, Kesler KA. Treatment of non-small cell lung cancer, stage IIIB: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:266S-276S.

Johnson DH, Blot WJ, Carbone DP, et al. Cancer of the lung_ Non-small cell lung cancer and small cell lung cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008:chap 76.

Treatment

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Treatment
Treatment depends on the specific type of lung cancer. Each type is treated differently. Chemotherapy, radiation, and surgery may be needed.

See the individual articles on the different types of lung cancer:

Non-small cell lung cancer
Small cell lung cancer

Signs And Tests

2010-03-27T01:18:00.001-07:00

Signs And Tests
The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked.

When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer.

Tests that may be performed include:

Chest x-ray
Sputum cytology test to look for cancer cells
Blood work
CT scan of the chest
MRI of the chest
Positron emission tomography (PET) scan
In some cases, the health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:

Bronchoscopy combined with biopsy
Pleural biopsy
CT scan directed needle biopsy
Mediastinoscopy with biopsy
Open lung biopsy
For more information, see:

Small cell lung cancer
Non-small cell lung cancer

Symptoms

2010-03-27T01:17:00.002-07:00

Early lung cancer may not cause any symptoms. Many times, lung cancer is found when an x-ray is done for another reason.

Symptoms depend on the specific type of cancer you have, but may include:

Cough that doesn't go away
Coughing up blood
Shortness of breath
Wheezing
Chest pain
Loss of appetite
Losing weight without trying
Fatigue
Additional symptoms that may also occur with lung cancer:

Weakness
Swallowing difficulty
Nail problems
Joint pain
Hoarseness or changing voice
Swelling of the face
Facial paralysis
Eyelid drooping
Bone pain or tenderness
These symptoms can also be due to other, less serious conditions, so it is important to talk to your health care provider.

For more information, see:

Small cell lung cancer
Non-small cell lung cancer

Causes, Incidence, And Risk Factors

2010-03-27T01:17:00.001-07:00

Causes, Incidence, And Risk Factors
Lung cancer is the deadliest type of cancer for both men and women. Each year, more people die of lung cancer than breast, colon, and prostate cancers combined.

Lung cancer is more common in older adults. It is rare in people under age 45.

Cigarette smoking is the leading cause of lung cancer.

The more cigarettes you smoke per day and the earlier you started smoking, the greater your risk of lung cancer. There is no evidence that smoking low-tar cigarettes lowers the risk.

However, lung cancer has occurred in people who have never smoked.

Secondhand smoke (breathing the smoke of others) increases your risk of lung cancer. According to the American Cancer Society, an estimated 3,000 non-smoking adults will die each year from lung cancer related to breathing secondhand smoke.

The following may also increase one's risk of lung cancer:

High levels of air pollution
High levels of arsenic in drinking water
Radon gas
Asbestos
Family history of lung cancer
Radiation therapy to the lungs
Exposure to cancer-causing chemicals such as uranium, beryllium, vinyl chloride, nickel chromates, coal products, mustard gas, chloromethyl ethers, gasoline, and diesel exhaust
http://www.righthealth.com/topic/Lung_Cancer_Photo/overview/adam20?fdid=Adamv2_007270§ion=Full_Article

Lung cancer Guide

2010-03-27T01:08:00.000-07:00

Definition
Lung cancer is cancer that begins in the lungs, the two organs found in the chest that help you breathe.

The lungs are made up of areas called lobes. The right lung has three lobes; the left lung has two, so there's room for the heart. When you breathe, air goes through your nose, down your windpipe (trachea), and into the lungs where it spreads through tubes called bronchi. Most lung cancer begins in the cells that line these tubes.

There are two main types of lung cancer:

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer.
Small cell lung cancer makes up about 20% of all lung cancer cases.
If the lung cancer is made up of both types, it is called mixed small cell/large cell cancer.

If the cancer started somewhere else in the body and spread to the lungs, it is called metastatic cancer to the lung.http://www.righthealth.com/topic/Lung_Cancer_Photo/overview/adam20?fdid=Adamv2_007270§ion=Full_Article

lung cancer

2010-03-27T01:06:00.000-07:00

lung cancer cancer that originates in the tissues of the lungs . Lung cancer is the leading cause of cancer death in the United States in both men and women. Like other cancers, lung cancer occurs after repeated insults to the genetic material of the cell. By far the most common source of these insults is tobacco smoke, which is responsible for about 85% of U.S. lung cancer deaths (see smoking ). The incidence of lung cancer in other countries follows their smoking patterns. Some other carcinogens known to cause lung cancer are found in the workplace. These include bischloromethyl ether and chloromethyl ether in chemical workers, arsenic in copper smelting, and asbestos in shipbuilders and other asbestos workers. Radon poses a risk to uranium and fluorspar miners and may pose a risk in some private residences as well. African Americans have a higher incidence of lung cancer than European Americans, even after adjusting for smoking.

Types of Lung Cancer

Lung cancers are classified according to the type of cell present in the tumor. The majority are referred to as non-small cell carcinomas. These include squamous cell or epidermoid carcinomas (the most common type worldwide), adenocarcinomas, and large cell carcinomas. Small cell carcinoma (which includes the subtypes oat cell and intermediate) comprises approximately 20% to 25% of lung cancers; it often has metastasized by the time it is detected. Lung cancer most commonly spreads to the brain, bone, liver, or bone marrow.

Symptoms

The primary symptoms of lung cancer are cough, shortness of breath, hoarseness, blood in the sputum, and pain. In some types, the cancer cells themselves produce hormones or other substances that can create an imbalance and result in various symptoms. Metastatic lung cancer also can cause symptoms that result from its effect on the organ to which the cancer has spread.

Diagnosis and Treatment

Diagnosis of lung cancer may be made by physical examination, chest X rays, bronchoscopy (see bronchoscope ), or percutaneous needle biopsy (insertion of a fine needle through the skin and into the lung to obtain tissue for study). In many cases definitive diagnosis is made after surgical specimens have been evaluated. Evaluation of suspected sites of metastasis may involve CAT scans or magnetic resonance imaging (MRI). A special CAT-scanning technique (helical low-dose CAT-scanning) has also been used for initial diagnosis because it can detect small tumors before they have spread.

Lung cancer is staged according to its location, size, cell type, and spread. This staging plus the state of health of the patient are used to determine treatment.

Treatment typically consists of surgical excision of the tumor alone or in combination with either external-beam radiation therapy or chemotherapy using one or more anticancer drugs. Photodynamic therapy is sometimes used if the cancer is still localized. In this therapy a substance that makes cells more sensitive to light is injected into the body. When it has passed out of most of the tissues, but remains in the cancer cells, the cancer is destroyed by a beam of laser light.

Prevention

Not starting to smoke or ceasing to smoke is by far the most effective lung cancer preventive. The risk of lung cancer in ex-smokers begins to decline about five years after quitting, and after 15 to 20 years their risk is 80% less than that of smokers. The reduction in cigarette smoking since the 1964 report of the Surgeon General's Advisory Committee on Health began to be translated into a decrease in the incidence of lung cancer in the 1990s; this decrease averaged more than 1% per year from 1990 to 1995. The preventive role of dietary antioxidants is under study.

Bibliography

See D. N. Carney, ed., Lung Cancer (1995). See also publications of the National Cancer Institute and the American Cancer Society. http://www.encyclopedia.com/topic/lung_cancer.aspx

How to Get Clear Skin With Healthy Foods

2010-02-01T21:55:00.000-08:00

1 Step Avocados! Avocados are not only rich in protein, omega 3, and packed with antioxidant for overall health, but its B complex properties, as well as essential vitamins are what's responsible for creating smooth, youthful looking skin. Simply one avocado per day has 3.8 mg niacin which translates to 27% of your daily need. Avocados, can of course make a delicious side meal or make a for a tasty smoothie blend. But you can take it a step further and really get the benefits from it by making your own homemade facial mask.

2. Step Soft mushy fruits like mangos hold more than 80% of your daily vitamin A need. Vitamin A is necessary for clear skin because it is responsible for repairing old facial cells and rejuvenating dry, blotchy, skin. Vitamin A can acts as an antioxidant by keeping skin looking naturally glowing and youthful.

3. Step Up your creamy curd intake. Cottage cheese, best known for its vitamin D properties essential for bone health, can also fight against skin caner and prevent wrinkles as it holds lots of selenium. Almonds are the warm and tasty and can fight against aging and skin cancer as well.

4.Step Get clear skin and prevent wrinkles by decreasing your caffeine, alcohol and processed food intake as they strip the skin of its natural healthy glow by blocking oxygen to the skin. If you smoke, please quit, as smoking can cause extreme premature skin aging

What about follow-up care for skin cancer?

2010-02-01T21:51:00.000-08:00

What about follow-up care for skin cancer?

Skin cancer has a better prognosis, or outcome, than most other types of cancer. It is generally curable. Even though most skin cancers are cured, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer of the skin. This is the reason why it is so important for patients to continue to examine themselves regularly, visit their doctor for regular checkups, and follow their doctor's instructions on how to reduce their risk of developing skin cancer again.

How about vitamin D and cancer?

Some recent reports suggest that getting vitamin D from sun exposure may prevent the occurrence and spread of cancers, both of internal organs and of the skin. In spite of the occasional controversy surrounding these studies, their common-sense implications are simple enough. Even those doctors who recommend sun for vitamin D only suggest 15 minutes a few times a week. For most people, especially those who have day jobs or live in cooler climates, following this advice is not likely to result in markedly higher risk of skin cancer. No responsible authority suggests that to help with vitamin D, people ought to sunbathe or visit tanning salons.

What resources are available to patients with skin cancer?

Skin Cancer Foundation
245 Fifth Avenue, Suite 2402
New York, NY 10016
212-725-5176

This nonprofit organization provides publications and audiovisual materials on the prevention, early detection, and treatment of skin cancer. The foundation also publishes Sun and Skin News and The Skin Cancer Foundation Journal, which have nontechnical articles on skin cancer. Send a stamped, self-addressed envelope to the above address to receive free printed information.

American Academy of Dermatology
PO Box 4014
Schaumburg, IL 60168-4014
708-330-0230

The American Academy of Dermatology is an organization of doctors who specialize in diagnosing and treating skin problems. It provides free booklets on skin cancer and can refer people to dermatologists in their local area.

American Society of Plastic and Reconstructive Surgeons
444 East Algonquin Road
Arlington Heights, IL 60005
1-800-635-0635

This society sends free information about various surgical procedures. It can also provide the names of board-certified plastic surgeons in a patient's area.

Skin Cancer At A Glance
•There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
•Skin cancer is the most common form of cancer in humans.
•Ultraviolet light, which is in sunlight, is the main cause of skin cancer.
•The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal. Unexplained changes in the appearance of the skin lasting longer than two weeks should be evaluated by a doctor.
•Nonmelanoma skin cancer is generally curable. The cure rate for nonmelanoma skin cancer could be 100% if these lesions were brought to a doctor's attention before they had a chance to spread.
•Treatment of nonmelanoma skin cancer depends on the type and location of the skin cancer, the risk of scarring, as well as the age and health of the patient. Methods used include curettage and desiccation, surgical excision, cryosurgery, radiation, and Mohs micrographic surgery.
•Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

Squamous cell carcinoma

2010-02-01T21:46:00.000-08:00

Squamous cell carcinoma

What is squamous cell carcinoma?

Squamous cell carcinoma is cancer that begins in the squamous cells, which are thin, flat cells that look like fish scales under the microscope. The word squamous came from the Latin squama, meaning "the scale of a fish or serpent" because of the appearance of the cells.

Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Thus, squamous cell carcinomas can actually arise in any of these tissues.

Squamous cell carcinoma of the skin occurs roughly one-quarter as often as basal cell carcinoma. Light-colored skin and a history of sun exposure are even more important in predisposing to this kind of cancer than to basal cell carcinoma. Men are affected more often than women. Patterns of dress and hairstyle may play a role. Women, whose hair generally covers their ears, develop squamous cell carcinomas far less often in this location than do men.

The earliest form of squamous cell carcinoma is called actinic (or solar) keratosis. Actinic keratoses appear as rough, red bumps on the scalp, face, ears, and backs of the hands. They often appear against a background of mottled, sun-damaged skin. They can be quite sore and tender, out of proportion to their appearance. In a patient with actinic keratoses, the rate at which one such keratosis may invade deeper in the skin to become a fully-developed squamous cell carcinoma is estimated to be in the range of 10%-20% over 10 years, though it may take less time. An actinic keratosis that becomes thicker and more tender raises the concern that it may have transformed into an invasive squamous cell carcinoma.

A rapidly-growing form of squamous cell carcinoma that forms a mound with a central crater is called a keratoacanthoma. While some consider this not a true cancer but instead a condition that takes care of itself, most pathologists consider it to be a form of squamous cell cancer and clinicians treat is accordingly.

Other forms of squamous cell carcinoma that have not yet invaded deeper into the skin include

•actinic cheilitis, involving the lower lip with redness and scale, and blurring the border between the lip and the surrounding skin;

•Bowen's disease, sometimes referred to as squamous cell carcinoma in situ. (The Latin words in situ refer to the presence of the cancer only in the superficial epidermis, without deeper involvement.) Bowen's disease appears as scaly patches on sun-exposed parts of the trunk and extremities; and

•Bowenoid papulosis: These are genital warts that under the microscope look like Bowen's disease but behave like warts, not like cancers.
What are risk factors for developing squamous cell carcinoma?

The single most important factor in producing squamous cell carcinomas is sun exposure. Many such growths can develop from precancerous spots, called actinic or solar keratoses. These lesions appear after years of sun damage on parts of the body like the forehead and cheeks, as well as the backs of the hands. Sun damage takes many years to promote skin cancer. It is therefore common for people who stopped being "sun worshipers" in their 20s to develop precancerous or cancerous spots decades later.

Several rather uncommon factors may predispose to squamous cell carcinoma. These include exposure to arsenic, hydrocarbons, heat, or X-rays. Some squamous cell carcinomas arise in scar tissue. Suppression of the immune system by infection or drugs may also promote such growths. Some strains of HPV (the human papillomavirus responsible for causing genital warts) can promote development of squamous cell carcinoma in the anogenital region.

Can squamous cell carcinoma of the skin spread (metastasize)?

Yes. Unlike basal cell carcinomas, squamous cell carcinomas can metastasize, or spread to other parts of the body. These tumors usually begin as firm, skin-colored or red nodules. Squamous cell cancers that start out within solar keratoses or on sun-damaged skin are easier to cure and metastasize less often than those that develop in traumatic or radiation scars. One location particularly prone to metastatic spread is the lower lip. A proper diagnosis in this location is, therefore, especially important.

How is squamous cell carcinoma diagnosed?

As with basal cell carcinoma, doctors usually perform a biopsy to make a proper diagnosis. This involves taking a sample by injecting local anesthesia and punching out a small piece of skin using a circular punch blade. Usually the method used referred to as a punch biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.

How is squamous cell carcinoma treated?

Techniques for treating squamous cell carcinoma are similar to those for basal cell carcinoma (for detailed descriptions, see above under treatment of basal cell carcinoma):

•Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.

•Surgical excision: The tumor is cut out and stitched up.

•Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.

•Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.

•Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed, "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.

•Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (Aldara). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.
The possibility of metastasis makes it especially important to diagnose squamous cell carcinomas early and treat them adequately.

How is squamous cell carcinoma prevented?

Even more so than is the case with basal cell carcinoma, the key principles of prevention are minimizing sun exposure and getting regular checkups.

Common-sense preventive techniques are the same as for basal cell carcinoma and include

•limiting recreational sun exposure;

•avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);

•wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;

•regularly using a waterproof or water-resistant sunscreen with UVA protection and SPF 30 or higher;

•undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of a doctor; and

•avoiding the use of tanning beds and using a sunscreen with an SPF 30 and protection against UVA (long waves of ultraviolet light). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."

Introduction

2010-02-01T21:41:00.000-08:00

Introduction

Skin cancer is the most common form of human cancer. It is estimated that over 1 million new cases occur annually. The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. It has also been estimated that nearly half of all Americans who live to age 65 will develop skin cancer at least once.

The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal.

The term "skin cancer" refers to three different conditions. From the least to the most dangerous, they are:

•basal cell carcinoma (or basal cell carcinoma epithelioma)

•squamous cell carcinoma (the first stage of which is called actinic keratosis)
•melanoma
The two most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma. Together, these two are also referred to as nonmelanoma skin cancer. Melanoma is generally the most serious form of skin cancer because it tends to spread (metastasize) throughout the body quickly. Skin cancer is also known as skin neoplasia.

This article will discuss the two kinds of nonmelanoma skin cancer.

Basal cell carcinoma

What is basal cell carcinoma?

Basal cell carcinoma is the most common form of skin cancer and accounts for more than 90% of all skin cancer in the U.S. These cancers almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue.

Skin Cancer What are risk factors for developing basal cell carcinoma?

Light-colored skin, sun exposure, and age are all important factors in the development of basal cell carcinomas. People who have fair skin and are older have higher rates of basal cell carcinoma. About 20% of these skin cancers, however, occur in areas that are not sun-exposed, such as the chest, back, arms, legs, and scalp. The face, however, remains the most common location for basal cell lesions. Weakening of the immune system, whether by disease or medication, can also promote the risk of developing basal cell carcinoma. Other risk factors include

•exposure to sun. There is evidence that, in contrast to squamous cell carcinoma, basal cell carcinoma is promoted not by accumulated sun exposure but by intermittent sun exposure like that received during vacations, especially early in life. According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, which are areas that receive high amounts of UV radiation.

•age. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.

•exposure to ultraviolet radiation in tanning booths. Tanning booths are very popular, especially among adolescents, and they even let people who live in cold climates radiate their skin year-round.

•therapeutic radiation, such as that given for treating other forms of cancer.
Basal Cell What does basal cell carcinoma look like?

A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangiectases. The texture of such a spot is often shiny and translucent, sometimes referred to as "pearly." It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain melanin pigment, making them look dark rather than shiny.

Superficial basal cell carcinomas often appear on the chest or back and look more like patches of raw, dry skin. They grow slowly over the course of months or years.

Basal cell carcinomas grow slowly, taking months or even years to become sizable. Although spread to other parts of the body (metastasis) is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.

How is basal cell carcinoma diagnosed?

To make a proper diagnosis, doctors usually remove all or part of the growth by performing a biopsy. This usually involves taking a sample by injecting a local anesthesia and scraping a small piece of skin. This method is referred to as a shave biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.

How is basal cell carcinoma treated?

There are many ways to successfully treat a basal cell carcinoma with a good chance of success of 90% or more. The doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.

Methods used to treat basal cell carcinomas include:

•Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.

•Surgical excision: The tumor is cut out and stitched up.

•Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.

•Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.

•Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.

•Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (imiquimod [Aldara]). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.
How is basal cell carcinoma prevented?

Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

Common sense preventive techniques include

•limiting recreational sun exposure;

•avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);

•wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;

•regularly using a waterproof or water resistant sunscreen with UVA protection and SPF 30 or higher;

•undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor; and

•avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light.). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."

Skin cancer - Tantastic - BBC

2010-02-01T21:36:00.000-08:00

Some people will risk everything to get a sun tan, irrespective of the real risk of skin cancer. From BBC Worldwide.

Dr. Coyle Connolly Does a Full-Body Exam For Skin Cancer

2010-02-01T21:34:00.000-08:00

How to Identify Skin Cancer Signs : How to Examine your Body for Skin Cancer Signs

2010-02-01T21:33:00.000-08:00

Skin Cancer - Melanoma

2010-02-01T21:32:00.000-08:00

Skin Cancer Prevention

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Minimizing sun exposure is the best way to prevent skin damage, including many types of skin cancer:

Protect your skin from the sun when you can -- wear protective clothing such as hats, long-sleeved shirts, long skirts, or pants.

Try to avoid exposure during midday, when the sun is most intense.

Use sunscreen with an SPF of at least 15. Apply sunscreen at least one-half hour before sun exposure, and reapply frequently.

Apply sunscreen during winter months as well.

Skin Cancer treatments

2010-02-01T21:29:00.001-08:00

Skin Cancer treatments
A variety of treatment options are available for those diagnosed with non-melanoma skin cancer. Some carcinomas can be removed by cryosurgery, the process of freezing with liquid nitrogen. Uncomplicated and previously untreated basal cell carcinoma of the trunk and arms is often treated with curettage and electrodesiccation, which is the scraping of the lesion and the destruction of any remaining malignant cells with an electrical current. Removal of a lesion layer-by-layer down to normal margins (Moh's surgery) is an effective treatment for both basal and squamous cell carcinoma. Radiation therapy is best reserved for older, debilitated patients or when the tumor is considered inoperable. Laser therapy is sometimes useful in specific cases; however, this form of treatment is not widely used to treat skin cancer.

Skin cancer treatments for Squamous cell cancer

The treatment varies with the tumor's size, depth, location and how much it has spread (metastasis).

Surgical removal of the tumor, which may include removal of the skin around the tumor (wide excision), is often recommended. Microscopic shaving (Mohs' surgery) may remove small tumors. Skin grafting may be needed if wide areas of skin are removed.

The tumor may be reduced in size by radiation treatments.

Chemotherapy can be used if surgery and radiation fail, but it is usually minimally effect

Skin cancer treatments for Basal cell carcinoma

Treatment varies depending on the size, depth, and location of the cancer.

The carcinoma is removed using one of these procedures:

Scraping
Cauterization (burning)
Surgical removal, including microscopic shaving (Mohs' surgery)
Cryosurgery (freezing)
Radiation
Skin Cancer Treatments for Melanoma

The cancerous skin cells and a portion of the normal surrounding skin usually need to be surgically removed. A procedure called surgical lymph node biopsy may be necessary to see if the cancer has spread to nearby lymph nodes, which also may need to be removed. A skin graft may be necessary after the surgery if a large area of skin is affected.

Only the smallest and most shallow melanomas can be cured by surgery alone, so early diagnosis is very important. Radiation therapy, chemotherapy, or immunotherapy (use of medications that stimulate the immune system, such as interferon) may be recommended in addition to surgery.

If the skin cancer is deeper than 4 mm or the lymph nodes have cancer, there is a high risk of the cancer spreading to other tissues and organs. Using interferon after surgery may be useful for these patients. Studies have suggested that interferon improves the overall chance of cure by approximately 10%.

However, interferon has many side effects and is sometimes difficult to tolerate. Patients with high-risk melanomas should consider enrolling in clinical trials (research studies of new medications or other treatments).

For patients with melanoma that has spread beyond the skin and lymph nodes to other organs, treatment is more difficult. At this point, melanoma is usually not curable. Treatment is usually directed at shrinking the tumor and improving symptoms. Both chemotherapy and use of interferon or interleukin may be tried. These patients also should consider participating in clinical trials

Skin Cancer Staging

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Staging of basal cell or squamous cell carcinoma
Stage 0: Carcinoma in situ that is confined to the epidermis - the top layer of the skin (see Skin Anatomy). Squamous cell carcinoma in situ - also known as Bowen's disease - is the first stage of squamous cell skin cancer.
Stage 1: Small tumor that is less than 2 centimeters in size and has not spread to the lymph nodes or other organs.
Stage 2: Tumor that is larger than 2 centimeters, but has not spread to the lymph nodes or other organs.
Stage 3: Tumor that has metastasized (spread) to the tissues under the skin (muscle, bone, or cartilage) and/or to the regional (nearby) lymph nodes.
Stage 4: Tumor of any size that has metastasized (spread) to distant organs such as the lungs or brain.

Saging for Melamona
The AJCC staging system is based on three sets of criteria: how thick the tumor is (T), the extent to which it has spread to the lymph nodes (N), and the extent to which it has metastasized to other parts of the body (M). The AJCC staging system is outlined below, with the TNM parameters and corresponding Clark's level in parentheses. The TNM levels are explained following the outline of the staging system. The AJCC and the Clark's level stages do not always correspond, and when they don't, the AJCC system should always take precedence.

Stage 0 This is melanoma in situ, meaning the cancer is in the epidermis and has not begun to spread yet. (Clark's level I)
Stage IA Localized melanoma that is less than 0.75 mm (Clark's level II: the tumor has spread to the upper dermis; T1N0M0).
Stage IB Localized melanoma that is thicker than 0.75 mm but less than 1.5 mm (Clark's level III: the tumor involves most of the upper dermis); T2N0M0).
Stage IIA Localized melanoma that is thicker than 1.5 mm but less than 4 mm (Clark's level IV: the tumor has spread to the lower dermis; T3N0M0).
Stage IIB Localized melanoma that is greater than 4 mm (Clark's level V: the tumor has spread beneath the dermis; T4N0M0).
Stage III The melanoma has spread to nearby lymph nodes or less than 5 in-transit metastases are found. An in-transit metastasis is metastasis that is located between the primary tumor and the closest lymph node region. It results from melanoma cells getting trapped in the lymphatic channels (any T, N1M0).
Stage IV The tumor has metastasized to other parts of the body (any T, any N, M1 or M2).

TNM levels
Thickness of the primary tumor (T):

T1: The tumor is 0.75 mm or less in thickenss and invades the upper dermis.
T2: The tumor is more than 0.75 mm but not more than 1.5 mm in thickness and/or begins to invade the lower dermis.
T3: The tumor is more than 1.5 mm but not more than 4 mm in thickness and/or invades the lower dermis.
T3a: The tumor is more than 1.5 mm but not more than 3 mm in thickness.
T3b: The tumor is more than 3 mm but not more than 4 mm in thickness.
T4: The tumor is more than 4 mm in thickness and/or invades the subcutaneous tissue (the tissue beneath the skin) and/or satellites within 2 cm of the primary tumor.
T4a: The tumor is more than 4 mm in thickness and/or invades the subcutaneous tissue.
T4b: The tumor satellites within 2 cm of the primary tumor.

Involvement of The Regional Lymph Nodes (N)

NX: The regional lymph nodes cannot be assessed.

N0: There is no regional lymph node metastasis.
N1: Metastasis is 3 cm or less in greatest dimension in any regional lymph node(s).
N2: Metastasis is more than 3 cm in greatest dimension in any regional lymph node(s) and/or there is in-transit metastasis. An in-transit metastasis is one that is located between the primary tumor and the closest lymph node region. It results from melanoma cells getting trapped in the lymphatic channels.
N2a: Metastasis is more than 3 cm in greatest dimension in any regional lymph node.
N2b: There is in-transit metastasis.
N2c: Both N2a and N2b.

Extent of Distant Metastasis (M)

MX: Distant metastasis cannot be assessed.
M0: There is no distant metastasis.
M1: Distant metastasis is present.
M1a: Metastasis is in the skin or subcutaneous tissue or lymph node(s) beyond the regional lymph nodes.
M1b: Metastasis occurs in other parts of the body

Skin Cancer Diagnosis

2010-02-01T21:26:00.001-08:00

To diagnose skin cancer, doctors must carefully examine the lesion and ask the patient about how long it has been there, whether it itches or bleeds, and other questions about the patient's medical history. If skin cancer cannot be ruled out, a sample of the tissue is removed and examined under a microscope (a biopsy). A definitive diagnosis of squamous or basal cell cancer can only be made with microscopic examination of the tumor cells. Once skin cancer has been diagnosed, the stage of the disease's development is determined. The information from the biopsy and staging allows the physician and patient to plan for treatment and possible surgical intervention.

The different types of skin biopsy

Skin cancer self-examination before diagnosis
A skin cancer self-examination is easy enough to perform. A full-length mirror, hand mirror or family member can help you check hard-to-see areas of your body. Memorize the ABCDE rule for skin cancer: check for asymmetry, border, color, diameter or elevation changes.

ABCDE rule for skin cancer diagnosis

Asymmetry: Does the mole have the same shape on one side as the other? If you were to divide the mole in half, would the two halves match? Odd-shaped moles should be reported to your doctor.

Border: A mole's edges are usually smooth, and clearly defined when compared to the surrounded skin. "Scalloped" or "blotchy" borders may indicate a problem, as can pigment that appears to "bleed" into the surrounding skin.

Color: Moles are usually one color. A growth that is multi-colored, or changes in color tone, should be considered suspect.

Diameter: A sudden increase in mole size should be investigated, especially if the growth is larger then six millimeters across (about the area of a pencil eraser).

Elevation: If a previously flat mole suddenly becomes elevated (raised up from the surrounding area), report it to your doctor.

In addition to the ABCDE rule for skin cancer diagnosis, report any moles that bleed, cause itching or pain, or ulcerate (destroy epidermal tissue, causing a pit-like sore). Remember, the earlier melanoma is caught, the better the chance that it can be cured.

Skin Cancer Symptoms

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Skin cancer is the uncontrolled growth of skin cells. If left unchecked, these cancer cells can spread from the skin into other tissues and organs.

Skin cancers can have many different appearances. They can be small, shiny, or waxy; scaly or rough; firm and red; crusty or bleeding; or have other features. Therefore, anything suspicious should be looked at by a physician. See the individual articles on specific skin cancers for more information.

Here are some symptoms to look for:

Asymmetry: one half of the abnormal skin area is different than the other half
Borders: irregular borders
Color: varies from one area to another with shades of tan, brown, or black (sometimes white, red, blue)
Diameter: usually (but not always) larger than 6mm in size (diameter of a pencil eraser)
Use a mirror or have someone help you look on your back, shoulders, and other hard-to-see areas.

Skin cancer symptoms - types of skin cancer
There are different types of skin cancer. Basal cell carncinoma is the most common. Melanoma is less common, but more dangerous.

Skin cancer is the growth of abnormal cells capable of invading and destroying other associated skin cells. Skin cancer is often subdivided into either melanoma or non-melanoma. Melanoma is a dark-pigmented, usually malignant tumor arising from a skin cell capable of making the pigment melanin (a melanocyte). Non-melanoma skin cancer most often originates from the external skin surface as a squamous cell carcinoma or a basal cell carcinoma.

The cells of a cancerous growth originate from a single cell that reproduces uncontrollably, resulting in the formation of a tumor. Exposure to sunlight is documented as the main cause of almost 800,000 cases of non-melanoma skin cancer diagnosed each year in the U.S. The incidence increases for those living where direct sunshine is plentiful, such as near the equator.

Basal cell carcinoma affects the skin's basal layer and has the potential to grow progressively larger in size, although it rarely spreads to distant areas (metastasizes). Basal cell carcinoma accounts for 80% of skin cancers (excluding melanoma), whereas squamous cell cancer makes up about 20%. Squamous cell carcinoma is a malignant growth of the external surface of the skin. Squamous cell cancers metastasize at a rate of 2-6%, with up to 10% of lesions affecting the ear and lip.

Location of Skin Cancer Symptoms
Squamous cell and basal cell skin cancers are usually found on sun exposed areas such as the face, neck, and lower legs.

The more worrisome melanoma skin cancers are most frequently found on the backs of men, or on the backs or legs in women. These tend to be larger than a pencil eraser and have two or more colors (usually black and brown) as well as uneven edges.

Benign moles are usually small, symmetrical, and a single shade of brown with even edges.

Early Skin Cancer Picture

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Early Skin Cancer
It is important to become familiar with the moles on your skin because, in rare cases, they can become cancerous. Monitoring your moles and other pigmented patches, such as freckles and age or liver spots, is an important first step in reducing your risk of skin cancer — especially malignant melanoma, which may begin in or near a mole or other dark spot on the skin. Melanoma also can arise in areas of normal pigmentation.

Skin Cancer

2010-02-01T21:07:00.000-08:00

Skin Cancer
Skin cancer is the uncontrolled growth of skin cells. If left unchecked, these cancer cells can spread from the skin into other tissues and organs.

There are different types of skin cancer. Basal cell carncinoma is the most common. Melanoma is less common, but more dangerous.

General information about Skin Cancer
Skin cancer is the growth of abnormal cells capable of invading and destroying other associated skin cells. Skin cancer is often subdivided into either melanoma or non-melanoma. Melanoma is a dark-pigmented, usually malignant tumor arising from a skin cell capable of making the pigment melanin (a melanocyte). Non-melanoma skin cancer most often originates from the external skin surface as a squamous cell carcinoma or a basal cell carcinoma.

The cells of a cancerous growth originate from a single cell that reproduces uncontrollably, resulting in the formation of a tumor. Exposure to sunlight is documented as the main cause of almost 800,000 cases of non-melanoma skin cancer diagnosed each year in the U.S. The incidence increases for those living where direct sunshine is plentiful, such as near the equator.

Types of Skin Cancer
Basal cell carcinoma develops from abnormal growth of the cells in the lowest layer of the epidermis and is the most common type of skin cancer.
Squamous cell carcinoma involves changes in the squamous cells, found in the middle layer of the epidermis.
Melanoma occurs in the melanocytes (cells that produce pigment) and is less common than squamous or basal cell carcinoma -- but more dangerous. It is the leading cause of death from skin disease.
Basal cell carcinoma affects the skin's basal layer and has the potential to grow progressively larger in size, although it rarely spreads to distant areas (metastasizes). Basal cell carcinoma accounts for 80% of skin cancers (excluding melanoma), whereas squamous cell cancer makes up about 20%. Squamous cell carcinoma is a malignant growth of the external surface of the skin. Squamous cell cancers metastasize at a rate of 2-6%, with up to 10% of lesions affecting the ear and lip.

Causes of Skin Cancer
Cumulative sun exposure is considered a significant risk factor for non-melanoma skin cancer. There is evidence suggesting that early, intense exposure causing blistering sunburn in childhood may also play an important role in the cause of non-melanoma skin cancer. Basal cell carcinoma most frequently affects the skin of face, with next most common sites being the ears, the backs of the hands, the shoulders, and the arms. It is prevalent in both sexes and most commonly occurs in people over 40.

Basal cell carcinoma usually appears as a small skin lesion that persists for at least three weeks. This form of non-melanoma looks flat and waxy, with the edges of the lesion translucent and rounded. The edges also contain small, fresh blood vessels. An ulcer found in the center gives the lesion a dimpled appearance. Basal cell carcinoma lesions vary from 4-6 mm in size, but can slowly grow larger if untreated.

Squamous cell carcinoma also involves skin exposed to the sun, such as the face, ears, hands or arms. This form of non-melanoma also is most common among people over 40. Squamous cell carcinoma presents itself as a small, scaling, raised bump on the skin with a crusting ulcer in the center, but without pain and itching.

Basal cell and squamous cell carcinomas can grow more easily when people have a suppressed immune system because they are taking immunosuppressive drugs or are exposed to radiation. Some people must take immunosuppressive drugs to prevent the rejection of a transplanted organ or because they have a disease in which the immune system attacks the body's own tissues (autoimmune illnesses); others may need radiation therapy to treat another form of cancer. Because of this, all people taking these immunosuppressive drugs or receiving radiation treatments should undergo complete skin examination at regular intervals. If proper treatment is delayed and the tumor continues to grow, the tumor cells can spread (metastasize) to muscle, bone, nerves, and possibly the brain

Breast Cancer - Male

2009-11-09T08:08:00.000-08:00

Current Research

Research about breast cancer in men is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.

•New surgical methods that save tissue or prevent scarring are being tested in clinical trials. A skin-sparing mastectomy may result in less scarring than traditional surgery.

•Improved radiation therapy, to lower the risk of side effects

•New therapies and combinations of therapies, including chemotherapy, hormone therapy, and targeted therapy are being studied in clinical trials.

2009-11-09T08:00:00.001-08:00

Breast Cancer - Male

2009-11-09T07:58:00.002-08:00

Overview

Breast cancer in men is rare, accounting for less than 1% of all breast cancer cases. Although breast cancer in men occurs less frequently than breast cancer in women, the diseases are similar in many ways.

The breast is mainly composed of fatty tissue. Within this tissue is a network of lobes, which are made up of tiny, tube-like structures called lobules that contain milk glands. Tiny ducts connect the glands, lobules, and lobes to the nipple, located in the middle of the areola (darker area that surrounds the nipple of the breast). Blood and lymph vessels run throughout the breast; blood nourishes the cells, and the lymph system drains bodily waste products. The lymph vessels connect to lymph nodes, which are tiny, bean-shaped organs that normally help fight infection.

The main types of breast cancer are the same for men and women. About 90% of all breast cancer cases start in the ducts or lobes. Almost 75% of all breast cancers begin in the cells lining the milk ducts and are called ductal carcinomas. Approximately 30% of male breast cancers are lobular carcinoma (cancer that begins in the lobules) that is found in both breasts.

A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating ductal carcinoma (IDC). The majority of male breast cancer cases are IDC. If the cancer begins at the end of the ducts, it is called infiltrating lobular carcinoma, a rare type of breast cancer.

Disease that has not spread is called in situ, meaning "in place." The course of in situ disease, as well as its treatment, depends on where in the breast the cancer started. Currently, oncologists recommend that ductal carcinoma in situ (DCIS), which accounts for the majority of in situ breast cancers, be surgically removed to help prevent the cancer from spreading to other parts of the breast or the body. DCIS is uncommon in men.

Inflammatory breast cancer makes up about 1% to 5% of all breast cancers. Paget's disease of the nipple begins in the ducts, but spreads to the skin of the nipple. Paget’s disease is more common in men than in women. Other, less common cancers of the breast include medullary, mucinous, tubular, or papillary.

Cancer may begin as a single, genetically abnormal cell. As this one cell divides, it eventually becomes a tumor (a mass of cells) and develops a blood supply to nourish its continued growth. At some point, cells may break off from the primary mass and move to other parts of the body in a process called metastasis.

Breast cancer spreads when breast cancer cells move to other sites in the body through the blood vessels and/or lymph vessels. A common site of spread is the regional lymph nodes. The lymph nodes can be axillary (located under the arm), cervical (located in the neck), or supraclavicular (located just above the collarbone). The most common sites of distant metastasis are the bones, lungs, and liver. Less commonly, breast cancer may spread to the brain. The cancer can also recur (come back after treatment) locally in the skin, in the same breast (if it was not removed as part of treatment), other tissues of the chest, or elsewhere in the body.

Breast cancer in men is detected the same way as breast cancer in women is—through self-examination, clinical examination, or mammography (x-ray of the breast). Changes in the breast may be easier to detect because men have less breast tissue. However, the awareness of breast cancer in men is much lower than it is in women; therefore, men may not perform regular breast self-examinations or talk with their doctor about the disease.

Statistics

In 2009, there will be an estimated 1,910 new cases of breast cancer diagnosed in men in the United States. An estimated 440 men will die of breast cancer this year.

Breast cancer in men and women has similar survival rates. For the earliest stages of breast cancer, stages 0 and I, the five-year relative survival rate (the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) is 98%. Survival rates drop as the stages (see Staging) increase. Men with breast cancer that has spread regionally have an 84% five-year relative survival rate, and men with cancer that has spread to other parts of the body have a 27% five-year survival rate. Even if the cancer is found at a more advanced stage, new therapies enable many people with breast cancer to experience the same quality of life as before their diagnosis.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a man how long he will live with breast cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2009.

Find out more about basic cancer terms used in this section.

2009-11-09T07:58:00.001-08:00

Current Research

Research for inflammatory breast cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.

The latest trend in research is looking at the effectiveness of antibodies combined with chemotherapy for people with inflammatory breast cancer. Trastuzumab combined with chemotherapy is promising for treatment before surgery of people with inflammatory breast cancer with a cancer that has extra copies of HER2. Also, the drug bevacizumab (Avastin), used in combination with the established drugs doxorubicin (Adriamycin, Rubex) and docetaxel (Taxotere), is being evaluated. Bevacizumab is a new drug that works by blocking the growth of new blood vessels that can bring nutrients to the cancer cells, called anti-angiogenesis.

2009-11-09T07:57:00.001-08:00

After Treatment

After treatment for breast cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. The recommendations for breast cancer follow-up care usually include regular physical examinations and mammograms. Specific information can be found in the Follow-Up Care for Breast Cancer. In addition, ASCO offers forms to help keep track of the breast cancer treatment you received and develop a survivorship care plan once treatment ends. Read more about the ASCO Cancer Treatment Summaries.

Breast cancer can come back in the breast or other areas of the body. The symptoms of a cancer recurrence include a new lump in the breast, under the arm, or along the chest wall; bone pain or fractures; headaches or seizures; chronic coughing or trouble breathing; extreme fatigue; and/or feeling ill. Talk with your doctor if you have these or other symptoms. The possibility of recurrence is a common concern among cancer survivors; learn more about Coping With Fear of Recurrence.

After surgery (mastectomy or lumpectomy) to treat breast cancer, the breast may be scarred and may have a different shape or size than before surgery. If lymph nodes were removed as part of the surgery or affected during treatment, lymphedema (swelling of the hand and/or arm) may occur. Read more about preventing lymphedema after breast cancer treatment, after a mastectomy, breast reconstruction, and choosing a breast prosthesis.

Some patients experience breathlessness, a dry cough, and/or chest pain two to three months after finishing radiation therapy because the treatment can cause swelling and fibrosis (hardening or thickening) of the lungs. These symptoms are usually temporary. Talk with your doctor if you develop any new symptoms after radiation therapy or if the side effects are not going away.

Women taking tamoxifen should have yearly pelvic exams, because this drug can increase the risk of uterine cancer. Tell your doctor or nurse if you notice any abnormal vaginal bleeding or other new symptoms. Women who are taking an aromatase inhibitor, such as anastrozole, exemestane, or letrozole, should have a bone density test before they start treatment and as recommended by their doctor, as these drugs may cause some bone weakness or bone loss.

Women recovering from breast cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level and lowers the risk of recurrence. Your doctor can help you create a safe exercise plan based upon your needs, physical abilities, and fitness level. Learn more about healthy living after cancer.

2009-11-09T07:56:00.001-08:00

Side Effects of Cancer and Cancer Treatment

Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, infection, fatigue, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.

Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health.

Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net’s section on Managing Side Effects , based on ASCO’s curriculum.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient.

For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor.

2009-11-09T07:55:00.001-08:00

Clinical Trials Resources

Doctors and scientists are always looking for better ways to treat patients with inflammatory breast cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that this is the only way to make progress in treating breast cancer, such as finding new drugs. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with inflammatory breast cancer.

To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so that the person understands the standard treatment, and how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.

2009-11-09T07:54:00.000-08:00

Treatment

The treatment of inflammatory breast cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. For inflammatory breast cancer, treatment often includes surgery, radiation therapy, chemotherapy, and hormone therapy. Each treatment option is described below. Inflammatory breast cancer is typically considered a late-stage breast cancer and, therefore, treated aggressively.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, read the Clinical trials section.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the drug and the dose used, but can include fatigue, hair loss, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Rarely, long-term side effects may occur, such as heart damage, nerve damage, or secondary cancers, but studies have shown that these side effects do not shorten a woman’s survival time.

Chemotherapy may be given orally (by mouth) or intravenously (injected into a vein) and is usually given in cycles. Chemotherapy generally does not require a hospital stay; it is given in an outpatient setting. Chemotherapy may be neoadjuvant therapy (given before surgery to shrink a large tumor) or adjuvant therapy (given after surgery to reduce the risk that the cancer returns). Chemotherapy may also be given at the time of a breast cancer recurrence. Patients in clinical trials may be offered new drugs or new combinations of existing drugs.

Chemotherapy may be the first treatment given for inflammatory breast cancer, especially because cancer cells may have already spread to other parts of the body. Chemotherapy can reduce the size of the tumor and the swelling in the breast, increasing the likelihood of successful surgery.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources , which provides links to multiple drug databases.

Surgery

The type of surgery for inflammatory breast cancer depends on the stage of the cancer. Because inflammatory breast cancer grows quickly, a mastectomy (removal of the entire breast), is often done. In some cases, lumpectomy (removal of the tumor and a disease-free area [margin] of tissue around it), is possible.

For more information about considerations after breast cancer surgery, read after a mastectomy and preventing lymphedema after breast cancer treatment, breast reconstruction, and choosing a breast prosthesis.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Adjuvant radiation therapy is given regularly for a number of weeks after a lumpectomy or partial mastectomy to eliminate any remaining cancer cells near the tumor site or elsewhere within the breast. Adjuvant radiation therapy is also recommended for some women after a mastectomy depending upon the size of their tumor, number of cancerous lymph nodes under the arm, and width of the tissue margin around the tumor removed by the surgeon. Adjuvant radiation therapy is effective in reducing the chance of breast cancer returning in both the breast and the chest wall. Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove, although this approach is rare.

Radiation therapy can cause side effects, including fatigue, swelling, and skin changes. A small amount of the lung can be affected by the radiation, although the risk of pneumonitis, or a radiation-related pneumonia, is rare. In the past, with older equipment and techniques of radiation therapy, women treated for left-sided breast cancers had a small increase in the long-term risk of heart disease. Modern techniques are now able to spare most of the heart from radiation damage. Although exposure to radiation is thought to be a risk factor for cancer after many years, less than one in 500 survivors will develop a different kind of cancer, other than a breast cancer, within the area that was treated. Clinical trials comparing lumpectomy and adjuvant radiation therapy with mastectomy have not shown a difference in the number of patients developing or dying of other cancers within a 20-year time span.

The most common type of radiation treatment is called external beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. In this treatment, small radioactive pellets are placed in or near the site of the breast tumor within plastic catheters placed temporarily in the breast. A balloon catheter placed near the breast that delivers radiation therapy (called Mammosite) is another type of radiation therapy.

For more information on radiation therapy, read the Cancer.Net Feature: Understanding Radiation Therapy, the Cancer.Net Feature: Radiation Therapy—Your Personal Experience, and the Cancer.Net Feature: Side Effects of Radiation Therapy.

Hormone therapy

Hormone therapy is useful to manage a tumor that tests positive for either estrogen or progesterone receptors for both early-stage and metastatic cancer. This type of tumor uses hormones to fuel its growth. Blocking the hormones usually limits the growth of the tumor.

If it is determined that the tumor is hormone receptor-positive (uses estrogen or progesterone to grow [see Diagnosis]), then adjuvant hormone treatment may be used alone or after chemotherapy. Examples of hormone therapy used as adjuvant therapy are tamoxifen (Nolvadex), anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin).

Tamoxifen is the drug that researchers have studied the longest for use as a hormone therapy. It blocks estrogen from binding to breast cancer cells. It has been shown to be effective for reducing the risk of recurrence in the treated breast, the risk of developing cancer in the other breast, and the risk of developing cancer in women with no history of the disease but who are at higher than average risk for breast cancer. Current research shows that there is no benefit of taking tamoxifen longer than five years.

The side effects of tamoxifen include hot flashes, a small increased risk of uterine (endometrial) cancer and uterine sarcoma, and an increase in the risk of blood clots. Tamoxifen can be effective for both premenopausal and postmenopausal women.

In postmenopausal women who have an increased risk of developing breast cancer, raloxifene has shown to be another hormone therapy that is as effective as tamoxifen in preventing invasive breast cancer, but not as effective in preventing noninvasive cancer, such as ductal carcinoma in situ (DCIS). The side effects of raloxifene include a small risk of blood clots, leg and joint pain, hot flashes, pain during sexual intercourse, and vaginal dryness. Raloxifene has not been studied in premenopausal women, and it is not considered a substitute for tamoxifen for adjuvant therapy for women with hormone receptor-positive breast cancer.

An aromatase inhibitor (AI) decreases the amount of estrogen in postmenopausal women by blocking the aromatase enzyme, which is needed to make estrogen. These drugs include anastrozole, letrozole, and exemestane. The side effects of AIs may include joint pain and an increased risk of fractures (broken bones). Clinical trials are evaluating whether women benefit from an AI after tamoxifen, or by taking an AI for more than five years. For more information about AIs, read the ASCO Technology Assessment for Patients: Aromatase Inhibitors for Early Breast Cancer.

Recurrent and metastatic breast cancer

Breast cancer is called recurrent if the cancer has come back after it was first diagnosed and treated. It may come back in the breast (a local recurrence); in the chest wall; or in another part of the body, including distant organs (such as the lungs, liver, and bones). Some patients live years after a recurrence of breast cancer.

Breast cancer may also spread to other organs such as the brain, the opposite breast, adrenal glands, spleen, and ovaries and is called metastatic breast cancer. This type of cancer is treatable, but not curable. The goal of treatment for advanced disease is to achieve remission (temporary or permanent absence of disease) or slow the growth of the tumor.

Generally, a recurrence is detected when a person has symptoms. Even though there are tests that may detect a metastatic recurrence before the onset of symptoms, research shows that having such tests does not improve the response to treatments used for advanced disease, nor do they prolong life.

Signs and symptoms depend on the site of the recurrence and may include:

•A lump under the arm or along the chest wall

•Bone pain or fractures, which may signal bone metastases

•Headaches or seizures, which may signal brain metastases

•Chronic coughing or trouble breathing, which may signal lung metastases
Other symptoms may be related to the location of metastasis and may include changes in vision, changes in energy levels, feeling ill, or extreme fatigue. A biopsy of the recurrent site is often recommended to be certain of the diagnosis and to check for ER, PR, and HER2 status, because this may have changed from the time of the original diagnosis.

The treatment of metastatic or recurrent breast cancer depends on the previous treatment(s) and the characteristics of the tumor (such as ER, PR, and HER2 status). Once metastatic disease is detected, the treatment may involve surgery to remove the metastasis and/or chemotherapy, hormone therapy, targeted therapy, and radiation therapy (if it hasn’t been already given) to control it. In some circumstances, radiation therapy may also be given to relieve symptoms.

Treatment guides from ASCO for breast cancer include Aromatase Inhibitors for Early Breast Cancer,Bisphosphonates for Breast Cancer, Follow-Up Care for Breast Cancer, HER2 Testing for Breast Cancer, Sentinel Lymph Node Biopsy for Early-Stage Breast Cancer, and Tumor Markers for Breast Cancer.

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Diagnosis

Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

•Age and medical condition

•The type of cancer suspected

•Severity of symptoms

•Previous test results
In addition to a physical examination, the following tests may be used to diagnose inflammatory breast cancer:

Imaging tests

Diagnostic mammography. Diagnostic mammography is similar to screening mammography (x-ray of the breast) except that more views (pictures) of the breast are taken, and it is often used when a woman is experiencing signs, such as nipple discharge or a new lump. Diagnostic mammography may also be used if something suspicious is found on a screening mammogram.
Ultrasound. An ultrasound uses high-frequency sound waves to create an image of the breast tissue. An ultrasound may distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium (a special dye) may be injected into a patient’s vein to create a clearer picture. An MRI may be used once a woman has been diagnosed with cancer to check the other breast for cancer, but the benefit of this is controversial. It may also be used for screening. According to the American Cancer Society, women at high risk for breast cancer (for example, women with breast cancer [BRCA] gene mutations or a strong family history of breast cancer) should receive MRI screening along with a mammogram. MRI may often be better at seeing a small mass within a woman’s breast than a mammogram or ultrasound, especially for women with very dense breast tissue, but has a higher rate of false-positive test results (a test result that indicates cancer when there is no cancer present) and may result in more biopsies. In addition, an MRI does not show calcifications, which could indicate in situ breast cancer. Talk with your doctor for more information.

Surgical tests

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

•Image guided biopsy is used when a distinct lump can't be felt. It can be done with a fine needle aspiration biopsy (FNAB, uses a small needle to remove the tissue sample), stereotactic core biopsy (uses x-rays to find the area of tissue to be removed), or a vacuum-assisted biopsy (uses a thicker needle to remove multiple large cores of tissue). During this procedure, a needle is guided to the area of concern with the help of mammography, ultrasound, or MRI. A small metal clip may be put into the breast to mark the site of biopsy, in case the sample tissue proves cancerous and additional surgery is required. An advantage of this technique is that a patient may only need one operation for treatment or staging.

•Core biopsy can obtain tissue or FNAB can obtain cells in masses that can be felt, and these can then be analyzed for the presence of malignant (cancerous) cells.

•Surgical biopsy removes the largest amount of tissue. This biopsy may be incisional (removal of part of the lump) or excisional (removal of the entire lump).
If cancer is diagnosed, a second surgery may be needed to get a clear margin (area of tissue around the tumor where there are no cancer cells) and/or remove lymph nodes.

Doctors may also test the tissue from a biopsy to help guide treatment decisions. The tests include:

•Tumor features. Examination of the tumor under the microscope determines if it is invasive or in situ (disease that has not spread); ductal or lobular; grade (how different the cancer cells look from healthy cells); and whether the cancer has spread to the blood vessels or lymph vessels. The margins of the tumor are also examined.

•Estrogen receptor (ER) and progesterone receptor (PR) tests. Breast cancer cells with these receptors depend on the hormones estrogen and progesterone to grow. The presence of these receptors helps determine both the patient’s prognosis (chance of recovery) and whether the cells are likely to respond to hormone therapy. Generally, ER-positive or PR-positive tumors respond to hormone therapy.

•HER2 tests. There is too much of the protein HER2 in about 25% of breast cancers. The HER2 status helps determine whether a drug, such as trastuzumab (Herceptin), might be useful for treating breast cancer. Read more in the HER2 Testing for Breast Cancer.

•Genetic description of the tumor. Tests that look at the biology of the tumor are becoming more common to understand more about a woman’s breast cancer.
Blood tests

The doctor may also need to do blood tests to learn more about the cancer.

Complete blood count (CBC). CBC is a blood test done to determine the following:

•Hemoglobin level (a measure of the number of oxygen-carrying cells)

•Hematocrit level (the percentage of red blood cells in whole blood)

•The number of white blood cells (cells that help to fight infection)

•The number of platelets (cells that help blood to clot as necessary)

•Differential (the percentage of several types of white blood cells)
Alkaline phosphatase levels. High levels of this enzyme could indicate the disease has spread to the liver, bone, or bile ducts.

Total bilirubin count, serum glutamic-oxaloacetic transaminase(SGOT), and serum glutamate pyruvate transaminase (SGPT) levels. These tests evaluate liver function. High levels of any of these substances can indicate liver damage, a signal of possible spread to that organ.

Tumor marker tests. A tumor marker (also called a serum marker or biomarker) is a substance found in a person's blood, urine, or body tissue. The presence of a tumor marker, or having higher or lower than normal levels of a tumor marker, may indicate an abnormal process in the body, which could be because of cancer or a noncancerous condition. Tumor markers may be used for diagnosis, treatment planning, and/or treatment monitoring. For more information, read the Tumor Markers for Breast Cancer.

Additional tests

The doctor may order additional tests (depending on the individual’s medical history and results of the physical examination) to evaluate the stage of the cancer. Read the Staging section for more information. These tests are not recommended for all patients.

•A chest x-ray may be used to look for cancer that has spread from the breast to the lung.

•A bone scan may be used to look for spread to the bones. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark.

•A computed tomography (CT or CAT) scan may be used to look for distant tumors. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium is injected into a patient’s vein to provide better detail.

•A positron emission tomography (PET) scan may be used to determine whether the cancer has spread. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.
To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed.

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Symptoms

Women with inflammatory breast cancer may experience the following symptoms. Sometimes, women with inflammatory breast cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor. Symptoms of inflammatory breast cancer may appear quickly and within a short time of each other.

•A red, swollen, or warm breast. This symptom is caused when the cancer cells block the lymph vessels in the skin of the breast. Because inflammatory breast cancer cells are located within the lymph channels of the breast, it often quickly spreads throughout the body.

•Skin or nipple changes, including ridges, puckering, or roughness on the skin. This roughness has been compared with the skin of an orange (peau d’orange).

•A lump in the breast, although often there is not distinct lump

•Pain in the breast or nipple

•Nipple discharge

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Risk Factors

A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most directly do not cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor can help you make more informed lifestyle and health-care choices.

It is not known what factors can raise a person’s risk of inflammatory breast cancer. A family history of inflammatory breast cancer may increase the risk of developing the disease, but to date, no gene mutation has been found specifically for this type of breast cance

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